Objectives - Immunization Updates and Public Health Concerns
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7/31/18
Becky Mroczenski, RN BSN
Communicable Disease Manager
Objectives
Have an understanding of Wisconsin school
immunization rates and their impact on public
health.
Have an understanding of communicable diseases
that can affect school age children and your role in
working with public health.
Have fun!
1
7/31/18
2016-2017 School Year
92.5% of students met the minimum immunization
requirements.
1.6% of students were behind schedule.
4.8% of students had a wavier for one or more
immunizations.
Only 1.0% of students waived all immunizations.
Check out your schools rates!
https://www.dhs.wisconsin.gov/immunization/dat
a.htm
School Report
Reminders
Postcards will not be mailed this year.
School booklet materials will be online only:
https://www.dhs.wisconsin.gov/immunization/in
dex.htm
No changes to immunization requirements for 2018-
2019 school year.
Use the School Report form provided in the 2018-
2019 booklet.
2
7/31/18
Reminders-Continued
If your school/school district had a compliance level
less than 99% the previous school year,
noncompliant students must be excluded beginning
school day 31.
Must be reported to the local health department by
the 40th school day using the School Report form.
Noncompliance Roster
Reminders
If the LHD declares a health emergency due to an
outbreak of a vaccine-preventable disease at your
school, the LHD may ask you to share the
information on the Noncompliance Roster with them
in order to control the outbreak of a certain disease.
Your school should assess whether disclosure for
this purpose is necessary to protect the health or
safety of one or more students or adults, consistent
with federal law.
3
7/31/18
Save the Date!
Student Immunization Law: What schools need to
know for Fall 2018 Webinar
Thursday August 23rd 1PM to 2:30PM
https://connect.wisconsin.gov/dhsbcdschoolbooklet/
Resources
Local health department-this can be any local public
health department, not restricted by student’s county
of residence.
Student’s medical provider.
Local Pharmacies.
Federally Qualified Health Centers(FQHC);
Example-Bridge Community Health Center,
Marshfield Clinic Sites
4
7/31/18
Communicable Diseases
Pertussis vs. Parapertussis
Influenza/ILI
Measles
Norovirus
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Pertussis
Respiratory illness commonly known as whooping
cough, that begins with symptoms similar to the
common cold.
Very contagious and is spread person to person. A
person with pertussis can infect up to 12 to 15 other
people.
Infected people are most contagious up to about 2
weeks after the cough begins, but can spread
pertussis for up to 3 weeks after the cough begins.
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Other Pertussis Facts
Coughing fits due to pertussis infection can last for
up to 10 weeks or more; this disease is sometimes
know as the “100 day cough.”
Pertussis can cause serious and sometimes deadly
complications in babies and young children,
especially those who have not received all
recommended pertussis vaccines.
Parapertussis
Parapertussis is a bacterial illness that is similar to
pertussis but is typically milder than pertussis.
Symptoms are similar to pertussis, but can include
coughing fits, coughing to the point of vomiting, and a
whoop sound after coughing.
Median duration of cough is usually shorter-14 vs. 28
days.
Limited data regarding parapertussis; as no studies have
been conducted on the management of parapertussis.
Individuals can have both pertussis and parapertussis.
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Pertussis Parapertussis
Treat with appropriate Treat with appropriate
antibiotics. antibiotics.
Reportable to public Not reportable to public
health. health.
No isolation, should
Isolation until completed avoid contact with
5 days of antibiotics. infants.
All household and high Most often no need for
risk close contacts should household contacts or
receive preventative close contacts to take
treatment. preventative treatment.
Vaccine preventable. Not vaccine preventable.
Influenza/ILI
Influenza or Influenza Like Illness commonly occurs
during the fall and winter. Exact timing and duration
varies. Usually peaks between December and
February.
Schools can be an important in helping slow the
spread of influenza/ILI.
Closing of schools has not proven to be effective in
stopping the flu.
87/31/18
Resources
CDC-has a lot of good materials to utilize with
parents and school staff.
https://www.cdc.gov/flu/school/index.htm
Wisconsin Department of Health Services
https://www.dhs.wisconsin.gov/influenza/index.h
tm
Keep Flu out of School
http://www.preventchildhoodinfluenza.org/keep-
flu-out-of-school
97/31/18
Measles
Measles is a disease that is caused by a virus.
Typically begins with high fever, cough, runny nose,
and red watery eyes. Tiny white spots(Koplik spots)
can appear 2-3 days after symptoms begin.
Three to five days after symptoms begin, a rash
breaks out.
Measles
Koplik Spots Rash
107/31/18
Measles
Spreads through the air when an infected person
coughs or sneezes.
Can spread virus 4 days prior to developing the skin
rash to four days after the rash erupts.
If one person has it, 9 out of 10 people around him
will also become ill if they are not protected.
You can get measles just by being in room where a
person with measles has been, even up to 2 hours
after that person has left.
Complications
Ear infections (1 in 10), which can result in
permanent hearing loss.
Pneumonia (1 in 20), the most common cause of
death from measles in children.
Encephalitis or swelling of the brain (1 in 1000).
1 or 2 out of 1,000 people with measles will die, even
with the best care.
1 in 4 people in the U.S. will be hospitalized.
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2018 Cases
U.S. numbers from January 1 to July 14, 2018
107 people in 21 states.
April 2018 measles exposure in Wisconsin.
No cases from exposure.
Significant amount of time spent on follow up of
contacts.
What happens if there is a
case at a school?
Individual is excluded and isolated until 4 days after
the rash onset. Rash onset is day zero.
Identify all individuals exposed; typically with
measles this means the entire school.
Identify individuals at high risk for serve disease or
complications. These individuals would be referred
to their medical provider.
Exclude susceptible contacts.
127/31/18
Who’s excluded?
Previously unvaccinated persons are quarantined
from day 7 through day 21 after exposure to the last
case of measles, unless a dose of MMR vaccine was
received with 72 hours of first exposure.
Vaccinated persons with only 1 previous dose are
also excluded unless a second dose is received within
72 hours of exposure.
137/31/18
Norovirus
Viral infection of the stomach or intestines or both.
Common symptoms-diarrhea, throwing up, nausea,
stomach pain.
Usually develop symptoms within 12 to 48 hours
after being exposed to the virus.
Not necessarily reportable, but food or waterborne
outbreaks are reportable.
Norovirus
Highly contagious; you are most contagious when
you are ill with symptoms and the first few days
after you recover from the virus.
Leading cause of vomiting and diarrhea from acute
gastroenteritis; 19-21 million cases in the US.
Can spread quickly in closed places like daycare
centers, nursing homes, schools, and cruise ships.
Outbreaks usually occur from November to April in
the United States.
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157/31/18
Working with Public
Health
Depending on the number of ill students or events
surrounding a spike in ill students an investigation
may be done.
Offer guidance regarding cleaning of school.
https://www.youtube.com/watch?v=TAkH4jakLYA
Provide education materials.
Provide consultation regarding possible school
closure.
167/31/18
Resources
Wisconsin Immunization Registry
Wisconsin Department of Health Services:
www.dhs.wisconsin.gov
Centers for Disease Control: www.cdc.gov
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