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 end of this training, you will be able to: List immunization requirements for school entry Identify acceptable forms of immunization records Complete the California School Immunization Record (CSIR)/Blue Card correctly Correctly report your immunizations to the state yearly Create a tracking system for conditional entrants and exemptions How to submit the state immunization report to CDPH accurately
Spread of Disease is just a Cough, Sneeze or Handshake away
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 www.sdiz.org
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!!
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
SCHOOL LAW REQUIREMENTS VACCINE Polio Diphtheria, Tetanus, and Pertussis Measles, Mumps, Rubella (MMR) Varicella REQUIRED DOSES 4 doses at any age - but... 3 doses meet requirement for ages 4 6 years if at least one was given on or after the 4th birthday1; 3 doses meet requirement for ages 7 17 years if at least one was given on or after the 2nd birthday. Age 6 years and under: DTP, DTaP or any combination of DTP or DTaP with DT (diphtheria and tetanus) 5 doses at any age - but... 4 doses meet requirements for ages 4 6 years if at least one was on or after the 4th birthday. Age 7 years and older: Tdap, Td, or DTP, DTaP or any combination of these 4 doses at any age - but...3 doses meet requirement for ages 7 17 years if at least one was on or after the 2nd birthday.1 If last dose was given before the 2nd birthday, one more (Tdap) dose is required Kindergarten: 2 doses both on or after 1st birthday. 7th grade: 2 doses both on or after 1st birthday. Grades 1 6 and 8 12: 1 dose on or after 1st birthday. Under 13 years: 1 dose 13-17 Years: 2 doses for student starting vaccination at ages 13 17 years Tdap Booster (Tetanus, reduced diphtheria, and pertussis) 7 th - 1 dose on or after 7th birthday. (Tdap, Dtap or DTP after 7 years meets requirement.
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* *A hard copy blue card is not required if using a CDPH approved system
CDPH APPROVED SYSTEMS Carlsbad Union School District Escondido Union School District Sweetwater Union High School District Vista Unified School District San Diego County Office of Education San Diego County Department of Health (SDIR) San Diego Unified School District (SDIR) Grossmont Union School District
CA REQUIRED VACCINES TK-12 IMM 231 Every child must be up-to-date with their immunizations
VACCINE COMBINATIONS
HELPFUL TOOLS Available for download at: www.sdiz.org
CONDITIONAL REQUIREMENTS Admitting under Conditional and follow-up schedule
Admitting Children without an Immunization Record WHAT? Transfer Students within the USA: Allow up to 30 days for a cumulative folder from another school, to reach your school Students who are homeless: Under the McKinney-Vento Homeless Education Act, homeless children can be admitted conditionally, up to 30 days without required immunization documentation
NO GRACE PERIOD Student Entering any grade level from another country without vaccine history: Do not allow any grace period Refer family to their physician or public health dept. Students entering 7 th grade without a Tdap There is no grace period for Tdap
THE TDAP/TD STORY Students entering 7 th grade from outside country or who have no history of DTP: 1. Tdap given before school entry 2. Td given 4-8 weeks from Tdap dose 3. Td given 6-12 months from last Td dose
WHAT CAN BE DONE Students who do not have an immunization history should be referred to a physician.
THE YELLOW CARD Yellow Cards are best if a parent does not have one, suggest they have their current record transcribed for future convenience
MEDICAL RECORDS Jane Doe ACCEPTABLE? YES! Record has dates each vaccine was given Official form from a clinic
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
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 Sterling @ 619-692-6619
HOW TO COMPLETE THE CALIFORNIA SCHOOL BLUE CARD
BLUE CARD Completing the California School Immunization Record (Blue Card) 2. Vaccination History 1. Demographic Information 3. Documentation 4. Status of Requirements
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
STEP 2: VACCINATION HISTORY Enter the date of each shot was given based on the student s personal immunization record full dates should always be used (month/day/year) if not available use the 15 th day of the month School entry is based on the number of doses for the grade level the child is entering Compare doses on Blue Card to the requirements for grade level An updated Blue Card must be maintained in the child s file A electronic record can only be kept instead of a hard copy if CDPH s Immunization Branch, has approved your system
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
DOCUMENTING CHICKEN POX DISEASE X Dr. Disease History Titers Pediatrics 619-999-9999 DISEASE * *History of disease must be documented!
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
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
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.
