Vaccination Assessment Activities of School Facilities

Centers for Disease Control and Prevention • National Immunization Program

Vaccination Assessment Activities
of School Facilities

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Grantee:

Name:

Title:

Email:

Telephone Number:

() -

Facsimile Number:

() -

Is five year-old Kindergarten (not pre-k) required in your state/territory/Pacific Island.

Yes No

Does the law specify the vaccines/antigens and doses to be included in the assessment of immunization status of school children?

Yes No No, it specifies ACIP Recommendations

What vaccine/antigen does state/territorial/Pacific Island law require you to monitor for children to enter school? Are doses required by law consistent with ACIP recommendations? Are doses monitored using ACIP recommendations?

A. Kindergarten
Vaccine/Antigen	Is your immunization law consistent with ACIP recommendations?	Is monitoring required by law?	Are the doses monitored based on State Law or ACIP recommendations or both?

Polio	Yes No	Yes No	Law ACIP Both NA
DTP/DTaP/DT	Yes No	Yes No	Law ACIP Both NA
Measles*	Yes No	Yes No	Law ACIP Both NA
Mumps*	Yes No	Yes No	Law ACIP Both NA
Rubella*	Yes No	Yes No	Law ACIP Both NA
Hepatitis B	Yes No	Yes No	Law ACIP Both NA
Varicella	Yes No	Yes No	Law ACIP Both NA
Hib	Yes No	Yes No	Law ACIP Both NA
PCV	Yes No	Yes No	Law ACIP Both NA
Hepatitis A	Yes No	Yes No	Law ACIP Both NA
Other	Yes No	Yes No	Law ACIP Both NA
Other	Yes No	Yes No	Law ACIP Both NA
Other	Yes No	Yes No	Law ACIP Both NA

Comments:

B. First Grade
Vaccine/Antigen	Is your immunization law consistent with ACIP recommendations?	Is monitoring required by law?	Are the doses monitored based on state Law or ACIP recommendations or both?

Polio	Yes No	Yes No	Law ACIP Both NA
DTP/DTaP/DT	Yes No	Yes No	Law ACIP Both NA
Measles*	Yes No	Yes No	Law ACIP Both NA
Mumps*	Yes No	Yes No	Law ACIP Both NA
Rubella*	Yes No	Yes No	Law ACIP Both NA
Hepatitis B	Yes No	Yes No	Law ACIP Both NA
Varicella	Yes No	Yes No	Law ACIP Both NA
Hib	Yes No	Yes No	Law ACIP Both NA
PCV	Yes No	Yes No	Law ACIP Both NA
Hepatitis A	Yes No	Yes No	Law ACIP Both NA
Other	Yes No	Yes No	Law ACIP Both NA
Other	Yes No	Yes No	Law ACIP Both NA
Other	Yes No	Yes No	Law ACIP Both NA

Comments:

C. Middle School
Vaccine/Antigen	Is your Immunization law consistent with ACIP recommendations?	Is monitoring required by law?	Are the doses monitored based on State Law or ACIP recommendations or both?

Booster Td	Yes No	Yes No	Law ACIP Both NA
MMR2	Yes No	Yes No	Law ACIP Both NA
Hepatitis B	Yes No	Yes No	Law ACIP Both NA
Varicella	Yes No	Yes No	Law ACIP Both NA
Other	Yes No	Yes No	Law ACIP Both NA
Other	Yes No	Yes No	Law ACIP Both NA
Other	Yes No	Yes No	Law ACIP Both NA

Comments:

Is there a standard state/territorial/Pacific Island certificate or document that is required to present to the school/facility to document vaccination status?

Yes No(specify)

Do student records include the individual vaccine/antigen and the dates of receipt?

Yes No

When during the year do you collect data for your school report that is due to CDC on April 30th?

Aug Sep Oct Nov Dec Jan Feb Mar Apr May

Do you give temporary exemptions to newly entering students who are not up to date?

Yes For a period of
No

Which of the following exemptions are allowed by your state/territorial/Pacific Island law?

Check all that apply.

Permanent medical

Temporary medical

Religious

Philosophical

None

What documentation is required for medical exemptions?

Check all that apply.

Medical exemptions are not permitted (go to question 10)

Certificate

Form

Letter

Affadavit

Immunization Record

Other (describe)

Signed by: Check all that apply.

Doctor (M.D.,D.O.)

Physician's Assistant

Health Department

Chiropractor

Nurse

Parent/Guardian

Notary Public

Other (describe)

10.

What documentation is required for religious exemptions?

Check all that apply.

Religious exemptions are not permitted (go to question 11)

Statement

Letter

Form

Affidavit

Other (describe)

Signed by: Check all that apply.

Parent/Guardian

Religious Official

Notary Public

Other (describe)

11.

What documentation is required for philosophical exemptions?

Check all that apply.

Philosophical exemptions are not permitted (go to question 12)

Statement

Letter

Form

Affidavit

Other (describe)

Signed by: Check all that apply.

