1. Welcome to the Immunization Requirements Webinar for Clinic Staff! For technical difficulties, call 1-888-259-8414, press 1. During this webinar, everyone will be placed on mute. Please type in any questions in the question box. We will answer questions at the end of the presentation. The webinar will be recorded. The presentation and recording will be available after today’s webinar here: www.doh.wa.gov/Portals/1/Documents/Pubs/April28WebinarAnnou ncement.pdf www.doh.wa.gov/Portals/1/Documents/Pubs/April28WebinarAnnou ncement.pdf

2. Child Care and School Immunization Requirements Department of Health Office of Immunization and Child Profile April 28, 2016

3. Why do we need immunizations and immunization laws? Which vaccines are required for child care and school? What are some of the common rules and exceptions to the rules? What is the change to the varicella requirement for school? Exemptions Washington State Department of Health Topics to be covered

4. We don’t see diseases once common. Vaccines successfully prevent disease However, diseases and outbreaks still occur Children are at increased risk in the school and child care setting School and child care immunization requirements effective in reducing disease Washington State Department of Health Why do we need immunizations and an immunization law?

6. Students attending school and child care/preschool must comply with immunization requirements to protect against diseases. 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 Status (or Certificate of Exemption).Certificate of Immunization Status Certificate of Exemption Washington State Department of Health What are the immunization laws?

7. Washington State Department of Health

8. Recommended vs required Recommended Hepatitis B DTaP Tdap IPV MMR Varicella PCV Hib Hepatitis A HPV Meningococcal Flu Rotavirus Required Hepatitis B DTaP Tdap IPV MMR Varicella PCV (for child care) Hib (for child care)

9. Vaccine Requirements

10. www.doh.wa.gov/Portals/1/Docum ents/Pubs/348-284- IndividualVaccineReqs2016-17.pdf IVRS: Individual Vaccine Requirements Summary

11. www.doh.wa.gov/Portals/1/Documents/Pubs/348-053-ChildCareChart2016-2017.pdf

15. www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineReqs2016-17.pdf

21. Washington State Department of Health

23. Vaccine Requirements – Hep B K-9 th grade Dose 3 must be given min age of 24 weeks 10 th -12 th grade Dose 3 must be given min age of 4 months

24. Case Example – Hep B Washington State Department of Health Does this patient need more hep B doses?

25. Washington State Department of Health

26. Vaccine Requirements – DTaP Washington State Department of Health For children up to 7 years of age If dose 4 was given on or after the 4 th birthday, dose 5 is NOT required Patients 7-10 years of age not fully immunized with DTaP should get one Tdap followed by additional doses of Td if needed DTaP given after age 7 counts for the Tdap dose; no Tdap required at 11-12 years of age

27. Vaccine Requirements – Tdap Washington State Department of Health For children 7 years of age and older Students without any DTaP should get one Tdap followed by 2 Td. Then Td is recommended every 10 years If incomplete series of DTaP, Tdap should be given Tdap given between 7-10 years of age meet the 6 th grade requirement; no Tdap required at 11 years of age

28. Case Example – DTaP and Tdap Washington State Department of Health Td was given. What additional vaccines, if any, does this patient need?

29. Washington State Department of Health

30. Vaccine Requirements – IPV Washington State Department of Health Dose 4, if given on or after Aug 7, 2009Must be given >4 years of ageSeparated from dose 3 by >6 months K-5 th Grade

31. Case Example – IPV Washington State Department of Health Does this patient need more IPV?

32. Washington State Department of Health

33. Vaccine Requirements – MMR Washington State Department of Health Dose 1 given <12 months of age must be repeated (4 day grace applies) If not given on same day, minimum interval between MMR and varicella is >28 days If MMR and varicella not given on the same day, the second vaccine given is not valid and should be repeated

34. Case Example - MMR Washington State Department of Health Does this patient need any vaccines?

35. Washington State Department of Health

36. Vaccine Requirements – Varicella Washington State Department of Health 2 doses required for K-12 th grade in the fallDose 1 must be given minimum of 1 year of age 3 months is recommended between dose 1 and 2; however, if at least 4 weeks separates doses, this is valid

37. Immunization Requirements - Varicella Option 1 History of varicella disease Option 2 Blood test showing titer for immunity Option 3 Exemption

38. Chickenpox Verification on the CIS

39. www.doh.wa.gov/YouandYourFamily/Immunization/FormsandPublications/Forms Varicella Flyer

40. Exemptions

41. Washington State Department of Health

42.  Main school and child care web page: www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization.aspx www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization.aspx  Vaccines Required for School chart: www.doh.wa.gov/Portals/1/Documents/Pubs/348-051- SchoolChart2016-2017.pdf www.doh.wa.gov/Portals/1/Documents/Pubs/348-051- SchoolChart2016-2017.pdf  Vaccines Required for Child Care/Preschool chart: www.doh.wa.gov/Portals/1/Documents/Pubs/348-053- ChildCareChart2016-2017.pdf www.doh.wa.gov/Portals/1/Documents/Pubs/348-053- ChildCareChart2016-2017.pdf  Immunization web page: www.doh.wa.gov/YouandYourFamily/Immunization www.doh.wa.gov/YouandYourFamily/Immunization  Immunization Action Coalition: www.immunize.org www.immunize.org Resources Washington State Department of Health

43.  Individual Vaccine Requirements Summary: www.doh.wa.gov/Portals/1/Documents/Pubs/348- 284-IndividualVaccineReqs2016-17.pdf www.doh.wa.gov/Portals/1/Documents/Pubs/348- 284-IndividualVaccineReqs2016-17.pdf  CDC job aids for DTaP/Tdap/Td, Hib, and PCV: www.cdc.gov/vaccines/schedules/hcp/child- adolescent.html www.cdc.gov/vaccines/schedules/hcp/child- adolescent.html  For clinical questions, contact your local health department or send an email to DOH nurses at immunenurses@doh.wa.gov immunenurses@doh.wa.gov  For school requirement questions, send an email to oicpschools@doh.wa.gov oicpschools@doh.wa.gov Resources Washington State Department of Health

44. Please take a few minutes to complete an evaluation after the webinar. A certificate of completion is available after you complete the evaluation: www.doh.wa.gov/Portals/1/Documents/Pubs/April28Webinar Announcement.pdf www.doh.wa.gov/Portals/1/Documents/Pubs/April28Webinar Announcement.pdf