BACKGROUND:
The varicella vaccine has proven successful in decreasing the burden of disease due to varicella, yet there remain children susceptible to disease. Due to reduced virus transmission these children may remain unexposed and unvaccinated as they grow older. To increase vaccination coverage levels and identify hidden susceptibles, several states, including Georgia, have implemented middle-school entry requirements for children.

OBJECTIVE:
The objective of this study was to identify students susceptible to varicella disease within the Clayton County, Georgia middle-school system.

METHOD:
Phase I of the study, conducted in 2002, included a parental survey requesting information on varicella vaccination or disease history of rising 5th and 6th grade students. Phase II of the study utilized an electronic database to identify rising 6th grade students with inadequate immunizations. Information on the immunization requirements was communicated to parents through letters, the school website, and a cable access channel.

RESULT:
In phase I of the study 839 survey responses were collected for evaluation. Only 59% gave a positive response for varicella disease or immunization. The remaining 41% were negative. Individuals in the negative response category required vaccination prior to school entry. In Phase II a database query identified 2,001 (50 % of the total registered rising 6th grade) students out of compliance for immunizations. Approximately 90% were missing appropriate documentation for varicella disease. Following the educational campaign, the percent of children susceptible to varicella disease decreased to only 179 students (5% of the rising 6th grade population).

CONCLUSION:
Our data suggest a significant percent of students in middle-school remain susceptible to disease. Our results reinforce the need for middle-school entry requirements and interventions targeted at identifying susceptible children. Additional research is needed to further explore the changing epidemiology of varicella disease in the middle-school population.

LEARNING OBJECTIVES:
1. Participants will learn the importance of ascertaining the varicella susceptibility status of adolescents in a middle-school setting.
2. Participants will learn how to develop and institute a varicella screening process in their school system.