ClifCaliforn ia IIiimmunization Requirements for School & Child Care Entry
Jennifer Sterling San Diego Immunization Partnership www.sdiz.org CtCounty of San Diego, HlthHealth and Human SSiervices Agency Immunization Partnership Training Objectives
At the end of this training, you will be able to:
• List the immunization requirements for child care entry.
• Identify acceptable forms of personal immunization records.
• Correctly complete the California School Immunization Record (CSIR)/Blue Card.
• Create a management system for conditional entrants and exemptions. Why Do We Need Immunizations?
• Protect children and families
• Prevent illnesses which can cause death and disability
• Protect the health of others in the community
• Good Public Health Practice Spread of Disease read of Disease –– a a cough, cough, sneezesneeze, or handshake away, or handshake away Vaccine Preventable Diseases in San Diego County Pertussis (Whooping Cough) >604 cases so far in 2010! The worst epidemic in 55 years. • Adults spreading sickness to babies. Nine babies under 3 months of age have died in California this year. • To prevent the sprea d o f Per tuss is, ge t the TDAP vacci ne!
Chickenpox • 2009: 69 cases in 10 school districts • 2010: 10 cases in 2 school districts
Measles • 2010: Three measles cases in Carlsbad, nine children quarantined • Measles outbreak in San Diego during January and February 2008‐first measles outbreak since 1991! ‐12 cases in 2008 ‐71 peopl e quarantined
Polio is still epidemic in 4 countries! Pertussis – Nearly 50% of the time, infants are infected by their parents Prevention of Disease – SimpleSimple!! Immunizations help prevent the spread of communicable diseases.
Cover mouth (w/arm) when coughing or sneezing.
Wash hands w//p soap & water
Avoid contact with people who are sick. 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 sch ool & child care provid ers t o enforce immunization requirements!! CDC Recommendations vs. CA State Law Requirements CDC Recommendations Change yearly Extensive list of immunizations ACIP recommends to stay healthy Base d on age and hi gh ri sk groups across th e lif espan
CA Requirements Have not changed since 2003 Limited list of vaccines reqqyuired by age (()child care) or grade level (school) Recommended Schedule Aged 0 through 6 years Recommended Schedule Aged 7 through 18 years CA Required Vaccines – Child Care (2010 Special Schedule)
• Every child within each interval must be uptodate with their immunizations
• Hib change remains in effect until further notice Tools to Help Implement the Immunization Requirements
•The “Blue Book” Has helpful information & tools as well as the actual law to use as a reference
•7TH Edition is most recent (July ’03) Please recyyycle any older editions as the information is out of date
• Download from our website (www.sdiz.org) San Diego Regional Immunization Registry SDIR • FREE online database of shot records
• Figures out differences between requirements and recommendations
• Many private providers and all public providers put shot records into the Registry
• Available to schools & child care centers to view shot records
• CAN PRINT BLUE CARD S! CAIR Form
Ifhldf a child is not in the registry, parents can fill out this form and send their child’s immunization records directly to SDIB to have them enteredhd into the registry Other______Helpful ___Tools_
IZ Names & Abbreviations
Binational Immunization Guide IlImplementi ng IIiimmunization Requirements 1. Obtain the child’s personal immunization record . Must show the date each required vaccine dose was received (signatures and stamps are desired but not required) . Acceptable records: medical charts, out ‐of‐state or international records, military records, other Blue Cards, etc. (any written record showing the dates the vaccines were add)dministered) Page D81 of Blue Book: Article 5, Section 6065, Paragraph (b)
2. Complete a California School Immunization Record (Blue Card) Admitting Children without an Immunization Record – WHAT?
1. Transfer Students: . Allow 30 days for a cumulative folder from another school to reach your school
Page 10, paragraph 3 2. Students who are homeless: . Under the McKinney ‐Vento Homeless Education Act, homeless children can be admitted conditionally without required immunization documentation.
Page 9, paragraph 2 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 Chart
ACCEPTABLE? YES!
Record has dates each vaccine was given
Official form from a clinic Official Mexican Immunization ______Record ACCEPTABLE? NO! Record is stamped but does not show dates each vaccine was given What Can Be Done? • Option 1: – Meet with a physician and have the PHYSICIAN recreate dates for the vaccines based on the parent’s best recollection (either at original clinic or doctor nearby) • Option 2: – If the ph ysi ci an i s unabl e to recrea te da tes for the vaccines, the child can be revaccitdinated. Confusing Immunization Records??? Fax record to: 619‐692‐5677 (use a cover sheet) . Family, friends, etc. can be used as uuonoffic catasatosial translators . If no one is available, suggest a bilingual physician ______Completing ______the _____ California ______School ______Immunization Record____ (blue_____ card) ––44 steps
1. Demographic Information
2. Vaccination History 3. Documentation
4. Status of Requirements Step 1: Demographic Information • Parents may complete this section – Make sure they don’t accidentally sign the back!
