CALIFORNIA IMMUNIZATION REQUIREMENTS CHILD CARE/PRESCHOOL PROGRAMS

Jennifer Sterling San Diego Immunization Program

County of San Diego Health and Human Services Agency

www.sdiz.org

2018

List immunization requirements for childcare

Identify acceptable forms of immunization records

Complete the California School Immunization Record (CSIR)/Blue

Card correctly

Create a tracking system for conditional entrants and exemptions

How to submit the state immunization report to CDPH accurately

At the end of this training, you will be able to:

TRAINING OBJECTIVES

Spread of Disease is just a Cough, Sneeze or Handshake away

Immunizations help prevent the spread of communicable diseases

Cover mouth (w/arm) when coughing or sneezing

Wash hands w/ soap & water

Avoid contact with people who are sick

These signs along with many others are available at www.sdiz.org

PREVENTION OF DISEASE - SIMPLE

WHY CHECK IMMUNIZATION RECORDS?

To prevent children from serious diseases like chicken pox and measles.

To help parents keep their kids healthy and on track with their shots.

The California School Immunization Law requires school & child care providers to enforce immunization requirements!!

Advisory Committee of Immunization Practices (ACIP) Recommendations

Change yearly

Based on valid doses Extensive list of immunizations ACIP recommends to stay

healthy Based on age and high risk groups across the lifespan CA Requirements Have had minimal changes since 2003: Based on a number of doses Limited list of vaccines required by age and/or grade level

ACIP RECOMMENDATIONS VS STATE LAW REQUIREMENTS

1. Obtain the child’s personal immunization record

Must identify the student by name and DOB

Must show the date each required vaccine dose was received

Acceptable records: medical charts, out-of-state or international records, military records, other Blue Cards, etc.

2. Complete a California School Immunization Record (Blue

Card). A blue card must be on file for every student regardless

of immunization status

IMPLEMENTING IMMUNIZATION REQUIREMENTS

CA REQUIRED VACCINES – CHILD CARE/PRESCHOOL

IMM 230 Every child must

be up-to-date with their immunizations

VACCINE COMBINATIONS

Available for download at: www.sdiz.org

HELPFUL TOOLS

Admitting under Conditional and

follow-up schedule

CONDITIONAL SCHEDULE

Students who do not have an immunization history should be referred to a physician.

WHAT CAN BE DONE

Yellow Cards are best – if a parent does not have one, suggest they have their current record transcribed for future convenience

THE YELLOW CARD

ACCEPTABLE?

YES! Record has dates each

vaccine was given Official form from a

clinic

Jane Doe

MEDICAL RECORDS

Acceptable???

NO! Record is stamped but

does not show dates each vaccine was given

Official Mexico Immunization Record

Hernandez, Jose

12/12/2006

MEDICAL RECORDS CONTINUED

Family, friends, etc. can be used as unofficial translators

If no one is available, suggest a bilingual physician

Fax the record to: Jennifer Sterling @ 619-692-6619

CONFUSING IMMUNIZATION RECORDS

HOW TO COMPLETE THE CALIFORNIA SCHOOL BLUE CARD

1. Demographic Information

2. Vaccination History

3. Documentation

4. Status of Requirements

Completing the California School Immunization Record (Blue Card)

BLUE CARD

Parents may complete this section Don’t send home – form should be completed in front of you

Please answer questions in full The State & County use this information to find health

disparities

Ethnicity is an important part of the card

You do not have to update address/phone each time it changes

STEP 1: DEMOGRAPHIC INFORMATION

STEP 2: VACCINATION HISTORY

Children Entering your program from another country without vaccine history:

Do not allow any grace period Refer family to their physician or public health dept.

Children Entering your program from another preschool program without vaccine history:

There is no grace period for this situation.

Children who have received vaccine doses up to (and including) 4 days before the recommended age or required intervals will not have to repeat the doses.

MMR: must be given on or after the 1st birthday

Up to 4 days before the birthday is okay!

Date of Birth: January 7, 2009

MMR 1: January 8, 2010 = VALID

MMR 1: January 4, 2010 = VALID

MMR 1: January 2, 2010 = INVALID*

*MMR must be given again

4-DAY GRACE PERIOD

DISEASE *

*History of disease must be documented!

X

Dr. Disease History

Titers Pediatrics

619-999-9999

DOCUMENTING CHICKEN POX DISEASE

1. Sign and Date this section. a) It does not have to be

signed by a nurse b) It should be signed

even if the child is NOT up-to-date

2. Specify which kind of

personal shot record you used to make the blue card

STEP 3: DOCUMENTATION

(a) All requirements are met

(b) Currently up-to-date, but more doses are due later. Requires follow-up

Exemption was granted for:

(c) Medical Reason - Permanent

(d) Medical Reason – Temporary

(e) No longer to be used for new

records

STEP 4: STATUS OF REQUIREMENTS

Status (A) Students who are up-to-date on all their vaccines for the grade level they attend are considered “All Requirements Met” Date the documentation section of the card and place in the student’s permanent folder.

ALL REQUIREMENTS MET

Children currently are up-to-date (next doses not yet due) These children will be admitted on the condition that they will receive still-needed doses as they become due in the future.

Staff must follow-up by:

Notifying parents: Notice of Immunizations Needed

Checking documentation that the needed immunizations were received

Adding the new dates to the Blue Card

ADMITTING CHILDREN “ON CONDITION” STATUS (B)

Children with health insurance should receive immunizations through their healthcare provider or local pharmacy

Immunizations may be provided at Public Health Centers for children who meet vaccine eligibility criteria:

Covered by Medi-Cal Uninsured

WHERE TO RECEIVE IMMUNIZATIONS

Permanent Medical (C) Must have written documentation from

doctor*

Must identify student by name and DOB

Keep document with the Blue Card

Ex: Child with an allergy to a vaccine or 4-day rule violation

* Must be licensed MD or DO

STATUS OF REQUIREMENTS EXEMPTIONS: STATUS (C)

Temporary Medical (D)

Must have written documentation from doctor*

with an end-date to exemption

Must identify student by name and DOB

Must get shots at end of exemption Ex: Child who was sick at appointment

* Must be licensed MD or DO

STATUS OF REQUIREMENTS EXEMPTIONS: STATUS (D)

STATUS OF REQUIREMENTS EXEMPTIONS: STATUS (E)

*Personal Beliefs (PBE) (E)

• Requires specific form CDPH 8262 be signed prior to January 1,

2016 • Requires signature by provider and parent on the form

acknowledging consent • Not acceptable for first time registrants

*Religious Belief • Requires documentation on CDPH 8262 • Requires the form be signed prior to January 1, 2016 • Requires parent signature

• Not acceptable for first time registrants

The Law

SENATE BILL 277

This bill eliminated the personal belief and religious belief exemption from existing for specified immunization requirements.

SB277 took affect on July 1, 2016. This affected the 2016/2017

childcare year Students who have had CDPH form 8262 signed prior to January 1,

2016, will be grandfathered in until child advances into TK/Kinder *Define “grade span” as: a) birth to preschool; b) kindergarten (including transitional kindergarten) to grade 6; or c) grades 7 to 12.

Keep Blue Cards separate Conditional Entrants who need follow-up

Kids with exemptions

Ensure that your system is secure

from public viewing – be HIPPA

Compliant!

Use a Calendar

Use a tickler file

FOLLOW-UP SYSTEMS

The child has 10 business days to receive the needed

immunizations.

Choose vaccines they need

Provide “END” date for receiving vaccines

IF REQUIREMENT IS NOT MET

TRANSFERRING RECORDS

Child Care Centers: The original “Blue Card” or a copy of it

must be kept with the child’s file during the period of enrollment and for three years after the child leaves your care.

REQUIRED ANNUAL REPORTING

Annual Assessments

Completed each fall

Child care centers (ages 2 – 4 yrs 11 months)

No infant reports

Submitted online to the California Department of Public Health

Selective Review

Spring review of specific cohort will be checked every year (childcare, kinder and 7th grade)

Collect information from Blue Cards to compare to fall report

Provide assistance

REPORTING

Reporting to the state is a mandatory activity. Reporting will be completed online. It is recommended that you familiarize yourself with the website and expectations.

http://reporting.shotsforschool.org/CC/login.aspx

ANNUAL REPORTING CONTINUED

Reporting usually starts in September and you are notified via the California Department of Public Health, Immunization Branch, via email and letter.

Child Care Centers ages 2-5 report first

It is up to you to update your contact information if you have had a staff change at your facility

REPORTING

REPORTING CHILD CARE

Child Care Worksheet Allows you to calculate Auto sums if use

online tool

REPORTING CHILD CARE WORKSHEET

REPORTING CHILD CARE SUMMARY

Total Number of Children • Total number of children in your facility aged 2-5

years

(A)Unconditional Admission

• Total number of children in your facility, aged 2-5 years, that require no additional doses of vaccine

REPORTING CHILD CARE

Personal belief prior to January 1, 2016 Must have Form 8262 onsite Form must be signed prior to 1/1/16

Permanent Medical Exemptions Must have written letter on doctor letterhead that states

which vaccines and identify the student by name and DOB. This letter can only be signed by a MD or DO

Others: Active Individual Education Plan (IEP)

Everything under the blue line is for children who are missing immunizations and the reason they are missing

Requirements Met, But Missing Doses

Personal Belief Exemption E 0

Permanent Medical Exemption C 0

Others:

IEP Services F1 0

pre-

2016

REQUIREMENTS MET, BUT MISSING DOSES

Conditional Admission, Needs Follow-up

Conditional entrant As Up to Date as possible with vaccines, more needed later

Temporary Medical Exemption Must have written letter on doctor letterhead that states which

vaccines and identify the student by name and DOB. This letter can only be signed by a MD or DO and must have an end date

CONDITIONAL ADMISSION, NEED FOLLOW-UP

Conditional Entrant B 0

Temporary Medical Exemption D 0

CONDITIONAL ADMISSION – NEEDS FOLLOW UP

Requirements NOT met, Missing Doses A child in this section can be enrolled in your

program but not attending. These children need to be as up to date as possible to attend your program

REQUIREMENTS NOT MET, MISSING DOSES

Overdue- Enrolled but Not Attending G 0

OVERDUE!

Missing Doses By Vaccine:

Children that are missing doses (below the blue line). Please total the number of

students missing each vaccine:

Polio 0 Hep B 0

DTP 0 Varicella 0

MMR 0

Any missing immunizations for a child must be documented.

Document the children who are missing doses

REQUIREMENTS MET, BUT MISSING DOSES

Note for children who meet criteria in multiple categories:

If a child has an exemption and is also a conditional entrant, please report the child as having the exemption only.

MEET MULTIPLE CRITERIA

All schools and child care centers are mandated to report certain diseases to your local health department. List of diseases you must report to local health department under State guidelines

*CDPH 110a lists all diseases that need to be reported and how you should report Epidemiology Department 619-692-8499

DISEASE REPORTING

WHAT’S NEWS

PROPOSED REGS CHANGES - EXEMPTIONS

Deletes the personal belief exemption pursuant to statutory changes in SB 277 (Stats. 2015, ch. 35)

Clarifies requirements of a medical exemption:

Must be signed

California-licensed MD/DO

WHAT’S NEWS

PROPOSED REGS CHANGES – IMMUNIZATION RECORD

CA School Immunization Record/Blue Card:

No PBE boxes

New layout

Record on file must contain all elements (Blue Card available but optional)

1. Can I let a child with an active PBE transfer into my facility If a child has a CHDP 8262 signed, prior to 2016, from another California

childcare program, they may transfer to your facility

Can I accept a medical waiver from a doctor in Mexico No, the medical exemption is only acceptable from a provider (MD or DO)licensed

in the United States 3. Can I accept a medical waiver from any doctor in the United States

Yes, as long as the provider is a MD or DO. Physician Assistants or Nurse Practitioner cannot sign the letter.

