California Department of Public Health Immunization Requirements for Child Care

1. California Department of Public Health, Immunization Branch

3. Tools & Resources Available at Local Health Departments www.ShotsforSchool.org CAIR Blue Card Online and at Local Health Departments www.ShotsforSchool.org

4. Up-to-Date Online Resource

5. What Will I Learn? By the end of this lesson, you’ll be able to: Locate immunization requirements by age Describe the ways children may be admitted Implement immunization requirements

6. Locate Immunization Requirements

7. Locate Immunization RequirementsEntry for Child Care* * Includes child-care centers, day nurseries, nursery schools, family day care homes, and development centers For infants and children ages 2 months to 5 years. Note: The ages depicted refer to both the age a child enters child care and the ages when subsequent doses are due.

8. Locate Immunization RequirementsEntry for Child Care Self Check Cecilia is 20 months old and about to enter child care. Which immunizations are required for entry based on her age?

9. What Will I Learn? By the end of this lesson, you’ll be able to: Locate immunization requirements by age Describe the ways children may be admitted Implement immunization requirements

10. Describe How Children May Be AdmittedImmunizations Are Current What does this mean? Children who are current on all required immunizations and have no remaining doses for their age may be unconditionally admitted. Children may be admitted if they: Are 18 months or older and have received all required immunizations for age.

11. Describe How Children May Be AdmittedPermanent Medical Exemption • What does this mean? • A licensed physician determines that one or more vaccine(s) is not indicated due to a permanent physical condition or medical circumstance. A valid Permanent Medical Exemption requires submission of a licensed physician’s written statement which states: • the physical condition or medical circumstance of the child is such that the required immunization(s) is not indicated, • the vaccine(s) to be exempted, and • the medical exemption is permanent. Children may be admitted if they: Have filed a valid statement of Permanent Medical Exemption and immunization records for required shots not received or otherwise exempted.

12. Describe How Children May Be AdmittedConditional Admission for Child Care California Code of Regulations • A valid Temporary Medical Exemption requires submission of a licensed physician’s written statement which states: • the physical condition or medical circumstance of the child is such that the required immunization(s) is not indicated; • the vaccine(s) to be exempted; and • the date the temporary medical exemption will end. Children may be admitted if they: Meet one of these conditions for conditional admission:

13. Refer to “Laws” Tab for Details

14. Describe How Children May Be AdmittedTransferring PBEs Filed before 2016 (per SB 277) Children may be admitted if they: • Have a PBE previously filed before 2016 at a child-care facility and immunization records or medical exemptions for all required shots not included in the PBE. Senate Bill 277 (Pan, 2015) Parents of students in any school or child-care facility are no longer allowed to submit a new personal beliefs exemption (PBE) to a currently required vaccine. Personal beliefs exemptions may be transferred between child-care facilities in California. A personal beliefs exemption filed with a child-care facility before January 1, 2016 is valid until entry into the next grade span (transitional kindergarten through 6th grade). However, if the personal belief exemption documentation is no longer available, children must meet immunization requirements to attend the new child-care facility.

15. Personal Beliefs Exemptions No Longer an Option for New Admissions (Effective 1/1/2016) FAQs are available to assist

16. Describe How Children May Be AdmittedSummary Children may be admitted if they: Are 18 months or older and have received all required immunizations for age. Have filed a valid statement of Permanent Medical Exemption and immunization records for required shots not received or otherwise exempted. Have a PBE previously filed before 2016 at a child-care facility and immunization records or medical exemptions for all required shots not included in the PBE. Qualify to be admitted as conditional entrants.

17. Conditional EntrantsFor Child Care Self Check Under which three conditions may children be admitted into child care as conditional entrants?

18. What Will I Learn? By the end of this lesson, you’ll be able to: Locate immunization requirements by age and grade Describe the ways children may be admitted Implement immunization requirements

19. Implement Immunization RequirementsStep by Step: Preparing for a Child’s 1st Day Before starting, you’ll need these items: Student’s personal immunization record(yellow card, CAIR, or other record); California School Immunization Record(Blue Card);(Obtain a blank one to fill out or print from CAIR.) Guide to Immunizations Required for Child Care or Preschool; Your facility’s follow-up system (to add entries as needed). Tip: The Window for Immunizations is a free resource that helps you identify missing immunizations required for child care.

20. Implement Immunization RequirementsStep by Step: Preparing for a Child’s 1stDay Child-care staff should: Obtain the child’s personal immunization record—even if the child has an exemption. Complete the top portion of the Blue Card and transfer vaccine dates from child’s personal immunization record. (Or printout from CAIR.)(Follow instructions on the back of the Blue Card.) Determine if requirements are met by comparing number of doses on the Blue Card to the Guide to Immunizations Required for Child Care or Preschool. If child has a Permanent/ Temporary Medical Exemption or a PBE filed prior to 2016 at a previous facility, make sure that immunization records are submitted for any vaccines not exempted. Complete the Documentation and Status of Requirements box.(Follow instructions on the back of the Blue Card.) File the completed Blue Card in the child’s folder.

