Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/Preschools

August XX, 2011

Preschool/Child Care Immunization RequirementsDepartment of Health Office of Immunization and Child Profile

May 2013

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? 

Why Do We Need Immunizations?

We don’t see diseases once common. Vaccines successfully prevent disease

However, diseases and outbreaks still occurChildren are at risk in the child care and preschool

setting

Immunization RequirementsChildren 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

Immunization Requirements

Comply with State Board of Health immunization requirements

Required to report to DOH

Licensed child care center (and preschool) √ √

Licensed family home child care

Must comply with DEL rules --

Licensed child care for school age children √ --

Head Start, ECEAP √ √Any preschool in school setting √ √

Changes to Exemption Lawwww.doh.wa.gov/CommunityandEnvironment/Schools

/Immunization/Exemptions.aspx

Sample Certificates of ExemptionTraining videoFrequently Asked Questions

Vaccines Required for Preschool or Child Care Attendance

DTaPHepatitis BHibIPVMMRPCVVaricella

Recommended, but Not Required

FluHepatitis ARotavirus

Immunization Status

Complete/Fully ImmunizedConditional

Temporary status to allow child to get fully immunized

Out of ComplianceExempt

www.doh.wa.gov/Portals/1/Documents/Pubs/348-051-ChildcareChart2013-2014.pdf

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

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

4 Day Grace PeriodVaccines given 4 days or fewer before the

minimum interval or age are validVaccines 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

Patient Name: Katey SIIS Patient ID:

Date of Birth: 02/15/2011 Age: 99 weeks, 22 months, 1 yrs

Vaccination Summary

Does not include all vaccination types. Vaccinations outside the ACIP schedule are marked with an 'X'.

Vaccine Family 1 2 3 4 5 6 7 8

OPV/IPV 04/15/2011 8 weeks

06/18/2012 4 months

08/12/2011 5 months

Invalid Vaccinations

Invalid Vaccinations Date Reason Vaccination Forecast

The forecast automatically switches to the accelerated schedule when a patient is behind schedule.

Vaccine Family Dose Recommended

Date Minimum Valid Date

Overdue Date

Status

Polio 4 02/15/2015 02/15/2015 02/15/2018 Up to Date

4 Day Grace Example

Dose 3 valid given 3 days

before 6 months of age

DTaP RequirementVACCINE By 3 Months

(on or before last day of mo 2)

By 5 Months(on or before last

day of mo 4)

By 7 Months(on or before last

day of mo 6)

By 16 Months(on or before last

day of mo 15)

By 19 Months(on or before last

day of mo 18)

Diphtheria, Tetanus, Pertussis(DTaP/DT)

1 dose 2 doses 3 dosesMay get as early as 6 months.

4 dosesMay get 4th dose as early as 12 months as long as 6 months separate dose 3 and

dose 4.

DTaP Minimum Age and Intervals

Dose # Minimum Age Minimum Interval Between Doses

1 6 weeks 4 weeks between Dose 1 & 2

2 10 weeks 4 weeks between Dose 2 & 3

3 14 weeks 6 months between Dose 3 & 4

4 12 months 6 months between Dose 4 & 5

DTaP DetailsRoutine schedule: 2, 4, 6, 15-18 months, and

booster dose at 4-6 years6 months interval recommended between dose

3 and 4, but 4 months or more is acceptableDTaP given to children less than 7 years of

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

Patient Name: Isabella SIIS Patient ID:

Date of Birth: 04/17/2008 Age: 246 weeks, 56 months, 4 yrs

Vaccination Summary

Does not include all vaccination types. Vaccinations outside the ACIP schedule are marked with an 'X'.

Vaccine Family 1 2 3 4 5 6 7 8

DTaP/DTP/Td 06/17/2008 8 weeks

07/18/2008 3 months

08/18/2008 4 months

X 12/19/2008 8 months

Invalid Vaccinations

Invalid Vaccinations Date Reason DTaP/DT/Td 12/19/2008 Minimum age for this dose not met.

Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule.

Vaccine Family Dose Recommended

Date Minimum

Valid Date Overdue

Date Status

DTaP/DT/Td 4 06/19/2009 06/19/2009 11/17/2009 Past Due

Note red X because Dose

4 given too early

DTaP Example

Dose 4 past due

Hepatitis B Requirement

VACCINEBy 3 Months

(on or before last day of mo 2)

By 5 Months(on or before last

day of mo 4)

By 7 Months(on or before last

day of mo 6)

By 16 Months(on or before last

day of mo 15)

By 19 Months(on or before last

day of mo 18)

Hepatitis B1 dose

May get dose 1at birth.