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
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
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
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
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 grades Kinder or 7 th Not acceptable for all new students *Religious Belief Requires documentation on CDPH 8262 Requires the form be signed prior to January 1, 2016 Requires parent signature Not acceptable for grades Kinder or 7th Not acceptable for all new students
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, 2016. This affected the 2016/2017 school and childcare year Students who have had CDPH form 8262 signed prior to January 1, 2016, will be grandfathered in until pupil advances into the next *grade span. *Define grade span as: a) birth to preschool; b) kindergarten (including transitional kindergarten) to grade 6; or c) grades 7 to 12.
SB 277 CONTINUED SB277 EXEMPTED FROM THE LAW Students who fall into the following categories: 1. A student who is home schooled or who is enrolled in a independent study program and does NOT attend a classroom setting 2. A student who qualifies for an individualized education program (IEP), will not be prohibited from accessing any special education and related services required by his or her individualized education program.
FOLLOW-UP SYSTEMS Use a Calendar Use a tickler file Keep Blue Cards separate Conditional Entrants who need follow-up Kids with exemptions Ensure that your system is secure from public viewing be HIPPA Compliant!
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
TRANSFERRING RECORDS TK/K 12 th Grade Education Code Section 49068 requires that schools send cumulative folders within 10 school days, following request from new school For foster students, Education Code Section 48853.5 requires that within two business days of the foster child s request for enrollment, the new school shall contact the school last attended by the foster child to obtain all academic and other records
REQUIRED ANNUAL REPORTING Annual Assessments Completed each fall Child care centers (ages 2 4 yrs 11 months) No infant reports Kinder & 7 th grade 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
REPORTING Reporting to the state is a mandatory activity. Reporting will need to be completed online. It is recommended that you familiarize yourself with the website and expectations. http://www.shotsforschool.org/reporting/kindergarten/ http://www.shotsforschool.org/reporting/7th/
ANNUAL REPORTING CONTINUED Reporting usually starts in September and you are notified via the California Department of Public Health, Immunization Branch via email and a letter. Annual Reporting is completed in 3 different sections: A) Child Care Centers ages 2-5 report first B) Kindergarten Programs including TK report second C) 7 th Grade programs report last
REPORTING
REPORTING KINDER
REPORTING KINDER
REPORTING KINDER Total Number of Students Total number of TK/Kinders you have actively participating at your school (A)Unconditional Admission Total number of students that are fully up to date with their immunization requirements
REQUIREMENTS MET BUT MISSING DOSES Permanent Medical Students who have a doctor s note stating that there is a permanent medical reason why they are not receiving the vaccines Others: Individual Education Plan (IEP) Student must have an active IEP. Independent Study Student participates in an independent study program with no classroom time. Home Based-Private School Student participates in a home based school program with no classroom time.
UNDER THE BLUE LINE Everything under the blue line is for students who are missing immunizations and the reason they are missing Requirements Met, But Missing Doses Permanent Medical Exemption C 0 Others: IEP Services F1 0 Independent Study F2 0 Home-based Private School F3 0 CONDITIONAL ADMISSION, NEED FOLLOW-UP Conditional Entrant B 0 Temporary Medical Exemption D 0
REQUIREMENTS NOT MET, BUT MISSING DOSES This category is subject to exclusion. A student who is missing a dose(s) in a series and the deadline after previous dose has passed. Students who have not received all their vaccines. These student should not be attending school REQUIREMENTS NOT MET, MISSING DOSES Overdue- Enrolled but Not Attending G 0 TOTAL 0
DOCUMENTING MISSING DOSES You are required to report what doses your students are missing. This applies to any missing doses under the following categories: Permanent Medical IEP Home Schooled Temp Medical Independent study Conditional
REQUIREMENTS MET, BUT MISSING DOSES Any missing immunizations for a student must be documented. Document students who are missing doses Missing Doses By Vaccine: Students 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
REPORTING 7 TH GRADE
REPORTING 7 TH GRADE
REPORTING 7 TH GRADE Total number of enrolled and participating 7 th grade students in your school Total number of 7 th grade students with a Tdap vaccine after the age of 7 years.
