Immunization & Examination Requirements for School Entry Revised 07/2016

Immunization & Examination Requirements for School Entry Hawaii Revised Statutes (State Laws) Hawaii Administrative Rules Chapter 11-157 (HAR) Revised 07/2016

Health Requirements Physical Examination (PE) Tuberculosis (TB) Examination Immunizations (IZ) Revised 07/2016

Physical Examination (PE) Each student must present a record of a PE before first attending school in Hawaii. Must be performed within 12 months before first school attendance. Must be performed and signed by either a U.S. licensed physician, Assistant Physician Registered Nurse (APRN), or Physician Assistant (PA). A valid PE may be used for transfer into all other schools in Hawaii. Revised 07/2016

TB Examination Requirements Each student must provide a TB certificate dated within 12 months before first entering school in Hawaii. Must be issued by either the Hawaii Dept. of Health (DOH), a U.S. licensed physician, APRN, or PA. A valid certificate of TB examination may be used for transfer into all other schools in Hawaii. Revised 07/2016

TB Examination Requirements, Cont’d Children who first attend school before age 12 months: must turn in a TB certificate before they reach 14 months of age, or be excluded from school until the certificate is obtained. Revised 07/2016

Tuberculosis Examination Must be performed within 12 months before first attending school in Hawaii. e.g. Given Read Results 1-2-13 1-4-13 0mm 12-31-13 or 4-6-14? Must be a Mantoux tuberculin skin test (PPD). A Tine Test is not acceptable. Revised 07/2016

Tuberculosis Examination, Continued A certificate of TB must include: date administered & read. results in millimeters. signature or stamp of either MD, Doctor of Osteopathic Medicine (DO), APRN, PA, or clinic. Revised 07/2016

Tuberculosis Examination, Cont’d TB Test Results: <10 mm: acceptable for school entry. 10 mm: must also have a CXR (Chest X-Ray). Written documentation of a negative CXR must be provided prior to first attendance at school. Revised 07/2016

Tuberculosis Examination, (Cont’d) Students with a documented, past positive PPD test, may have a CXR (Chest X-Ray) performed without a repeat skin test. Revised 07/2016

Required Immunizations: Preschool/Daycare/Head Start For children < 19 months, there are different immunization requirements, depending on the child’s age. HAR Chapter 11-157, Exhibit B (page 2) Table 1. Revised 07/2016

For children 19 months of age & older: 4 DTaP Required Immunizations: Preschool/Daycare/Head Start (Per CDC Recommendation) For children 19 months of age & older: 4 DTaP 3 IPV (Polio) 1 MMR 4 Hib (at least 3 doses on or after age 12 months) 3 Hep B 1 Varicella Revised 07/2016

Required Immunizations: K – 12 (Per CDC Recommendation) 5 DTaP/1 Tdap 4 IVP (Polio) 2 MMR 3 Hep B 2 Hep A 2 Varicella 3 HPV 2 Meningococcal 1 Influenza (Annually) Revised 07/2016

Required Immunizations: 7th Grade Attendance (Per CDC Recommendation) 2 Hep A 2 Varicella 3 HPV 2 MCV 1 Tdap Revised 07/2016

Immunization Requirements Must have complete dates (month/day/year). Must meet minimum ages & intervals between doses. e.g. (BD: 1-4-13) Hep B 1-5-13 3-5-13 5-1-13 or 7-5-13? Must be signed or stamped by either a U.S. licensed physician, APRN, PA, or DOH clinic. Revised 07/2016

Immunity by Serologic Testing Laboratory evidence of immunity may be substituted for a record of immunization. Requires a laboratory report, signed by either a U.S. licensed physician, APRN, or PA certifying that student is immune to specified disease. Revised 07/2016

Clinical History of Varicella Infection A documented history of Varicella (Chickenpox), signed by either a U.S. licensed physician, APRN, or PA may be substituted for the Varicella vaccine requirement. Revised 07/2016

