1. Changes to Regulation 645 under the Immunization of School Pupils Act Additional Protection for Children Attending School in Ontario Coming July 1, 2014

2. Immunization of School Pupils Act (ISPA) ISPA requires immunization against designated diseases or a valid exemption Changes have been made to Regulation 645 under the ISPA

3. What? Three new vaccine preventable diseases have been added – Meningococcal Disease – Pertussis (whooping cough) – Varicella (chicken pox) Revisions follow the current Ontario immunization schedule for recommended vaccines, now required.

4. Why? Ontario Immunization Schedule of publicly funded vaccines has changed in recent years More vaccines have been added Intervals between doses and the number of doses required to provide protection have changed based on evidence and NACI recommendations

5. How? Regulation was changed and The changes were announced Provincial planning for implementation began Health units began planning locally, keeping in mind Provincial direction, HKPR business practices, and Panorama requirements.

6. Actions to Date Communication plan developed Media release(s) prepared Information to schools and school boards Information for schools to share with parents Additional clinics, vaccine distribution over the summer

7. Three Additional Diseases Meningococcal Disease: rare but serious disease, caused by five sero groups of meningococcal bacteria with severe complications

8. Three Additional Diseases Pertussis (whooping cough): serious illness with complications, especially in infants and unvaccinated individuals

9. Three Additional Diseases Varicella (chicken pox): can have serious complications (encephalitis, invasive group A strep)

10. Three Additional Diseases All three diseases are vaccine preventable Serious complications are therefore preventable

11. Meningococcal Disease Two vaccines against meningococcal disease are currently recommended in the Ontario Immunization Schedule Voluntary until July 1, 2014 As of July 1, 2014, now required in order to attend school in Ontario

12. Students Who May be Affected Children who have received all doses of vaccines as recommended in the Ontario Immunization Schedule will not likely require additional doses Parents may be asked to provide updated immunization records to the Health Unit

13. Students Who May be Affected One dose of Meningococcal Conjugate-C (Men-C-C) vaccine administered in infancy at 12 months One dose of Meningococcal Conjugate ACYW 135 (Men-C-ACYW 135 )administered in Grade 7 (school program)

14. Pertussis (Whooping Cough) Pertussis vaccine is included in the Ontario immunization schedule, not required for school entry Now required for school attendance Required doses as indicated in the Ontario Immunization Schedule

15. Students Who May be Affected Students who have not received their 4 to 6 year “booster” by age 7. Students who are due for their adolescent booster will require pertussis containing vaccine (Tdap). Students who are not immunized will require a valid exemption if immunization is not completed.

16. Varicella (chicken pox) Ontario Immunization schedule recommends: One dose of varicella vaccine at 15 months of age One dose of varicella vaccine (may be given as MMRV) at 4 to 6 years Children born in 2010 or later, will now be required to show proof of vaccination or proof of immunity, or have a valid exemption

17. Which students will be most affected? For children born in 2010 (likely in Kindergarten in the 2014-15 school year) proof of vaccination as recommended in the Ontario Schedule will now be required.

18. Which students will be most affected? If the recommended schedule is followed, dose(s) will be required when due Of Note: children born on or after January 1, 2000 continue to be eligible to receive publicly funded varicella vaccine, and vaccination is recommended

19. What does this mean for parents? Parents will be required to continue to provide HKPR with up to date immunization records for their children

20. What does this mean for parents? For children from JK up to Grade 6, we will require proof that the child has received one dose of Men-C-C vaccine after the first birthday One dose of Men-C-ACYW 135 vaccine will continue to be offered to all students in Grade 7

21. What does this mean for parents? During the grade 7 school year, children can be vaccinated with Men-C-ACYW 135 at school Students in grade 8 and subsequent grades for whom HKPR has no record on file of their receiving Men-C-ACYW 135 will be assessed as overdue at the time of the next ISPA assessment

22. What does this mean for parents? Parents will receive a notice from the Health Unit at that time in order that they may take appropriate action

23. Suggestions for Parents Check their children’s immunization records Questions: contact their health care provider (HCP) or the Health Unit to identify missing doses. If a child did not receive Men-C-C in infancy, parents can make an appointment with their HCP, up to the end of Grade 6.

24. Suggestions for Parents For children now in grades 8-12 who have not received one dose of Men-C-ACYW 135 vaccine (missed it in grade 7) contact the Health Unit. Students who will be in Grade 7 in Sept 2014 will be eligible to receive the vaccine at school. A parent or legal guardian will need to sign a consent.

25. Additional Information There are still some details requiring clarification from the Ministry of Health and Long Term Care, we are expecting more information on an ongoing basis.

26. Additional Information Suspension is possible if children remain unvaccinated after Grade 7 and we do not have a valid exemption on file at the Health Unit. Health Unit clinics will continue to be available by appointment

27. Additional Information The suspension process takes place over a period of a few months Two notices to parents prior to the date of suspension Provides opportunity for parents to update immunization and Health Unit records.

28. What Stays the Same? CDC staff will continue to implement the ISPA Student registration is verified against school board data Each student’s immunization status is assessed according to the record on file at HKPR. HKPR records are updated as parents provide records of missing doses and as students receive vaccinations at HKPR and school clinics.

29. What stays the same? Begin (usually in January of the school year) the process that may lead to suspension – First Notice: gives parents an opportunity to have their child immunized and to provide the health unit with the record. If no record is received, – Second and final notice which includes the date the suspension will go into effect. If still no record is received, – Notice of suspension from school is sent to parents and principal.

30. What Stays the Same? HKPR staff make every to minimize suspensions and time lost from school through parent notices, additional clinics, communication to health care providers. Our efforts are directed toward making sure students are protected

31. What stays the same? Opportunity for Schools, Public Health and parents together to increase protection for all students in our schools, to reduce the risk of illness from and outbreaks of vaccine preventable diseases Opportunity for parents to be reminded of needed or missed doses and to take action to ensure that their child is protected, and to ensure that records are on file with the Health Unit.

32. What is different? No ISPA implementation in HKPR during the 2013-2014 school year due to Panorama work; we can expect double the usual number of due and overdue students who receive a first notice. Requirement for vaccination against the three additional diseases will further increase the number of notices. Expect comparable increases in parental inquiries requiring CDC staff response.

33. What is different? Children who were up to date prior to the additional requirements may not be up to date now Understanding of the changes to the requirements is important for parents, schools, and for health care providers Understanding of the implementation process will help us all contribute to a successful outcome.

34. What is Different? CDC staff will be working with Panorama, a new electronic database to be implemented this summer, HKPR “go live” date is June 23, 2014 The preparation and learning has been and will continue to be extensive. Panorama will change how health units maintain, update and access immunization records.

35. Conclusion We can expect our ability to monitor vaccine coverage rates, follow up outbreaks of vaccine preventable diseases, and to promote immunization to be enhanced. This is an exciting and challenging time in Public Health and for our Communicable Disease Control Staff working in Vaccine Preventable Diseases.

36. Conclusion Questions?