Immunization of School Pupils Act Estimated Coverage & Non-Medical Exemption Rates, By School 2018-19 School Year Immunization of School Pupils Act Estimated Coverage & Non-Medical Exemption Rates, By School 2018-19 School Year Summary This document summarizes the estimated coverage rates and non-medical exemption rates by school for Measles, Mumps, and Rubella vaccine (MMR) and for Diphtheria, Tetanus and Polio vaccines (DTP) for children attending school in the Region of Peel for the 2018-19 school year. Estimated coverage rates are not the same as immunization coverage rates. Overall for the 2018-19 school year: • the average estimated coverage rate across all Peel schools was 94.6% for MMR. • the average estimated coverage rate across all Peel schools was 90.8% for DTP. The difference in DTP rates compared to MMR (combined) is due to the additional requirement for an adolescent vaccine dose for diphtheria and tetanus. • the average non-medical exemption rates for MMR and for DTP were 1.8%. Background In Ontario, the Immunization of School Pupils Act (ISPA) requires children attending school to be vaccinated or have a valid exemption for the immunizations as described in Regulation 645. This legislation is important to protect children from vaccine preventable diseases and helps to decrease incidence of disease or outbreaks. Region of Peel – Public Health (‘Peel Public Health’) staff assess immunization records for one of the fastest growing populations in Ontario. Records for over 250,000 students, who attend a school located in the Region of Peel, are assessed every school year. According to the legislation, parents must provide records of immunization to public health; or if applicable, provide the necessary documentation for a medical or non-medical exemption (i.e. conscience/religious exemption). Peel Public Health sends screening letters to parents of children whose records are incomplete for immunizations required for school attendance. Parents must ensure that their child is immunized or in the case of exemptions, complete the appropriate documentation, and provide the necessary immunization records and documentation to Peel Public Health. In some cases, the child is immunized but the parent has not yet provided the documentation to Peel Public Health. If a parent has not responded to any of the screening letters delivered during the year, a child may be suspended from school until the necessary documentation is provided for school attendance. This report summarizes estimated coverage rates by school, for these six diseases in two combined groups: Measles, Mumps and Rubella (MMR) and Diphtheria, Tetanus and Polio (DTP). These vaccines are mandatory for school attendance, as per the ISPA. A student is considered to be in compliance with Created: September 2019 Page 1 the legislation if they have received the recommended number of doses of vaccine(s) for their age, at the time of assessment, and the maximum spacing intervals for the next dose in a vaccine series have been met (i.e. the student is not overdue for the next dose in a vaccine series). A student is also compliant if the appropriate documentation is completed and submitted to public health for either a medical or non-medical exemption. For the purposes of this report, students with medical and non- medical exemptions were subtracted from the number of students compliant in order to estimate coverage; further details are provided in the methods section. The calculation of this statistic differs in methodology with that of immunization coverage rate statistics which are calculated by Public Health Ontario (see Public Health Ontario’s Technical Annex for a detailed description of coverage rate methodology). Methods • Data were extracted from the Ministry of Health, Digital Health Immunization Repository1, by Peel Public Health on August 26, 2019. • Data were extracted using the Ministry of Health-created standard report; “PR2001 forecaster compliance for diseases by age or school” in the Panorama Enhanced Analytical Reporting (PEAR) tool. • The data extract included students born between 2001 and 2011, with an active school record in the Region of Peel at the time of assessment (students 7-17 years of age in the 2018-19 school year). • Inclusions: o Data for students attending school in Peel’s four publicly funded school boards: Conseil Scolaire Viamonde, Conseil Scolaire Catholique MonAvenir, Dufferin-Peel Catholic District School Board and Peel District School Board o Data for students with valid immunizations, and/or non-medical exemption and/or medical exemption • Exclusions: o Private schools, adult learning centres and schools with fewer than 10 students enrolled born between 2001 and 2011 • Calculations: o PR2001 standard report run by