School Immunization Requirements Update Implementing WA Trang New Kuss, State RN, Exemption MN, MPH Requirements - Department Training for of Health Schools Office and of Child Immunization Cares/Preschools and Child Profile February 28, 2013 August XX, 2011
Topics to be Covered Vaccine Requirements Compare Current and Upcoming School Requirements Reporting Resources
DTaP 5 doses required for K-12 th grades Exception: 4 doses required if 4 th dose given >4 th birthday DTaP for students through age 6 If >7 years old, need Tdap or Td
DTaP DTaP given to students 7-10 years of age counts for the Tdap dose Catch-up schedule for >7 years of age without any DTaP doses: One dose of Tdap followed by 2 doses of Td (>4 weeks between doses 1 & 2, and >6 months between doses 2 & 3)
Tdap 2012-2013: 1 dose required for 6 th to 11 th grades Required for >11 year olds Two brands: Boostrix for >10 year olds; Adacel for >11 year olds Licensed for just one dose
Tdap No need to wait 5 years between DTaP/Td and Tdap Students 7-10 years of age not fully vaccinated with DTaP required to get dose of Tdap Off-label use of Tdap vaccine, but providers follow ACIP recommendations as best medical practice Only one dose of Tdap required
Patient Name: Rebekah SIIS Patient ID: 5276918 Date of Birth: 05/09/2000 Age: 11 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 DTaP/DTP/Td Tdap 07/01/2000 7 weeks 05/09/2008 8 years Tdap Example 08/01/2000 12 weeks Rebekah also got Tdap at age 8 10/01/2000 4 months 06/01/2001 12 months Way to go! Rebekah is complete with 5 doses of DTaP 05/09/2004 4 years Rebekah is up to date until 2018 Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule. Recommended Minimum Overdue Vaccine Family Dose Status Date Valid Date Date DTaP/DT/Td 7 05/09/2018 05/09/2013 06/08/2018 Up to Date
DTaP/Tdap/Td Catch-up Schedule DTaP Dose 1 given <12 months of age, 4 total doses needed, as long as Tdap is given >7 years of age (any combination of DTaP, Tdap, and Td) Dose 1 - Dose 2: 4 weeks Dose 2 - Dose 3: 4 weeks Dose 3 - Dose 4: 6 months
DTaP/Tdap/Td Catch-up Schedule DTaP/DT Dose 1 given >12 months of age, 3 total doses needed, as long as Tdap is given >7 years of age (any combination of DTaP, Tdap, and Td) Dose 1 - Dose 2: 4 weeks Dose 2 - Dose 3: 6 months
Patient Name: Katey SIIS Patient ID: 5293041 Date of Birth: 08/14/2003 Age: 8 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 DTaP/DTP/Td Tdap DTaP/Tdap Example 10/14/2003 8 weeks 08/14/2010 7 years Tdap given to kids 7 and older are given as a 12/14/2003 4 months Td is past due Vaccination Forecast catch-up dose The forecast automatically switches to the accelerated schedule when a patient is behind schedule. Recommended Minimum Overdue Vaccine Family Dose Status Date Valid Date Date DTaP/DT/Td 4 02/14/2011 02/14/2011 03/16/2011 Past Due
IPV 4 doses required for K-12 th grades Exception: 3 doses required if dose 3 given >4 years of age Either IPV or OPV acceptable
IPV For K-1 st grade only for 2012-2013: Dose 4, if given on or after Aug 7, 2009, must be given >4 years of age and separated from dose 3 by >6 months
IPV For 2012-13: 2 nd 12 th grades Don t need to worry about minimum of 4 years of age for 4 th dose and 6 month minimum interval between doses 3 and 4 >4 week minimum interval must separate IPV doses Dose 4 must be given >18 weeks of age
IPV Students with 3 doses 4 th dose not needed if dose 3 given on or after 4 th birthday If dose 3 given after 4 th birthday If on or after 8/7/09, minimum of 6 months from dose 2 If before 8/7/09, minimum of 4 weeks from dose 2
Patient Name: Frank SIIS Patient ID: 5361747 Date of Birth: 09/20/2006 Age: 292 weeks, 67 months, 5 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 11/20/2006 8 weeks IPV Example 1 01/20/2007 4 months 03/25/2007 6 months X 09/21/2009 3 years Invalid Vaccinations Invalid Vaccinations Date Reason POLIO 09/21/2009 Minimum age for this dose not met. Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule. Vaccine Family Dose Recommended Minimum Overdue Date Valid Date Date IPV Dose 4 marked with a red X IPV dose 4 needs to be repeated and is due now Status POLIO 4 09/20/2010 09/20/2010 09/20/2013 Due Now
IPV Example 2 Name: Isabella SIIS Patient ID: 5361747 Date of Birth: 04/17/2006 Age: 296 weeks, 68 months, 5 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 11/20/2006 8 weeks 01/22/2007 4 months 03/20/2007 6 months 09/20/2008 24 months IPV Dose 4 valid at age 24 months since given before 8/7/09 Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule. Recommended Minimum Overdue Vaccine Family Dose Date Valid Date Date Status
2 doses required for K-12 th grade Blood test showing immunity to measles, mumps, and rubella acceptable MMR
MMR Dose 1 given <12 months of age must be repeated (4 day grace applies) If not given on same day, minimum interval between MMR and varicella is >28 days The second vaccine given is not valid and should be repeated 4 day grace DOES NOT apply between live vaccines not given at the same time
Patient Name: Katey SIIS Patient ID: 5293041 Date of Birth: 08/14/2003 Age: 8 yrs Vaccination Summary Does not include all vaccination types. Vaccinations outside the ACIP schedule are marked with an 'X'. Note red X. Vaccine Family 1 2 3 4 5 6 7 8 MMR Varicella MMR Example 08/14/2004 12 months X 08/16/2004 12 months Varicella not given same day as MMR 10/14/2004 14 months 10/14/2004 14 months Invalid Vaccinations Invalid Vaccinations Date Reason VARICELLA 08/16/2004 Live vaccines not administered on same date must be separated by 28 days. Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule. Vaccine Family Dose Recommended Minimum Overdue Date Valid Date Date Status VARICELLA 2 08/14/2007 01/14/2005 08/14/2010 Past Due
Varicella Implementation plan, 2008: Roll-up requirement, one grade per year for 2 doses By 2020, 2 doses required for K-12 th grade 2012-2013 school year: 2 doses required for K-4 th grade
Varicella If not given on same day, minimum interval between varicella and MMR is >28 days 4 day grace DOES NOT apply between live vaccines not given at the same time Minimum interval between dose 1 & 2 = 3 months.
