Who makes these rules? 04/19/2013. Guidelines for vaccine schedules Vaccine information materials Worksheets for assessing immunization i records

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1 2013 Childcare Provider Immunization Training Please sign in, take a packet and pretest Objectives Know immunization exemptions allowed in Nevada Identify immunizations required and recommended for childcare attendees Identify immunizations recommended for childcare providers Learn where to find the information needed to determine if child is up to date on immunizations Learn when to exclude a child that is not up to date on vaccines Packet Resources Guidelines for vaccine schedules Vaccine information materials Worksheets for assessing immunization i records Support contacts Sample letter to parents Childcare providers must ensure that all attendees are fully immunized as required by Nevada State Law (NRS 432A.230; NAC 432A A.510) 432A.510) Childcare Immunization Requirements Diphtheria Tetanus Pertussis Polio Hepatitis A Hepatitis B Measles Mumps Rubella Hib Pneumonia Chickenpox Who makes these rules? The Advisory Committee on Immunization Practices (ACIP) is a group of medical and public health experts that develop recommendations on how to use vaccines to control diseases in the United States Vaccine schedules change as ACIP recommendations change The Nevada State Legislature mandates required vaccines within childcare, public schools and private schools in Nevada The Washoe County Health Officer mandates vaccine requirements within Washoe County set for consistency more concise than ranges recommended Exemptions Nevada law does not allow for personal belief exemptions All exemptions must be presented to the school s governing body for approval Your facility can be more strict than the law These children should be easily identified in the event of a vaccine preventable disease outbreak 1

2 Religious Exemption Parent must write a note saying that they choose not to have the child vaccinated for religious reasons Medical Exemption Indicates that there is a valid medical contraindication, signedbyalicensed physician Overview of Vaccine Preventable Diseases Can be caused by a virus or bacteria Terms used: Shots Vaccines Immunizations Recommended vs. Required Combination Vaccines There are several combination vaccines available to reduce the number of shots/pokes the child gets You may see Pentacel, Pediarix, Kinrix, and more Pentacel = DTaP, HIB, Polio Pediarix = DTaP, HIB, Hep B Kinrix = DTaP, Polio Diphtheria, Tetanus, and Pertussis (DTaP) All are caused by bacteria Diphtheria and Pertussis are spread from person to person Tetanus enters the body through cuts or wounds Diphtheria Causes a thick covering in the back of the throat Can cause cutaneous (skin) infections Can lead to breathing problems, paralysis, heart failure and death 2

3 Tetanus (Lock Jaw) Causes painful tightening of the muscles, usually all over the body Can lead to locking of the jaw Leads to death in about 1 out of 10 cases Pertussis (Whooping Cough) Causes coughing spells so severe it s hard for infants to eat, drink, or breathe Can last tfor weeks Can lead to hospitalization, pneumonia, seizures, brain damage, and death Infants often are exposed via their parents Pertussis Resurgence 2010 California >9,000 cases 10 infant deaths 2012Washington >3,000 cases 2012 Oregon 290 cases 2012 Idaho 59 cases 1 death DTaP Schedule Total of 5* doses given at age: 2 months 4 months 6 months months (required by age 15 months for childcare) 4-6 years (required at age 4 for childcare) 5 th dose is not needed if the 4th dose received on or after age 4 years. DT (Diphtheria, Tetanus) Does not contain pertussis component For children unable to have a pertussis containing vaccine Children who receive DT instead of DTaP are not considered pertussis protected and need to be excluded if there is a pertussis outbreak Caused by a virus Polio Used to be very common in the U. S. Paralyzed and killed thousands before we had a vaccine Vaccination began in 1955 The last case of paralytic polio by wild virus in the U.S. occurred in 1979 DT and DTaP schedules are the same 3

4 Two Types of Polio Vaccine IPV: OPV: Inactivated Polio Vaccine Currently used in the U.S. today Oral Polio Vaccine Not currently used in the U.S. today May see on a foreign record IPV Schedule Total of 4 doses administered at age: 2 months 4 months 6-18 months (required at 6 months for childcare) 4-6 years (required at age 4 years for childcare) 4 th dose is not required if the 3 rd dose is administered on or after 4 years of age, all doses were the same type of vaccine (IPV or OPV) and at least 6 months between the 3 rd and 4 th dose) The last dose must be administered on or after age 4 regardless of the number of previous doses. MMR (Measles, Mumps and Rubella) Measles, mumps, and rubella are serious diseases that are spread from person to person Measles Causes rash, cough, runny nose, eye irritation, and fever Can lead to ear infection, pneumonia, seizures, brain damage, and death Measles is one of the most highly communicable infectious diseases Mumps Rubella (German Measles) Causes fever, headache, and swollen glands Can lead to deafness, meningitis (infection of the brain and spinal cord covering), painful swelling of the testicles or ovaries, and rarely, death Causes rash, mild fever, and arthritis (mostly in women) f b ll hil h i If a woman gets rubella while she is pregnant, she could have a miscarriage or her baby could be born with serious birth defects 4