Parent/Guardian

Notary Public

Other (describe)

12.

What does your state/territorial/Pacific Island law regarding vaccination of children include?

Check all that apply.

Children attending a private or public school/facility

Children schooled at home

Children schooled partly at home and partly at a private or public school/facility

13.

What type of schools does your assessment include?

Check all that apply.

Public schools

Private schools

Home schools

CENSUS ASSESSMENT

14.

Does your “census assessment” methodology require you to collect data from 100% or less than 100% of all schools/facilities (all refers to public and private schools)?

100% of all schools/facilities (skip to question 16)
less than 100% of all schools/facilities(continue with question 15)

15.

If your methodology includes less than 100% of all schools/facilities, how do you select the schools/facilities to be included in the annual assessment?

Probability sampling procedures

Please check which specific probability sampling procedure you use in selecting the schools/faciltities

Simple random sample (e.g. randomly sample schools/facilities across the entire state)

Stratified random sample (e.g. schools/facilities, such as by county or community, and then randomly sample schools/facilities in these groupings)

Random cluster sample (e.g. select a particular area or county and then randomly sample schools/facilities only in this area)

Other (describe)

Non-probability procedure.

Please check which specific probability sampling procedure you use in selecting the schools/faciltities

Convenience sample (e.g. sample schools/facilities based on convenience of location or information resources, such as proximity of schools to program sites or only schools/facilities that have the resources to conduct or aid in assessments)

Sample only the schools/facilities who respond to the assessment request

Sample only the schools/facilities that have had problems in the past

Receive aggregate data from the schools/facilities (e.g. health department does not conduct the census).

Other (describe)

School/facility sampling methodology unclear or unknown

Other type of school/facility sampling methodology used
(please describe in detail)

16.

Of schools/facilities included in your “census assessment,” do you collect information on 100% or less than 100% of all the children in each school/facility?

100% of all children (skip to question 18)
less than 100% of all children(continue with question 17)

17.

If your methodology includes the records of less than 100% of all the children, how do you select the children to be included in the school/facility coverage assessment?

Probability sampling procedures

Please check which specific probability sampling procedure you use in selecting the children

Simple random sample (e.g. randomly sample children across all the schools/facilities)

Stratified random sample (e.g. group children, such as by month of birth, and randomly sample in these groupings)

Random cluster sample (e.g. select a particular school/facility and then randomly sample children in that school/facility)

Other (describe)

Non-probability procedure.

Please check which specific probability sampling procedure you use in selecting the children

Convenience sample (e.g. sample children based on convenience)

Sample children based on a particlular characteristic (e.g. sample children based on economic class)

Receive aggregate data on children from the schools/facilities (e.g. state health department does not conduct the assessment)

Other (describe)

Child sampling methodology unclear or unknown

Other type of child sampling methodology used
(please describe in detail)

18.

How are data collected?

Schools send in a summary report
Health department staff reviews records
Other (describe)

19.

What information is “assessed” or reviewed during the assessment activities?

Check all that apply.

Dates of vaccination

Date of birth

Age at time of assessment

Required vaccinations

Other vaccinations (not required)

Exemption status

Other (describe)

20.

To whom are the results of your census assessment distributed?

Check all that apply.

State, local or other health department

Department of education

Individual school/facility

CDC or another federal agency

Other (describe)

21.

We would like to collect some information on deadlines for data collection:

What month is your deadline for accepting data from schools/facilities

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Any/No deadline

Does this month refer to the current year or prior year?
Current
Prior

22.

Does the assessment report form that you send to NIP reflect school/facility assessment results before or after “follow-up” of children who are not up-to-date? Follow-up refers to any activities or interventions implemented in order to ensure that non-compliant students become compliant.

Before follow-up
After follow-up

23.

Who has the primary responsibility for contacting parents of non-compliant children entering school?

Check all that apply.

School or local department of education

Local, district, or regional health department

State health department

None

Other (describe)

24.

Does the state/territorial/Pacific Island law impose a penalty for parents with children who are not immunized or not up to date?

No Yes(describe)

25.

Specify what actions are taken by the grantee to enforce vaccination school entry requirements.

Check all that apply.

1st

Middle

Exclude those students from school without documentation of adequate vaccination until such documentation is provided

Provide time-limited exemptions from school exclusion for those students without documentation of adequate vaccination and exclude those who fail to meet the terms of the exemption.

In the event of a case of a vaccine preventable disease (VPD) among staff or students, exclude students lacking documentation of adequate vaccination for that VPD for at least one incubation period after the last case.

Fiscally penalize individual schools (county school system, etc…) for students’ days absent from school resulting from being excluded because of lack of documentation.

Do 100% documentation of students’ vaccination status to identify students without documentation of adequate vaccinations.

Survey a sample of schools to verify the number of students reported excluded as a result of inadequate vaccinations.

Has and enforces a formal, structured procedure to receive requests for non-medical exemptions from students’ vaccination entry requirements.

None

Other (describe)

26.