Minimum Intervals Between Vaccine Doses Hawaii Administrative Rules: Exhibit B, Table 5. There is No maximum interval between doses. An immunization given before the minimum age or interval between doses will NOT be acceptable for school entry. Revised 07/2016

4-Day “Grace Period” A grace period of 4 days applies to each minimum age & interval. Revised 07/2016

Exemptions Apply to Immunizations: Two types: Medical or Religious. There are No exemptions to the TB clearance requirement. Philosophical exemptions are Not allowed by the State. Revised 07/2016

Medical Exemption A medical exemption may be granted by a U.S. licensed physician. A physician must state in writing the medical reason that giving a specific vaccine would endanger the student’s life or health. Revised 07/2016

Medical Exemption, Cont’d Must state the length of time during which the specific vaccine would endanger the student’s health or life. Must be on the stationery or printed forms of the physician. If no end date is indicated, a new physician certificate must be provided for the next school year. Revised 07/2016

Religious Exemption Parent/Legal Guardian must sign a statement certifying that the person’s religious beliefs prohibit the practice of ALL immunizations (EPI 7A – Refer to SHA Manual 5-1-2F). A religious exemption based on an objection to a specific vaccine will not be granted. Revised 07/2016

Provisional Attendance A student who does not complete: all required immunizations report of a PE may attend school Provisionally upon submitting written proof (appointment card) from a health care provider that the student is in the process of completing the missing requirements. There is NO provisional attendance for students lacking a TB clearance. Revised 07/2016

Provisional Attendance, Continued Students attending school on provisional attendance status have 3 months from the date of provisional attendance to complete the missing health requirements. e.g. First day of school: 8-1-14 Has TB clearance No PE, no IZ record EPI 10B sent home: 8-5-14 3 months = 11-5-14 Provisional Entrance Notice (EPI 10B), Refer to SHA Manual 5-1-2C. Revised 07/2016

Provisional Attendance, Cont’d For students who do not complete the missing immunizations or PE within 3 months: School shall send home the “Notice of Exclusion” (EPI 10D – SHA Manual 5-1-2E), to inform parent/legal guardian that the student will be excluded 30 calendar days from the date of notice. e.g. EPI 10D sent home: 11-7-14 Child will be excluded = 12-7-14 Revised 07/2016

Provisional Attendance, (Cont’d) Beginning 30 days from the date of the “Notice of Exclusion,” the student shall be excluded from school. Student may attend school after bringing documentation showing completion of the missing health requirements. Revised 07/2016

Screening Record Case Study (Refer to Attachments) Revised 07/2016

Screening Health Records: Case Sample (Form 14) Revised 07/2016

Case Sample: Student Name & Birth Date Revised 07/2016

Case Sample: PE Date - Within 12 Months of School Entry Date Revised 07/2016

Case Sample: PE – Valid Provider Signature (With Physician Credentials) Revised 07/2016

Case Sample: Valid TB Certification Documented by Physician Revised 07/2016

Resource: How to Complete the Form 14 Revised 07/2016

Case Sample: Immunization Record Screening Revised 07/2016

DTaP or DTP Vaccine Minimum Ages and Intervals Between Doses 1st dose: on or after 6 weeks of age. 2nd dose: at least 4 weeks after 1st 3rd dose: at least 4 weeks after 2nd 4th dose: at least 6 months after 3rd and not before12 months of age. 5th dose: on or after 4 years of age. Revised 07/2016

Exceptions for DTaP Students who received their 4th dose of DTaP on or after their 4th birthday are not required to receive a 5th dose. Revised 07/2016

Polio Vaccine Minimum Ages and Intervals Between Doses 1st dose: on or after age 6 weeks. 2nd dose: at least 4 weeks after 1st. 3rd dose: at least 4 weeks after 2nd. 4th dose: at least 4 weeks after 3rd. Revised 07/2016

Exceptions for Polio For students who receive only OPV or IPV: if the 3rd dose was given on or after the 4th birthday, the 4th dose is not required. For students that receive any combination of the OPV or IPV: 4 doses are required regardless of age when the series was initiated or completed. Revised 07/2016