22. Implement Immunization RequirementsPreparing for a Child’s 1st Day: Permanent Medical Exemption California School Immunization Record

23. Implement Immunization RequirementsPreparing for a Child’s 1stDay: Temporary Medical Exemption California School Immunization Record

24. Implement Immunization RequirementsPreparing for a Child’s 1stDay: Conditional Admission Under 18 months old? Look to Guide for Immunizations Required for Child Care or Preschool to determine if the child may be admitted. Eileen, I added this slide to distinguish between conditional admissions under 18 mos and over 18 mos old.

25. Implement Immunization RequirementsPreparing for a Child’s 1stDay: Conditional Admission 18 months or older and missing doses for age? Look to Table 2 to determine if the child may be admitted.

26. Implement Immunization RequirementsPreparing for a Child’s 1stDay: Conditional Admission • Use Notice of Immunizations Needed letter to notify parents of vaccines due before admission.

27. Implement Immunization RequirementsA Child’s 1st Day: Requirements Are Not Met If children are either due for doses or missing documentation on their 1st day: Do NOT admit or allow entry. Refer parents or guardians to primary care provider to receive immunizations (or their local health department for additional resources). You may use the Notice of Immunizations Needed letter and Parents’ Guide to ImmunizationsRequired for Child Care or Preschool to inform parents of the next doses needed.

28. Conditional Entrants: Under 18 Months Old Throughout the Year Determine timing for the next dose in a series: Children are due for the next dose in a series at the beginning of the age category.

29. Conditional Entrants: 18 Months or OlderThroughout the Year Determine timing for the next dose in a series:

30. Conditional EntrantsThroughout the Year Step by Step: • Create a reminder entry in your follow-up system to notify parents or guardians when next shots are due. • Use the Notice of Immunizations Needed letter and Parents’ Guide to ImmunizationsRequired for Child Care or Preschool to inform parents of the next doses needed. Please make sure you include the deadline. • Review records at least every (30) days. If you discover a child has missed the next dose and was not excluded, child-care facilities must notice parents or guardians and may give them up to (10) school days to comply before the child is excluded.

31. Sample Follow-Up SystemsFollow-up for Conditional Entrants Screaming Eagles Child Care James Doe 2nd MMR Jane Doe 3rd DTP Set a schedule and check your follow-up system every 30 days for children with pending vaccinations.

32. Conditional Entrants: Under 18 Months OldFor Child Care Steps Compare number of doses on his Blue Card to Guide to Immunizations Required for Child Care or Preschool. Jose will need an additional polio shot, additional dose of Hib (on or after 1st birthday), and (1) MMR (on or after 1st birthday). Contact and send parents the Notice of Immunizations Needed letter. Create another entry in your follow-up system to ensure that those doses are received when due. Self Check Today is November 2, 2015. You are running your monthly follow-up report and are reminded that Jose will turn 15 months and age into new requirements in one month. What will you do?

33. What Will I Learn? By the end of this lesson, you’ll be able to: Locate immunization requirements by age and grade Describe the ways children may be admitted Implement immunization requirements

34. Complete Annual Immunization Reporting Complete and submit the annual immunization reporting for Child Care each fall.

35. How is Your Facility Doing?Based on Fall Immunization Reporting

36. Reportable Diseases California Code of Regulations Child care facilities must report incidents of certain infectious diseases to the local health department as soon as identified.

37. Questions? You should now be able to: Locate immunization requirements by age Describe the ways children may be admitted Implement immunization requirements

38. Personal Beliefs Exemptions No Longer an Option for New Admissions (Effective 1/1/2016) Summary of Senate Bill 277 (Pan, 2015) Effective January 1, 2016, parents of students in any school or child-care facility are no longer allowed to submit a new personal beliefs exemption (PBE) to a currently required vaccine. A PBE filed before 2016 at: A child-care facility will remain valid until the child first enters the span between TK/K through 6th grade. Entry to any grade from TK/K through 6th grade will remain valid until the child completes 6th grade. Entry to any grade from 7th through 12th will remain valid through 12th grade. Students are no longer required to have immunizations for entry if they attend a home-based private school or an independent study program and do not receive classroom-based instruction. For these students, parents must continue to provide immunization records to their schools and schools must continue to maintain and report records of immunizations. Students who have an individualized education program (IEP) should continue to receive all necessary services identified in their IEP regardless of their vaccination status.