Preparing for the Immunization Annual Assessment

1. Preparing for the Immunization Annual Assessment Presented by: LaTonya Thomas, Immunization Assessment Coordinator

2. Presentation Goals • Georgia immunization requirements for school attendance • How to monitor, follow up and enforce the requirements for the certificates of attendance • Resources

3. School and Childcare Requirements • Georgia law requires children attending a school or childcare facility be protected from certain vaccine-preventable diseases. • The Official Code of Georgia (§ 20-2-771) states, “No child shall be admitted to or attend any school or facility in this state unless the child shall first have submitted a certificate of immunization to the responsible official of the school or facility.” • The immunization requirements for school and childcare facility attendance are outlined in the Georgia Immunization Certificate (Form 3231) and the Policy Guides 3231INS and 3231REQ. Childcare facility operators, school personnel, healthcare providers and parents are responsible for seeing that these rules and laws are enforced.

4. School and Childcare Requirements Lesson 1: Objectives • Physicians and Public Health Clinics: • Knowing the current legal requirements for attendance and accurately completing the certificate • Administering immunizations according to the current Recommended Childhood and Adolescent Immunization Schedule • Reporting the occurrence of any diseases listed on the “Notifiable Disease List” • Report any adverse event following the administration of a vaccine to VAERS • School : • Review the certificates for validity prior to accepting • Develop a system for immunization certificate management • Have certificates available for inspection and audit by health officials • Report the occurrence of any disease listed on the “Notifiable Disease List”

5. School and Childcare Requirements Lesson 1: Content • The immunization records of children enrolled in Head Start programs, prekindergarten programs and childcare facilities will be reviewed at least once a year by public health. • Public health or school officials will perform an annual review of kindergarten and sixth grade students.

6. School and Childcare Requirements Lesson 1: Wrap-up • Immunization documentation must be available at the school or childcare facility and be accessible for review during business hours. The school or childcare facility staff must assist the public health or school official in locating the immunization documentation for each child. • In addition to yearly reviews from public health, a staff member from the Georgia Immunization Program will review immunization documentation from randomly selected schools and childcare facilities annually.

7. Definition of Terms Lesson 2: Objectives • A “new entrant” is any child entering any school or childcare facility in Georgia for the first time or after having been absent for more than 12 months or one school year. • When a new entrant enrolls, the responsible official of any school or childcare facility may grant a 30 calendar day waiver of the certification requirement for a justified reason. Upon expiration of the waiver, the child shall not be admitted to or be permitted to attend the school or childcare facility unless a certificate of immunization is provided. • If the child withdraws and then returns, the parent is not allowed another 30 days to provide a certificate or affidavit. • “Facility” is defined as any public or private child care center or nursery intended for the care, supervision, or instruction of children • “School” is defined as any public or private educational program or institution instructing children at any level or levels, kindergarten through twelfth grade

8. Certificate of Immunization (Form 3231) Lesson 2: Content

9. Certificate of Immunization (Form 3231) Lesson 2: Wrap-up • A child must have a certificate on file at each facility or school they attends • Photocopies of appropriately completed and signed certificates are acceptable • If a certificate is not on file for each child attending, the facility is held legally responsible • A Georgia physician or health clinic is responsible for administering the required vaccines and completing the certificate • Only physician offices and health clinics can obtain blank certificates

10. Certificate of Immunization (Form 3231) Lesson 3: Objectives • The school or childcare facility must check each child’s certificate 3231 to be sure it is complete, current and includes the following information: • Name • Birth date • Either a “date of expiration” or “complete for school attendance” (It cannot be marked in both areas.) • An expiration date in the future that is entered by a physician or public health official for children younger than age 4. The expiration date should coincide with when the next required vaccine is due. • Dates that vaccines were given • Month, day and year for all dates except serology, diagnosis and history of disease dates (Serology, diagnosis and history of disease dates may be documented by entering the year only.)

11. Certificate Expiration Date Lesson 3: Content • Expires on the date entered as “Expiration Date” • Must be replaced with a current certificate within 30 days after the expiration date, or child is excluded from attending • Allows for a child who does not meet all the immunization requirements to attend child care or school while he is catching up • Required for all children under four years of age • Required if a medical exemption for a vaccine(s) is marked • Should not be completed if “Complete for School” is marked

12. Certificates Marked “Complete for School Attendance” Lesson 3: Wrap-up • Do not expire • May be issued only to children who: • Are four years of age or older; and • Have met all the requirements for school attendance as outlined in the Policy Guide 3231REQ; and • Have all the required vaccine administration dates or natural immunity dates filled in; and • Do not have a “Date of Expiration” completed

13. Exemptions Summary of Training Exemptions • Georgia law allows for two types of exemptions from the immunization requirements: • Medical • Religious • Each child must have one of two items on file; either a valid Georgia Immunization Certificate (Form 3231) or a signed, notarized statement, which is called an affidavit of religious exemption.

