Implementing WA New State Exemption Requirements -

Implementing WA New State Exemption Requirements - Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/PreschoolsTraining for Schools and Child Cares/Preschools

August XX, 2011August XX, 2011

Preschool/Child Care Immunization RequirementsPreschool/Child Care Immunization RequirementsDepartment of Health Office of Immunization and Child ProfileDepartment of Health Office of Immunization and Child Profile

May 2013May 2013

Topics to be Covered• What are the child care and preschool vaccine requirements in

Washington State?• Complete, Conditional, Out of Compliance: What do they

mean?• How can I use the Washington State Immunization Information

System (IIS) to find out if a child is complete?

Why Do We Need Immunizations?

We don’t see diseases once common. Vaccines successfully prevent disease

However, diseases and outbreaks still occurChildren are at risk in the child care and preschool

setting

Immunization RequirementsChildren attending licensed child care must comply with

immunization requirements to protect the health of the public and individuals

Children must be vaccinated against certain diseases at ages and intervals according to the national immunization schedule

Parents must turn in completed Certificate of Immunization Status (or Certificate of Exemption)

www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/Regulations.aspx

Immunization Requirements

Comply with State Board of Health immunization requirements

Required to report to DOH

Licensed child care center (and preschool) √ √

Licensed family home child care

Must comply with DEL rules --

Licensed child care for school age children √ --

Head Start, ECEAP √ √Any preschool in school setting √ √

Certificate of Exemption From School, Child Care and Preschool Immunization Requirements1

Child’s Last Name: First Name: Middle Initial: Birthdate (mm/dd/yyyy): Sex:

Parent/Guardian Name (please print):

NOTICE: To exempt a child, a parent/guardian sign & date the ‘Parent/Guardian Notice.’ Any exemption must also have a licensed health care provider sign & date the ‘Provider Statement2.’ Exception: a ‘Provider Statement’ is not required for religious exemptions with the ‘Demonstration of Religious Membership’ section completed.

Parent/Guardian, please choose the exemption(s) that apply to your child below.

Temporary Medical Exemption

Permanent Medical Exemption Until Vaccine(s) Date (or Permanent)

Print Name of Licensed Health Care Provider (MD, DO, ND, PA, ARNP)

Personal/Philosophical Exemption

Religious Exemption

I do not want my child to get the following vaccine(s):

Diphtheria Hepatitis B Hib Measles Mumps Pertussis (whooping cough) Pneumococcal Polio Rubella Tetanus Varicella (chickenpox)

X X Signature of Licensed Health Care Provider Date

Other (indicate):

Provider Statement2: “I, Pr int Name , am a physician, physician’s assistant, naturopath, or advanced registered nurse practitioner licensed under Title 18 RCW. I confirm that the parent or guardian signing the section entitled “Parent/Guardian Notice” has received information on the benefits and risks of immunization to their child as a condition for exempting their child for medical, religious, personal, or philosophical reasons.” X X Signature of Licensed Health Care Provider (MD, DO, ND, PA, ARNP) Date

Parent/Guardian Demonstration of Religious Membership: “I have indicated on this certificate that I am exempting my child for religious reasons. I am a member of a church or religious body whose beliefs or teachings do not allow for medical treatment from a health care practitioner. By supplying the information requested below, no further proof or signed provider statement is required for this religious exemption.” X Name of church or religious body

X X Signature of Parent/Guardian Date

Parent/Guardian Notice: “I certify that all the information provided on this certificate is correct and verifiable. I understand that if there is an outbreak of a vaccine-preventable disease my child has not been fully immunized against (as indicated above, for medical, personal/philosophical or religious reasons), my child may be at risk for disease and can be excluded from school, child care, or preschool until the outbreak is over.” X X Signature of Parent/Guardian Date

1 RCW 28A.210.080-090 states that before or on the first day of every child’s attendance at any public and private school or licensed child care center in Washington State, the parent or guardian must present proof of either: (1) full immunization, (2) the initiation of and compliance with a schedule of immunization, as required by rules of the State Board of Health, or (3) a certificate of exemption, signed by a parent or guardian and a licensed health care provider. 2 A letter (not a copy) may substitute for a signed ‘Provider Statement’ on this certificate. To be accepted, the letter must reference the child’s name on this certificate, confirm that the child’s parent or guardian got information on the risks and benefits of immunization to their child, and be signed by a licensed health care provider.

If you have a disability and need this document in a different format, please call 1-800-525-0127 (TDD/TTY 1-800-833-6388).