REPORTING 7 TH GRADE Requirements Met But Missing Doses: Permanent Medical Doctor s note Others: Active IEP Independent Study Program Home Based Private School
REPORTING 7 TH GRADE Conditional Admission that requires follow up: Temporary medical Exemption Requirements Not Met, Missing Doses, Needs Follow-up: Student is missing their Tdap and should not be in school
REPORTING 7 TH GRADE Based on your documentation, the report will autofill your total for you
STUDENTS THAT MEET MULTIPLE CRITERIA Note for students meeting criteria of multiple categories: If a student has an exemption and is also a conditional entrant, please report the student as having the exemption only. Only place a child in F1, F2, F3 if the child does not fit in any other category.
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 619-692-8499
WHAT S NEWS State proposes Regulation Changes - Overall Simplify age and grade requirements Uniform requirements for K-12 Improve tables to Consolidate Immunization Requirements and doses Better reflect current national recommendations
WHAT S NEWS Proposed Changes Dose Requirements Deletes age and date restrictions for Hib, mumps, pertussis, Hep B and varicella. Requires at admission to K-12: 2 doses varicella vaccine 2 doses of MMR 3 doses of Hep B Time limited 2-dose varicella vaccine check at 7 th grade entry Grade Number of doses Required of each immunizations 1,2,3 K-12 Admission 4 Polio (4) 5 Dtap (5) 3 Hep B 2 MMR (6) 2 Varicella (7 th 12 th ) 7 1 Tdap 7 th Grade Advancement 8, 9 2 Varicella (9) 1 Tdap (7)
WHAT S NEWS Existing K-12 Admission Table Proposed K-12 Admission Table
WHAT S NEWS PROPOSED REGS CHANGES CONDITIONAL ADMISSION Clarifies in table pupils must be excluded at end of interval if they have not received doses due Clarifies students transferring to 7 th grade on 1 st day of school must provide Tdap documentation (no 30 school day admission allowed)
WHAT S NEWS PROPOSED REGS CHANGES ADMISSION TABLES Existing Conditional Admission Table Proposed K-12 Conditional Admission Table
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
WHAT S NEWS PROPOSED REGS CHANGES IMMUNIZATION RECORD CA School Immunization Record/Blue Card: Tdap row added (Tdap sticker repealed) No PBE boxes New layout Record on file must contain all elements (Blue Card available but optional)
TOP EXEMPTION QUESTIONS 1. Can I let a 12 th grader stay with an active PBE If a student has a CHDP 8262 signed, prior to 2016, the student may remain in school 2. Can I let an 8 th grader, with a PBE, begin school, if they were homeschooled for 7 th No, this student would need to begin all the vaccines found under the 7-17 age range and include the 7 th grade Tdap requirement, 3. Can I accept a medical waiver from a doctor in Mexico No, the medical exemption is only acceptable from a provider licensed in the United States 4. 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.
TEST YOUR KNOWLEDGE Meet Penny, Patty and Maddie All 3 girls are coming from an offsite Preschool to your Kindergarten program this year. Penny & Maddie are fully vaccinated. Patty has 1 MMR vaccine given yesterday. Can Patty start Kindergarten with her 1 dose of MMR today? YES You will need to follow-up with Patty s parents to ensure that she goes to her next appointment.
TEST YOUR 7 TH GRADE KNOWLEDGE Meet Parker Parker had a confirmed case of pertussis last year Parker s doctor put disease history in the Tdap field on the yellow card Does Parker need a Tdap to start 7 th grade? YES or Parker would need a doctor s note on doctor s letterhead stating he will not vaccinate Parker with Tdap
HOMESCHOOLED Meet Lilly Lilly was homeschooled for 7 th grade Lilly s mom did not get a waiver of any kind for 7 th grade. Lilly s mom is trying to register her for 8 th grade at your school Can Lilly start 8 th grade 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 registering for 6 th grade at your school Frankie is coming from another San Diego School Frankie only has 1 MMR can you allow him to start school? YES Grades 1-6 and 8-12 only require 1 MMR, but remind parents that he will need a second dose for 7 th grade
IMMUNIZATION RESOURCES YOU CAN USE San Diego Immunization Branch www.sdiz.org Shots for School www.shotsforschool.org California Immunization Coalition www.immunizeca.org Centers for Disease Control and Prevention www.cdc.gov/vaccines/ American Academy of Pediatrics www.aap.org Institute for Vaccine Safety www.vaccinesafety.edu National Network for Immunization Information (NNii) www.immunizationinfo.org
THANK YOU for all you do to protect our children, families, and community from disease!
Contact Information Jennifer Sterling School and Childcare Coordinator 619-692-8366 Jennifer.sterling@sdcounty.ca.gov