An evaluation of 1994 school entry immunization certificates on the Central Coast of New South Wales

School immunisation certificates--a review over time in a disadvantaged community

OBJECTIVES

To compare proportions of kindergarten children in Auburn presenting School Immunisation Certificates (SIC) or other school-entry immunisation documentation over time, and to examine the immunisation status of these children.

METHODS

Immunisation records of kindergarten children enrolled in all primary schools in the Auburn local government area were reviewed in 1994 and 1998.

RESULTS

Eight hundred and thirty-three and 737 school entry records of children enrolled in kindergarten were reviewed in 1998 and 1994 respectively. There was no change in the overall proportion of children with immunisation documentation and SICs. Sixty-nine per cent (571/833) of children had SICs in 1998, compared with 72% (531/737) in 1994. Thirteen per cent of children had other immunisation documentation in 1998, compared with 11% in 1994. The proportion of invalid certificates fell from 39.2% in 1994 to 12.6% in 1998 (p<0.001). The 1998 survey indicated that 80.2% of children provided a certificate indicating they were completely immunised compared with 56.7% in 1994 (p<0.001).

IMPLICATIONS

Although SICs play an important role in promoting the importance of immunisation among parents and in the school community, there continues to be a substantial number of children whose immunisation status is unknown. In the event of an outbreak, an effective public health response may need to incorporate the use of additional objective measures, such as the Australian Childhood Immunisation Register or personal health records.

Adolescent hepatitis B immunisation--should it be the law?

Universal hepatitis B immunisation of young adolescents was included in the Australian Standard Vaccination Schedule in 1998. However, rates of immunisation among adolescents world-wide have often been inadequate. Australia's experience in this area is no exception, particularly in States where school-based delivery is not carried out. Legislation for pre-school immunisation certification currently exists in several States and this legislation is distinctly different from the compulsory or mandatory immunisation that exists in several other developed countries. There have been demonstrable gains in uptake as a result of mandatory immunisation requirements in the United States and there is evidence to suggest that immunisation certification in Australia has also been beneficial. However, it is important to recognise that both certification and mandatory immunisation legislation have inherent difficulties. In this paper, we argue that legislation for high school immunisation certification, as part of a multi-faceted vaccine delivery strategy tailored to adolescents, is required to achieve the uptake that will lead to interruption of transmission of the hepatitis B virus in Australia. Not only will it substantially reduce incident cases of hepatitis B for the next decade, it will also provide a framework for the successful introduction of future adolescent vaccine initiatives in Australia.

Limitations of school entry immunization certificates

OBJECTIVE

To compare the immunization certificate submission rate for kindergarten school children on the Central Coast of New South Wales for 1994 and 1995; to contact individual parents of children with incomplete or missing immunization certificates by issuing a personalised immunization reminder letter, and measuring their response.

METHODOLOGY

Seventy Central Coast schools were surveyed. Immunization documentation for 4177 kindergarten enrolements in 1995 were assessed. Children with incomplete or unknown immunization status were identified. Immunization reminder letters were sent by the schools to parents of the children that were identified. The school recorded any additional immunization certificates submitted.

RESULTS

In 1995, 79% of kindergarten children submitted immunization certificates, unchanged from the previous year. Immunization reminder letters were sent to 856 families of children with no certificate and 215 families of children with an incomplete certificate. A further 263 immunization certificates were submitted, representing a 25% response rate. This intervention increased the percentage of kindergarten children with a certificate from 79% to 86%.

CONCLUSIONS

Education of school staff during the 1994 immunization survey did not change the overall immunization certificate submission rate. Specifically targeting parents through schools can be an effective way of increasing immunization certificate submission.