4 Day Grace Period Vaccines given <4 days before the minimum interval or age are valid Applies to all inactivated vaccines before minimum intervals OR ages Grace period DOES NOT apply between two different live vaccines not given at the same visit Grace period DOES apply if live vaccines given at the same visit
Patient Name: Katey SIIS Patient ID: 5293041 Date of Birth: 08/14/2003 Age: 8 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 08/14/2003 10/14/2003 02/10/2004 Hep B 3 Dose 0 days 8 weeks 5 months Vaccination Forecast 4 Day Grace Example 1 The forecast automatically switches to the accelerated schedule when a patient is behind schedule. Recommended Minimum Overdue Vaccine Family Dose Date Valid Date Date Dose 3 is valid and doesn t need to be repeated Hep B Dose 3 given 4 days earlier than 6 months of age Status
4 Day Grace Example 2 Patient Name: Katey SIIS Patient ID: 5293041 Date of Birth: 08/14/2003 Age: 8 yrs Guardian: TEST Status: Active Vaccination Summary Does not include all vaccination types. Varicella Dose Vaccinations outside the ACIP schedule are marked with an 'X'. 2 given 5 days Vaccine Family 1 2 before 3 it 4 was 5 6 7 8 MMR Varicella 08/14/2004 12 months 08/14/2004 12 months 09/14/2004 13 months X 10/09/2004 13 months Invalid Vaccinations Invalid Vaccinations Date Reason VARICELLA 10/09/2004 Live vaccines not administered on same date must be separated by 28 days. Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule. Recommended Minimum Overdue Vaccine Family Dose Status Date Valid Date Date VARICELLA 2 01/09/2005 01/09/2005 08/14/2010 Past Due due
School Immunization Requirements 2012-13 School Year DTaP: 5 doses (4 doses acceptable if dose 4 given on or after the 4 th birthday) Hep B: 3 doses Tdap: 1 dose for 6 th -11 th grade (>11 years of age) 2013-14 School Year DTaP: no change Hep B: change in requirements Tdap: 1 dose for 6 th -12 th grade (>11 years of age)
School Immunization Requirements 2012-13 School Year IPV: 4 doses (3 doses acceptable if dose 3 given on or after the 4 th birthday) Kindergarten-1 st grade: final dose given after 8/7/09 must be given at a min of 4 years of age AND min interval of 6 months from the previous dose MMR: 2 doses 2013-14 School Year IPV: no change EXCEPT Kindergarten-2 nd grade: final dose given after 8/7/09 must be given at a min of 4 years of age AND min interval of 6 months from the previous dose MMR: no change
School Immunization Requirements 2012-13 School Year Varicella: 2 doses: Kindergarten-4 th grade 1 dose: 5 th -6 th grade Recommended, but not required: 7 th -12 th grade 2013-14 School Year Varicella: 2 doses: Kindergarten-5 th grade 1 dose: 6 th grade Recommended, but not required: 7 th -12 th grade
2013-14 Immunization Requirements: Hep B Changes ACIP recommendations in 1994 Dose 3: min age of 4 months Recommendations updated 2002 Dose 3: min age of 24 weeks Min interval between Dose 1 and 3 is 16 weeks Many older students out of compliance
2013-14 Immunization Requirements: Hep B Changes K-6 th grade Min interval between doses 1 and 2 = 1 month Min interval between doses 2 and 3 = 2 months Min interval between doses 1 and 3 = 16 weeks Min age for dose 3 is 24 weeks 7 th -12 th grade Min interval between doses 1 and 2 = 1 month Min interval between doses 2 and 3 = 2 months No min interval between doses 1 and 3 Min age for dose 3 is 4 months
Reporting Update About 91% of all schools reported In the fall, use the IIS to report OR send Skyward export to oicpschools@doh.wa.gov For those using the IIS: Registration/contact info changes in spring and fall We re working on login issues (one username, forgot password) Child care reporting (not through the IIS)
Resources www.doh.wa.gov/immunization/schoolandchildcare School Training Videos: www.doh.wa.gov/communityandenvironment/schools/immuniz ation.aspx Individual Vaccine Requirements Summary: www.doh.wa.gov/portals/1/documents/pubs/348-284- IndividualVaccineRequirements.pdf Vaccines Required for School Attendance chart: www.doh.wa.gov/communityandenvironment/schools/immuniz ation/vaccinerequirements.aspx Immunization Manual for Schools and Child Cares: www.doh.wa.gov/communityandenvironment/schools/immuniz ation/schoolmanual.aspx
Contact Information Trang Kuss, RN, MN, MPH School and Child Care Coordinator trang.kuss@doh.wa.gov; 360-236-3760