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Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/Preschools August XX, 2011 Preschool/Child Care Immunization Requirements Department of Health Office of Immunization and Child Profile May 2013 Slide 2 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? Slide 3 Why Do We Need Immunizations? We dont see diseases once common. Vaccines successfully prevent disease However, diseases and outbreaks still occur Children are at risk in the child care and preschool setting Slide 4 Immunization Requirements Children 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 www.doh.wa.gov/CommunityandEnvironment/Schools /Immunization/Regulations.aspx Slide 5 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 Slide 6 Slide 7 Slide 8 Changes to Exemption Law www.doh.wa.gov/CommunityandEnvironment/Schools /Immunization/Exemptions.aspx www.doh.wa.gov/CommunityandEnvironment/Schools /Immunization/Exemptions.aspx Sample Certificates of Exemption Training video Frequently Asked Questions Slide 9 Vaccines Required for Preschool or Child Care Attendance DTaP Hepatitis B Hib IPV MMR PCV Varicella Slide 10 Recommended, but Not Required Flu Hepatitis A Rotavirus Slide 11 Immunization Status Complete/Fully Immunized Conditional Temporary status to allow child to get fully immunized Out of Compliance Exempt Slide 12 www.doh.wa.gov/Portals/1/Documents/Pubs/348-051-ChildcareChart2013-2014.pdf Slide 13 Slide 14 www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf Slide 15 www.doh.wa.gov/Portals/1/Documents/Pubs/348-051-SchoolChart2013-2014.pdf Slide 16 4 Day Grace Period Vaccines given 4 days or fewer before the minimum interval or age are valid Vaccines 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 Slide 17 4 Day Grace Example Dose 3 valid given 3 days before 6 months of age Slide 18 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) By 7 Months (on or before last day of mo 6) By 16 Months (on or before last day of mo 15) By 19 Months (on or before last day of mo 18) Diphtheria, Tetanus, Pertussis (DTaP/DT) 1 dose2 doses 3 doses May get as early as 6 months. 4 doses May get 4 th dose as early as 12 months as long as 6 months separate dose 3 and dose 4. Slide 19 DTaP Minimum Age and Intervals Dose #Minimum AgeMinimum Interval Between Doses 16 weeks4 weeks between Dose 1 & 2 210 weeks4 weeks between Dose 2 & 3 314 weeks6 months between Dose 3 & 4 412 months6 months between Dose 4 & 5 Slide 20 DTaP Details Routine schedule: 2, 4, 6, 15-18 months, and booster dose at 4-6 years 6 months interval recommended between dose 3 and 4, but 4 months or more is acceptable DTaP given to children less than 7 years of age; Tdap and Td given to children 7 years of age or older Slide 21 Note red X because Dose 4 given too early DTaP Example Dose 4 past due Slide 22 Hepatitis B Requirement VACCINE By 3 Months (on or before last day of mo 2) By 5 Months (on or before last day of mo 4) By 7 Months (on or before last day of mo 6) By 16 Months (on or before last day of mo 15) By 19 Months (on or before last day of mo 18) Hepatitis B 1 dose May get dose 1 at birth. 2 doses May get dose 2 as early as 1 month. 3 doses Slide 23 Hepatitis B Minimum Age and Intervals Dose #Minimum Age Minimum Interval Between Doses 1Birth4 weeks between Dose 1 & 2 24 weeks8 weeks between Dose 2 & 3 324 weeks16 weeks between Dose 1 & 3 Slide 24 Hepatitis B Details Routine schedule: birth, 1 month, and 6 months Pay attention to min age for dose 3 and minimum intervals between doses Slide 25 Hib Requirement VACCINE By 3 Months (on or before last day of mo 2) By 5 Months (on or before last day of mo 4) By 7 Months (on or before last day of mo 6) By 16 Months (on or before last day of mo 15) By 19 Months (on or before last day of mo 18) Haemophilus influenzae type B (Hib) 1 dose2 doses3 doses4 doses Slide 26 Hib Minimum Age and Intervals Dose #Minimum Age Minimum Interval Between Doses 16 weeks4 weeks between Dose 1 & 2 210 weeks4 weeks between Dose 2 & 3 314 weeks8 weeks between Dose 3 & 4 412 months - Slide 27 Hib Details Routine schedule: 2, 4, 6, and 12-15 months Not recommended for children 5 years or older The recommended immunization schedule for Hib vaccines: Vaccine2 Months4 Months6 Months12-15 Months PRP-T* (ActHib) Dose 1Dose 2Dose 3Booster PRP-OMP (PedvaxHib) Dose 1Dose 2 Booster Slide 28 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. Slide 29 Doses before age 12 months Doses on or after age 12 monthsStatus 31Complete 21 11 Needs 1 Booster Dose (If Last Dose Given Before 15 Months) 01 Needs 1 Booster Dose (If Last Dose Given Before 15 Months) 40Needs 1 Booster Dose 30 20 10 00Needs 1 Dose Hib Doses Required Chart www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf Slide 30 Hib Example Slide 31 IPV Requirement VACCINE By 3 Months (on or before last day of mo 2) By 5 Months (on or before last day of mo 4) By 7 Months (on or before last day of mo 6) By 16 Months (on or before last day of mo 15) By 19 Months (on or before last day of mo 18) Polio (IPV or OPV) 1 dose2 doses May get as early as 4 months. 