Implementing WA New State Exemption Requirements -

1. School Immunization Requirements: Part 3 August, 2012 Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/Preschools August XX, 2011

2. 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

3. Required School Immunizations • Hep B • DTaP • Tdap • IPV • MMR • Varicella

4. Hepatitis B Requirements

5. Hepatitis B Example Red X shows Dose 3 is invalid Forecast shows Dose 3 should be repeated and is now past due

6. 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)

7. DTaP Example Note red X because Dose 5 given too early Dose 5 due now according to vaccination forecast

8. 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

9. 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

10. Tdap/Td Catch-up Schedule for >7 Years of Age

11. Tdap Example 2 Td is past due Tdap given to kids 7 and older are given as a catch-up dose

12. 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

13. 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

14. IPV Example 1 IPV Dose 4 marked with a red X IPV dose 4 needs to be repeated and is due now

15. IPV Example 2 IPV Dose 4 valid at age 24 months since given before 8/7/09

16. 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

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

18. 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.

19. 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

20. 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

21. 4 Day Grace Example 2 Varicella Dose 2 given 5 days before it was due

22. 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

23. Thank you for watching this training! Send clinical questions to: immunenurses@doh.wa.gov Please complete an evaluation at: School Immunization Requirements Evaluation