INTEROFFICE MEMORANDUM

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DATE:

January 3, 2003

TO:

County Health Department Directors/Administrators

FROM:

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

Deputy State Health Officer

SUBJECT:

Kindergarten and Seventh Grade Immunization Status Report 2002–2003

INFORMATION ONLY

Each October, all public and private elementary schools and schools with a seventh grade are

required to submit reports indicating the immunization status of kindergarten and seventh grade

students. This information is compiled and sent to the Bureau of Immunization for tabulation.

Attachments 1, 2, 3, and 4 are summaries of kindergarten data, and attachments 5, 6, 7, and 8

represent seventh grade data for the 2002–2003 school year. This information was submitted

by 2,870 schools with 208,393 kindergarten students enrolled and 1,773 schools with 224,039

seventh grade students enrolled.

Purpose:

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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.

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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.

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To identify those counties needing assistance to improve the immunization levels in

kindergarten and seventh grade to at least 95 percent.

Results – Kindergarten:

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Statewide, 92.5 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 of mumps, rubella vaccines (preferably as two MMR), three doses of hepatitis B,

and one dose of varicella.

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Students with exemptions from immunization accounted for 7.4 percent of the total

kindergarten population, as reflected in the following: religious exemptions totaled 661,

or 0.3 percent; permanent medical exemptions totaled 441, or 0.2 percent; 30-day

exemptions totaled 1,570, or 0.8 percent; and temporary medical exemptions totaled

12,715, or 6.1 percent. The national shortage of DTaP is reflected in the increase of

temporary medical exemptions.

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County Health Department Directors/Administrators

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Page Two

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January 3, 2003

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Twenty-five of the 67 counties, or 37.3 percent, reported that 95 percent or more of

public and private students had received all required immunizations.

Concerns – Kindergarten:

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The statewide coverage level decreased from 93.6 percent in the 2001–2002 school

year to 92.5 percent in the 2002–2003 school year. Temporary medical exemptions

(TMEs) accounted for 82.6 percent of all exemptions, while 30-day exemptions

accounted for 10.2 percent. Children whose DTaP was deferred as a result of the

shortage need to be tracked for completion.

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This year, 55 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.

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

documentation to attend school; however, 11 counties reported a total of 159 students,

or 0.1 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:

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Statewide, 53.8 percent of seventh grade students were reported as receiving all

immunizations required for school attendance: completion of the hepatitis B series,

a second dose of measles (preferably MMR), and a tetanus-diphtheria booster (Td).

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Students with exemptions from immunization accounted for 45.1 percent of the total

seventh grade population, as reflected in the following: religious exemptions totaled

589, or 0.3 percent; permanent medical exemptions totaled 483, or 0.2 percent; 30-day

exemptions totaled 942, or 0.4 percent; and temporary medical exemptions totaled

99,116, or 44.2 percent. The national shortage of Td vaccine continues to have an

impact on the number of temporary exemptions in the 2002–2003 school year.

Concerns – Seventh Grade:

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Now that there is an adequate supply of Td vaccine, the large number of TMEs 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.

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

documentation to attend school; however, 22 counties reported a total of 2,360 students,

or 1.1 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.

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County Health Department Directors/Administrators

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Page Three

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January 3, 2003

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

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

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December 2002, approved by the CDC’s Advisory Committee on Immunization Practices, the

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American Academy of Pediatrics, and the American Academy of Family Physicians, and

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implemented clinical practices outlined in the

Standards for Pediatric Immunization Practices

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A copy of the schedule can be found on the CDC’s Web site at:

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

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work with local community partners to promote implementation.

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

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

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they complete the immunization series. In addition, cooperative efforts between the school

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health nurse and school administration to update the electronic immunization data will benefit

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both the health and education system. The hepatitis B series, which takes several months to

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complete, and the Td shortage account for the large number, or 44.2 percent, of temporary

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medical exemptions. Using a reminder recall system for subsequent vaccines in the series

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could facilitate completion of the hepatitis B series.

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The strength of this program is a result of the cooperative effort by schools and county health

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departments to protect Florida's children from vaccine-preventable diseases. The Bureau of

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Immunization will continue to support this effort as we work together to eliminate the needless

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threat of vaccine-preventable diseases from our children's lives. If you have any questions, you

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may call Frances Dennard, Bureau of Immunization, at (850) 245-4342 or SunCom 205-4342.

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BJS/cha/fhd

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Attachments

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

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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