SECTION: IMMUNIZATION RECORD REQUIREMENTS FOR CHILDREN

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1 KEEP ON TRACK KEEPING IMMUNIZATION RECORDS Keeping accurate, up-to-date records for the children in your care is a very important, legislated part of your job. It is a requirement of the Day Nurseries Act to help ensure a healthier environment for everyone. The secret to managing this kind of paperwork is to do it on a regular basis. The monthly return of immunization forms and records will facilitate this process. Make sure you comply with all requirements when registering a new child. Update records as information changes and keep your desk clear and centre healthy. LEGISLATION Day Nurseries Act,1990 April 2006 Created by Region of Peel Public Health 3-1

2 KEEP ON TRACK IMMUNIZATION REQUIREMENTS OF THE DAY NURSERIES ACT (1990) The Medical Officer of Health requires that every child attending a licensed child care centre has up-todate immunization against diphtheria, pertussis, tetanus, polio, measles, mumps, rubella and haemophilus influenzae type b (Hib). Age Diphtheria Routine Immunizations Pertussis Tetanus Polio - IPV or OPV 3 2 mos 4 mos 6 mos Hib 4 1 year 1 15 mos 2 Measles Mumps 18 mos 4-6 yrs 5 & 8 Age 12(grade 7) yrs 7 Every 10 years Annually after age 6 months 1. Measles, Mumps and Rubella (MMR) must be given after the first birthday. 2.These vaccines can be given as early as 12 months. 3. Polio vaccine can be IPV or OPV. Children with immunization records from other countries may have OPV (oral vaccine) recorded. 4. Haemophilus influenzae type b (Hib). Hib is routinely given to children under five (5) years of age. 5. MMR- Dose #2 must be given a minimum of 29 days after Dose #1. 6. If child has not had the Meningococcal Conjugate vaccine (at one year of age), then he/she can receive the vaccine at 12 years of age in grade 7, or 15 through 19 years of age. 7. Although only Diphtheria and Tetanus are required, Pertussis vaccination is also recommended at this time. Therefore, vaccination with dtap (Diphtheria, Tetanus and Acellular Pertussis) may be offered and is publicly funded. 8. Children who have not had chicken pox disease or the Varicella vaccine when they were 15 months old are eligible to receive Varicella vaccine at five years of age. *Voluntary vaccinations: Check with your physician or call Peel Public Health at for more info. Rubella Hepatitis B* Influenza* Varicella* Pneumococcal Conj* Meningococcal Conj* 3-2 Created by Region of Peel Public Health April 2006

3 KEEP ON TRACK The following vaccines are recommended but are not mandatory: Pneumococcal conjugate Meningococcal conjugate Varicella (chickenpox) Hepatitis B Influenza *Refer to the Routine Immunization Schedule (p.3-2) to determine the ages at which each vaccine is publicly funded. The regulations governing the immunization requirements are identified in the Day Nurseries Act. R.R.O. 1990, Reg. 262, consolidated to O. Reg. 14/02,s.33 and 48. Section 33 States: (1) Every operator shall ensure that before a child is admitted to a day nursery operated by the operator or to a location where private-home day care is provided by the operator, and from time to time thereafter, the child is immunized as recommended by the local medical officer of health. (2) Subsection (1) does not apply where a parent of the child objects in writing to the immunization on the ground that the immunization conflicts with the sincerely held convictions of the parent s religion or conscience or a legally qualified medical practitioner gives medical reasons in writing to the operator as to why the child should not be immunized. Section 48 States: (1) Every operator shall ensure that up-to-date [immunization] records are available for inspection by a program adviser at all times and are kept on the premises of a day nursery or private-home day care agency operated by the operator in respect of each child enrolled. Section 48 States: In the Region of Peel, operators must collect and provide to Peel Public Health upon request, immunization information as well as the following information as stated in the amendment to Section 48 (6) of the Day Nurseries Act: (6) Every operator shall ensure that, (a) (b) the medical officer of health or his or her designate, upon producing proper identification, is permitted to inspect the records referred to in clauses (1) (b), (c), (f), (g) and (j); copies of those records are provided to him or her on request. The records referred to in Section 48 include: (1) (b) name, date of birth, [gender] and home address of the child, (c) (f) (g) names, home addresses and telephone numbers of the parents/[guardian] of the child; name, address, and telephone number of the child s family physician; the name and number shown on the child s health insurance identification card (i.e. Ontario Health Card Number). April 2006 Created by Region of Peel Public Health 3-3