4. Can I accept a new enrollment whose parents tell me they have any appointment next month for vaccines. No. This child would need to start their vaccine series prior to coming in to your

facility.

TOP EXEMPT QUESTIONS

Meet Penny, Patty and Maddie

• All 3 girls are coming from an offsite Preschool to your preschool program this year.

• Penny & Maddie are fully vaccinated. Patty has no history of MMR.

• Can Patty start Kindergarten with no doses of MMR today?

No – You will need to follow-up with Patty’s parents to ensure

that she goes to her next appointment.

TEST YOUR KNOWLEDGE

TEST YOUR KNOWLEDGE

Meet Parker

Parker had a confirmed case of pertussis last year

Parker’s doctor put “disease history” in the DTaP field on the yellow card

Does Parker need to finish his DTaP series?

YES – or…Parker would need a doctor’s note on doctor’s letterhead stating he will not vaccinate Parker with DTaP

OUT OF STATE

Meet Lilly Lilly was in a preschool program in another state

Lilly’s mom is trying to register her at your school

Lilly’s mom had a active personal belief waiver in the state

Can Lilly start at your school?

No Being homeschooled at the last grade span to bypass vaccines does

not exempt a student. Lilly will be required to start the 7-17 age group vaccines .

MMR DILEMMA

Meet Frankie

Frankie is 19 months old and is registering for your program

Frankie has had the individual vaccines for 1 measles, 1 mumps and 1 rubella after his first birthday

Knowing this information, can Frankie start in your program today?

YES – The individual vaccines meet the requirement for the 1 dose of MMR

Under SB 792, day care centers and family day care homes, as part of their licensure requirements, will have to maintain vaccination records for their employees and volunteers for influenza, pertussis, and measles. SB 792 went into effect September 1, 2016. This allowed day care centers a year from the time of its signing to the time of its implementation.

SB 792 (MENDOZA) VACCINES FOR DAY CARE WORKERS

SECTION 1. Section 1596.7995 is added to the Health and Safety Code

Under the new section of the H&S code, childcare staff will be required to show proof of:

1 – Tdap Booster 1 – MMR (a second dose may be needed. Consult with your healthcare provider to determine your level of risk) 1 – Influenza vaccine given between August 1 and December 1 of each year Failure to maintain accurate records will be treated like any other

violation of licensure requirements.

SECTION 1596.7995 REVISION

SB 792 also allows a 30-day grace period of conditional employment.

Staff and Volunteers have 30-days from

day of hire to retrieve or receive required vaccines

EMPLOYEE GRACE PERIOD

A person is medically exempt from the requirements of this section only under any of the following circumstances:

(1) The person submits a written statement from a licensed physician including: Declaring physical/medical Indicate the probable duration of the medical condition

(2) The person submits a written statement from a licensed physician providing that the person has evidence of current immunity to the diseases described in subdivision(a).

MEDICAL EXEMPTION TO THE LAW

A person can have a personal exempt from the influenza requirement only under the following circumstances: (1) The person submits a written declaration that he or she has

declined the influenza vaccination. This exemption applies only to the influenza vaccine. (2) The person was hired after December 1 of the previous year and before August 1 of the current year. This exemption applies only to the influenza vaccine.

PERSONAL EXEMPTION TO THE LAW

San Diego Immunization Branch www.sdiz.org

Shots for School www.shotsforschool.org

California Immunization Coalition www.ImmunizeCa.org

Centers for Disease Control and Prevention www.cdc.gov/vaccines/

American Academy of Pediatrics www.aap.org

Institute for Vaccine Safety www.vaccinesafety.edu

National Network for Immunization Information (NNii) www.immunizationinfo.org

IMMUNIZATION RESOURCES YOU CAN USE

THANK YOU for all you do to protect

our children, families, and community

from disease!

Jennifer Sterling School and Childcare Coordinator

619-692-8366 Jennifer.sterling@sdcounty.ca.gov

Contact Information