INTEROFFICE MEMORANDUM

INFORMATION ONLY

INTEROFFICE MEMORANDUM

County Health Department Directors/Administrators

Bonita J. Sorensen, M.D., M.B.A.

Deputy State Health Officer

Kindergarten and Seventh Grade Immunization Status Report 2003–2004

INFORMATION ONLY

Each October, all public and private schools and schools with a kindergarten and/or seventh

grade are required to submit reports indicating the immunization status of their kindergarten

and/or seventh grade students. This information is compiled and sent to the Bureau of

Immunization for tabulation. Attachments 1 through 4 are summaries of kindergarten data, and

attachments 5 through 8 represent seventh grade data for the 2003-2004 school year. This

information was submitted by 3,031 schools with 217,444 kindergarten students enrolled and

1,974 schools with 228,680 seventh grade students enrolled.

To assist in elimination of diphtheria, hepatitis B, pertussis (whooping cough), polio,

measles, mumps, rubella, tetanus, and varicella disease in Florida by increasing school

children’s immunization levels.

To ensure the enforcement of section 1003.22 (previously 232.032), Florida Statutes,

Florida School Immunization Law, and Chapter 64D-3, Florida Administrative Code,

regarding immunization.

To identify those counties needing assistance in raising their immunization coverage

levels in kindergarten and seventh grade to at least 95 percent.

Results – Kindergarten:

Statewide, 94.4 percent of kindergarten students were reported as receiving all immunizations

required for school entry/attendance.

Five doses of diphtheria, tetanus, pertussis (DTaP) vaccine

Four doses of polio vaccine

Two doses of measles, and one dose each of mumps and rubella vaccines (preferably

Three doses of hepatitis B

One dose of varicella

Students with exemptions from immunization accounted for 5.5 percent of the total kindergarten

population, as reflected in the following:

782 religious exemptions, or 0.4 percent

County Health Department Directors/Administrators

457 permanent medical exemptions, or 0.2 percent

2,760 30-day exemptions, or 1.3 percent

7,861 temporary medical exemptions, or 3.6 percent

Forty-nine of the 67 counties, or 73.1 percent, reported that 95 percent or more of public and

private students had received all required immunizations.

Concerns – Kindergarten:

This year, 57 selected counties were allowed to submit their public kindergarten data

electronically to the Department of Education. While most of these counties’ electronic

data remained within the acceptable range, several still had an excess of students in the

temporary medical exemption, 30-day exemption, or out-of-compliance categories.

Section 1003.22(10a), Florida Statutes, does not allow students without proper

documentation to attend school; however, 16 counties reported a total of 262 students,

or 0.12 percent, with inadequate documentation of immunizations. These schools are in

violation of the law and these students should be excluded from school until adequate

documentation is provided.

Results – Seventh Grade:

Statewide, 75.6 percent of seventh grade students were reported as receiving all immunizations

required for school attendance:

Completion of the hepatitis B series

Two doses of measles (preferably MMR)

Tetanus-diphtheria booster (Td)

Students with exemptions from immunization accounted for 23.6 percent of the total seventh

grade population, as reflected in the following:

623 religious exemptions, or 0.3 percent

441 permanent medical exemptions, or 0.2 percent

1,518 30-day exemptions, or 0.7 percent

51,296 temporary medical exemptions, or 22.4 percent

While the national shortage of Td vaccine ended in the summer of 2002, this continues to have

an impact on the number of temporary medical exemptions in the 2003–2004 school year.

Concerns – Seventh Grade:

With an adequate supply of Td vaccine, the large number of exemptions from both last

year and this school year will need to be tracked, monitored, and the electronic

database updated as children receive the Td booster.

County Health Department Directors/Administrators

Section 1003.22(10a), Florida Statutes, does not allow school attendance for students

with incomplete immunization documentation. However, given this requirement, 27

counties still reported 2,020 students, or nearly one percent, were allowed school

admission without adequate documentation of their immunizations. These schools

are in violation of the state law and these students should be excluded from school

until adequate documentation is provided.

The number of temporary exemptions could be significantly reduced if all healthcare providers

implemented the Recommended Childhood Immunization Schedule, United States, January–

June 2004, approved by the Centers for Disease Control and Prevention’s (CDC) Advisory

Committee on Immunization Practices, the American Academy of Pediatrics, and the American

Academy of Family Physicians, and implemented clinical practices outlined in the

Pediatric Immunization Practices

. A copy of the schedule can be found on the CDC’s web site

at: http://www.cdc.gov/nip/recs/child-schedule.pdf. We encourage county health departments

to work with local community partners to promote implementation.

The school health nurse or authorized public or non-public school official is responsible for

follow-up on children with temporary medical exemptions or 30-day exemptions to ensure

that children complete the immunization series. In addition, cooperative efforts between the

school health nurse and school administration to update the electronic submission of

immunization data will benefit both the health and education system. Using a reminder system

to recall students still needing immunizations has been shown to increase the completion of the

hepatitis B series.

High immunization coverage rates are a result of cooperative efforts by dedicated school

and county health department officials. These efforts protect Florida's children from vaccine-

preventable diseases. The Bureau of Immunization supports your local efforts to improve

immunization coverage and is available to assist in any effort to reduce the threat of vaccine-

preventable diseases to our children's lives. If you have any questions, you may call

Deanna Bishop in the Bureau of Immunization at (850) 245-4342, or SUNCOM 205-4342.

cc: Mary Jo Butler, Director of Intervention and Prevention Services Program

Department of Education

Lavan Dukes, Data Base Management

Department of Education

Landis K. Crockett, M.D., M.P.H., Director

Division of Disease Control

Annette Phelps, A.R.N.P., M.S.N., Director

Division of Family Health Services

Shannon B. Lease, M.S., Director

Office of Performance Improvement

Charles H. Alexander, Chief

Bureau of Immunization

County Health Department Nursing Directors

Bureau of Immunization Field Staff