california immunization requirements for school entry
TRANSCRIPT
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
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
At the end of this training, you will be able to:
TRAINING OBJECTIVES
Spread of Disease is just a Cough, Sneeze or Handshake away
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
PREVENTION OF DISEASE - SIMPLE
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!!
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
ACIP RECOMMENDATIONS VS STATE LAW REQUIREMENTS
VACCINE REQUIRED DOSES Polio 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.
Diphtheria, Tetanus, and Pertussis
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
Measles, Mumps, Rubella (MMR)
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. Varicella 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)
7th - 1 dose on or after 7th birthday. (Tdap, Dtap or DTP after 7 years meets requirement.
SCHOOL LAW 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
IMPLEMENTING IMMUNIZATION REQUIREMENTS
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
CDPH APPROVED SYSTEMS
IMM 231 Every child must
be up-to-date with their immunizations
CA REQUIRED VACCINES TK-12
VACCINE COMBINATIONS
Available for download at: www.sdiz.org
HELPFUL TOOLS
Admitting under Conditional
and follow-up schedule
CONDITIONAL REQUIREMENTS
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
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 7th grade without a Tdap
There is no grace period for Tdap
NO GRACE PERIOD
Students entering 7th 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
THE TDAP/TD STORY
Students who do not have an immunization history should be referred to a physician.
WHAT CAN BE DONE
Yellow Cards are best – if a parent does not have one, suggest they have their current record transcribed for future convenience
THE YELLOW CARD
ACCEPTABLE?
YES! Record has dates each
vaccine was given Official form from a clinic
Jane Doe
MEDICAL RECORDS
Acceptable???
NO! Record is stamped but
does not show dates each vaccine was given
Official Mexico Immunization Record
Hernandez, Jose
12/12/2006
MEDICAL RECORDS CONTINUED
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
CONFUSING IMMUNIZATION RECORDS
HOW TO COMPLETE THE CALIFORNIA SCHOOL BLUE CARD
1. Demographic Information
2. Vaccination History
3. Documentation
4. Status of Requirements
Completing the California School Immunization Record (Blue Card)
BLUE CARD
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 1: DEMOGRAPHIC INFORMATION
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 15th 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
STEP 2: VACCINATION HISTORY
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 1st 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
4-DAY GRACE PERIOD
DISEASE *
*History of disease must be documented!
X
Dr. Disease History
Titers Pediatrics
619-999-9999
DOCUMENTING CHICKEN POX DISEASE
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 3: DOCUMENTATION
(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
STEP 4: STATUS OF REQUIREMENTS
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.
ALL REQUIREMENTS MET
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
ADMITTING CHILDREN “ON CONDITION” STATUS (B)
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
WHERE TO RECEIVE IMMUNIZATIONS
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 (C)
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 (D)
*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 7th • 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
STATUS OF REQUIREMENTS EXEMPTIONS: STATUS (E)
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.
SENATE BILL 277
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.
SB 277 CONTINUED…
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!
Use a Calendar
Use a tickler file
FOLLOW-UP SYSTEMS
The child has 10 business days to receive the
needed immunizations.
Choose vaccines they need
Provide “END” date for receiving vaccines
IF REQUIREMENT IS NOT MET
TK/K – 12th 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
TRANSFERRING RECORDS
Annual Assessments
Completed each fall
Child care centers (ages 2 – 4 yrs 11 months)
No infant reports
Kinder & 7th 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 7th grade)
Collect information from Blue Cards to compare to fall report
Provide assistance
REQUIRED ANNUAL 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/
REPORTING
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) 7th Grade programs report last
ANNUAL REPORTING CONTINUED
REPORTING
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
REPORTING KINDER
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.
“REQUIREMENTS MET BUT MISSING DOSES”
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
UNDER THE BLUE LINE
REQUIREMENTS NOT MET, MISSING DOSES
Overdue- Enrolled but Not
Attending G
0
TOTAL
0
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, BUT 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
DOCUMENTING 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
Any missing immunizations for a student must be documented.
Document students who are missing doses
“REQUIREMENTS MET, BUT MISSING DOSES”
REPORTING 7TH GRADE
REPORTING 7TH GRADE
Total number of enrolled and participating 7th grade students in your school
Total number of 7th grade students with a Tdap vaccine after the age of 7 years.
REPORTING 7TH GRADE
Requirements Met But Missing Doses:
Permanent Medical – Doctor’s note Others:
Active IEP Independent Study Program Home Based Private School
REPORTING 7TH 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 7TH GRADE
Based on your documentation, the report will autofill your total for you
REPORTING 7TH GRADE
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.
STUDENTS THAT MEET MULTIPLE CRITERIA
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
DISEASE REPORTING
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
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 7th grade entry
Proposed Changes – Dose Requirements
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
(7th – 12th) 7 1 Tdap
7th 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
Clarifies in table pupils must be excluded at end of interval if they have not received doses due
Clarifies students transferring to 7th grade on 1st day of school must provide Tdap documentation (no 30 school day admission allowed)
PROPOSED REGS CHANGES – CONDITIONAL ADMISSION
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)
WHAT’S NEWS
1. Can I let a 12th 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 8th grader, with a PBE, begin school, if they were homeschooled for 7th
No, this student would need to begin all the vaccines found under the 7-17 age range and include the 7th 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.
TOP EXEMPTION QUESTIONS
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 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 7th grade?
YES – or…Parker would need a doctor’s note on doctor’s letterhead stating he will not vaccinate Parker with Tdap
TEST YOUR 7TH GRADE KNOWLEDGE
Meet Lilly
Lilly was homeschooled for 7th grade
Lilly’s mom is trying to register her for 8th grade at your school
Lilly’s mom did not get a waiver of any kind for 7th grade.
Can Lilly start 8th 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 .
HOMESCHOOLED
Meet Frankie
Frankie is registering for 6th 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 7th grade
MMR DILEMMA
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
IMMUNIZATION RESOURCES YOU CAN USE
THANK YOU for all you do to protect
our children, families, and community
from disease!
Jennifer Sterling School and Childcare Coordinator
619-692-8366 [email protected]
Contact Information