• Please answer questions in full – The State & County use this information to find health disparities – You do not have to update address/phone eachih time i t ch anges Step 2: Vaccination History • Enter the date each shot was given based on the student’s personal immunization record – full dates should always be used (month/day/year) • COUNT DOSES! – Child care entry is based on NUMBER of doses • CdBlCdhCompare doses on Blue Card to the requirements for child’s age Pages 2 & 3 of Blue Book – You can use the Pink Windows for help 4Day Grace Period • Children who have received vaccine doses up to (and ildi)4dbfincluding) 4 days before th e recommend dded age or required intervals will not have to repeat those doses. Page 4 of Bl ue B ook • MMR: must be given on or after the 1st birthday o Up to 4 days before the birthday is okay! Date of Birth: January 7, 2009 MMR 1: January 8, 2009 = VALID MMR 1: January 4, 2009 = VALID MMR 1: JJy,anuary 2, 2009 = INVALID MMR must be given again Documenting Chickenpox Disease
FRIENDLY HILLS PEDIATRICS X
DISEASE * Page 5 of Blue Book
*History of disease must be documented! Step 3: Documentation
• Sign & date this section – It does not have to be signed by a nurse – It s hou ld be s igne d even if the child is NOT up‐to‐ date
• Specify which kind of personal shot record you used to make the Blue Card Step 4: Status of Requirements • All Requirements are met . (A) •Currentlyyp up‐to‐date, but more doses are due later. Needs follow‐up. (B) • EtitdExemption granted: – Medical Reasons‐ Permanent (()C) – Medical Reasons‐ Temporary (D) – Personal Beliefs (E) Admitting Children “On Condition” Option (B)
• Children currently are up‐to‐date (next doses not yet due) • Admitted on the condition that they will receive still‐ needed doses as they become due in the future .
• Staff must follow‐up by: Pages 9-11 in Blue Book – Notifying parents: Notice of Immunizations Needed – Checking documentation that the needed immunizations were received – Adding the new dates to the Blue Card
ElExample: Star te d Hepatiti s B ser ies 2 wee ks pr ior to s tar t o f child care Exemptions: Option C, D, or E • Permanent Medical (C) Pages 7 & 8 of Blue Book – Must have written documentation from doctor – Keep document with the Blue Card – Ex: Child with an allergy to a vaccine or 4‐day rule violation • Temporary Medical (D) – Must have written documentation from doctor with an end‐ date to exemption – Must get shots at end of exemption – Ex: Child who was sick at appointment or on an alternative vaccination schedule • Personal Beliefs (PBE) (E) – Does not require written documentation – Parent/Guardian MUST sign back of Blue Card – Ex: Immunization is against religious or personal belief Personal Beliefs Exemption ((PBE)PBE) • To be used for deeply held philosophical beliefs
• Personal immunization record still needs to be reviewed
• Implications of Exemptions: – Children who are too young to be immunized or have a medical exemption are at risk – Un‐immunized children may be excluded from child care during an outbreak – Un‐immunized children are susceptible to dangerous and sometimes deadly diseases – All c hildren are at r is k as “her d” immun ity is comprom ise d Follow_____up __ Systems______• Keep Blue Cards separate – Conditional Entrants who need follow ‐up – Kids with exemptions
Use a tickler file
Use a ClCalen dar
Pages 1214 of Blue Book If Requirements Are Not Met…
The child has 10 school days to receive the Page D81 of Blue Book: needed immunizations. Article 4, Section 6055 Pop Quiz • Allergy to a vaccine (has A ‐ All Requirements Met note from ppyhysician) B ‐ Will need more doses • UptoDate later
• Child had high fever (has C ‐ Temporary Medical note from ppyhysician) Exemption
• Parents don’t want D ‐ Permanent Medical vaccines (sign back of EiExemption card) E ‐ Personal Beliefs • Child is midseries Exemption Transferring and Storing Records… Child Care Centers:
• The original “Blue Card” or a copy of it must be kept with child’s file during the period of enrollment and for three years after the child leaves your care.
