Accelerated Immunization Risk Mitigation Strategy in Peel Region Public Health in Action

Transcription

1 Accelerated Immunization Risk Mitigation Strategy in Peel Region in Action CPHA Conference Toronto June 15, 2010 Presented by: Isabelle Mogck Director, Communicable Diseases Loretta Rowan Manager, Vaccine Preventable Diseases

2 Region of Peel Includes the City of Mississauga, City of Brampton and the Town of Caledon One of the largest municipalities in Canada In Ontario, it is second in size only to Toronto

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5 Population 2006 Census Population: 1,159,405 Increased 58% between 1991 and % in Peel were born outside of Canada 28% in Ontario 20% in Canada 10% of immigrants arrived within the past five years

6 Student Populations ~ 254,000 students 2 English Boards of Education (243,000) 2 French Language Boards of Education (4,000) Private Schools (7,000)

7 Mandate Ontario Standards (2008) Ensure children have up-to-date immunization Collect and assess student immunization records Progressive enforcement of legislation (Immunization of School Pupils Act) Required Antigens Measles, Mumps, Rubella (MMR) Diphtheria, Tetanus, Polio (DTP)

8 Student Immunization in Peel Prior to 2006 Immunization records initiatives deferred due to funding shortfalls Reviewed available data Coverage rates appeared very low but data varied and was unreliable Could not distinguish unimmunized vs. unreported

9 Immunization Risk Mitigation Plan Pilot (2007) Sample indicated actual coverage rate was ~60% (95% required for measles herd immunity) Engaged the Boards of Education Reviewed and refined processes First year of 3 year plan 130 of 369 schools completed

10 Accelerating the Project Spring 2008 Measles Outbreak One Peel student confirmed with measles 50% of students in one school excluded Majority of students up-to-date but no record on file ACCELERATED Immunization Risk Mitigation Funding approved by Regional Council Goal: Complete all remaining schools in school-year

11 Results

12 Pre & Post Coverage 100% 90% 90.2% 93.7% 80% 70% 68.5% 60% 50% 40% 47.7% Coverage Pre-Screening Coverage Post Screening 30% 20% 10% Average Pre = 58.1% 0% DTP MMR Average Post = 91.9%

13 Contributors to Coverage 100% 90% 80% 70% 60% 50% 40% 30% 20% 17.5% 24.9% 47.7% 9.0% 16.1% 68.5% Immunized as a result of screening Immunized prior to screening but didn t report to PH Coverage Pre-Screening 10% 0% DTP MMR

14 Health Impacts Vaccine uptake 44,150 doses of required vaccines administered 29,623 DTP 14,527 MMR Accurate immunization information In the event of an outbreak, accurate information is available for Measures

15 Process in Action!

16 Data System (IRIS) Limitations No unique identifier results in: Duplicate records 22.8 weeks of work effort annually Incorrectly identifies some as incomplete Misdirected mail Real-time data No why on the notice of required immunization Outdated

17 Stakeholders Schools Parents Public Health Doctors

18 Parents Schools Parents Obtain immunization for child from doctor Present records to school at registration Respond to communications from public health Update the record on ongoing basis Public Health Doctors

19 Schools Schools Parents Advertise registration and request records Copy records at registration and forward to public health Provide electronic file of student information Field questions and direct to public health Enforce suspension orders Public Health Doctors

20 Doctors Schools Parents Advise on immunization Administer immunization Document immunization and provide record to parent Certify any medical exemptions Public Health Doctors

21 Schools Parents Use influence to bring stakeholders together to direct resources to the issue Enforce the Immunization of School Pupils Act Receive and input immunization records Import and clean student information files from school boards Prepare and maintain database of immunization records Public Health Doctors

22 Schools Parents Screen database for incomplete records Assist parents in understanding their children s immunization needs and in accessing immunizations Public Health Implement progressive measures to ensure compliance, culminating in suspension Doctors

23 Reaching Our Stakeholders Comprehensive Communication Strategy Parents Updated notification packages On-line record submission Parent Council packages Clinics to review records and immunize Media Campaign (newspaper, bus backs, malls)

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25 Reaching Our Stakeholders Schools Planning meetings with Boards of Ed Presentations to Trustees School nurse visits and follow-up Information packages Newsletter, auto calling & announcement content

26 Reaching Our Stakeholders Physicians Presentation at Hospital Rounds Health Professionals Updates Waiting room posters Patient reminders MD Frequently Asked Questions (FAQs)

27 Reaching Our Multilingual Population 32.2% do not speak English at home Strategies Web site information in 26 languages Telephone interpretation Mail insert translated in 26 languages Training of settlement workers

28 Conclusions

29 It s messy,, but it works! 92% Coverage

30 Conclusions Legislation is a powerful tool Engages the stakeholders Creates a call to action to vaccinate beyond infancy Ensures data needed for decision making The lack of alignment between segments of the health care system creates confusion and requires a lot of resources

31 Conclusions Large project-based approach facilitates success Easier to engage stakeholders (especially staff!) Concentrates resources Demonstrates results which supports ongoing work Students enrolled in ESL not more or less likely to be suspended than non-esl students (preliminary result)

32 Questions?

33 Thank you for your attention. For further information, please contact: