Jennifer Sterling San Diego Immunization Program County of San Diego Health and Human Services Agency.

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1 CALIFORNIA IMMUNIZATION REQUIREMENTS CHILD CARE/PRESCHOOL PROGRAMS Jennifer Sterling San Diego Immunization Program County of San Diego Health and Human Services Agency

2 TRAINING OBJECTIVES At the end of this training, you will be able to: List immunization requirements for childcare Identify acceptable forms of immunization records Complete the California School Immunization Record (CSIR)/Blue Card correctly Create a tracking system for conditional entrants and exemptions How to submit the state immunization report to CDPH accurately

3 Spread of Disease is just a Cough, Sneeze or Handshake away

or sneezing Wash hands w/ soap & water Avoid contact with people

4 PREVENTION OF DISEASE - SIMPLE Immunizations help prevent the spread of communicable diseases Cover mouth (w/arm) when coughing or sneezing Wash hands w/ soap & water Avoid contact with people who are sick These signs along with many others are available at

5 WHY CHECK IMMUNIZATION RECORDS? To prevent children from serious diseases like chicken pox and measles. To help parents keep their kids healthy and on track with their shots. The California School Immunization Law requires school & child care providers to enforce immunization requirements!!

6 ACIP RECOMMENDATIONS VS STATE LAW REQUIREMENTS Advisory Committee of Immunization Practices (ACIP) Recommendations Change yearly Based on valid doses Extensive list of immunizations ACIP recommends to stay healthy Based on age and high risk groups across the lifespan CA Requirements Have had minimal changes since 2003: Based on a number of doses Limited list of vaccines required by age and/or grade level

7 IMPLEMENTING IMMUNIZATION REQUIREMENTS 1. Obtain the child s personal immunization record Must identify the student by name and DOB Must show the date each required vaccine dose was received Acceptable records: medical charts, out-of-state or international records, military records, other Blue Cards, etc. 2. Complete a California School Immunization Record (Blue Card). A blue card must be on file for every student regardless of immunization status

8 CA REQUIRED VACCINES CHILD CARE/PRESCHOOL IMM 230 Every child must be up-to-date with their immunizations

9 VACCINE COMBINATIONS

10 HELPFUL TOOLS Available for download at:

11 CONDITIONAL SCHEDULE Admitting under Conditional and follow-up schedule

12 WHAT CAN BE DONE Students who do not have an immunization history should be referred to a physician.

13 THE YELLOW CARD Yellow Cards are best if a parent does not have one, suggest they have their current record transcribed for future convenience

14 MEDICAL RECORDS Jane Doe ACCEPTABLE? YES! Record has dates each vaccine was given Official form from a clinic

15 MEDICAL RECORDS CONTINUED Official Mexico Immunization Record Hernandez, Jose 12/12/2006 Acceptable??? NO! Record is stamped but does not show dates each vaccine was given

16 CONFUSING IMMUNIZATION RECORDS Family, friends, etc. can be used as unofficial translators If no one is available, suggest a bilingual physician Fax the record to: Jennifer

17 HOW TO COMPLETE THE CALIFORNIA SCHOOL BLUE CARD

18 BLUE CARD Completing the California School Immunization Record (Blue Card) 2. Vaccination History 1. Demographic Information 3. Documentation 4. Status of Requirements

19 STEP 1: DEMOGRAPHIC INFORMATION Parents may complete this section Don t send home form should be completed in front of you Please answer questions in full The State & County use this information to find health disparities Ethnicity is an important part of the card You do not have to update address/phone each time it changes

20 STEP 2: VACCINATION HISTORY Children Entering your program from another country without vaccine history: Do not allow any grace period Refer family to their physician or public health dept. Children Entering your program from another preschool program without vaccine history: There is no grace period for this situation.

21 4-DAY GRACE PERIOD Children who have received vaccine doses up to (and including) 4 days before the recommended age or required intervals will not have to repeat the doses. MMR: must be given on or after the 1 st birthday Up to 4 days before the birthday is okay! Date of Birth: January 7, 2009 MMR 1: January 8, 2010 = VALID MMR 1: January 4, 2010 = VALID MMR 1: January 2, 2010 = INVALID* *MMR must be given again

22 DOCUMENTING CHICKEN POX DISEASE X Dr. Disease History Titers Pediatrics DISEASE * *History of disease must be documented!

23 STEP 3: DOCUMENTATION 1. Sign and Date this section. a) It does not have to be signed by a nurse b) It should be signed even if the child is NOT up-to-date 2. Specify which kind of personal shot record you used to make the blue card

24 STEP 4: STATUS OF REQUIREMENTS (a) All requirements are met (b) Currently up-to-date, but more doses are due later. Requires follow-up Exemption was granted for: (c) Medical Reason - Permanent (d) Medical Reason Temporary (e) No longer to be used for new records

25 ALL REQUIREMENTS MET Status (A) Students who are up-to-date on all their vaccines for the grade level they attend are considered All Requirements Met Date the documentation section of the card and place in the student s permanent folder.

26 ADMITTING CHILDREN ON CONDITION STATUS (B) Children currently are up-to-date (next doses not yet due) These children will be admitted on the condition that they will receive still-needed doses as they become due in the future. Staff must follow-up by: Notifying parents: Notice of Immunizations Needed Checking documentation that the needed immunizations were received Adding the new dates to the Blue Card

27 WHERE TO RECEIVE IMMUNIZATIONS Children with health insurance should receive immunizations through their healthcare provider or local pharmacy Immunizations may be provided at Public Health Centers for children who meet vaccine eligibility criteria: Covered by Medi-Cal Uninsured

28 STATUS OF REQUIREMENTS EXEMPTIONS: STATUS (C) Permanent Medical (C) Must have written documentation from doctor* Must identify student by name and DOB Keep document with the Blue Card Ex: Child with an allergy to a vaccine or 4-day rule violation * Must be licensed MD or DO

29 STATUS OF REQUIREMENTS EXEMPTIONS: STATUS (D) Temporary Medical (D) Must have written documentation from doctor* with an end-date to exemption Must identify student by name and DOB Must get shots at end of exemption Ex: Child who was sick at appointment * Must be licensed MD or DO

30 STATUS OF REQUIREMENTS EXEMPTIONS: STATUS (E) *Personal Beliefs (PBE) (E) Requires specific form CDPH 8262 be signed prior to January 1, 2016 Requires signature by provider and parent on the form acknowledging consent Not acceptable for first time registrants *Religious Belief Requires documentation on CDPH 8262 Requires the form be signed prior to January 1, 2016 Requires parent signature Not acceptable for first time registrants

31 SENATE BILL 277 The Law This bill eliminated the personal belief and religious belief exemption from existing for specified immunization requirements. SB277 took affect on July 1, This affected the 2016/2017 childcare year Students who have had CDPH form 8262 signed prior to January 1, 2016, will be grandfathered in until child advances into TK/Kinder *Define grade span as: a) birth to preschool; b) kindergarten (including transitional kindergarten) to grade 6; or c) grades 7 to 12.

32 FOLLOW-UP SYSTEMS Use a Calendar Keep Blue Cards separate Conditional Entrants who need follow-up Kids with exemptions Use a tickler file Ensure that your system is secure from public viewing be HIPPA Compliant!

33 IF REQUIREMENT IS NOT MET Choose vaccines they need The child has 10 business days to receive the needed immunizations. Provide END date for receiving vaccines

34 TRANSFERRING RECORDS Child Care Centers: The original Blue Card or a copy of it must be kept with the child s file during the period of enrollment and for three years after the child leaves your care.

35 REQUIRED ANNUAL REPORTING Annual Assessments Completed each fall Child care centers (ages 2 4 yrs 11 months) No infant reports Submitted online to the California Department of Public Health Selective Review Spring review of specific cohort will be checked every year (childcare, kinder and 7 th grade) Collect information from Blue Cards to compare to fall report Provide assistance

36 REPORTING Reporting to the state is a mandatory activity. Reporting will be completed online. It is recommended that you familiarize yourself with the website and expectations.

37 ANNUAL REPORTING CONTINUED Reporting usually starts in September and you are notified via the California Department of Public Health, Immunization Branch, via and letter. Child Care Centers ages 2-5 report first It is up to you to update your contact information if you have had a staff change at your facility

38 REPORTING

39 REPORTING CHILD CARE

40 REPORTING CHILD CARE WORKSHEET Child Care Worksheet Allows you to calculate Auto sums if use online tool

41 REPORTING CHILD CARE SUMMARY

42 REPORTING CHILD CARE Total Number of Children Total number of children in your facility aged 2-5 years (A)Unconditional Admission Total number of children in your facility, aged 2-5 years, that require no additional doses of vaccine

43 REQUIREMENTS MET, BUT MISSING DOSES Everything under the blue line is for children who are missing immunizations and the reason they are missing Personal belief prior to January 1, 2016 Must have Form 8262 onsite Form must be signed prior to 1/1/16 Permanent Medical Exemptions Must have written letter on doctor letterhead that states which vaccines and identify the student by name and DOB. This letter can only be signed by a MD or DO Others: Active Individual Education Plan (IEP) Requirements Met, But Missing Doses Personal Belief Exemption E 0 pre Permanent Medical Exemption C 0 Others: IEP Services F1 0

44 CONDITIONAL ADMISSION NEEDS FOLLOW UP Conditional Admission, Needs Follow-up Conditional entrant As Up to Date as possible with vaccines, more needed later Temporary Medical Exemption Must have written letter on doctor letterhead that states which vaccines and identify the student by name and DOB. This letter can only be signed by a MD or DO and must have an end date CONDITIONAL ADMISSION, NEED FOLLOW-UP Conditional Entrant B 0 Temporary Medical Exemption D 0

45 OVERDUE! Requirements NOT met, Missing Doses A child in this section can be enrolled in your program but not attending. These children need to be as up to date as possible to attend your program REQUIREMENTS NOT MET, MISSING DOSES Overdue- Enrolled but Not Attending G 0

46 REQUIREMENTS MET, BUT MISSING DOSES Any missing immunizations for a child must be documented. Document the children who are missing doses Missing Doses By Vaccine: Children that are missing doses (below the blue line). Please total the number of students missing each vaccine: Polio 0 Hep B 0 DTP 0 Varicella 0 MMR 0

47 MEET MULTIPLE CRITERIA Note for children who meet criteria in multiple categories: If a child has an exemption and is also a conditional entrant, please report the child as having the exemption only.

48 DISEASE REPORTING All schools and child care centers are mandated to report certain diseases to your local health department. List of diseases you must report to local health department under State guidelines *CDPH 110a lists all diseases that need to be reported and how you should report Epidemiology Department

49 WHAT S NEWS PROPOSED REGS CHANGES - EXEMPTIONS Deletes the personal belief exemption pursuant to statutory changes in SB 277 (Stats. 2015, ch. 35) Clarifies requirements of a medical exemption: Must be signed California-licensed MD/DO

50 WHAT S NEWS PROPOSED REGS CHANGES IMMUNIZATION RECORD CA School Immunization Record/Blue Card: No PBE boxes New layout Record on file must contain all elements (Blue Card available but optional)

51 TOP EXEMPT QUESTIONS 1. Can I let a child with an active PBE transfer into my facility If a child has a CHDP 8262 signed, prior to 2016, from another California childcare program, they may transfer to your facility Can I accept a medical waiver from a doctor in Mexico No, the medical exemption is only acceptable from a provider (MD or DO)licensed in the United States 3. Can I accept a medical waiver from any doctor in the United States Yes, as long as the provider is a MD or DO. Physician Assistants or Nurse Practitioner cannot sign the letter. 4. Can I accept a new enrollment whose parents tell me they have any appointment next month for vaccines. No. This child would need to start their vaccine series prior to coming in to your facility.

TEST YOUR KNOWLEDGE Meet Penny, Patty and Maddie All 3 girls are coming from an offsite Preschool to your preschool program this year. Penny & Maddie are fully vaccinated.