Page 15 of Blue Book Practice Time!!! Example #1 ‐ Ben
Date of Birth: May 17, 2007 . MMR given May 10, 2008 . All other required vaccines were given on time and were properly dtddocumented. . Can he be accepted? Example #2 ‐‐ Ann
Date of birth: Feb. 2, 2008 . She has all required vaccines ‐ EXCEPT for MMR & Varicella. . No history of disease. . Her parents do not want her to receive the MMR and Varicella vaccines. . Can you enroll her? Example #3 Example #3 ‐‐JohnJohn
Date of Birth: January 2, 2010 . How old is he TODAY? . He has 2 doses each of Polio, DTaP, Hib and Hepatitis B . Can he come into child care? Will he need more shots? Example______#4 ‐ Wendy
Date of Birth: October 10, 2008 . How old is she TODAY? . Started child care January 20, 2009 with 3 doses eachfPlh of Polio and dDTP2d DTaP; 2 doses each hfHB of Hep B and Hib and 1 MMR (given 10/12/09) . Was she up‐to‐date when she enrolled? . Does she need more vaccines? Example #5 – Alex
Date of birth: February 15, 2007 . He has the following shots: 3 Polio, 4 DTaP, and 3 Hep B . He has a note signed by his doctor that he will not receive any more vaccines because he has a chronic medical condition . Can you enroll him? Example #6 Freda
Date of birth: December 25, 1995 . She has the following shots: 4 Polio, 3 DTaP, 1 Tdap, 1 MMR & Varicella, 2 Hep B . She has a note from her doctor stating she has recently been diagnosed with Diabetes . Cllh?Can you enroll her?
Page D-78 of Blue Book Required Annual Reporting Annual Assessments • Completed each fall • Child care centers (ages 2 – 5 years) • NifNo infant report s • Submitted to County of San Diego Immunization Branch on or before October 15
Selective Review • SiSpring revi ew of fhild child care bl ue car d(ds (every oth er year) • Collect information from Blue Cards to compare to fall report • Provide technical assistance Disease Reporting
• Child care personnel are State‐mandated to report cases of infectious diseases in schools and child care centers . List of diseases you must report to local health department under State guidelines
Page D-74 in Blue Book
• VillVaricella (h(chick enpox )5): 5 cases in one facility is reportable Vaccines Recommended for Teens and Adults
• Tdap is a one‐dose booster – New Recommendation AB 354 • Needed to decrease transmission of whooping cough from adults to children (important for care providers) • HPV is a three‐dose series (Complete the whlhole series) • Protects against 4 strains most commonly responsible for cervical cancer • Meningococcal is a one‐dose vaccine • Protects teens against meningitis which is rare but often deadly • Zoster one‐dose for shingles • Recommended for adults over 60 • Pneumococcal (PPSV) one dose vaccine • Recommended for adults over 65 Immunization News & Updates IfInfants and Children • Rotavirus (RV): 3 dose series for infants . Start series at age 6 through 14 weeks
• Hepatitis A: age limit lowered from 2 years to 1 year . Protects against foodborne disease
• Combinations . Pediarix: DTaP/Polio/Hepatitis B . Kinrix: DTaP/Polio . Pentacel: DTaP/Polio/Hib Immunization News & Updates Infants & Children
• HPV: • Approved for males 9 – 26 years • Two HPV vaccines available for females
• Varicella: 2nd dose for kids 4 – 18 years . Seeing many cases of breakthrough disease IiiImmunization News & UdtUpdates FLU SHOT RECOMMENDED YEARLY
. ALL children 6 months – 18 years . Kids under 9 years getting the flu shot for the first time should have 2 doses . Child care and school staff need it, too!
CALL 211 www.211.org www.sdiz.org Immunization Resources You Can Use
• San Diego Immunization Branch www.sdiz.org •Calflifornia Immunization Coa lition www.ImmunizeCa.org • Centers for Disease Control and Prevention www.cdc.gg/ov/vaccines / • American Academy of Pediatrics www.aap.org • Institute for Vaccine Safety www.vaccinesafety.edu • ViEdiCVaccine Education Center www.vaccihdine.chop.edu • National Network for Immunization Information (NNii) www.immunizationinfo.org Other Health Department Programs • Oral Health Assessment Requirement – All Kindergarteners need an assessment within 12 months of school by licensed California dentist – www.sdt/dcoe.net/nurse (for f orms) • Share the Care: – Emergency dental care – www.sharethecaredental.org • San Diego Kids Health Assurance Network – Links families to no/low cost dental & medical – 1.800.675.2229 or Erin Piskura: 619.692.8486 • Tuberculosis Branch: 619. 692. 8600 • Childhood Lead Poisoning Prevention Program:619.515.6629 Contact Information County IZ Branch Jennifer Sterling Main line School and Childcare Coordinator 866/3582966 6196928366 Jennifer.sterling@sdcounty .ca .gov Fax 619/6925677 Website Florencia Sisterson, PHN Public Health Nurse www.sdiz.org 6196928691 [email protected] THANK YOU for what you do to protect our children, families, and community from disease!