groups of diseases (Measles, Mumps and Rubella for the “MMR” vaccine and Diphtheria, Tetanus and Polio vaccines noted collectively as “DTP”) (# of students compliant - # of students with a medical or non-medical exemption) Estimated Coverage Rate = × 100% # of students enrolled # of students with a valid non-medical exemption Non-Medical Exemption Rate = × 100% # of students enrolled Limitations 1 The “Digital Health Immunization Repository” may also be referred to as “Panorama”. Created: September 2019 Page 2 • The data reported are a measure of whether students have complied2 through immunization with the Immunization of School Pupils Act (ISPA). These statistics should not be interpreted as population level immunization coverage as the methodologies are different. However, these data can be used to help estimate coverage. • Percentages for the schools may not add up to 100% as the difference represents individuals that are not immunized in compliance with ISPA or have a medical exemption. • The data reported reflect the enrolled population only for students born between January 1, 2001 and December 31, 2011 (i.e. 7-17 years of age). As such, the estimated immunization and exemption rates reflected in this report are not comprehensive and do not reflect the entire population of the school. • Due to school board enrolment upload dates, the student population may not reflect the same students who were attending school at the end of the 2018-19 school year. Secondary schools may be disproportionately affected as students who graduated from Grade 12 may no longer be associated with the school in Panorama. • Students who have more than one active school record at the time of reporting may be counted more than once in this report. • Estimated coverage and exemption rates in this report reflect point in time data from a production database. As such, these data cannot be reproduced at a later date using the PR2001 standard report. • An estimated coverage rate for a disease may not be the same as the rate for a group of diseases (MMR and DTP). For example, estimated coverage for Rubella would typically be higher when run separately from Measles and Mumps as only one valid dose of Rubella containing vaccine is required, whereas two valid doses of Measles and Mumps containing vaccine are required to meet ISPA requirements. • Non-medical exemption rates were also reported for groups of diseases. The exemption rates reported may not be the same for each disease in the group. In other words, a student with an active exemption in Panorama only for Polio would be counted in this report as having an exemption for DTP. • Students who have an immunization history for a disease that meets immunization compliance criteria and who also have an active exemption for that disease in Panorama are excluded from the estimated coverage rate. An active exemption in Panorama overrides the system’s ability to assess the status of the immunization history for that disease. 2 An individual has received the recommended number of doses of a vaccine at a specific age. The maximum spacing interval for the next dose in a series has not yet elapsed (i.e. the student is not overdue for the next dose in a vaccine series). Created: September 2019 Page 3 • Due to a limitation of the report used, students who have a medical exemption due to proven immunity from a disease are excluded from the estimated coverage rates in this report. As a result, the estimated coverage rates in this report are an underestimate. Created: September 2019 Page 4 Table 1: ISPA estimated coverage rates and non-medical exemption rates by school, 2018-19 school year DTP Vaccine MMR Vaccine MMR Non- Enrolled DTP Non-Medical School Name Estimated Estimated Medical Population Exemption Rate Coverage Rate Coverage Rate Exemption Rate AGNES TAYLOR PUBLIC SCHOOL - 004880 295 95.3% 1.7% 94.9% 1.7% ALL SAINTS SEPARATE SCHOOL - 685461 242 91.3% 5.4% 93.8% 5.4% ALLAN A MARTIN SENIOR PUBLIC SCHOOL - 012815 513 96.9% 1.9% 97.7% 1.9% ALLAN DRIVE MIDDLE SCHOOL - 011533 482 93.4% 5.4% 93.8% 5.4% ALLOA PUBLIC SCHOOL - 013463 432 95.8% 0.9% 97.5% 0.9% ALOMA CRESCENT PUBLIC SCHOOL - 057274 155 85.8% 1.9% 89.7% 1.9% ALTON PUBLIC SCHOOL - 074438 59 89.8% 6.8% 89.8% 6.8% APPLEWOOD HEIGHTS SECONDARY SCHOOL - 892203 1,235 73.9% 2.9% 88.9% 2.9% APPLEWOOD SCHOOL - 901887 40 75.0% 5.0% 92.5% 5.0% ARCHBISHOP ROMERO CATHOLIC SECONDARY SCHOOL - 51 76.5% 2.0% 88.2% 2.0% 736228 ARNOTT CHARLTON PUBLIC SCHOOL - 021369 299 93.0% 1.3% 92.6% 1.3% ARTESIAN DRIVE PUBLIC SCHOOL - 102016 289 92.7% 1.7% 93.1% 1.7% ASCENSION OF OUR LORD SECONDARY SCHOOL - 687308 743 83.8% 0.3% 96.2% 0.3% AYLESBURY PUBLIC SCHOOL - 503560 454 91.2% 1.5% 92.1% 1.5% BALMORAL DRIVE SENIOR PUBLIC SCHOOL - 030880 669 94.2% 1.3% 96.0% 1.2% BARONDALE