4 KEEP ON TRACK EXEMPTIONS FROM IMMUNIZATION The following exemptions apply to any of the immunizations required by the Medical Officer of Health under the Day Nurseries Act, R.R.O. 1990, Reg. 262, consolidated to O.Reg. 14/ Statement of Medical Exemption There may be circumstances when a child cannot be immunized due to medical problems such as cancer or immune system illness. The Statement of Medical Exemption form can be obtained from Peel Public Health by the parent/ guardian of a child seeking an exemption from the immunization requirements for medical reasons. A qualified physician must complete and sign the Statement of Medical Exemption form. 2. Statement of Conscience or Religious Belief Affidavit A child may be exempted from the immunization requirements if immunization conflicts with the religious or philosophical beliefs of the parent. The Statement of Conscience or Religious Belief form can be obtained by the parent/guardian from Peel Public Health. This statement must be signed by the parent and sworn before a commissioner of oaths (e.g. notary public, justice of the peace, lawyer). Exemption forms can be obtained by calling Peel Public Health at Note: Children who are exempted from immunization requirements or who have incomplete immunization records will be excluded from attending the child care centre during an outbreak of a vaccine preventable disease (e.g. measles, pertussis, etc.) for their own protection until the Medical Officer of Health deems the outbreak is over. 3. Temporary Exemption A child may be temporarily exempt from immunization requirements if the child is ill or on certain medications during the eligible immunization period. A temporary exemption is valid for 30 days. A temporary exemption or more information on temporary exemptions can be obtained by calling Peel Public Health at Created by Region of Peel Public Health April 2006

5 KEEP ON TRACK DATA COLLECTION OF IMMUNIZATION RECORDS IN LICENSED CHILD CARE CENTRES Peel Public Health will: Print, distribute and collect Immunization Records for Child Care Facility forms for each new registrant Maintain an up-to-date immunization database on IRIS (Immunization Records Information System) for each registered child Issue a Notice of Incomplete Immunization form for each child two years of age and older without age appropriate immunization coverage Assist parents requesting information about exemption from the requirement of the Day Nurseries Act for immunization Assist parents requesting information about immunization Issue an immunization reminder and a second copy of the Notice of Incomplete Immunization form to any child who does not return the initial form Issue a centre specific certificate of immunization coverage rates at the completion of the record assessment process on a yearly basis Provide a list of children whose immunization records are incomplete at the completion of the record assessment The Operator will: Distribute an Immunization Records for Child Care Facility form to the parent of each new registrant Distribute copies of the Immunization Records for Child Care Facility forms as follows: Yellow: Child s file at child care centre White: Send to Peel Public Health at the end of each month (Regional Centres may courier to Peel Public Health; Private Centres may mail to Peel Public Health) Peel Public Health Immunization Program 44 Peel Centre Drive, Suite 102 Brampton, ON L6T 4B5 Inform parents of the requirements of the Day Nurseries Act, 1990 Provide the telephone number of Peel Public Health at for immunization inquiries and for parents requesting an exemption to the requirements for reasons of conscience, religion or for medical reasons Advise parents to return completed immunization forms to Peel Public Health Distribute notices of incomplete immunization from Peel Public Health Distribute reminders and a second copy of incomplete immunization as required Call Peel Public Health at for more forms April 2006 Created by Region of Peel Public Health 3-5

6 KEEP ON TRACK The Parent will: Notify Peel Public Health whenever their child receives any vaccine Return the completed Immunization Records for Child Care Facility form to the child care centre Return any Notice of Incomplete Immunization forms directly to Peel Public Health by: fax: Peel Public Health at: mail with a photocopy of the child s immunization record to: Peel Public Health Immunization Program 44 Peel Centre Drive, Suite 102 Brampton, ON L6T 4B5 3-6 Created by Region of Peel Public Health April 2006

