Preschool/Child Care Immunization Requirements
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Preschool/Child Care Immunization Requirements Trang Kuss, RN, MN, MPH Department of Health Office of Immunization and Child Profile January 18, 2013. Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/Preschools August XX, 2011. Contact Information.

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Preschool/Child Care Immunization Requirements

Trang Kuss, RN, MN, MPH

Department of Health Office of Immunization and Child Profile

January 18, 2013

Implementing WA New State Exemption Requirements -

Training for Schools and Child Cares/Preschools

August XX, 2011


Contact information
Contact Information

Dept. of Health Office of Immunization and Child Profile

Trang Kuss, RN, MN, MPH

School and Child Care Coordinator

[email protected]; 360-236-3760


Topics to be covered
Topics to be Covered

  • What are the child care and preschool immunization requirements in Washington State?

  • Complete, Conditional, Out of Compliance: What do they mean?

  • How can I use the Washington State Immunization Information System to help determine if a child is complete? 


Immunization requirements
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 vaccine-preventable diseases at ages and intervals according to the national immunization schedule

  • Parent must submit completed Certificate of Immunization (or Certificate of Exemption)

  • www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/Regulations.aspx



Examples of those not required to comply
Examples of those not required to comply

  • Facilities not required to have a DEL license

  • Coop preschool

  • Birth to Three Program


Required immunizations for preschool or child care attendance
Required Immunizations for Preschool or Child Care Attendance

  • DTaP

  • Hepatitis B

  • Hib

  • IPV

  • MMR

  • PCV

  • Varicella


Recommended but not required
Recommended, but Not Required Attendance

  • Hepatitis A

  • Rotavirus

  • Flu


Immunization status
Immunization Status Attendance

  • Complete/Fully Immunized

  • Conditional

    • Temporary status to allow child to get fully immunized

  • Out of Compliance

  • Exempt


www.doh.wa.gov/Portals/1/Documents/Pubs/348-051-ChildcareChart2013-2014.pdfwww.doh.wa.gov/Portals/1/Documents/Pubs/348-051-ChildcareChart2013-2014.pdf


www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdfwww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Dtap requirement
DTaP Requirementwww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Dtap minimum age and intervals
DTaP Minimum Age and Intervalswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Dtap details
DTaP Detailswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

  • 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; Td and Tdap given to children 7 years of age or older


What to do if
What to do if:www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

  • If Tdap given for dose 1, 2, or 3 instead of DTaP Repeat with DTaP

  • If Tdap given for dose 4 or dose 5 instead of DTaP Acceptable


Note red X because Dose 4 given too earlywww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

Dose 4 past due

DTaP Example


Note red X – Tdap given as dose 2www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

DTaP Example


Hepatitis b requirement
Hepatitis B Requirementwww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Hepatitis b minimum age and intervals
Hepatitis B Minimum Age and Intervalswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Hepatitis b details
Hepatitis B Detailswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

  • Routine schedule: birth, 1 month, and 6 months

  • Pay attention to min age for dose 3 and minimum intervals between doses


Hib requirement
Hib Requirementwww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Hib minimum age and intervals
Hib Minimum Age and Intervalswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Hib details
Hib Detailswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

  • Routine schedule: 2, 4, 6, and 12-15 months

  • Not recommended for children 5 years or older

  • The recommended immunization schedule for Hib vaccines:


Hib details1
Hib Detailswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

  • Unvaccinated children 7 months of age and older may not require full series. Total number of doses depends on child’s current age.

  • Final booster dose should be given at 12 months or older and a min of 8 weeks after previous dose.


Hib details2
Hib Detailswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

  • 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.


Hib Doses Required Chartwww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Hib Example www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Ipv requirement
IPV Requirementwww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Ipv minimum age and intervals
IPV Minimum Age and Intervalswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Ipv details
IPV Detailswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

  • Routine schedule: 2, 4, 6-18 months, and booster at 4-6 years.

  • IPV used routinely in US for polio vaccination, but students coming from a foreign country may get OPV

  • Any combination of IPV or OPV valid


Mmr requirement
MMR Requirementwww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Mmr minimum age and intervals
MMR Minimum Age and Intervalswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Mmr details
MMR Detailswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

  • Routine schedule: 12-15 months and 4-6 years

  • Dose 1 given <12 months of age must be repeated (4 day grace applies)

  • MMR or MMRV can be used

  • 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


Note red X – MMR given 5 days too earlywww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

MMR Example


Pneumococcal conjugate pcv requirement
Pneumococcal Conjugate (PCV) Requirementwww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

*Some children may get 5 total doses. A single supplemental dose of PCV13 is recommended, but not required, for all children aged 14–59 months who got 4 doses of PCV7.


Pcv minimum age and intervals
PCV Minimum Age and Intervalswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Pcv details
PCV Detailswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

  • Routine schedule: 2, 4, 6, and 12-15 months

  • A single supplemental dose of PCV13 is recommended, but not required, for all children aged 14–59 months who got 4 doses of PCV7

    • PCV13 replaced PCV7 in 2010


Pcv details1
PCV Detailswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

  • 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 and Dose 3 given at >12 months.


Katey is complete with 3 doses!www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

PCV Example


Varicella requirement
Varicella Requirementwww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Varicella minimum age and intervals
Varicella Minimum Age and Intervalswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


Varicella details
Varicella Detailswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

  • 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


Note red X – Varicella not given same day as MMRwww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

Varicella Example


4 day grace period
4 Day Grace Periodwww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

  • Vaccines given <4 days before the minimum interval or age are valid

  • Applies to all inactivated vaccines before minimum intervals OR ages

  • Grace period applies if live vaccines given at the same visit


Dose 3 valid given 3 days before 6 months of agewww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

4 Day Grace Example


Resources
Resourceswww.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

  • Individual Vaccine Requirements Summary: 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/Immunization/VaccineRequirements.aspx

  • Immunization Manual for Schools and Child Cares: www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/SchoolManual.aspx


Thank you for all you do!www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

Implementing WA New State Exemption Requirements -

Training for Schools and Child Cares/Preschools

August XX, 2011


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