Immunization Bill Gets Elm City Booster

Hartford — When he returned to New Haven in 2015, Dr. Byron Kennedy encountered a troubling statistic: Approximately 3,000 kids in the city’s public school system weren’t up to statewide immunization standards. And those were just the students who were accounted for.

A board-certified physician, Kennedy is the director of New Haven’s Health Department, a position to which he was appointed in 2015. Wednesday, that concern about the city’s youth brought him to the first floor of the Legislative Office Building, where the Public Health Committee was holding a public hearing on 24 proposed bills. Among them was one that has caught his interest: a proposed Senate bill expanding Connecticut’s population-based immunization and tracking system.

Introduced by New Haven State Sen. Gary Winfield and New Haven State Reps. Toni Walker, Robyn Porter, Roland Lemar, Juan R. Candelaria as well as Waterbury Sen. Joan Hartley and Rep. Geraldo Reyes, the bill would expand the Connecticut Immunization Registry and Tracking Service (CIRTS) to track students until they are 18 years of age. It would also require standard CIRTS reporting for health care providers who administer vaccines to children. Currently, the program tracks kids through only their sixth birthdays, and reporting is voluntary for physicians and health care providers. 

In the state, children entering public kindergarten programs are required to be immunized against measles, mumps, rubella, poliomyelitis, diptheria, tetanus, pertussis, hemophilus influenzae type B (i.e. influenza), Hepatitis B, and varicella unless their parents or legal guardians seek legal, religious or medical exemption. Kennedy is working to get 18 school-based health clinics in the city to direct attention to this issue; he said there are students who still show up without vaccines, and without exemptions. 

Since the bill’s conception, sponsors have maintained that it is not in any way a backdoor route to requiring vaccination for parents who currently object to doing so for their children. Nor does it bear any of the same language as a proposed House bill from Reps. Liz Lenahan and Josh Elliott requiring vaccination education for parents seeking religious immunization exceptions.

Instead, New Haven legislators see it as a public health issue. As states report a rise in measles, mumps, rubella and pertussis — virus-based illnesses against which kids can get two vaccinations, one around their first birthday and the second around their fourth or fifth — they maintain that a centralized system like CIRTS will act as a preventative tool, working to streamline records for healthcare providers and parents.

Speaking just before 6 p.m., Kennedy sought to paint for members of the Committee exactly why that matters. First, he said, expanding CIRTS will let families change schools, school districts, or pediatricians without losing precious immunization information. 

“Children will often move from one pediatric practice to another during their years of attending school and the paper trail may become disjointed and incomplete,” he said, noting that the American Academy of Pediatrics had endorsed similar models to CIRTS. ​“Expanding electronic registries to cover all school-aged children can help providers check a child’s immunization history through a centralized database, whether for school, daycare, or camp, without depending on the parents for a paper record.”

In addition, he said, an extension of CIRTS would assess vaccination coverage for a wider youth population, leading to a more comprehensive and rapid statewide response in the instance of an outbreak. Noting that the Centers for Disease Control (CDC) has reported better tracking, immunization rates, and ultimate public health outcomes in Delaware, Massachusetts, Georgia, Michigan, New York, and Rhode Island, Kennedy insisted that ​“immunization registries are effective at increasing vaccination rates and reducing vaccine-preventable diseases.”

“These registries help support reminder and recall systems for both parents and providers, determine a child’s vaccination status for decisions made by clinicians, health departments, and schools … guide public health responses to outbreaks of vaccine-preventable diseases … or provide vaccination documents to displaced families … assess vaccination coverage, missed vaccination opportunities, invalid dose administration, and disparities in vaccination coverage, and … facilitate vaccine management and accountability,” he added in a written testimony that he both read from and provided committee members with.

Privacy Concerns On The Horizon

Kennedy concluded his testimony on a statistic he still finds surprising: Connecticut leads the state in the number of vaccinations for children under 3. That’s thanks in part to 2012’s passage of the Connecticut Vaccine Program—but that number drops off as they age out of CIRTS. While 64 percent of American youth 11 – 17 are ​“included in a state or local immunization registry,” Connecticut’s adolescent population isn’t included. Which, he thinks, is a missed opportunity.

“If enacted, this expansion of CIRTS would align Connecticut with the immunization registries of other states such as Massachusetts, New York, Rhode Island, and Vermont, to name a few,” he said. ​“Moreover, these types of population-based registries are endorsed by a number of national organizations including the American Academy of Pediatrics, the Community Preventive Services Task Force, and the Centers for Disease Control and Prevention.”

As he finished speaking, Milford State Rep. Pam Staneski peppered Kennedy with questions: Who, exactly, would have access to these records? Who would be distributing information on vaccines, booster shots, and age-appropriate immunizations to parents and schools? And who would be paying for the expansion?

Immunization records are processed through electronic health records, which wouldn’t change, Kennedy responded. Those will be uploaded by physicians to the Connecticut Department of Health. The Connecticut Department of Health would have access to the entire database, to which physicians would be required to submit information on a mandatory basis. Parents, legal guardians and physicians would be able to reference CIRTS as a record for their child or patient(s), but that information would be kept completely confidential unless they signed a form authorizing the release of confidential information. That would actually help when immunization reminders roll around, said Kennedy — right now, there isn’t a streamlined system to get adolescents under 18 into doctor’s offices for vaccines that may protect them — and their classmates — from disease.

“We have many mechanisms already in place to handle this type of confidential information,” he told Staneski. ​“In the state of Connecticut, we actually have confidential databases that cover communicable disease, not just vaccinations — sexually transmitted disease, including HIV … so I think in public health, both at the state and the local level, we’re used to having confidential information, including in their electronic formats.”

“Where there are broad requirements — like if the governor’s HPV plan passes — then the system could give notice to parents as it [an immunization deadline] approaches,” added New Haven State Liaison Mike Harris in a message after the hearing. ​“But most of the function is as a reference and a repository for records.” 

Kennedy also answered Staneski’s other two questions as well. The Department of Public Health would be sending out those reminders — electronic, to phones, and through the mail to both families and healthcare providers. And because CIRTS already exists, it’s not expected to cost the state extra funding. 

Following is a status report on bills of particular interest to New Haven before the state legislature this session:

The 2017 Agenda