Changes to Regulation 645
under the Immunization of
School Pupils Act
Additional Protection for Children
Attending School in Ontario
Coming July 1, 2014
Immunization of School Pupils Act
(ISPA)
• ISPA requires immunization against
designated diseases or a valid exemption
• Changes have been made to Regulation 645
under the ISPA
What?
• Three new vaccine preventable diseases
have been added
– Meningococcal Disease
– Pertussis (whooping cough)
– Varicella (chicken pox)
• Revisions follow the current Ontario
immunization schedule for recommended
vaccines, now required.
Why?
• Ontario Immunization Schedule of publicly
funded vaccines has changed in recent years
• More vaccines have been added
• Intervals between doses and the number of
doses required to provide protection have
changed based on evidence and NACI
recommendations
How?
• Regulation was changed and
• The changes were announced
• Provincial planning for implementation began
• Health units began planning locally, keeping
in mind Provincial direction, HKPR business
practices, and Panorama requirements.
Actions to Date
• Communication plan developed
• Media release(s) prepared
• Information to schools and school boards
• Information for schools to share with parents
• Additional clinics, vaccine distribution over the
summer
Three Additional Diseases
• Meningococcal Disease: rare but serious
disease, caused by five sero groups of
meningococcal bacteria with severe
complications
Three Additional Diseases
• Pertussis (whooping cough): serious illness
with complications, especially in infants and
unvaccinated individuals
Three Additional Diseases
• Varicella (chicken pox): can have serious
complications (encephalitis, invasive group A
strep)
Three Additional Diseases
• All three diseases are vaccine preventable
• Serious complications are therefore
preventable
Meningococcal Disease
• Two vaccines against meningococcal disease
are currently recommended in the Ontario
Immunization Schedule
• Voluntary until July 1, 2014
• As of July 1, 2014, now required in order to
attend school in Ontario
Students Who May be Affected
• Children who have received all doses of
vaccines as recommended in the Ontario
Immunization Schedule will not likely require
additional doses
• Parents may be asked to provide updated
immunization records to the Health Unit
Students Who May be Affected
• One dose of Meningococcal Conjugate-C
(Men-C-C) vaccine administered in infancy at
12 months
• One dose of Meningococcal Conjugate
ACYW135 (Men-C-ACYW135)administered in
Grade 7 (school program)
Pertussis (Whooping Cough)
• Pertussis vaccine is included in the Ontario
immunization schedule, not required for
school entry
• Now required for school attendance
• Required doses as indicated in the Ontario
Immunization Schedule
Students Who May be Affected
• Students who have not received their 4 to 6
year “booster” by age 7.
• Students who are due for their adolescent
booster will require pertussis containing
vaccine (Tdap).
• Students who are not immunized will require
a valid exemption if immunization is not
completed.
Varicella (chicken pox)
Ontario Immunization schedule recommends:
• One dose of varicella vaccine at 15 months
of age
• One dose of varicella vaccine (may be given
as MMRV) at 4 to 6 years
• Children born in 2010 or later, will now be
required to show proof of vaccination or proof
of immunity, or have a valid exemption
Which students will be
most affected?
• For children born in 2010 (likely in
Kindergarten in the 2014-15 school year)
proof of vaccination as recommended in the
Ontario Schedule will now be required.
Which students will be
most affected?
• If the recommended schedule is followed,
dose(s) will be required when due
• Of Note: children born on or after January 1,
2000 continue to be eligible to receive publicly
funded varicella vaccine, and vaccination is
recommended
What does this mean for parents?
• Parents will be required to continue to provide
HKPR with up to date immunization records
for their children
What does this mean for parents?
• For children from JK up to Grade 6, we will
require proof that the child has received one
dose of Men-C-C vaccine after the first
birthday
• One dose of Men-C-ACYW135 vaccine will
continue to be offered to all students in
Grade 7
What does this mean for parents?
• During the grade 7 school year, children can
be vaccinated with Men-C-ACYW135 at school
• Students in grade 8 and subsequent grades
for whom HKPR has no record on file of their
receiving Men-C-ACYW135 will be assessed as
overdue at the time of the next ISPA
assessment
What does this mean for parents?
• Parents will receive a notice from the Health
Unit at that time in order that they may take
appropriate action
Suggestions for Parents
• Check their children’s immunization records
• Questions: contact their health care provider
(HCP) or the Health Unit to identify missing
doses.
• If a child did not receive Men-C-C in infancy,
parents can make an appointment with their
HCP, up to the end of Grade 6.
Suggestions for Parents
• For children now in grades 8-12 who have
not received one dose of Men-C-ACYW135
vaccine (missed it in grade 7) contact the
Health Unit.
• Students who will be in Grade 7 in Sept 2014
will be eligible to receive the vaccine at
school. A parent or legal guardian will need to
sign a consent.
Additional Information
• There are still some details requiring
clarification from the Ministry of Health and
Long Term Care, we are expecting more
information on an ongoing basis.
Additional Information
• Suspension is possible if children remain
unvaccinated after Grade 7 and we do not
have a valid exemption on file at the Health
Unit.
• Health Unit clinics will continue to be available
by appointment
Additional Information
• The suspension process takes place over a
period of a few months
• Two notices to parents prior to the date of
suspension
• Provides opportunity for parents to update
immunization and Health Unit records.
What Stays the Same?
• CDC staff will continue to implement the ISPA
• Student registration is verified against school
board data
• Each student’s immunization status is assessed
according to the record on file at HKPR.
• HKPR records are updated as parents provide
records of missing doses and as students
receive vaccinations at HKPR and school
clinics.
What stays the same?
• Begin (usually in January of the school year)
the process that may lead to suspension
– First Notice: gives parents an opportunity to have
their child immunized and to provide the health
unit with the record. If no record is received,
– Second and final notice which includes the date
the suspension will go into effect. If still no record
is received,
– Notice of suspension from school is sent to
parents and principal.
What Stays the Same?
• HKPR staff make every to minimize
suspensions and time lost from school
through parent notices, additional clinics,
communication to health care providers.
• Our efforts are directed toward making sure
students are protected
What stays the same?
• Opportunity for Schools, Public Health and
parents together to increase protection for all
students in our schools, to reduce the risk of
illness from and outbreaks of vaccine
preventable diseases
• Opportunity for parents to be reminded of
needed or missed doses and to take action
to ensure that their child is protected, and to
ensure that records are on file with the Health
Unit.
What is different?
• No ISPA implementation in HKPR during the
2013-2014 school year due to Panorama
work; we can expect double the usual
number of due and overdue students who
receive a first notice.
• Requirement for vaccination against the three
additional diseases will further increase the
number of notices.
• Expect comparable increases in parental
inquiries requiring CDC staff response.
What is different?
• Children who were up to date prior to the
additional requirements may not be up to
date now
• Understanding of the changes to the
requirements is important for parents,
schools, and for health care providers
• Understanding of the implementation process
will help us all contribute to a successful
outcome.
What is Different?
• CDC staff will be working with Panorama, a
new electronic database to be
implemented this summer, HKPR “go live”
date is June 23, 2014
• The preparation and learning has been and
will continue to be extensive.
• Panorama will change how health units
maintain, update and access immunization
records.
Conclusion
• We can expect our ability to monitor vaccine
coverage rates, follow up outbreaks of
vaccine preventable diseases, and to promote
immunization to be enhanced.
• This is an exciting and challenging time in
Public Health and for our Communicable
Disease Control Staff working in Vaccine
Preventable Diseases.
Conclusion
Questions?