1. Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/Preschools August XX, 2011 Preschool/Child Care Immunization Requirements Trang Kuss, RN, MN, MPH Department of Health Office of Immunization and Child Profile January 18, 2013

2. Contact Information Dept. of Health Office of Immunization and Child Profile Trang Kuss, RN, MN, MPH School and Child Care Coordinator trang.kuss@doh.wa.govtrang.kuss@doh.wa.gov; 360-236-3760

3. Topics to be Covered What are the child care and preschool immunization requirements in Washington State? Complete, Conditional, Out of Compliance: What do they mean? How can I use the Washington State Immunization Information System to help determine if a child is complete?

4. Immunization Requirements Children attending licensed child care must comply with immunization requirements to protect the health of the public and individuals 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 (or Certificate of Exemption) www.doh.wa.gov/CommunityandEnvironment/Schools/I mmunization/Regulations.aspx www.doh.wa.gov/CommunityandEnvironment/Schools/I mmunization/Regulations.aspx

5. Immunization Requirements

6. Examples of those not required to comply Facilities not required to have a DEL license Coop preschool Birth to Three Program

9. Required Immunizations for Preschool or Child Care Attendance DTaP Hepatitis B Hib IPV MMR PCV Varicella

10. Recommended, but Not Required Hepatitis A Rotavirus Flu

11. Immunization Status Complete/Fully Immunized Conditional Temporary status to allow child to get fully immunized Out of Compliance Exempt

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

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

16. DTaP 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) Diphtheria, Tetanus, Pertussis (DTaP/DT) 1 dose2 doses 3 doses May get as early as 6 months. 4 doses May get 4 th dose as early as 12 months as long as 6 months separate dose 3 and dose 4.

17. DTaP Minimum Age and Intervals Dose #Minimum Age Minimum Interval Between Doses 16 weeks4 weeks between Dose 1 & 2 210 weeks4 weeks between Dose 2 & 3 314 weeks6 months between Dose 3 & 4 412 months6 months between Dose 4 & 5 54 years –

18. DTaP Details Routine schedule: 2, 4, 6, 15-18 months, and booster dose at 4-6 years 6 months interval recommended between dose 3 and 4, but 4 months or more is acceptable DTaP given to children less than 7 years of age; Td and Tdap given to children 7 years of age or older

19. What to do if: If Tdap given for dose 1, 2, or 3 instead of DTaP Repeat with DTaP If Tdap given for dose 4 or dose 5 instead of DTaP Acceptable

20. Note red X because Dose 4 given too early DTaP Example Dose 4 past due

21. DTaP Example Note red X – Tdap given as dose 2

22. Hepatitis B 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) Hepatitis B 1 dose May get dose 1 at birth. 2 doses May get dose 2 as early as 1 month. 3 doses

23. Hepatitis B Minimum Age and Intervals Dose # Minimum Age Minimum Interval Between Doses 1Birth4 weeks between Dose 1 & 2 24 weeks8 weeks between Dose 2 & 3 324 weeks 16 weeks between Dose 1 & 3

24. Hepatitis B Details Routine schedule: birth, 1 month, and 6 months Pay attention to min age for dose 3 and minimum intervals between doses

25. 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 dose2 doses3 doses4 doses

26. Hib Minimum Age and Intervals Dose #Minimum Age Minimum Interval Between Doses 16 weeks4 weeks between Dose 1 & 2 210 weeks4 weeks between Dose 2 & 3 314 weeks8 weeks between Dose 3 & 4 412 months -

27. Hib Details Routine schedule: 2, 4, 6, and 12-15 months Not recommended for children 5 years or older The recommended immunization schedule for Hib vaccines: Vaccine2 Months4 Months6 Months12-15 Months PRP-T* (ActHib) Dose 1Dose 2Dose 3Booster PRP-OMP (PedvaxHIB) Dose 1Dose 2 Booster

28. Hib Details Unvaccinated children 7 months of age and older may not require full series. Total number of doses depends on child’s current age. Final booster dose should be given at 12 months or older and a min of 8 weeks after previous dose.

29. 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.

