PROPOSED ORDER OF
DEPARTMENT OF HEALTH SERVICES
TO ADOPT PERMANENT RULES
The Wisconsin Department of Health Services (the “department”) proposes an order to repeal DHS 144.03 (3) and (3m), DHS 144.07 (4) (a) 1. and 2.; to amend DHS 144.01 (2), DHS 144.03 (1), (2) (title), (a) and (b), (4) to (6), (10) (a), DHS 144.04 to DHS 144.06, DHS 144.07 (title), (1), (1m), (3), (4) (a), (b), (5) to (7), (9), (10), DHS 144.08 (1), (3), and DHS 144.09 (1) (a); to repeal and recreate DHS 144.04 (1), DHS 144.02, Table DHS 144.03-A , DHS 144.03 (2) (c) to (i), DHS 144.03 (3) and DHS 144.03 (3m); to create DHS 144.03 (2) (j) and (k), DHS 144.09 (1) (c) (Note), relating to Immunization of Students.
Explanation of agency authority
The Legislature directed the department in s. 252.04 (1), Stats., to carry out a statewide immunization program to eliminate mumps, measles, rubella (German measles), diphtheria, pertussis (whooping cough), poliomyelitis and other diseases that the department specifies by rule, and to protect against tetanus.
Related statute or rule
Plain language analysis
The department is required to carry out a statewide immunization program to eliminate mumps, measles, rubella (German measles), diphtheria, pertussis (whooping cough), poliomyelitis and other diseases that the department specifies by rule, and to protect against tetanus. Minimum immunization requirements for entry into Wisconsin schools and child care centers are established in ch. DHS 144. The department proposes to make the following revisions to the rule chapter: 1. Varicella (chicken pox) and meningococcal disease are identified by the department as vaccine-preventable diseases. However, a substantial outbreak of these diseases is not currently defined in ch. DHS 144. The department proposes to amend the definition of a “substantial outbreak” to include Varicella (chicken pox) and meningococcal disease, and to ensure consistency with CDC recommendations.
2. In recent years, mumps outbreaks have occurred in highly-vaccinated populations and in high-transmission settings, including elementary, middle, and high schools, colleges, and camps. A substantial outbreak of mumps is currently defined as an incidence of the disease exceeding 2% of the unvaccinated population. In 2012, the CDC revised the Manual for the Surveillance of Vaccine-Preventable Diseases, to define a substantial outbreak of mumps as three or more cases linked by time and place. The department proposes to amend the definition of a “substantial outbreak” of mumps to be consistent with the CDC Manual for the Surveillance of Vaccine-Preventable Diseases.
3. The department is proposing to move the current recommendation for Tdap from 6th grade to 7th grade to ensure that children are old enough to meet this age minimum (some children are 10 years old when starting 6th grade). This will reduce the number of children who enter 6th grade and are not vaccinated for Tdap, as some clinicians choose to wait until they are 11 years of age to vaccinate.
4. Neisseria meningitidis is a vaccine-preventable disease and a leading cause of bacterial meningitis and sepsis in the United States. The meningococcal vaccine is recommended by the Wisconsin Chapter of the American Academy of Pediatrics and the Wisconsin Academy of Family Physicians to reduce the incidence of bacterial meningitis and sepsis. Since 2005, the CDC Advisory Committee on Immunization Practices has recommended that the vaccine be administered at the 11-12 year old health care visit, along with other routine vaccinations such as Tdap. The department proposes to add the meningococcal vaccine to the list of vaccines required for students entering the 7th grade. This provision will ease the burden on families, providers, and schools by ensuring that both meningococcal and Tdap vaccines are received at the same visit and the same grade level. The department also proposes a booster dose for students entering 12th grade which is in accordance with ACIP recommendations. This will help to ensure students are fully vaccinated prior to leaving school.
5. Under the current rule, a parent or adult student may report a history of varicella disease as an acceptable exception to varicella vaccination. Recent studies have demonstrated that there is a high incidence of unvaccinated children who report a positive history of varicella that are not immune. The department proposes to allow the exception only when a history of varicella disease has been reported by a health care provider.
6. Chapter DHS 144 currently includes provisions relating to the 2008-2009 phase-in of Tdap and Varicella Vaccine coverage. The department proposes to eliminate these provisions because phase-ins are completed.
7. Curently, schools must only report compliance with program requirements and key indicators of vaccine-preventable disease and outbreaks to local health departments. The department proposes to add the state as a recipient of these reports which would be congruent with the current day care reporting requirements. This will improve the availability of important information and improve the department’s reporting to the legislature, under s. 252.04 (11), Stats.. 8. Chapter DHS 144 has not been substantially revised since 1981. The department proposes to update, correct, or clarify any outdated provisions in order to reflect current definitions, standards, and best practices. There are no reasonable alternative to the proposed rulemaking. The department is required by s. 252.04 (1), Stats., to maintain a statewide immunization program.
Summary of, and comparison with, existing or proposed federal regulations
There appear to be no existing or proposed federal regulations that address the activities to be regulated by the proposed rules.
Comparison with rules in adjacent states
Similar to the proposed rule, Illinois, Iowa, Michigan, and Minnesota all require at least one dose of meningococcal conjugate vaccine at either 6th or 7th grade. All states but Michigan require a booster dose either at the appropriate age of 16-18 years or grade 12, as is proposed in the proposed rule.
Similar to the proposed rule, adjacent states all require Tdap vaccine for students entering 7th grade, require a health care provider’s documentation of varicella disease instead of parental reporting, and refer to CSTE case definitions and CDC guidance and recommendations in regards to disease outbreak definitions.
These states all have similar reporting requirements of vaccine preventable diseases.
The Illinois Department of Public Health outlines school and child care immunization requirements in 77 Ill. Admin. Code 665. Beginning with the school year 2015-2016, a student entering the 6th grade is required to have received one dose of meningococcal conjugate vaccine on or after their eleventh birthday. Students who do not meet the age requirement are monitored by the school. A student entering the 12th grade is required to have a second dose after their sixteenth birthday. If the first dose is received when the student is sixteen years of age or older, only one dose is required.
The Tdap vaccine is required for students entering 7th through 12th grade.
Proof of prior varicella disease must be verified with the date of illness signed by a physician, a health care provider’s interpretation that a parent’s or legal guardian’s description of varicella disease history is indicative of past infection, or laboratory evidence of varicella immunity. A health care provider is defined as a physician, child care or school health professional, or health official.
The Illinois Department of Public Health 77 Ill. Admin. Code 690 outlines mandated reporters, such as health care providers, hospitals, and schools, to report suspected or confirmed cases of vaccine-preventable diseases which include the same diseases as outlined in the proposed rule.