2 dosesMay get dose 2 as early as 1 month. 3 doses

Hepatitis B Minimum Age and Intervals

Dose # Minimum Age Minimum Interval Between Doses

1 Birth 4 weeks between Dose 1 & 2

2 4 weeks 8 weeks between Dose 2 & 3

3 24 weeks 16 weeks between Dose 1 & 3

Hepatitis B DetailsRoutine schedule: birth, 1 month, and 6 monthsPay attention to min age for dose 3 and

minimum intervals between doses

Hib Requirement

VACCINE By 3 Months(on or before last day of mo

2)

By 5 Months(on or before last day of mo

4)

By 7 Months(on or before last day of mo

6)

By 16 Months(on or before

last day of mo 15)

By 19 Months(on or before last

day of mo 18)

Haemophilus influenzae type B(Hib)

1 dose 2 doses 3 doses 4 doses

Hib Minimum Age and Intervals

Dose # Minimum Age Minimum Interval Between Doses

1 6 weeks 4 weeks between Dose 1 & 2

2 10 weeks 4 weeks between Dose 2 & 3

3 14 weeks 8 weeks between Dose 3 & 4

4 12 months -

Hib DetailsRoutine schedule: 2, 4, 6, and 12-15 monthsNot recommended for children 5 years or olderThe recommended immunization schedule for Hib

vaccines:

Vaccine 2 Months 4 Months 6 Months 12-15 Months

PRP-T* (ActHib)Dose 1 Dose 2 Dose 3 Booster

PRP-OMP (PedvaxHib)

Dose 1 Dose 2 Booster

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.

Doses beforeage 12 months

Doses on or afterage 12 months Status

3 1 Complete

2 1 Complete

1 1 Needs 1 Booster Dose(If Last Dose Given Before 15 Months)

0 1 Needs 1 Booster Dose(If Last Dose Given Before 15 Months)

4 0 Needs 1 Booster Dose

3 0 Needs 1 Booster Dose

2 0 Needs 1 Booster Dose

1 0 Needs 1 Booster Dose

0 0 Needs 1 Dose

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

Patient Name: Isabella SIIS Patient ID:

Date of Birth: 04/17/2008 Age: 246 weeks, 56 months, 4 yrs

Vaccination Summary

Does not include all vaccination types. Vaccinations outside the ACIP schedule are marked with an 'X'.

Vaccine Family 1 2 3 4 5 6 7 8

Hib 06/18/2008 8 weeks

05/17/2009 13 months

Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule.

Vaccine Family Dose Recommended

Date Minimum Valid Date

Overdue Date

Status

Hib 3 07/12/2009 07/12/2009 8/17/2009 Past Due

Hib Example

IPV Requirement

VACCINE

By 3 Months(on or before

last day of mo 2)

By 5 Months(on or before last

day of mo 4)

By 7 Months(on or before

last day of mo 6)

By 16 Months(on or before last day of mo

15)

By 19 Months(on or before last day of mo

18)

Polio(IPV or OPV)

1 dose 2 dosesMay get as early as 4 months.

3 doses

IPV Minimum Age and Intervals

Dose # Minimum Age Minimum Interval Between Doses

1 6 weeks 4 weeks between Dose 1 & 2

2 10 weeks 4 weeks between Dose 2 & 3

3 14 weeks 6 months between Dose 3 & 4

IPV DetailsRoutine schedule: 2, 4, 6-18 months, and

booster at 4-6 yearsIPV used routinely in US for polio vaccination,

but children coming from a foreign country may get OPV

Any combination of IPV or OPV valid

MMR RequirementVACCINE

By 3 Months(on or before last

day of mo 2)

By 5 Months(on or before last

day of mo 4)

By 7 Months(on or before last

day of mo 6)

By 16 Months(on or before last

day of mo 15)

By 19 Months(on or before last

day of mo 18)

Measles, Mumps, Rubella (MMR)

Not given before 12 months of age. 1 dose

MMR Minimum Age and Intervals

Dose # Minimum Age Minimum Interval Between Doses

1 12 months 4 weeks between Dose 1 & 2

MMR Details

Routine schedule: 12-15 months and 4-6 yearsDose 1 given <12 months of age must be

repeated (4 day grace applies)MMR or MMRV can be usedIf not given on same day, minimum interval

between MMR and varicella is >28 dayso The second vaccine given is not valid and

should be repeated

Patient Name: Katey SIIS Patient ID:

Date of Birth: 02/15/2011 Age: 99 weeks, 22 months, 1 yrs

Vaccination Summary

Does not include all vaccination types. Vaccinations outside the ACIP schedule are marked with an 'X'.