DOH 348-106 May 2011

Changes to Exemption Lawwww.doh.wa.gov/CommunityandEnvironment/

Schools/Immunization/Exemptions.aspx Sample Certificates of ExemptionTraining videoFrequently Asked Questions

Vaccines Required for Preschool or Child Care Attendance

DTaPHepatitis BHibIPVMMRPCVVaricella

Recommended, but Not Required

FluHepatitis ARotavirus

Immunization Status

Complete/Fully ImmunizedConditional

Temporary status to allow child to get fully immunized

Out of ComplianceExempt

www.doh.wa.gov/Portals/1/Documents/Pubs/348-051-ChildcareChart2013-2014.pdf

www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

www.doh.wa.gov/Portals/1/Documents/Pubs/348-051-SchoolChart2013-2014.pdf

4 Day Grace PeriodVaccines given 4 days or fewer before the

minimum interval or age are validVaccines given more than 4 days before the

minimum interval or age are NOT valid and need to be repeated

Applies to all vaccines before minimum intervals OR ages

Patient Name: Katey SIIS Patient ID:

Date of Birth: 02/15/2011 Age: 99 weeks, 22 months, 1 yrs

Vaccination Summary

Does not include all vaccination types. Vaccinations outside the ACIP schedule are marked with an 'X'.

Vaccine Family 1 2 3 4 5 6 7 8

OPV/IPV 04/15/2011 8 weeks

06/18/2012 4 months

08/12/2011 5 months

Invalid Vaccinations

Invalid Vaccinations Date Reason Vaccination Forecast

The forecast automatically switches to the accelerated schedule when a patient is behind schedule.

Vaccine Family Dose Recommended

Date Minimum Valid Date

Overdue Date

Status

Polio 4 02/15/2015 02/15/2015 02/15/2018 Up to Date

4 Day Grace Example

Dose 3 valid given 3 days

before 6 months of age

DTaP Requirement

VACCINE By 3 Months(on or before last

day of mo 2)

By 5 Months(on or before last

day of mo 4)


day of mo 6)


day of mo 15)


day of mo 18)

Diphtheria, Tetanus, Pertussis(DTaP/DT)

1 dose 2 doses3 doses

May get as early as 6 months.

4 dosesMay get 4th dose as early as 12 months as long as 6 months

separate dose 3 and dose 4.

DTaP Minimum Age and Intervals

Dose # Minimum Age Minimum Interval Between Doses

1 6 weeks 4 weeks between Dose 1 & 2


3 14 weeks 6 months between Dose 3 & 4

4 12 months 6 months between Dose 4 & 5

DTaP DetailsRoutine schedule: 2, 4, 6, 15-18 months, and

booster dose at 4-6 years6 months interval recommended between dose

3 and 4, but 4 months or more is acceptableDTaP given to children less than 7 years of

age; Tdap and Td given to children 7 years of age or older

Patient Name: Isabella SIIS Patient ID:


Vaccination Summary



DTaP/DTP/Td 06/17/2008 8 weeks

07/18/2008 3 months

08/18/2008 4 months

X 12/19/2008 8 months


Invalid Vaccinations Date Reason DTaP/DT/Td 12/19/2008 Minimum age for this dose not met.

Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule.


Date Minimum

Valid Date Overdue

Date Status

DTaP/DT/Td 4 06/19/2009 06/19/2009 11/17/2009 Past Due

Note red X because Dose

4 given too early

DTaP Example

Dose 4 past due

Hepatitis B Requirement

VACCINE By 3 Months(on or before last

day of mo 2)


day of mo 4)


day of mo 6)


day of mo 15)


day of mo 18)

Hepatitis B1 dose

May get dose 1at birth.

2 dosesMay get dose 2 as early as 1 month.

3 doses

Hepatitis B Minimum Age and Intervals

Dose # Minimum AgeMinimum Interval Between

Doses

1 Birth 4 weeks between Dose 1 & 2



Hepatitis B DetailsRoutine schedule: birth, 1 month, and 6 monthsPay attention to min age for dose 3 and

minimum intervals between doses

Hib Requirement

VACCINEBy 3 Months(on or before last day of mo

2)

By 5 Months(on or before last day of mo

4)


6)

By 16 Months(on or before

last day of mo 15)


lastday of mo 18)

Haemophilus influenzae type B(Hib)

1 dose 2 doses 3 doses 4 doses

Hib Minimum Age and Intervals


Doses




4 12 months -

Hib DetailsRoutine schedule: 2, 4, 6, and 12-15 monthsNot recommended for children 5 years or olderThe recommended immunization schedule for Hib

vaccines:

Vaccine 2 Months 4 Months 6 Months 12-15 Months

PRP-T* (ActHib)Dose 1 Dose 2 Dose 3 Booster

PRP-OMP (PedvaxHib)

Dose 1 Dose 2 Booster

Hib Details• One total dose for unvaccinated child 15-59 months of

age.• Two doses total if Dose 1 given >12 months and Dose 2

given >15 months of age.• Three doses total if 2 doses given before 12 months

and Dose 3 given >12 months.

Doses beforeage 12 months

Doses on or afterage 12 months Status

3 1 Complete

2 1 Complete

1 1 Needs 1 Booster Dose(If Last Dose Given Before 15 Months)

0 1 Needs 1 Booster Dose(If Last Dose Given Before 15 Months)

4 0 Needs 1 Booster Dose




0 0 Needs 1 Dose

Hib Doses Required Chartwww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf



Vaccination Summary



Hib 06/18/2008 8 weeks

05/17/2009 13 months



Date Minimum Valid Date

Overdue Date

Status

Hib 3 07/12/2009 07/12/2009 8/17/2009 Past Due

Hib Example

IPV Requirement

VACCINEBy 3 Months(on or before

last day of mo 2)


day of mo 4)


last day of mo 6)


15)


18)

Polio(IPV or OPV)

1 dose 2 dosesMay get as early as 4 months.

