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School Immunization Validation Survey

Results of the 2002-2003 School Validation

Indiana State Department of Health

Gregory A. Wilson, M.D., State Health Commissioner

M. Elizabeth Carroll, J.D., Deputy State Health Commissioner

Community and Family Health Services Commission

Wendy Gettelfinger, R.N., D.N.S., J.D., Assistant Commissioner

Immunization Program

Michael Runau, M.S., Program Director

Charlene Graves, M.D., Medical Director

Primary Author

Megan Steiger, M.P.H., Epidemiologist

Immunization Program

Indiana State Department of Health

2 North Meridian

Indianapolis, IN  46204

Published: 08/2003

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, sixth grade, and newly enrolled 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 2002 - 2003 school year are represented in this report.

Methods

A random sample of schools was selected from the 2,164 schools listed in the 2002 - 2003 school immunization assessment database. This sampling was conducted according to procedures developed by the Assessment Branch of the National Immunization Program at CDC. Factors involved in this sampling include: total number of students, approximate immunization coverage levels, and acceptable level of error in sampling. Using this methodology, a total of 102 schools were selected for validation. Of these, 34 were selected for a validation of their kindergarten immunization report and 33 for a validation of their sixth grade immunization report (i.e. of the schools with kindergarten and sixth grade students combined, 32 sites were selected to receive validations for both grades).  Validations for the first grade were completed at 35 schools using the standardized random selection.

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 102 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 2002 - 2003 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.

Summary Tables and Graphs

The Indiana State Department of Health validated 102 schools from the 2002 - 2003 annual school immunization assessment.

Table 1. Percent of kindergarten, first grade, and sixth grade students with complete immunizations, 1995-1996 to 2002-2003 school years, annual school immunization assessments, Indiana.

*For the 1999-2000 school year, 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.

The results of the 2002 - 2003 school immunization validation survey indicate one-fourth of the schools showed no change between the school assessment report and school validation survey.

Figure 1. Percent change in overall completion levels at time of validation compared with school assessment reports, 2002-2003 Indiana school immunization validation survey. (N = 102 schools)

Figure 2. Mean immunization completion levels, by grade level, 2002-2003 school assessment reports and validation surveys, Indiana. (N= 102 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.
• Overall, the difference between the school report and validation survey was minute.  The schools validated during the 2002-2003 assessment year should be recognized for their excellence in reporting immunization rates.
• 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.
• Schools and parents need to ensure that students missing immunizations receive the proper vaccinations to bring them up-to-date on their immunization requirements.
• 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.
• Significant drops were experienced in the percent of students enrolled in kindergarten and sixth grade with complete immunizations, which may be associated with the vaccine shortage experience during the 2002-2003 school year.

Data in this report was collected from validation surveys conducted by ISDH immunization field representatives at a sample of 102 schools throughout Indiana