14. Exemptions Assessment and Evaluation • Medical: • Should be used only when there is a condition that contraindicates immunization with a specific vaccine • Should be documented in the medical exemption box indicated for each vaccine • Should be reviewed annually • Religious: • Not documented on the certificate • No special certificate available or needed • Documented by a notarized affidavit stating that immunization conflicts with the parent/guardian’s religious belief • Notarized statement should be kept on file by the school or facility in lieu of a Certificate of Immunization • Do not expire

15. Required Number of Doses For Children Who Started Immunizations Before Age 7 Years

16. Required Number of Doses For Children Who Started Immunizations After Age 7 Years

17. Certificate Certification Each certificate must : • Be signed by a physician licensed in Georgia, a public health official or Georgia Registry of Immunization Transactions and Services (GRITS) official. A stamp of a physician’s signature is permissible when cosigned by an office staff member. • Have a printed, typed or stamped address of the physician or health department. • Have a complete date of issue with the month, day and year. • A photocopy or faxed copy of a certificate is acceptable.

18. Top Ten Certificate “Bloopers” Top Ten 3: Completing both boxes: Should be one or the other 10: “Complete for School” checked for child under age 4 9: No dose DTaP after 4th birthday 2: Doses Hep B spaced incorrectly 7: 1st dose MMR given before age 1 yr. 5: Varicella Immunity not documented by vaccine or hx/dx/serology date 6: 1st dose varicella given before age 1 yr. 8: No 2nd dose varicella documented 4: Address and/or contact information not completed 1: No physician signature

19. Georgia Registry of Immunization Transactions and Services (GRITS)

20. Georgia Registry of Immunization Transactions and Services (GRITS) • GRITS is a statewide Web-based system that stores immunization information about residents of Georgia from birth to death. • The GRITS immunization information system allows for a child’s history to be stored in a secure database. Doctors’ offices, clinics, schools and childcare facilities enrolled as GRITS providers can access a child’s vaccination history quickly and easily.

21. Georgia Registry of Immunization Transactions and Services (GRITS) • GRITS determines the vaccinations that are due or overdue and those that are valid or invalid based on minimum age and time intervals from the Advisory Committee on Immunization Practices (ACIP). GRITS also: • Provides guidance to healthcare providers about which vaccines a child should receive at each visit. • Creates and prints valid immunization certificates (Form 3231). • Features a demographic screen where users can view and print data and access a child’s full immunization history. • Enables schools and childcare providers to print signed copies of Form 3231 if the child is current on his immunizations. • Allows schools and childcare facilities to create reports and manage immunization coverage within their facility. • GRITS offers a variety of training methods, including onsite training and interactive CDs. Contact GRITS at 404-463-0809 for more information about how your facility can access GRITS.

22. Keeping Certificates Organized and Current • Schools and childcare facilities are responsible for setting up and keeping an organized system for filing immunization certificates. • Keeping immunization certificates organized: –Allows for easier identification of unprotected children in the event of a disease outbreak. – Provides a method for quickly reviewing records for audits.

23. Keeping Certificates Organized and Current • Any system that works is acceptable as long as the required information can be easily located. Using an organized system or method for tracking current certificates of immunization allows you to easily identify certificates that will expire and notify the parents ahead of time. Certain spreadsheets and software programs work well to track when certificates will expire, but a notebook will always be needed to maintain the following: – A list of all children who are current in your facility and where each certificate is located – A list of names and birth dates of students who have medical or religious exemptions (The religious affidavit should be placed in the student’s permanent record) – A list of students who are excluded from attending – All current and valid certificates

24. Keeping Certificates Organized and Current • It will be important to have a system for reminding parents that new certificates are • due within 30 days of the expiration date. The status of expiring or expired certificates should be clearly noted with information about how you notified the parent or guardian, including the dates you spoke to the parent or guardian or sent a letter requesting a certificate and any other comments. • Plan for children who are excluded from attending school: – There should be a specific plan for sending home all children whose parent or guardian does not provide updated current certificates within 30 days of the expiration date. – A list of those excluded from attending also should be in the notebook. – The certificates for children excluded from attending may be kept in a separate folder. – The certificates in the notebook are for children who are currently attending your school or childcare facility.

25. Keeping Certificates Organized and Current • If a child leaves or transfers, the certificate should be given to the parent or guardian or sent to the new school or childcare facility. If you keep a copy of these certificates, file them in a folder labeled “inactive.” • Immunization certificates that are marked “complete for school” may be submitted by the parent or guardian or printed from GRITS. The certificates should be filed immediately in the student’s permanent record.

26. The Assessment • The following information is recorded during the immunization assessment: • Number of children enrolled • Number of children who have valid current certificates • Number of children with expired certificates • Number of children with current 30-day waivers • Number of children with religious exemptions • Number of children with medical exemptions • Number of children with certificates marked “complete” but missing required doses • Number of children with no documentation on file

27. The Assessment • When the certificates are reviewed, 100 percent of children attending the school or childcare facility must have appropriate immunization documentation to meet the requirements of the law. • Noncompliant childcare facilities will be reported to the Georgia Department of Early Care and Learning (DECAL). • Noncompliant private and public schools will be reported to the Georgia Department of Community Health’s Office of the Inspector General. In addition, noncompliant public schools will be reported to the Georgia Department of Education (DOE).

28. Resources The Assessment • Local Health Department • District Immunization Coordinator • GA Immunization Program Office • On call Help line: 404-657-3158 • GRITS Help Line:1-888-223-8644 • VFC Help Line:1-800-848-3868 • Website http://health.state.ga.us/programs/immunization • Your local Immunization Program Consultant (IPC) • GA Chapter of the AAP • GA Academy of Family Physicians

29. Http://health.state.ga.us/programs/immunization

30. Questions ?????