Implementing WA New State Exemption Requirements -

1. 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

2. Contact Information Dept. of Health Office of Immunization and Child Profile Trang Kuss, RN, MN, MPH School and Child Care Coordinator trang.kuss@doh.wa.gov; 360-236-3760

3. 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? 

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 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

5. Immunization Requirements

6. Examples of those not required to comply • Facilities not required to have a DEL license • Coop preschool • Birth to Three Program

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

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

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

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

16. DTaP Requirement

17. DTaP Minimum Age and Intervals

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

19. What to do if: • 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

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

21. Note red X – Tdap given as dose 2 DTaP Example

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 • 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.

29. 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.

30. Hib Doses Required Chart

31. Hib Example

32. IPV Requirement

33. IPV Minimum Age and Intervals

34. IPV Details • 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

35. MMR Requirement

36. MMR Minimum Age and Intervals

37. 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

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

39. Pneumococcal Conjugate (PCV) Requirement *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.

40. PCV Minimum Age and Intervals

41. PCV Details • 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

42. 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.

44. Katey is complete with 3 doses! PCV Example

45. Varicella Requirement

46. Varicella Minimum Age and Intervals

47. 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

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

49. 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 applies if live vaccines given at the same visit

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