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|8 Childhood Vaccination Coverage
|Description | Specific Indicators | Corresponding OPHS Outcomes | Corresponding National Indicators | Data Sources | Alternative Data Sources | ICD Codes | Analysis Check List | Method of Calculation | Basic Categories | Indicator Comments | Cross-References to Other Sections | Cited References | Other References | Acknowledgements | Changes Made|
- Proportion of children aged 2 years in licensed child care facilities who are known to be complete for age for vaccination against diphtheria, tetanus, and polio; measles, mumps and rubella; Haemophilus influenzae type B; pertussis; invasive pneumococcal disease; invasive meningococcal disease; or varicella (chickenpox).
- Proportion of school children aged 7 years who are known to be complete for age for vaccination against diphtheria, tetanus, and polio, or measles, mumps and rubella.
- Proportion of high school students aged 17 years who are known by the health unit to have completed vaccination against diphtheria, tetanus, and polio, or measles, mumps and rubella.
- Proportion of grade 7 students who have completed vaccination against hepatitis B or invasive meningococcal disease by the end of grade 7.
- Proportion of grade 8 females who have completed vaccination against human papillomavirus.
- Proportion of infants born to mothers who are hepatitis B carriers who have completed vaccination against hepatitis B per the recommended schedule.
Corresponding Outcome from the Ontario Public Health Standards (OPHS)
- Childhood vaccine coverage rates for diphtheria, tetanus, and polio; measles, mumps and rubella; Haemophilus influenzae type B; pertussis; invasive pneumococcal disease; invasive meningococcal disease; or varicella (chickenpox).
- Adolescent hepatitis B or invasive meningococcal disease vaccine coverage.
- Adolescent female human papillomavirus vaccine coverage.
- Infant hepatitis B vaccine coverage.
The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.
Link to OPHS
- Societal Outcome (vaccine preventable diseases): Target coverage rates for vaccine preventable diseases are achieved
- Board of Health Outcome (vaccine preventable diseases): Target coverage rates for provincially funded immunizations are achieved.
- Board of Health Outcome (vaccine preventable diseases): Children have up-to-date immunizations according to the current Publicly Funded Immunization Schedules for Ontario and in accordance with the Immunization of School Pupils Act and the Day Nurseries Act.
Corresponding Health Indicator(s) from Statistics Canada and CIHI
Numerator and Denominator: Immunization Records Information System
|Original source: Immunization Records Information System, [Public Health Unit] |
|Distributed by: Public Health Unit|
|Suggested citation (see Data Citation Notes): IRIS [years], Extracted: [date] |
Numerator and Denominator: Public health unit hepatitis B, meningococcal C-conjugate, and human papillomavirus vaccination clinic data
|Original source: Public Health Unit |
|Distributed by: Public Health Unit|
|Suggested citation (see Data Citation Notes): Public Health Unit Vaccination Data [years], Extracted: [date] |
Analysis Check List
- Consider aggregation of data values and/or cell suppression when appropriate when dealing with small numbers to avoid risk of confidentiality breach. A new resource is currently under development to provide more detailed information on this issue.
- For IRIS:
- Data are by vaccine so each vaccine is requested /analyzed separately.
- Data are collected by birth year rather than age or grade. Data requests should be for children with immunization status that is “complete for age” since some vaccines require a series of shots at different ages.
Method of Calculation
Number of children aged two years in licensed child care who are known by the health unit to be complete for age for vaccination against diphtheria, tetanus, and polio; measles, mumps and rubella; Haemophilus influenzae type B; pertussis; invasive pneumococcal disease; invasive meningococcal disease group C; or varicella (chickenpox) in a specified time period
| x 100|
Number of children aged two in licensed child care in that time period
Number of school children aged seven years who are known by the health unit to be complete for age for vaccination against diphtheria, polio, and tetanus, or measles, mumps and rubella in a specified time period
| x 100|
|Number of school children aged seven in that time period|
| ||Number of students aged seventeen who have completed vaccination against diphtheria, polio, and tetanus, or measles, mumps and rubella in a specified time period|| x 100|
|Number of students aged seventeen in that time period|
| ||Number of grade 7 students who have completed vaccination against hepatitis B or invasive meningococcal disease group Cby the end of grade 7 in a specified time period|| x 100|
|Total number of Grade 7 students in that time period|
| ||Number of grade 8 female students who have completed vaccination against human papillomavirus by the end of grade 8 in a specified time period|| x 100|
|Total number of grade 8 female students in that time period|
| ||Number of infants born to mothers who are hepatitis B carriers, who completed vaccination against hepatitis B according to the recommended schedule in a specified time period|| x 100|
|Total number of infants born to mothers who are hepatitis B carriers in that time period|
- Sex: male, female
- Age group
- Geographic areas: public health unit
- The diseases listed in this indicator are all preventable through adequate immunization.
- High vaccine coverage not only reduces the risk of infection for vaccinated individuals but also reduces the risk of disease transmission to others within a population whether they are vaccinated or not (herd immunity). This is because widespread vaccination decreases the chance that an infected person will come into contact with a susceptible person.