Vaccine Family 1 2 3 4 5 6 7 8

MMR X 02/10/2012 11 months

Invalid Vaccinations

Invalid Vaccinations Date Reason MMR 02/10/20012 Minimum age for this dose not met.

Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule.

Vaccine Family Dose Recommended

Date Minimum

Valid Date Overdue

Date Status

MMR 1 03/09/2012 03/09/2012 06/15/2012 Past Due

MMR Example

Note red X – MMR given 5

days too early

Pneumococcal Conjugate Vaccine (PCV) Requirement

VACCINE By 3 Months(on or before last day of mo

2)

By 5 Months(on or before last day of mo

4)

By 7 Months(on or before last day of mo

6)

By 16 Months(on or before

last day of mo 15)

By 19 Months(on or before

last day of mo 18)

Pneumococcal Conjugate(PCV7 or PCV13)

1 dose 2 doses 3 doses 4 doses

PCV Minimum Age and Intervals

Dose # Minimum Age Minimum Interval Between Doses

1 6 weeks 4 weeks between Dose 1 & 2

2 10 weeks 4 weeks between Dose 2 & 3

3 14 weeks 8 weeks between Dose 3 & 4

4 12 months -

PCV Details

Routine schedule: 2, 4, 6, and 12-15 monthsPCV is not recommended for children 5 and olderA single supplemental dose of PCV13 is

recommended, but not required, for all children aged 14–59 months who got 4 doses of PCV7o PCV13 replaced PCV7 in 2010

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.

PCV Doses Required Chart

Doses before Age 12 months

Doses on or after Age 12 months Status

3 1 Complete(If PCV7 given, needs one additional dose of PCV13)

21 (8 weeks after

# 2)Complete

0 2 Complete1 2 Complete1 1 Needs 1 dose 8 weeks after Dose 2

0 1 Needs 1 dose 8 weeks after Dose 1 if # 1 received at age ≤ 24 months

4 0 Needs 1 dose 8 weeks after Dose 4

3 0 Needs 1 dose 8 weeks after Dose 3

2 0 Needs 1 dose 8 weeks after Dose 2

1 0 Needs 2 doses (8 weeks apart) if age 12 - 24 monthsNeeds 1 dose if age ≥ 24 - 59 months

0 0 Needs 2 doses (8 weeks apart) if age 12 - 24 monthsNeeds 1 dose if age ≥ 24 - 59 months

Patient Name: Katey SIIS Patient ID:

Date of Birth: 02/15/2011 Age: 99 weeks, 22 months, 1 yrs

Vaccination Summary

Does not include all vaccination types. Vaccinations outside the ACIP schedule are marked with an 'X'.

Vaccine Family 1 2 3 4 5 6 7 8

Pneumococcal, PCV-13 (Prevnar13®) 04/15/2011 8 weeks

06/15/2012 4 months

02/16/2012 12 months

Invalid Vaccinations

Invalid Vaccinations Date Reason

Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule.

Vaccine Family Dose Recommended

Date Minimum

Valid Date Overdue

Date Status

PCV Example

Katey is complete

with 3 doses!

Varicella Requirement

VACCINE

By 3 Months(on or before

last day of mo 2)

By 5 Months(on or before last day of mo

4)

By 7 Months(on or before last

day of mo 6)

By 16 Months(on or before

last day of mo 15)

By 19 Months(on or before

last day of mo 18)

Varicella Not given before 12 months of age.1 dose

Required: if unvaccinated, health care provider must verify

disease.

Varicella Minimum Age and Intervals

Dose # Minimum Age Minimum Interval Between Doses

1 12 months 3 months between Dose 1 & 2

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

Patient Name: Isabella SIIS Patient ID:

Date of Birth: 04/17/2008 Age: 246 weeks, 56 months, 4 yrs

Vaccination Summary

Does not include all vaccination types. Vaccinations outside the ACIP schedule are marked with an 'X'.

Vaccine Family 1 2 3 4 5 6 7 8

MMR 02/17/2012 12 months

Varicella X 02/27/2012

12 months

Invalid Vaccinations Invalid Vaccinations Date Reason

Varicella 02/27/2012 Live vaccines not administered on same date must be separated by 28 days.

Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule.

Vaccine Family Dose Recommended

Date Minimum

Valid Date Overdue

Date Status

Varicella 1 03/26/2012 03/26/2012 06/15/2012 Past Due

Varicella Example

Note red X – Varicella not given same day as MMR

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

Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/Preschools

August XX, 2011