3 doses

IPV Minimum Age and Intervals




3 14 weeks 6 months between Dose 3 & 4

IPV DetailsRoutine schedule: 2, 4, 6-18 months, and

booster at 4-6 yearsIPV used routinely in US for polio vaccination,

but children coming from a foreign country may get OPV

Any combination of IPV or OPV valid

MMR RequirementVACCINE


day of mo 2)


day of mo 4)


day of mo 6)


day of mo 15)


day of mo 18)

Measles, Mumps, Rubella (MMR)

Not given before 12 months of age. 1 dose

MMR Minimum Age and Intervals


Doses

1 12 months 4 weeks between Dose 1 & 2

MMR DetailsRoutine schedule: 12-15 months and 4-6 yearsDose 1 given <12 months of age must be repeated (4 day grace

applies)MMR or MMRV can be usedIf not given on same day, minimum interval between MMR and

varicella is >28 dayso The second vaccine given is not valid and should be repeated



Vaccination Summary



MMR X 02/10/2012 11 months


Invalid Vaccinations Date Reason

MMR 02/10/20012 Minimum age for this dose not met.



Date Minimum

Valid Date Overdue

Date Status

MMR 1 03/09/2012 03/09/2012 06/15/2012 Past Due

MMR Example

Note red X – MMR given 5

days too early

Pneumococcal Conjugate Vaccine (PCV) Requirement

VACCINE By 3 Months(on or before last day of mo

2)


4)


6)


last day of mo 15)


last day of mo 18)

Pneumococcal Conjugate(PCV7 or PCV13)

1 dose 2 doses 3 doses 4 doses

PCV Minimum Age and Intervals





4 12 months -

PCV Details

Routine schedule: 2, 4, 6, and 12-15 monthsPCV is not recommended for children 5 and olderA single supplemental dose of PCV13 is

recommended, but not required, for all children aged 14–59 months who got 4 doses of PCV7o PCV13 replaced PCV7 in 2010

PCV Details• 1 total dose only on or after 24 months unless high

risk.• Two doses total if both received between 12-24

months, given >8 weeks apart. • Three doses total if 2 doses given <12 months and

Dose 3 given at >12 months.

PCV Doses Required Chart

Doses before Age 12 months

Doses on or after Age 12 months

Status

3 1Complete

(If PCV7 given, needs one additional dose of PCV13)

21 (8 weeks after

# 2)Complete

0 2 Complete1 2 Complete1 1 Needs 1 dose 8 weeks after Dose 2

0 1Needs 1 dose 8 weeks after Dose 1 if # 1 received at age ≤ 24 months

4 0 Needs 1 dose 8 weeks after Dose 43 0 Needs 1 dose 8 weeks after Dose 32 0 Needs 1 dose 8 weeks after Dose 2

1 0Needs 2 doses (8 weeks apart) if age 12 - 24 months

Needs 1 dose if age ≥ 24 - 59 months

0 0Needs 2 doses (8 weeks apart) if age 12 - 24 months

Needs 1 dose if age ≥ 24 - 59 months



Vaccination Summary



Pneumococcal, PCV-13 (Prevnar13®) 04/15/2011 8 weeks

06/15/2012 4 months

02/16/2012 12 months


Invalid Vaccinations Date Reason



Date Minimum

Valid Date Overdue

Date Status

PCV Example

Katey is complete

with 3 doses!

Varicella Requirement

VACCINE


last day of mo 2)


4)


last day of mo 6)


last day of mo 15)


last day of mo 18)

Varicella Not given before 12 months of age.1 dose

Required: if unvaccinated, health care provider must verify

disease.

Varicella Minimum Age and Intervals


1 12 months 3 months between Dose 1 & 2

Varicella Details

Routine schedule: 12-15 months and 4-6 years of age

If not given on same day, minimum interval between varicella and MMR is >28 days



Vaccination Summary



MMR 02/17/2012 12 months

Varicella X 02/27/2012

12 months

Invalid Vaccinations Invalid Vaccinations Date Reason

Varicella 02/27/2012 Live vaccines not administered on same date must be separated by 28 days.



Date Minimum

Valid Date Overdue

Date Status

Varicella 1 03/26/2012 03/26/2012 06/15/2012 Past Due

Varicella Example

Note red X – Varicella not given same day as MMR

Resources www.doh.wa.gov/immunization/schoolandchildcare

Individual Vaccine Requirements Summary: www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

Vaccines Required for Preschool/Child Care Attendance chart: www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/VaccineRequirements.aspx

Immunization Manual for Schools and Child Cares: www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/SchoolManual.aspx

Implementing WA New State Exemption Requirements - Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/PreschoolsTraining for Schools and Child Cares/Preschools

August XX, 2011August XX, 2011