- Complete for age for vaccination is defined according to the Publicly Funded Immunization Schedules for Ontario - January 2009.1 Comparisons to other provinces schedules are available on the Public Health Agency of Canada website (Publicly funded Immunization Programs in Canada - Routine Schedule for Infants and Children including special programs and catch-up programs (as of March 2011)).
- The Day Nurseries Act does not specify which vaccinations are required but rather states that operators must ensure that before a child is admitted to a day nursery the child is immunized as recommended by the local medical officer of health.2 Recommended vaccinations may vary by health unit.
- Vaccination or a statement of exemption from vaccination against diphtheria, tetanus, polio, measles, mumps and rubella is required as set out in the Immunization of School Pupils Act, 1990.3
- Vaccination information is collected only for children currently attending private or public schools and children attending licensed child care facilities and therefore may not accurately reflect the true vaccination rate in the community.
- Data collected for children aged two is limited to licensed day care centres and does not include children who are at home or in unlicensed day care.
- Information on vaccines not required by legislation (e.g. pertussis, invasive pneumococcal disease, invasive meningococcal disease group C, varicella, hepatitis B, human papillomavirus) is not collected by all health units since reporting is voluntary. For those that do report these vaccinations, only some health units use IRIS to record the information.
- Some children/students may not be eligible for a vaccine due to natural immunity or medical contraindication. This information may be collected and recorded in IRIS. However, ineligible children are not excluded from the denominator of vaccine coverage calculations since not all IRIS vaccine coverage reports summarize this information. The number of ineligible individuals is likely to be small relative to the magnitude of the denominator and will have limited impact on vaccine coverage estimates.
- Children/students with exemptions (medical, philosophical, conscience or religious) or no information are treated as incomplete.
- The coverage report available in IRIS for Haemophilus influenzae type B reports coverage against this disease alone. Therefore, vaccine coverage against Haemophilus influenzae type B at age two years is calculated separately
- Neither numerator nor denominator data for calculating infant hepatitis B vaccination coverage are systematically captured and available for analysis within iPHIS or IRIS. Consult the individual health unit to determine the appropriate source of data for this indicator.
- Due to differences in reporting, data may not be comparable across health units.
Cross-References to Other Sections Cited References
- Evans AS, Brachman PS. Bacterial Infections in Humans: Epidemiology and Control. Springer, 1998.
- Heymann DL. Control of Communicable Diseases Manual. American Public Health Association, 2004.
- V Mai, M Bass, N MacDonald, L Noseworthy, C Shah, M Naus, C Jacobson. Vaccine Utilization and Preferences of Ontario Family Physicians and Pediatricians. PHERO, Volume 8(5), May 30, 1997;118-121.
- Mitchell D. Immunization Promotion Project Survey Results. PHERO, Volume 11(7), July and August 2000;155-162.
- Winter AL. Sciberras J. Operationalization of the Immunization of School Pupils Act: 2000/2001 School Year. PHERO Volume 13(1), January 28, 2002;2-8.
- National Advisory Committee on Immunization. Canadian Immunization Guide, Seventh Edition, 2006. Ottawa, ON: Public Health Agency of Canada, 2006. Available at http://www.phac-aspc.gc.ca/publicat/cig-gci/index-eng.php
- Haimes K, Schouten H, Harris T, Belzak L. National Standards for immunization coverage assessment: recommendations from the Canadian Immunization Registry Network. Can Commun Dis Rep 2005;31(9). Available at: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/05vol31/dr3109ea.html
- Public Health Agency of Canada. CCDR 2006;32S3:1-44. Canadian National Report on Immunization, 2006. Available at: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/06vol32/32s3/index.html
- Public Health Agency of Canada. Final Report of Outcomes from the National Consensus Conference for Vaccine-Preventable Diseases in Canada. CCDR 2007;33S3:1-56. Available at: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/08vol34/34s2/index-eng.php
- Deeks SL, Johnson IL. Vaccine coverage during a school-based hepatitis B immunization program. Can J Public Health. 199;89(2):98-101.
Andrea Currie, North York General Hospital
Dara Friedman, Ottawa Public Health
Core Indicators Infectious Disease Subgroup
Core Indicators Infectious Disease Subgroup
Effie Gournis, Toronto Public Health
Ameeta Mathur, Toronto Public Health
Rachel Savage, Ontario Agency for Health Protection and Promotion
Type of Review
(Formal or Adhoc)
Changes made by
March 16, 2009
Infectious Disease subgroup
- Changed name from "Vaccination Coverage".
- Removed pertussis from indicators for age 7 and 17 as it is not required by legislation.
- Created new indicator for Hepatitis B vaccination among infants.
- Added Meningococcal C-conjugate vaccine to grade 7 indicator.
- Created new indiator for vaccination against human papillomavirus.
- Added vaccinations for invasive pneumococcal disease, invasive meningococcal disease group C, and varicella to age 2 indicator.
|May 10, 2011|| Ad hoc|
Sherri Deamond on behalf of Infectious Disease subgroup
- Removed "group C" from invasive meningococcal disease vaccine to reflect current and future changes to strains covered.
- Removed "Private schools are not covered by this legislation." from indicator comments. This was not accurate.
|June 13, 2011|| Ad hoc|
Sherri Deamond on behalf of CIWG
- Added acknowledgments section