52 TEST YOUR KNOWLEDGE Meet Penny, Patty and Maddie All 3 girls are coming from an offsite Preschool to your preschool program this year. Penny & Maddie are fully vaccinated. Patty has no history of MMR. Can Patty start Kindergarten with no doses of MMR today? No You will need to follow-up with Patty s parents to ensure that she goes to her next appointment.

TEST YOUR KNOWLEDGE Meet Parker Parker had a confirmed case of pertussis last year Parker s doctor put disease history in the DTaP field on the yellow

53 TEST YOUR KNOWLEDGE Meet Parker Parker had a confirmed case of pertussis last year Parker s doctor put disease history in the DTaP field on the yellow card Does Parker need to finish his DTaP series? YES or Parker would need a doctor s note on doctor s letterhead stating he will not vaccinate Parker with DTaP

OUT OF STATE Meet Lilly Lilly was in a preschool program in another state Lilly s mom had a active personal belief waiver in the state Lilly s mom is trying to register her at your

54 OUT OF STATE Meet Lilly Lilly was in a preschool program in another state Lilly s mom had a active personal belief waiver in the state Lilly s mom is trying to register her at your school Can Lilly start at your school? No Being homeschooled at the last grade span to bypass vaccines does not exempt a student. Lilly will be required to start the 7-17 age group vaccines.

MMR DILEMMA Meet Frankie Frankie is 19 months old and is registering for your program Frankie has had the individual vaccines for 1 measles, 1 mumps and 1 rubella

55 MMR DILEMMA Meet Frankie Frankie is 19 months old and is registering for your program Frankie has had the individual vaccines for 1 measles, 1 mumps and 1 rubella after his first birthday Knowing this information, can Frankie start in your program today? YES The individual vaccines meet the requirement for the 1 dose of MMR

56 SB 792 (MENDOZA) VACCINES FOR DAY CARE WORKERS Under SB 792, day care centers and family day care homes, as part of their licensure requirements, will have to maintain vaccination records for their employees and volunteers for influenza, pertussis, and measles. SB 792 went into effect September 1, This allowed day care centers a year from the time of its signing to the time of its implementation.

57 SECTION REVISION SECTION 1. Section is added to the Health and Safety Code Under the new section of the H&S code, childcare staff will be required to show proof of: 1 Tdap Booster 1 MMR (a second dose may be needed. Consult with your healthcare provider to determine your level of risk) 1 Influenza vaccine given between August 1 and December 1 of each year Failure to maintain accurate records will be treated like any other violation of licensure requirements.

58 EMPLOYEE GRACE PERIOD SB 792 also allows a 30-day grace period of conditional employment. Staff and Volunteers have 30-days from day of hire to retrieve or receive required vaccines

59 MEDICAL EXEMPTION TO THE LAW A person is medically exempt from the requirements of this section only under any of the following circumstances: (1) The person submits a written statement from a licensed physician including: Declaring physical/medical Indicate the probable duration of the medical condition (2) The person submits a written statement from a licensed physician providing that the person has evidence of current immunity to the diseases described in subdivision(a).

60 PERSONAL EXEMPTION TO THE LAW A person can have a personal exempt from the influenza requirement only under the following circumstances: (1) The person submits a written declaration that he or she has declined the influenza vaccination. This exemption applies only to the influenza vaccine. (2) The person was hired after December 1 of the previous year and before August 1 of the current year. This exemption applies only to the influenza vaccine.

61 IMMUNIZATION RESOURCES YOU CAN USE San Diego Immunization Branch Shots for School California Immunization Coalition Centers for Disease Control and Prevention American Academy of Pediatrics Institute for Vaccine Safety National Network for Immunization Information (NNii)

62 THANK YOU for all you do to protect our children, families, and community from disease!

63 Contact Information Jennifer Sterling School and Childcare Coordinator

CALIFORNIA IMMUNIZATION REQUIREMENTS FOR SCHOOL ENTRY

CALIFORNIA IMMUNIZATION REQUIREMENTS FOR SCHOOL ENTRY Jennifer Sterling San Diego Immunization Program County of San Diego Health and Human Services Agency www.sdiz.org 2018 TRAINING OBJECTIVES At the