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School Immunization Requirements: Part 3 August, 2012. Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/Preschools August XX, 2011. Objectives. For each required vaccine: Describe detailed rules and exceptions to the rules

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School Immunization Requirements: Part 3

August, 2012

Implementing WA New State Exemption Requirements -

Training for Schools and Child Cares/Preschools

August XX, 2011


Objectives
Objectives

For each required vaccine:

  • Describe detailed rules and exceptions to the rules

  • Show how the WA State Immunization Information System can help determine valid doses


Required school immunizations
Required School Immunizations

  • Hep B

  • DTaP

  • Tdap

  • IPV

  • MMR

  • Varicella



Hepatitis B Example

Red X shows Dose 3 is invalid

Forecast shows Dose 3 should be repeated and is now past due


Dtap rules
DTaP Rules

  • DTaP given to students 7-10 years of age counts for the Tdap dose

  • Catch-up schedule for >7 years of age without any DTaP doses:

    • One dose of Tdap followed by 2 doses of Td (>4 weeks between doses 1 & 2, and >6 months between doses 2 & 3)


DTaP Example

Note red X because Dose 5 given too early

Dose 5 due now according to vaccination forecast


Tdap and td rules
Tdap (and Td) Rules

  • No need to wait 5 years between DTaP/Td and Tdap

  • Students 7-10 years of age not fully vaccinated with DTaP required to get dose of Tdap

    • Off-label use of Tdap vaccine, but providers follow ACIP recommendations as best medical practice


Tdap Example 1

Way to go! Rebekah is complete with 5 doses of DTaP

Rebekah also got Tdap at age 8

Rebekah is up to date until 2018



Tdap Example 2

Td is past due

Tdap given to kids 7 and older are given as a catch-up dose


What to do if
What to do if:

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

  • If Tdap given for dose 4 or dose 5 instead of DTaPCounts for 6th grade

  • If Tdap given between 7-10 years

    of age Counts for 6th grade


IPV

  • For K-1st grade only for 2012-2013:

    • Dose 4, if given on or after Aug 7, 2009, must have been given >4 years of age and separated from dose 3 by >6 months

  • Students with 4 valid doses before Aug 7, 2009 don’t need more doses

    • >4 week interval must separate IPV doses

    • Dose 4 must be given >18 weeks of age


IPV Example 1

IPV Dose 4 marked with a red X

IPV dose 4 needs to be repeated and is due now


IPV Example 2

IPV Dose 4 valid at age 24 months since given before 8/7/09


Mmr rules
MMR Rules

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

  • 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

  • 4 day grace DOES NOT apply between live vaccines not given at the same time


MMR Example

Note red X. Varicella not given same day as MMR


Varicella rules
Varicella Rules

  • If not given on same day, minimum interval between varicella and MMR is >28 days

  • 4 day grace DOES NOT apply between live vaccines not given at the same time

  • Minimum interval between dose 1 & 2 = 3 months.


4 day grace period
4 Day Grace Period

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

  • Applies to all inactivated vaccines before minimum intervals OR ages

  • Grace period DOES NOT apply between two different live vaccines not given at the same visit

  • Grace period DOES apply between the same live vaccines


4 Day Grace Example 1

Hep B Dose 3 given 4 days earlier than 6 months of age

Dose 3 is valid and doesn’t need to be repeated


4 Day Grace Example 2

Varicella Dose 2 given 5 days before it was due


Resources
Resources

  • Individual Vaccine Requirements Summary: www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

  • Vaccines Required for School Attendance chart: www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/VaccineRequirements.aspx

  • Centers for Disease Control and Prevention “Pink Book” http://www.cdc.gov/vaccines/pubs/pinkbook/index.html

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


Thank you for watching this training!

Send clinical questions to: [email protected]

Please complete an evaluation at:

School Immunization Requirements Evaluation


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