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School Immunization Validation Survey

Results of the 2006-2007 School Validation

Data in this report was collected from validation surveys
conducted by ISDH immunization field representatives
at a sample of 164 classes within 118 Indiana schools

Indiana State Department of Health
Judith A. Monroe, M.D., State Health Commissioner
Mary L. Hill, J.D., B.S.N., Deputy State Health Commissioner

Community and Family Health Services Commission
Loren Robertson, MS, R.E.H.S., Assistant Commissioner

Immunization Program
Amanda Mizell, M.B.A., Program Director
Charlene Graves, M.D., Medical Director

Primary Author
Kristin Ryker, MPH, Epidemiologist

Immunization Program
Indiana State Department of Health
2 North Meridian
Indianapolis , IN 46204
Published: 12/2007

Preface

State law (IC 20-34-4-6) requires all schools in Indiana to annually self-report immunization coverage levels of their kindergarten, first grade, and sixth grade students to the Immunization Program at the Indiana State Department of Health (ISDH).  In order to verify the accuracy of the reports sent to ISDH, the Immunization Program annually conducts a validation survey on a random sample of schools. The results of the school validation survey for the 2006-2007 school year are presented in this report.

Methods

A random sample of schools was selected from the 2,139 schools listed in the 2006-2007 school immunization assessment database.  This sampling was conducted according to the procedures developed by the Assessment Branch of the National Immunization Program at the Centers for Disease Control and Prevention.  A total sample size of 136 schools was selected for validation.  In the 136 schools selected, 36 validations included only kindergarten, 16 included only first grade, 33 included only sixth grade, and 51 included multiple grades.

ISDH immunization field representatives conducted validations at 86.8% (118/136) of the randomly selected school locations by reviewing immunization records of students enrolled in 165 kindergarten, first grade, or sixth grade classes.  Immunization records were reviewed for up-to-date or exemption status of students in the selected grade levels.  Complete immunization levels for each grade level were calculated and compared with the reported immunization coverage levels submitted for the 2006-2007 school report.  Completed validations were submitted to the Immunization Program for review.

Summary Tables and Graphs

More than 1800 schools submitted self-reported immunization data for the 2006-2007 school year. The Indiana State Department of Health validated immunization records from 165 classes within 118 schools from the 2006-2007 annual school immunization self-assessment. Data from one class was inadequate, thus 164 classes were included in analysis.

Table 1. Percent of kindergarten, first grade, and sixth grade students with complete immunizations, 1995-1996 to 2006-2007 school years, annual school self-reported immunization assessments, Indiana.

*For the 1999-2000 school year, Indiana implemented new school requirements, which affected kindergarten and first grade students.  First grade immunization rates began to be collected with the new requirements.
**Vaccine shortages were experienced during the 2002-2003 school year.
***For the 2004-2005 school year, new school requirements were adopted for kindergarten and first grade students.

The results of the 2006-2007 immunization validation survey indicate fairly accurate self-reporting by the schools. Immunization completion rates of more than one-fourth of classes did not change between school self-report and validation, while the rates of eighty-five percent of classes overall increased or decreased no more than five percentage points.

Figure 1. Percentage point change in overall immunization completion levels at time of validation compared with school self-assessment reports, 2006-2007 Indiana school immunization validation survey. (n = 164 classes within 118 schools).

Figure 2. Mean comparison of immunization completion levels of schools included in the validation for the 2006-2007 school year, by grade level for the school immunization self-assessment versus the school validation survey in Indiana. (n = 164 classes within 118 schools)

Discussion

• Overall, immunization rates increased 1.5 percentage points between the submission of the self-reported annual school immunization assessment and the validation of immunization records in the selected schools.
  
  
• The immunization rate for kindergarten showed the most improvement between the self-reported assessment and the validation survey, increasing 4.6 percentage points. The immunization rate for sixth grade increased 0.6 percentage points within the same time interval.
  
  
• First grade immunization rates decreased 0.6 percentage points with the validation of records.
  
  
• Forty-five schools (27.4%) showed no change in the immunization rates between the time of the school self- report and validation.
  
  
• Schools must take care when reviewing immunization records and submitting results to ISDH. Inaccurate submission of immunization data may result in inflated changes in immunization rates between self-report and validation.
  
  
• All schools must strictly enforce immunization policies to prevent the outbreak of vaccine-preventable diseases among their student population.  Failure to comply violates state law and unnecessarily places susceptible students at risk for contracting a vaccine-preventable disease.