30. Doses before age 12 months Doses on or after age 12 monthsStatus 31Complete 21 11 Needs 1 Booster Dose (If Last Dose Given Before 15 Months) 01 Needs 1 Booster Dose (If Last Dose Given Before 15 Months) 30Needs 1 Booster Dose 20 10 00Needs 1 Dose Hib Doses Required Chart

31. Hib Example

32. 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 dose2 doses May get as early as 4 months. 3 doses

33. IPV Minimum Age and Intervals Dose #Minimum Age Minimum Interval Between Doses 16 weeks4 weeks between Dose 1 & 2 210 weeks4 weeks between Dose 2 & 3 314 weeks6 months between Dose 3 & 4

34. IPV Details Routine schedule: 2, 4, 6-18 months, and booster at 4-6 years. IPV used routinely in US for polio vaccination, but students coming from a foreign country may get OPV Any combination of IPV or OPV valid

35. MMR 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) Measles, Mumps, Rubella (MMR) Not given before 12 months of age.1 dose

36. MMR Minimum Age and Intervals Dose #Minimum Age Minimum Interval Between Doses 112 months4 weeks between Dose 1 & 2

37. MMR Details Routine schedule: 12-15 months and 4-6 years Dose 1 given <12 months of age must be repeated (4 day grace applies) MMR or MMRV can be used If not given on same day, minimum interval between MMR and varicella is >28 days o The second vaccine given is not valid and should be repeated

38. MMR Example Note red X – MMR given 5 days too early

39. Pneumococcal Conjugate (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) Pneumococca l Conjugate (PCV7 or PCV13) 1 dose2 doses3 doses4 doses* *Some children may get 5 total doses. A single supplemental dose of PCV13 is recommended, but not required, for all children aged 14–59 months who got 4 doses of PCV7.

40. PCV Minimum Age and Intervals Dose #Minimum Age Minimum Interval Between Doses 16 weeks4 weeks between Dose 1 & 2 210 weeks4 weeks between Dose 2 & 3 314 weeks8 weeks between Dose 3 & 4 412 months -

41. PCV Details Routine schedule: 2, 4, 6, and 12-15 months A single supplemental dose of PCV13 is recommended, but not required, for all children aged 14–59 months who got 4 doses of PCV7 o PCV13 replaced PCV7 in 2010

42. 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.

43. PCV Doses Required Chart Doses before Age 12 months Doses on or after Age 12 months Status 31 Complete (If PCV7 given, needs one additional dose of PCV13) 2 1 (8 weeks after # 2) Complete 02 12 11Needs 1 dose 8 weeks after Dose 2 01 Needs 1 dose 8 weeks after Dose 1 if # 1 received at age ≤ 24 months 30Needs 1 dose 8 weeks after Dose 3 20Needs 1 dose 8 weeks after Dose 2 10 Needs 2 doses (8 weeks apart) if age 12 - 24 months Needs 1 dose if age ≥ 24 - 59 months 00 Needs 2 doses (8 weeks apart) if age 12 - 24 months Needs 1 dose if age ≥ 24 - 59 months

44. PCV Example Katey is complete with 3 doses!

45. Varicella Requirement VACCIN E 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) VaricellaNot given before 12 months of age. 1 dose Required: if unvaccinated, health care provider must verify disease.

46. Varicella Minimum Age and Intervals Dose #Minimum Age Minimum Interval Between Doses 112 months3 months between Dose 1 & 2

47. 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

48. Varicella Example Note red X – Varicella not given same day as MMR

49. 4 Day Grace Period Vaccines given <4 days before the minimum interval or age are valid Applies to all inactivated vaccines before minimum intervals OR ages Grace period applies if live vaccines given at the same visit

50. 4 Day Grace Example Dose 3 valid given 3 days before 6 months of age

51. Resources Individual Vaccine Requirements Summary: www.doh.wa.gov/Portals/1/Documents/Pubs/348-284- IndividualVaccineRequirements.pdf 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/Immuniza tion/VaccineRequirements.aspx www.doh.wa.gov/CommunityandEnvironment/Schools/Immuniza tion/VaccineRequirements.aspx Immunization Manual for Schools and Child Cares: www.doh.wa.gov/CommunityandEnvironment/Schools/Immuniza tion/SchoolManual.aspx www.doh.wa.gov/CommunityandEnvironment/Schools/Immuniza tion/SchoolManual.aspx

52. Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/Preschools August XX, 2011 Thank you for all you do!