Preschool Child Care Immunization Requirements Department of Health Office

Preschool/Child Care Immunization Requirements Department of Health Office of Immunization and Child Profile Implementing WA New State Exemption Requirements - May 2013 Training for Schools and Child Cares/Preschools August XX, 2011

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 occur Children are at risk in the child care and preschool setting

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 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/Communityand. Environment/Schools /Immunization/Regulations. aspx

Immunization Requirements Comply with State Board Required to report to of Health immunization DOH requirements Licensed child care center (and preschool) Licensed family home child care Licensed child care for school age children √ √ Must comply with DEL rules -- √ -- Head Start, ECEAP √ √ Any preschool in school setting √ √

Changes to Exemption Law www. doh. wa. gov/Communityand. Environment/Schools /Immunization/Exemptions. aspx Sample Certificates of Exemption Training video Frequently Asked Questions

Vaccines Required for Preschool or Child Care Attendance DTa. P Hepatitis B Hib IPV MMR PCV Varicella

Recommended, but Not Required Flu Hepatitis A Rotavirus

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

www. doh. wa. gov/Portals/1/Documents/Pubs/348 -051 -Childcare. Chart 2013 -2014. pdf

www. doh. wa. gov/Portals/1/Documents/Pubs/348 -284 -Individual. Vaccine. Requirements. pdf

www. doh. wa. gov/Portals/1/Documents/Pubs/348 -051 -School. Chart 2013 -2014. pdf

4 Day Grace Period Vaccines given 4 days or fewer before the minimum interval or age are valid Vaccines 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

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

DTa. P Requirement VACCINE Diphtheria, Tetanus, Pertussis (DTa. P/DT) By 3 Months By 5 Months By 7 Months By 16 Months (on or before last day of mo 2) day of mo 4) day of mo 6) day of mo 15) 1 dose 2 doses 3 doses May get as early as 6 months. By 19 Months (on or before last day of mo 18) 4 doses May get 4 th dose as early as 12 months as long as 6 months separate dose 3 and dose 4.

DTa. P 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

DTa. P 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 DTa. P given to children less than 7 years of age; Tdap and Td given to children 7 years of age or older

DTa. P Example Note red X because Dose 4 given too early Dose 4 past due

Hepatitis B Requirement VACCINE Hepatitis B By 3 Months (on or before last day of mo 2) 1 dose May get dose 1 at birth. By 5 Months (on or before last day of mo 4) By 7 Months By 16 Months (on or before last day of mo 6) day of mo 15) 2 doses May get dose 2 as early as 1 month. By 19 Months (on or before last day of mo 18) 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 Details Routine schedule: birth, 1 month, and 6 months Pay attention to min age for dose 3 and minimum intervals between doses

Hib Requirement VACCINE Haemophilus influenzae type B (Hib) 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) 1 dose 2 doses 3 doses By 16 Months (on or before last day of mo 15) By 19 Months (on or before last day of mo 18) 4 doses

Hib Minimum Age and Intervals Dose # Minimum Interval Between Doses Minimum Age 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 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: Vaccine PRP-T* (Act. Hib) PRP-OMP (Pedvax. Hib) 2 Months 4 Months 6 Months 12 -15 Months Dose 1 Dose 2 Dose 3 Booster 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.

Hib Doses Required Chart www. doh. wa. gov/Portals/1/Documents/Pubs/348 -284 -Individual. Vaccine. Requirements. pdf Doses before age 12 months Doses on or after age 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 Example

IPV Requirement VACCINE Polio (IPV or OPV) By 5 Months By 7 Months By 3 Months (on or before last (on or before day of mo 4) last day of mo 6) last day of mo 2) 1 dose By 16 Months (on or before last day of mo 15) 2 doses May get as early as 4 months. By 19 Months (on or before last day of mo 18) 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 Details Routine schedule: 2, 4, 6 -18 months, and booster at 4 -6 years IPV 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 Requirement VACCINE Measles, Mumps, Rubella (MMR) 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) Not given before 12 months of age. By 16 Months (on or before last day of mo 15) By 19 Months (on or before last day of mo 18) 1 dose

MMR Minimum Age and Intervals Dose # 1 Minimum Age 12 months Minimum Interval Between Doses 4 weeks between Dose 1 & 2

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

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

Pneumococcal Conjugate Vaccine (PCV) Requirement VACCINE Pneumococcal Conjugate (PCV 7 or PCV 13) 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) 1 dose 2 doses 3 doses By 16 Months (on or before last day of mo 15) By 19 Months (on or before last day of mo 18) 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 months PCV is not recommended for children 5 and older A single supplemental dose of PCV 13 is recommended, but not required, for all children aged 14– 59 months who got 4 doses of PCV 7 o PCV 13 replaced PCV 7 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 Doses on or after Age 12 months 3 2 0 1 Status Complete (If PCV 7 given, needs one additional dose of PCV 13) 1 Complete (8 weeks after # 2) 2 Complete 1 1 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 months Needs 1 dose if age ≥ 24 - 59 months 0 0 Needs 2 doses (8 weeks apart) if age 12 - 24 months Needs 1 dose if age ≥ 24 - 59 months

PCV Example Katey is complete with 3 doses!

Varicella Requirement By 3 Months By 5 Months (on or before last (on or before VACCINE day of mo 2) last day of mo 4) Varicella By 7 Months By 16 Months (on or before last (on or before day of mo 6) last day of mo 15) Not given before 12 months of age. By 19 Months (on or before last day of mo 18) 1 dose Required: if unvaccinated, health care provider must verify disease.

Varicella Minimum Age and Intervals Dose # 1 Minimum Age 12 months Minimum Interval Between Doses 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

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

Resources www. doh. wa. gov/immunization/schoolandchildcare Individual Vaccine Requirements Summary: Vaccines Required for Preschool/Child Care Attendance chart: www. doh. wa. gov/Portals/1/Documents/Pubs/348 -284 Individual. Vaccine. Requirements. pdf www. doh. wa. gov/Communityand. Environment/Schools/Immuniz ation/Vaccine. Requirements. aspx Immunization Manual for Schools and Child Cares: www. doh. wa. gov/Communityand. Environment/Schools/Immuniz ation/School. Manual. aspx

Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/Preschools August XX, 2011