3 doses Slide 32 IPV Minimum Age and Intervals Dose #Minimum AgeMinimum Interval Between Doses 16 weeks4 weeks between Dose 1 & 2 210 weeks4 weeks between Dose 2 & 3 314 weeks6 months between Dose 3 & 4 Slide 33 IPV Details Routine schedule: 2, 4, 6-18 months, and booster at 4-6 years IPV used routinely in US for polio vaccination, but children coming from a foreign country may get OPV Any combination of IPV or OPV valid Slide 34 MMR Requirement VACCINE By 3 Months (on or before last day of mo 2) By 5 Months (on or before last day of mo 4) By 7 Months (on or before last day of mo 6) By 16 Months (on or before last day of mo 15) By 19 Months (on or before last day of mo 18) Measles, Mumps, Rubella (MMR) Not given before 12 months of age.1 dose Slide 35 MMR Minimum Age and Intervals Dose #Minimum Age Minimum Interval Between Doses 112 months4 weeks between Dose 1 & 2 Slide 36 MMR Details Routine schedule: 12-15 months and 4-6 years Dose 1 given 28 days o The second vaccine given is not valid and should be repeated Slide 37 MMR Example Note red X MMR given 5 days too early Slide 38 Pneumococcal Conjugate Vaccine (PCV) Requirement VACCINE By 3 Months (on or before last day of mo 2) By 5 Months (on or before last day of mo 4) By 7 Months (on or before last day of mo 6) By 16 Months (on or before last day of mo 15) By 19 Months (on or before last day of mo 18) Pneumococcal Conjugate (PCV7 or PCV13) 1 dose2 doses3 doses4 doses Slide 39 PCV Minimum Age and Intervals Dose #Minimum AgeMinimum Interval Between Doses 16 weeks4 weeks between Dose 1 & 2 210 weeks4 weeks between Dose 2 & 3 314 weeks8 weeks between Dose 3 & 4 412 months - Slide 40 PCV Details Routine schedule: 2, 4, 6, and 12-15 months PCV is not recommended for children 5 and older A single supplemental dose of PCV13 is recommended, but not required, for all children aged 1459 months who got 4 doses of PCV7 o PCV13 replaced PCV7 in 2010 Slide 41 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. Slide 42 PCV Doses Required Chart Doses before Age 12 months Doses on or after Age 12 months Status 31 Complete (If PCV7 given, needs one additional dose of PCV13) 2 1 (8 weeks after # 2) Complete 02 12 11Needs 1 dose 8 weeks after Dose 2 01 Needs 1 dose 8 weeks after Dose 1 if # 1 received at age 24 months 40Needs 1 dose 8 weeks after Dose 4 30Needs 1 dose 8 weeks after Dose 3 20Needs 1 dose 8 weeks after Dose 2 10 Needs 2 doses (8 weeks apart) if age 12 - 24 months Needs 1 dose if age 24 - 59 months 00 Needs 2 doses (8 weeks apart) if age 12 - 24 months Needs 1 dose if age 24 - 59 months Slide 43 PCV Example Katey is complete with 3 doses! Slide 44 Varicella Requirement VACCINE By 3 Months (on or before last day of mo 2) By 5 Months (on or before last day of mo 4) By 7 Months (on or before last day of mo 6) By 16 Months (on or before last day of mo 15) By 19 Months (on or before last day of mo 18) VaricellaNot given before 12 months of age. 1 dose Required: if unvaccinated, health care provider must verify disease. Slide 45 Varicella Minimum Age and Intervals Dose #Minimum AgeMinimum Interval Between Doses 112 months3 months between Dose 1 & 2 Slide 46 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 Slide 47 Varicella Example Note red X Varicella not given same day as MMR Slide 48 Resources www.doh.wa.gov/immunization/schoolandchildcare www.doh.wa.gov/immunization/schoolandchildcare Individual Vaccine Requirements Summary: www.doh.wa.gov/Portals/1/Documents/Pubs/348-284- IndividualVaccineRequirements.pdf 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/Immuniz ation/VaccineRequirements.aspx 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 www.doh.wa.gov/CommunityandEnvironment/Schools/Immuniz ation/SchoolManual.aspx Slide 49 Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/Preschools August XX, 2011