Hepatitis B Vaccine Minimum Ages and Intervals Between Doses 1st dose: may be given at birth. 2nd dose: at least 4 weeks after 1st. 3rd dose: at least 8 weeks after 2nd dose, and 4 months after 1st dose but not before age 6 months. Revised 07/2016

Varicella Vaccine Minimum Ages and Intervals Between Doses 1st dose: on or after 12 months of age. 2nd dose: at least 4 weeks after 1st dose (only required if 1st dose is given on or after age 13 years). Revised 07/2016

MMR – Measles, Mumps, Rubella Minimum Ages and Intervals Between Doses 1st dose: on or after 12 months of age. 2nd dose: at least 4 weeks after the 1st. Revised 07/2016

MMR (Case Sample - Tom Immunize) 2 doses of MMR given: -1st dose invalid (given before 12 months of age). -2nd dose becomes first valid dose. - Tom needs one more dose of MMR. Revised 07/2016

Case Sample: Screening Results Tom Immunize - Form 14 Tom is missing polio dose number 4. He is also missing MMR dose number 2 because the 1st dose was given before the minimum age of 12 months. Revised 07/2016

EPI 12B Form - Section #1 Sample Case: Tom Immunize Revised 07/2016

EPI 12 B Form - Section #2 & #3 Sample Case: Tom Immunize Revised 07/2016

EPI 12 Form -Exemptions: Medical and Religious Sample Case: Tom Immunize Revised 07/2016

A Sample of the Final Report - EPI 12B Revised 07/2016

A Sample of the Final Report - EPI 12A New EPI12A form: Report enrollment separately for: students <19 months of age and students ≥19 months of age. Revised 07/2016

Reporting Requirement Immunization Assessment Report (EPI 12) Revised 07/2016

Immunization Assessment Reports Due Day: October 10th January 10th Revised 07/2016

Reporting Requirements All schools must report to the Department of Health by October 10th and January 10th the names of all students: Provisionally admitted. Excluded for failure to comply with immunization & examination requirements. Report must include the missing immunizations and dose numbers. Medical & Religious exemptions. Revised 07/2016

Reporting Requirements, Cont’d Schools that fail to report by October 10th and January 10th: For School Health Aides that do not submit EPI 12A and EPI 12B on time, the Immunization Program will send a letter to the school principal. Revised 07/2016

EPI 12A and EPI 12B Forms EPI 12A: Preschool, Head Start and Child Care Centers EPI 12B: Grades K-12 Revised 07/2016

EPI 12A & EPI 12B Forms Should only list students who are deficient. SHAs submits copies of EPI 12A and EPI 12B to School Designee for review before submitting electronically to Immunization Program. If handwritten, have School Designee sign bottom of form, follow FERPA Regulations (de-identify name, DOB) before mailing/or faxing to Immunization Program. Revised 07/2016

Reports Due: October 10th and January 10th Revised 07/2016

How to Order Forms EPI 6 Form (Request for Forms) Revised 07/2016

Online School Immunization Assessment Reporting System Website: https://immunization.doh.hawaii.gov/HIMedIC All Schools must register first. Call ATSS at (808) 586-8313 for instructions. Revised 07/2016

Hawaii State Department of Health (DOH) Contact Information Immunization Branch: ATSS: 586-8313 Neighbor Islands: 1-800-933-4832 ATSS Fax: (808) 586-7511 Web Site: www.vaxhawaii.com Tuberculosis Control Branch: (808) 832-5731 TB Information Line (808) 832-5738 Web Site: www.hawaii.gov/health/tb Revised 07/2016

Thank you! Revised 07/2016

This work is licensed under the Creative Commons Attribution 4 This work is licensed under the Creative Commons Attribution 4.0 International License (CC BY). To view a copy of this license, visit Creative Commons Attribution 4.0 International License "This workplace product was funded by a grant awarded by the U.S. Department of Labor. All other uses require the prior authorization of the copyright owner."