Implementing WA New State Exemption Requirements -

1. Preschool/Child Care Immunization Requirements Department of Health Office of Immunization and Child Profile May 2013 Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/Preschools August XX, 2011

2. Topics to be Covered • What are the child care and preschool vaccine requirements in Washington State? • Complete, Conditional, Out of Compliance: What do they mean? • How can I use the Washington State Immunization Information System (IIS) to find out if a child is complete? 

3. Why Do We Need Immunizations? • We don’t see diseases once common. Vaccines successfully prevent disease • However, diseases and outbreaks still occur • Children are at risk in the child care and preschool setting

4. 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 diseases at ages and intervals according to the national immunization schedule • Parents must turn in completed Certificate of Immunization Status (or Certificate of Exemption) • www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/Regulations.aspx

5. Immunization Requirements

8. Changes to Exemption Law • www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/Exemptions.aspx • Sample Certificates of Exemption • Training video • Frequently Asked Questions

9. Vaccines Required for Preschool or Child Care Attendance • DTaP • Hepatitis B • Hib • IPV • MMR • PCV • Varicella

10. Recommended, but Not Required • Flu • Hepatitis A • Rotavirus

11. Immunization Status • Complete/Fully Immunized • Conditional • Temporary status to allow child to get fully immunized • Out of Compliance • Exempt

12. 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

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

15. www.doh.wa.gov/Portals/1/Documents/Pubs/348-051-SchoolChart2013-2014.pdfwww.doh.wa.gov/Portals/1/Documents/Pubs/348-051-SchoolChart2013-2014.pdf

16. 4 Day Grace Period • Vaccines given 4 days or fewer before the minimum interval or age are valid • Vaccines given more than 4 days before the minimum interval or age are NOT valid and need to be repeated • Applies to all vaccines before minimum intervals OR ages

17. 4 Day Grace Example Dose 3 valid given 3 days before 6 months of age

18. DTaP Requirement

19. DTaP Minimum Age and Intervals

20. DTaP Details • 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; Tdap and Td given to children 7 years of age or older

21. DTaP Example Note red X because Dose 4 given too early Dose 4 past due

22. Hepatitis B Requirement

23. Hepatitis B Minimum Age and Intervals

24. Hepatitis B Details • Routine schedule: birth, 1 month, and 6 months • Pay attention to min age for dose 3 and minimum intervals between doses

25. Hib Requirement

26. Hib Minimum Age and Intervals

27. Hib Details • Routine schedule: 2, 4, 6, and 12-15 months • Not recommended for children 5 years or older • The recommended immunization schedule for Hib vaccines:

28. Hib Details • 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.

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

30. Hib Example

31. IPV Requirement

32. IPV Minimum Age and Intervals

33. IPV Details • Routine schedule: 2, 4, 6-18 months, and booster at 4-6 years • IPV used routinely in US for polio vaccination, but children coming from a foreign country may get OPV • Any combination of IPV or OPV valid

34. MMR Requirement

35. MMR Minimum Age and Intervals

36. MMR Details • 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

37. MMR Example Note red X – MMR given 5 days too early

38. Pneumococcal Conjugate Vaccine (PCV) Requirement

39. PCV Minimum Age and Intervals

40. PCV Details • Routine schedule: 2, 4, 6, and 12-15 months • PCV is not recommended for children 5 and older • 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

41. PCV Details • 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.

43. PCV Example Katey is complete with 3 doses!

44. Varicella Requirement

45. Varicella Minimum Age and Intervals

46. Varicella Details • 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

47. Varicella Example Note red X – Varicella not given same day as MMR

48. Resources www.doh.wa.gov/immunization/schoolandchildcare • 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

49. Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/Preschools August XX, 2011