P0154 - A Survey of Camp Leadership to Assess Immunization Requirements, Policies and Current Practices in a National Cohort of Summer Camps

Background: 14 million children attend summer camps yearly. While the American Academy of Pediatrics (AAP) recommends all campers and staff receive vaccinations, camp leaderships’ immunization practices and perspectives have not been well characterized. Our study objective was to assess the current state of summer camps’ immunization requirements, policies, and practices by surveying a national cohort of camp leadership.

Methods: We partnered with CampDoc.com, an online camp electronic health record system and the Association of Camp Nursing to conduct a 20-question online survey of camp leadership regarding current immunization requirements, policies and beliefs. One response was chosen from each camp by predetermined criteria. Results were analyzed using descriptive statistics, with multivariate logistic regression models applied to examine associations between camps having a written immunization policy and camp leadership responses and variables.

Results: A total of 710 of 881 respondents, representing a total of 378 individual summer camps, reported being qualified to answer the survey, of which 343 individual camps had answered the survey in its entirety. Survey respondents were directors (44%, n=164), nurses (26%, n=98), office staff (16%,n=60), physicians (3%, n=13), owners (2%, n=8), emergency medical technicians (1%, n=3) and other (8%, n=32). Table 1 illustrates the percentage of camps that required various immunizations. The majority of leadership (92% n=316) agreed that vaccines reduce risk of disease; 80% (n=276) responded that campers should be fully immunized prior to attending camp. Despite this belief, only 50% (n=174) of camps had an immunization policy requiring camper immunizations and 39% (n=133) for staff; 54% (n=181) allowed unvaccinated children with non-medical exemptions to attend camp; 3% (n=10) of camps had experienced an outbreak of a vaccine-preventable illness and 14% (n=47) were warned of a potential exposure within the county in the past two years; 20% (n=68) responded that camps might lose a significant number of campers by requiring immunizations. Stepwise logistic regression analysis (Table 2) indicated camps were more likely to report having a policy requiring immunization for campers if leadership believed all campers should be immunized (adjusted odds ratio [aOR]= 3.1 95% confidence interval [CI]: 1.5-6.2) or if camps were located in states requiring immunization documentation (aOR=4.86; 95% CI: 2.9-8.0), but were less likely to have a policy when accepting non-medical immunization waivers (aOR = 0.27; 95% CI: 0.1-0.4).

Conclusions: Despite AAP recommendations, a substantial proportion of leadership reported not having summer camp immunization policies that required camper immunizations. Policy-makers and camp health stakeholders should advocate for state policies that require camps to have documentation of campers’ immunizations status. Camp leadership should work with pediatricians to develop camps’ immunization policies that are fully aligned with AAP guidelines to ensure the optimal well-being of all children in summer camps.