PREPARED BY: Healthy Schools
DATE: September 26, 2024
SUBJECT: Student Immunization Coverage Report in Windsor-Essex County
BACKGROUND/PURPOSE
In Ontario, the Immunization of School Pupils Act (ISPA) R.S.O. 1990, requires children and adolescents attending primary or secondary school to be immunized against mumps, rubella, diphtheria, tetanus, meningococcal, varicella and polio, or have a valid Medical, Conscience or Religious Belief exemption on file at the Health Unit. As outlined in the Ontario Public Health Standards (OPHS), health units in Ontario are required to have a complete immunization record, or a valid exemption on file, for every student attending school in their area. The WECHU assessed the immunization records for all students in Windsor and Essex County (WEC) for the 2023-2024 school year. Updates on ISPA implementation program interventions, for both elementary and secondary schools, were shared as a part of the June 2024 WECHU Board of Health Meeting package. The purpose of this report is to share updated immunization coverage rates among 7, 12, and 17-year-olds and highlight program interventions and areas of opportunity.
Immunization Compliance and Coverage Rates
Immunization compliance rate refers to the proportion of a population that is appropriately immunized or have approved exemptions (medical and non-medical) for a vaccine preventable disease (VPD) based on legislation (e.g., under the ISPA) at a point in time.
Immunization coverage rate describes the proportion of a population that is appropriately immunized, based on scheduling (i.e., Publicly Funded Immunization Schedules for Ontario) for a VPD at a point in time. Achieving and maintaining high immunization coverage, amongst school age children, is essential for effective prevention and control of infectious diseases. Immunization coverage rates for ISPA required vaccines and strongly recommended school age vaccines are presented in Table 1 below.
| Vaccine Preventable Disease | ISPA Req | 7-year-olds | 12-year-olds | 17-year-olds | |||||
|---|---|---|---|---|---|---|---|---|---|
| WEC | Ontario | Canada | WEC | Ontario | WEC | Ontario | Canada | ||
| 2023-24 (%) | 2022-23 (%) | Goal (%) | 2023-24 (%) | 2022-23 (%) | 2023-24 (%) | 2022-23 (%) | Goal (%) | ||
| Diphtheria | Yes | 84.87 | 59.50 | 95 | 91.80 | 80.86 | 55.40 | 90 | |
| Hepatitis B | No | N/A3 | 68.94 | 58.20 | 78.26 | 76.40 | 90 | ||
| HPV | No | 59.41 | 47.80 | 70.47 | 68.50 | 90 | |||
| Measles | Yes | 85.94 | 60.20 | 95 | 92.75 | 92.92 | 92.30 | 90 | |
| Meningococcal | Yes | 92.271 | 79.80 | 95 by age 2 |
82.432 | 73.70 | 93.412 | 91.10 | 90 |
| Mumps | Yes | 85.79 | 60.00 | 95 | 92.69 | 92.86 | 92.00 | 90 | |
| Pertussis | Yes | 84.85 | 59.40 | 95 | 91.65 | 80.66 | 56.30 | 90 | |
| Polio | Yes | 82.83 | 59.60 | 95 | 90.78 | 92.01 | 90.10 | 90 | |
| Rubella | Yes | 93.05 | 83.10 | 95 | 93.43 | 94.49 | 94.10 | 90 | |
| Tetanus | Yes | 85.38 | 59.50 | 95 | 92.18 | 80.98 | 55.40 | 90 | |
| Varicella | Yes | 84.62 | 58.10 | 95 by age 2 |
91.35 | 47.69 | |||
- Vaccination with Meningococcal C conjugate vaccine.
- Vaccination with Quadrivalent meningococcal conjugate vaccine.
- Hepatitis B and HPV are recommended and offered to 12-year-olds during their grade 7 year.
Note: Canada has established Vaccination Coverage Goals and Vaccine Preventable Disease Reduction Targets to be achieved by 2025. National goals for 7 and 17-year-olds have been outlined in the table above. There are no national goals for 12-year-olds.
Note: Cells in green above highlight the immunization coverage rates in WEC that exceed the national goal.
Note: Cells in grey above indicate where data is not available through the Immunization Coverage Report for School Pupils in Ontario: 2019-20 to 2022-23 School Years. Provincial immunization coverage data has not been released by Public Health Ontario for the 2023-24 school year.
DISCUSSION
For the 2023-24 school year, the coverage rates for ISPA required vaccines for 7 and 17-year-olds in WEC are all above the provincial average rates. Many are close to, and some exceed national coverage goals. Compared to the previous school year, coverage rates have been maintained or improved. For example, Hepatitis B coverage rates for 17-year-olds in 2021-22 was 73.2%, 2022-23 it was 76.65%, and for 2023-24 it has increased to 78.26%. Local available temporal trends of immunization coverage rates among 7 and 17-year-olds is presented on the WECHU’s Immunization Coverage for School Pupils Data Dashboard.
Notably, Varicella coverage rates for 17-year-olds in WEC are significantly lower than other vaccines outlined in Table 1. This can be attributed to the fact that these students were born in 2006, before the ISPA required Varicella vaccination, amended in September 2014. Now the ISPA requires children born on or after 2010 to be vaccinated against Varicella-zoster – a herpes virus that causes chickenpox.
Under the Publicly Funded Immunization Schedules for Ontario, Grade 7 students are eligible for free vaccination against Hepatitis B, HPV, and Meningococcal disease. Hepatitis B and HPV vaccination are not required under the ISPA but are strongly recommended. The WECHU administers these vaccines through in-school and community clinics, as well as dispenses them to community health care providers upon request.
The coverage rates for Hepatitis B and HPV for 12 and 17-year-olds in WEC are all above the provincial average rates, however, remain below the national goals.
CONCLUSION
Vaccination remains one of our population’s best defenses against infectious diseases. Supporting provincially funded vaccine programs remains a priority for the WECHU. Although the WECHU has higher coverage rates compared to the provincial average for all ISPA required vaccines, there are opportunities to improve coverage rates in WEC, especially for Hepatitis B and HPV.
The WECHU continues to focus on strategies to reduce barriers to vaccination and increase confidence and uptake. This fall, a key strategy will be to implement the collection and assessment of immunization information for children attending licensed childcare centres in our community. This upstream approach aims to engage with families earlier to improve coverage rates in WEC by ensuring vaccinations are administered on schedule throughout childhood.
Additional proactive interventions underway include:
- Based on feedback from school administrators, in-class education sessions for Grade 7 students on immunization recommendations, were provided at the end of the school year for students in Grade 6.
- Based on feedback from families, the online Grade 7 immunization consent form was made available in June preceding the school year to allow more time for completion.
- Based on feedback from staff, WECHU immunization nurses reached out to individual families throughout the summer to obtain consent, offer support, and answer questions. This resulted in obtaining more than half of the consents prior to the start of the school year.
- In collaboration with community partners, the WECHU immunization nurses provided education about immunizations and vaccine administration at community events focused on newcomers and priority populations.
To ensure ongoing protections from vaccine preventable diseases, the WECHU remains committed to continued collaborations with school boards, school administration, community health care providers, and community agencies.