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School Immunization Validation Survey

Results of the 2000-2001 Validation

Immunization Program
Indiana State Department of Health
2 North Meridian
Indianapolis, IN 46204

Published: 07/2001

Indiana State Department of Health
Gregory A. Wilson, M.D., State Health Commissioner
Mary DePrez, Deputy State Health Commissioner

Public Health Services Commission
Joni Albright, M.P.A., Assistant Commissioner

Immunization Program
Michael Runau, M.S., Program Director

Primary Author
Geoff Prysak, M.P.H., Epidemiologist

  

Preface

Each year, according to Indiana Code 20-8.1-7-11, all schools in Indiana are required to self-report immunization coverage levels of their kindergarten, first grade, second grade, sixth grade, and newly enrolled students to the immunization program at the Indiana State Department of Health (ISDH). In order to verify that the reports schools send to ISDH are accurate, the immunization program annually conducts a validation survey on a random sample of schools. The results of the school validation survey for the 2000-2001 school year are found in this report.

 
Methods

Each year, according to Indiana Code 20-8.1-7-11, all schools in Indiana are required to self-report immunization coverage levels of their kindergarten, first grade, second grade, sixth grade, and newly enrolled students to the immunization program at the Indiana State Department of Health (ISDH). In order to verify that the reports schools send to ISDH are accurate, the immunization program annually conducts a validation survey on a random sample of schools. The results of the school validation survey for the 2000-2001 school year are found in this report.

ISDH immunization field representatives reviewed records for the up-to-date or exemption status of students in the selected grade levels at each of the 58 schools chosen to receive a validation. Complete immunization levels for each grade level were then calculated and compared with the school’s reported immunization coverage levels for the 2000-2001 school assessment. In order to determine overall coverage levels for each school, grade-level validation findings were combined at those schools where more than one grade was validated.

In 1999, Indiana implemented new and updated school immunization requirements which affected kindergarten, first grade, and newly-enrolled students. Due to the fact that many students did not have time to complete many of their immunization requirements prior to the beginning of school, school-reported immunization rates were lower than had been seen in previous years. This immunization level fluctuation resulted in a larger number of schools selected for validation this year. However, higher immunization rates are expected this year, because students have had time to complete their required immunizations for the present year school immunization report survey.
  

Results

The Indiana State Department of Health validated 87 schools from the 2000-2001 annual school immunization assessment. Table 1 shows a summary of kindergarten, first grade, and sixth grade immunization completion levels from the 1995-96 through the 2000-2001 school years. First grade information was not collected until the 1999-2000 school year due to new school immunization requirements.
 

 
The results of the 2000-2001 school immunization validation survey indicate that schools accurately reported their immunization coverage levels. Aggregate analysis of school data reflected that the median change in coverage between the validation survey and a school’s self-reported coverage was near zero (–0.2%; interquartile range: -1.4 – 1.7%). More specifically, the validation survey found that 8 schools (9.2%) had no change in the overall coverage levels reported in their 2000-2001 annual immunization assessment report. Many schools (34 of 87; 39.1%) were found to have higher immunization coverage levels in the validation survey than in the school report. However, the majority of schools (45 of 87; 51.7%) were found to have decreased immunization coverage levels upon validation (Figure 1).
 

Figure 1. Percent change in overall completion levels at time of validation compared with school assessment reports, 2000-2001 Indiana school immunization validation survey. (N = 87 schools)

Aggregate analysis of grade data found that for kindergarten, overall immunization coverage levels at the time of the validation survey were significantly higher than at the time the schools submitted their 2000-2001 immunization assessment report (p< 0.05, table 2). Median immunization coverage levels at the school level were also found to be higher upon validation for kindergarten and sixth grade, but median levels were found to be lower upon validation for first grade, sixth grade, and overall school levels (Table 2).
 

Table 2. Summary results of the 2000-2001 school immunization report validation survey,
Indiana (N = 87 schools)

	Kindergarten		First Grade		Second Grade		Sixth Grade		Total
	Report	Validation Survey	Report	Validation Survey	Report	Validation Survey	Report	Validation Survey	Report	Validation Survey
Number of validated schools include	58	58	68	68	68	68	31	31	87	87
Number of students enrolled	4275	4252	5259	4531	4326	4546	4836	5069	17,696	18,398
Number of student records examined	4275	3777*	4259	4259*	4326	4242*	4836	3968*	17,696	16,216*
Number of students adequately immunized	4001 (93.6%)	3587 (95.0%)	4083 95.9%	4063 (96.1%)	4026 (93.1%)	3929 (92.6%)	4735 (97.9%)	3926 (98.9%)	16,845 (95.2%)	15,505 (95.6%)

* Standardized sampling techniques were followed for reviewing records at schools with > 100 enrolled students.
  

 
Figure 2. Median immunization completion levels, by grade level, 2000-2001 school assessment reports and validation surveys, Indiana. (N= 87 schools)

  

Discussion

Validation of self-reported immunization coverage levels among a statistically significant sample of schools is an important role of the ISDH immunization program. Schools have consistently reported high immunization coverage levels in recent years, and validating these reports is an essential means of ensuring that the quality of reporting is maintained. With recent changes to school immunization requirements, the validation survey allows the immunization program to verify that schools are properly adhering to the new policies.

Although the findings of this validation survey verify that schools were accurate in the reporting of the immunization coverage levels of their students, changes in coverage levels were found for some of the schools where validations were completed.

Immunization reports from schools must be provided to the state immunization program within 60 days of the beginning of each school year. For this validation survey, data was collected from sampled schools two to five months after the initial school reports were received. For schools included in this survey, self-reported immunization coverage levels were found to be approximately 95%. The findings of the validation show that this rate is consistent, but may be higher if school immunization data were collected again at a later time in the year. The time interval between the school assessment and validation generally allows schools more opportunity to enforce the school and state immunization policies, thereby improving the overall coverage levels. However, it is imperative that schools track students’ immunization status early in the school year in order to limit the potential spread of vaccine preventable disease among susceptible students.

The fact that 51.7% (45 of 87) of schools randomly selected for the validation survey had a decrease in their coverage levels between the time of the self-report and the validation survey highlights the fact that not all schools are strictly adhering to state school immunization policies. This should be a cause for concern for these schools and the parents of children attending them. ALL schools must implement and strictly enforce immunization policies to prevent the outbreak of vaccine-preventable diseases among their student populations. Failure to do so not only violates state law, but also unnecessarily places susceptible students at risk for contracting an otherwise preventable disease.

Data in this report was collected from validation surveys conducted by ISDH immunization field representatives at a sample of 87 schools throughout Indiana.

 

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