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Ontario health units taking different approaches to student immunization catch up

A registered nurse administers a vaccination to a young boy in Mount Vernon, Ohio on May 17, 2019. Some Ontario students are starting to receive suspension notices over out-of-date immunization records, but many health units are giving families more time to catch up. Students between the ages of four and 17 in the province are required to have certain vaccines to attend school but health units have said immunizations lagged during the pandemic. The Windsor-Essex County Health Unit says it has issued 7,858 suspension orders to students with incomplete immunization records, who now have until Sept. 12 to update them. Toronto Public Health, meanwhile, says it is behind on assessing immunization records due to the pandemic and is currently in the process of reviewing them while holding clinics to help students catch up. THE CANADIAN PRESS/AP, Paul Vernon

TORONTO — Thousands of students in Windsor, Ont., are starting to receive suspension notices over out-of-date immunization records, but health units elsewhere in the province are giving families more time to catch up on routine shots after two years of pandemic disruptions. 

Students between the ages of four and 17 could face suspension from school if they do not have certain vaccinations. But health units say immunizations – and public health records-keeping related to them – have lagged during the COVID-19 pandemic, as have shots that aren't required to attend school but are made available during the academic year.

The Windsor-Essex County Health Unit said this week it has issued 7,858 suspension orders to students with incomplete immunization records, after reviewing secondary student records in June and sending out initial notices.

Students now have until Sept. 12 to update their records, or they could be suspended for up to 20 days starting Sept. 14, the health unit said. 

"Catch-up immunization clinics are being offered at the WECHU offices and across various locations in Windsor and Essex County, and will continue for the rest of the summer," it wrote in a statement.

The Middlesex-London Health Unit, meanwhile, said it so far had sent out 41,000 letters to students whose immunization records are out of date, noting there is a "higher than typical" number for whom immunization records aren't up-to-date.

"There are many reasons that could contribute to this, including: the student’s ability to access a healthcare provider during the COIVD-19 pandemic; as well as the reality that our health unit has not been requesting immunization records or suspending students during the pandemic," the health unit wrote in a statement, noting that some may have received vaccinations but have not provided the information to public health.

There are plans to review uptake at the end of summer, the health unit said, followed by a second round of letters and a first round of suspension notices expected to go out in December.

In Hamilton, the manager of vaccine services said suspension notices related to vaccinations aren't going out at this time because public health has decided to delay them "through the duration of the COVID-19 pandemic" due to "substantial barriers" to vaccine access.

Julie Prieto said in an email that public health in the city is instead trying to boost uptake through screening and catch-up clinics. 

Prieto said as of Aug. 8, an estimated 11,300 out of a total 38,400 students in Grades 7 to 12 were behind on meningococcal disease immunizations, and an estimated 5,200 of 13,200 students in Grades 11 and 12 were overdue for Tdap vaccines, which protect against tetanus, diphtheria and pertussis.

The North Bay Parry Sound District Health Unit said parents and guardians have until the end of this year to get their children up to date on required vaccinations, and it plans to start sending out notices in early 2023 that include a date by which records must be submitted to avoid suspension.

Toronto Public Health, which is running catch-up immunization clinics, said in a statement that it is behind on assessing immunization records due to the pandemic and is currently in the process of reviewing them.

The last review planned for the 2019-2020 school year was stopped in March 2020, the health unit said, and that work "has not restarted due to the ongoing pandemic response."

"This equates to more than two years of missed immunization assessment activities, translating into an overall decrease of students who are up-to-date with their vaccinations or a valid exemption from 85 per cent in 2018-2019 to the current 55 per cent," the statement said.

Peterborough Public Health said it believes more students are behind on immunizations than usual due to COVID-19 disruptions, and it's also running catch-up clinics.

Patti Fitzgerald, manager of the health unit's Vaccine Preventable Diseases team, said in a statement that the health unit might revisit enforcement of immunization rules next year, but is not issuing suspension orders at this time.

The public health unit in Niagara Region said it has not been able to comprehensively review immunization records in recent years due to the pandemic and it is running catch-up clinics for students.

Ottawa Public Health said it's planning to send reminder letters this school year to parents and guardians of children whose immunization records are out of date.

Nathalie Shane, program manager with the health unit, said "there has been limited capacity to enter and assess immunization records" during the pandemic and Ottawa Public Health expects to get a clearer picture of how many students are currently behind during the coming school year.

Both Ottawa and Niagara health units said they expect a higher than usual number of students to be behind on their required shots because of factors related to the pandemic.

The Immunization of School Pupils Act in Ontario requires that students get vaccinated against specific diseases including polio, measles, tetanus, mumps and diphtheria, to attend school, with some exemptions for religious or medical reasons.

Some were advocating earlier this year for COVID-19 vaccinations to be added to that list of required shots, but Ontario's chief medical officer ruled out that possibility for the time being. 

Other vaccinations aren't required to attend school, such as human papilloma virus, hepatitis B and meningococcal disease, but are typically offered to students in school-based clinics that have also fallen behind due to the pandemic. Health units said those vaccinations are part of catch-up clinics currently being planned, or underway.

This report by The Canadian Press was first published Aug. 10, 2022. 

Holly McKenzie-Sutter, The Canadian Press

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