Effectiveness of a Vaccination Reminder System in Toronto, Canada

Learning Objectives for this Presentation:
By the end of the presentation participants will be able to:
1. Describe the vaccination reminder system for Toronto students
2. Understand the effectiveness of Toronto's vaccination reminder system
3. Discuss improvements to the collection of vaccination information

Background:
In Ontario, parents must vaccinate their children and report the vaccination events to the local health department. Ontario law requires Toronto Public Health (TPH) to annually review all immunization records for Toronto students. Parents of students without evidence of proper vaccination are sent up to three notices requesting information before a child is suspended from school. The goal is to ensure an adequately immunized student population, while avoiding the need to suspend students.

Objectives:
To assess TPH's system of student reminder notices as an effective means for ensuring vaccination coverage.

Methods:
A representative sample of students who received at least one notice from the 2004/05 and 2005/06 school year was selected from the TPH Immunization Reporting Information System. Student demographics, overdue vaccine antigens, dates of vaccinations, and notice mail dates were used to assess vaccine status. Descriptive summaries and bivariate statistical tests were conducted with SAS.

Results:
From 6,548 randomly chosen students, 6,304 were included in the analysis. The majority (85.1%) of students provided documentation on previous vaccines (i.e. those given before the notice date), while 939 (14.9%) students received at least one vaccination on a date after TPH started to send notices.

Conclusions:
The reminder system was effective in ensuring Toronto's student population was vaccinated. Notices either stimulated vaccination among unvaccinated students or prompted parents to provide documentation that students had been previously vaccinated. Further study is needed to determine why timely vaccination information is not being provided to TPH. A comprehensive immunization registry that collects vaccination information at the point of service could be a useful tool for keeping student vaccination records current.