Estimate the number of weeks or months that your public health assessment team is involved in collecting and reporting data for the census assessment?

<1 2 3 4 5 >6

Weeks Months

27.

Approximately how many full and part-time public health staff members are involved in the collecting and reporting process?

Full-time Staff: 0 1-4 5-9 10-14 15-19 20+

Part-time Staff: 0 1-4 5-9 10-14 15-19 20+

VALIDATION ASSESSMENT

28.

Do you conduct a VALIDATION assessment or additional survey to verify the results of your previous assessment of coverage in schools/facilities?

Yes (Continue with questions 29-40) No:(skip to question 38)

29.

How do you select the schools/facilities to be included in the validation survey?

Probability sampling procedures

Please check which specific probability sampling procedure you use in selecting the schools/faciltities

Simple random sample (e.g. randomly sample schools/facilities across the entire state)

Stratified random sample (e.g. schools/facilities, such as by county or community, and then randomly sample schools/facilities in these groupings)

Random cluster sample (e.g. select a particular area or county and then randomly sample schools/facilities only in this area)

Other (describe)

Non-probability procedure.

Please check which specific probability sampling procedure you use in selecting the schools/faciltities

Sample only the schools/facilities who respond to the assessment request

Sample only the schools/facilities that have had problems in the past

Receive aggregate data from the schools/facilities (e.g. health department does not conduct the census).

Other (describe)

School/facility sampling methodology unclear or unknown

Other type of school/facility sampling methodology used
(please describe in detail)

30.

How do you select the children to be included in the school validation survey?

Probability sampling procedures

Please check which specific probability sampling procedure you use in selecting the children

Simple random sample (e.g. randomly sample children across all the schools/facilities)

Stratified random sample (e.g. group children, such as by month of birth, and randomly sample in these groupings)

Random cluster sample (e.g. select a particular school/facility and then randomly sample children in that school/facility)

Other (describe)

Non-probability procedure.

Please check which specific probability sampling procedure you use in selecting the children

Convenience sample (e.g. sample children based on convenience)

Sample children based on a particlular characteristic (e.g. sample children based on economic class)

Receive aggregate data on children from the schools/facilities (e.g. state health department does not conduct the assessment)

Other (describe)

Child sampling methodology unclear or unknown

Other type of child sampling methodology used
(please describe in detail)

31.

Who actually implements the validation survey?

State, local or other health department personnel (including school nurses employed by these entities)

Contractors hired by the state, local or other health department.

Other, describe:

32.

What information is “assessed” or reviewed during the validation survey?

Dates of vaccination

Date of birth

Age at time of assessment

Required vaccinations

Other vaccinations (not required)

Exemption status

Other (describe)

33.

To whom are the results of your validation study distributed?

Check all that apply.

State, local or other health department

Department of education

Individual school/facility

CDC or another federal agency

Other (describe)

34.

Are there consequences for facilities whose reports seriously or continually deviate from the validation study results?

No Yes, specify (letter, feedback, training, etc...)

Feedback

35.

How frequently do you conduct a validation study?

Annually,(yearly)

Biennially (every other year)

Other, (describe):

36.

When during the year do you conduct your validation study?

(month)

37.

Does your validation report reflect school/facility assessment results before or after “follow-up” of non-compliant children? Follow-up refers to any activities or interventions implemented in order to ensure that non-compliant students become compliant.

Before follow-up After follow-up:

38.

We would like to reduce the burden of data collection both in the census and validation portions of your assessments. Do you have “resource saving” ideas that you could share with other states?

No Yes, how would you like to share those?

Check all that apply.

Internet

On paper

Presentation or workshop at NIC

Presentation or workshop at regional conferences

Presentation via conference calls

Film/video

Other (specify)

39.

Is the state/territorial/Pacific Island law available on the web?

Yes, (provide the URL)
No (Send us a copy of the laws/mandates that you use to the address or fax to the number below)

Cindi Knighton
Centers for Disease Control and Prevention
National Immunization Program
1600 Clifton Road, NE (E 62)
Atlanta, GA 30333
Fax: (404)639-3266

40.

Do you have any additional comments that you would like to share with us (please send additional pages if necessary)?

We are changing our school survey methodology in 2005 and would like your thoughts. I would like to develop a survey that meets CDC/NIP guidelines that you are considering.

CDC is working hard to evaluate state assessments so that we may help the states to conduct assessments through educational materials and support. You may be contacted by telephone in the near future and asked to elaborate on some of your experiences pertaining to immunization assessments, immunization exemptions, and the enforcement of immunization laws. We appreciate your help and assistance in these efforts. If you have any general questions or comments, please contact Carol Stanwyck [CStanwyck@cdc.gov (404) 639-8308] or Cindi Knighton [CKnighton@cdc.gov (404) 639-8631]. If you have any questions or comments about immunization laws or mandates, please contact Gail Horlick [GHorlick@cdc.gov (404) 639-8345]. Thank you.

Date last modified: Tuesday, November 25, 2008 2:22:46 PM