5 MMR Schedule Total of 2 doses given at age: months (required by 15 months for childcare) 4-6 years (required at age 4 years for childcare) Hib (Haemophilus Influenzae Type b) Caused by a bacteria which usually strikes children under age 5 Can cause ear & skin infections, pneumonia and severe swelling in the throat Can cause infections in the blood, joints, bones, spinal cord and brain Hib disease was the leading cause of bacterial meningitis among children under 5 in the U.S. before Hib vaccine Hib Schedule Total of 4* doses given at age: 2 months 4 months 6** months months (required for childcare by age 15 months) *Depending on vaccine type, may be 3 doses and children receiving the first dose of vaccine at age 7 months or older require fewer doses ** Children receiving PedvaxHIB only require 3 doses Serious liver disease Hepatitis B Causes jaundice, diarrhea, vomiting, fatigue, muscle, joint and stomach pain, and chronic liver damage Can cause liver cancer Spread by contact with blood or body fluids Can be transmitted to infant during birth Hepatitis B Schedule Total of 3* doses given at age: Birth (required by age 2 months for childcare) 1 4 months (required by age 4 months for childcare) 6-18* months (required at age 6 months for childcare) Hepatitis A Serious liver disease caused by hepatitis A virus Spread by fecal-oral contact or eating food or drinking water containing hepatitis A virus Can cause jaundice, flu-like illness, severe stomach pains, diarrhea, liver damage Children under age 6 may not have symptoms Children receiving combination vaccine may have 4 doses 5

6 Hepatitis A Schedule Total of 2 doses given at age: months (required by age 15 months for childcare) 6-12 months after first dose (required at age 2 years *) * Must be 6 months between dose 1 & 2 Very contagious virus Varicella (Chickenpox) Passed person to person by air or by contact to chickenpox blisters Can cause severe skin infections, scarring, pneumonia, brain damage or death Varicella Schedule Total of 2 doses given at age: months (required by15 months for childcare) 4-6 years (required at age 4 for childcare) Vaccine not required if child has history of disease Pneumococcal Disease Streptococcus Pneumoniae Bacteria that can cause serious illness and death Before routine use of pneumococcal conjugate vaccine, pneumococcal infections caused over 700 cases of meningitis 13,000 blood infections about 5 million ear infections about 200 deaths annually in the United States in children under five. Pneumococcal Conjugate Vaccine (PCV7/PCV13) Total of 4* doses given at age: 2 months 4 months 6 months months (required by 15 months for childcare) All children under 5 years of age previously vaccinated with PCV7 need 1 supplemental dose of PCV-13. Currently not a childcare requirement Diarrheal disease Dehydration Highly infectious Rotavirus Spreads by fecal-oral contact Almost all children are infected by 5 years of age *May not need all 4 doses. Age dependent. 6

7 Rotavirus Vaccine Currently not required for childcare Recommend for all infants Depending upon type of vaccine 2 or 3 doses required Given at 2, 4 and 6 months Seasonal Influenza Is the Leading cause of: Illness Hospitalizations Deaths In the U. S. from all of the combined vaccine preventable diseases INFLUENZA VACCINE Recommended annually every flu season Available by injection or nasal mist Is currently not required for childcare Universal recommendation for all persons 6 months and older Requirements for Childcare Washoe County Age Required Immunizations 2 months DTaP, IPV, Hep B, PCV, Hib 4 months DTaP, IPV, Hep B, PCV, Hib 6 months DTaP, IPV, Hep B, PCV, Hib 15 months DTaP, PCV, Hib, Hep A, MMR,VZV 2 years Hep A 4 years DTaP, IPV, MMR, VZV If above requirements are not met EXCLUDE Does Child Need to be Excluded? If child is not up to date they have 10 business days to receive appropriate vaccines or be excluded If the child is behind schedule on required vaccines you may need to look at minimal intervals to know when next dose is due Vaccine Recommendations For Childcare Providers Annual Seasonal Influenza Hepatitis A Hepatitis B (OSHA requirement that Hepatitis B vaccine is made available to all workers with occupational exposure within 10 days of hire!) Tdap MMR Varicella or history of disease 7

8 Diphtheria Overview of Vaccine Preventable Diseases Tetanus Pertussis (Whooping Cough) Jennifer Lopez Public Service Announcement for Pertussis (Whooping Cough) - YouTube.url Polio Measles 8

9 Mumps Rubella (German Measles) Hib (Haemophilus Influenzae Type b) Hepatitis A & Hepatitis B Chickenpox (Varicella) Chickenpox (Varicella) 04/19/2013 9

10 Pneumococcal Infection (Streptococcus pneumoniae) How to Use the Worksheet Examples of immunization records Practice filling out worksheet Questions and answers Helpful Suggestions Child must have immunization record in health section of chart. The record must show child s name, date of birth and provider name, in ink. Record appears valid. A child may enter childcare conditionally if they are in the process of receiving required immunizations, but it is too soon for the next dose in the immunization series Religious exemption letter signed by parent is in chart Medical exemption letter signed by a licensed physician in chart Tickler/reminder file for upcoming required immunizations/how to handout in packet Review of Objectives Know immunization exemptions allowed in Nevada Identify immunizations required and recommended for childcare attendees Identify immunizations recommended for childcare providers Learn where to find the information needed to determine if child is up to date on immunizations Learn when to exclude a child that is not up to date on vaccines How to Access the Nevada State Registry WEB IZ You can access attendee immunization records in WEB IZ by signing up with the Nevada State WEB IZ program, call Janet Osalvo at or josalvo@health.nv.gov Parents can access their child s Nevada immunization record by logging onto izrecord.nv.gov Questions, problems or no computer access call the Nevada WebIZ helpdesk Download additional forms from the Health District Website To access the website for childcare immunization tools and forms once on the website, follow the directions in the hand out 10

11 Washoe County Health District s Immunization Program Staff Lynnie Shore R.N lshore@washoecounty.us Becky Koster R.N bkoster@washoecounty.us Nicole Mertz R.N nmertz@washoecounty.us Kathy Dickens R.N kdickens@washoecounty.us VACCINE RESOURCES Thank you Please remember to pick up your certificate 11