7 KEEP ON TRACK Health Department Child Care Facility Provide a copy of Keep on Track A Health and Resource Guide for Child Care Providers with Immunization Records for Child Care Facility forms. Distribute Immunization Records for Child Care Facility form to all parents and then on an ongoing basis to all new registrants. (Pg 3-8) Collect forms place yellow copy on child's file at the centre return white copy to Peel Public Health monthly. Enter immunization information onto database. Prepare Notice of Incomplete Immunization form for any child with incomplete immunization two years of age and older. Send Notice of Incomplete Immunization forms and alphabetical list to child care centre. Distribute Notice of Incomplete Immunization forms to parents of child. Advise parents to return forms to Peel Public Health by phone/fax/mail as per procedure. Answer parent s questions if possible. Direct facility and parent inquiries to Peel Public Health at Provide professional telephone counselling via Communicable Diseases Divisional Call Centre. Enter immunization information in the database. Send reminder and a second copy of Notice of Incomplete Immunization forms. Distribute reminders and second copy of Notice of Incomplete Immunization forms (Continued on next page) April 2006 Created by Region of Peel Public Health 3-7

8 KEEP ON TRACK Enter immunization information in the database. File hard copy of exemption form for future reference. (Continued from previous page) Provide child care centre with a certificate indicating immunization coverage rates for the centre and a list of any children with outstanding immunization. Keep Immunization Coverage Rates certificate in Keep on Track binder Parents with questions about their child s immunization requirements or records can be provided with a photocopy of Immunization Information A Guide for Parents (Appendix 3) and/or a copy of the pamphlet Immunization A Lifetime Investment (see plastic sleeve). Copies of this pamphlet may be obtained by calling Peel Public Health at Parents can also call Peel Public Health at with any additional questions. 3-8 Created by Region of Peel Public Health April 2006

9 KEEP ON TRACK EXEMPTION FROM THE REQUIREMENTS OF THE DAY NURSERIES ACT Peel Public Health will: Print, distribute, collect and maintain the original completed copy of all exemption forms (Statement of Conscience or Religious Belief Affidavit and Medical Exemption - Temporary Exemptions) Note: The original copy must be kept by Peel Public Health and will follow the child as they enter school. Complete necessary follow-up with physicians as required Order the director of the child care centre to exclude exempted children during outbreaks of vaccine preventable diseases until the Medical Officer of Health deems the outbreak is over Issue an Immunization Program Exemption from Immunization Requirements form to the operators when the Statement of Conscience or Religious Belief Affidavit or Medical Exemption form has been completed The Operator will: Advise parents requesting an exemption from the immunization requirements of the Day Nurseries Act to call Peel Public Health at Advise parents to return the completed exemption forms to: Peel Public Health Immunization Program 44 Peel Centre Drive, Suite 102 Brampton, ON L6T 4B5 Keep the Immunization Program Exemption from Immunization Requirements form on the child s file at the child care centre. Note: Parents can change their minds about Statement of Conscience exemptions and have their child immunized at any time. April 2006 Created by Region of Peel Public Health 3-9

10 KEEP ON TRACK TIPS FOR ASSESSING IMMUNIZATION RECORDS Immunization of children and staff is necessary to protect both children and caregivers in your centre against vaccine preventable diseases. In order for a child to attend your centre, parents must provide either proof of their child s immunization against these diseases or the appropriate exemption forms. When a Child Registers at Your Child Care Centre: Ensure the parent is supplying a valid immunization card. Most immunization records are yellow, although the child may have a different coloured card (e.g. white or blue), especially if they are coming from another province or country. Ensure the record has dates that are legible. Ensure the card has the name, date of birth and Ontario Health Card Number of the child who is registering. Assessment of an Immunization Record for Mandatory Vaccines: 1. The Primary Series The first needle that an infant receives contains protection against five diseases: diphtheria, pertussis, tetanus, polio and haemophilus influenzae b. This is given at two months and is repeated at four and six months of age. 2. The One-Year Needle All children require protection against measles, mumps and rubella. The first injection (two doses are required) is given to children at one year of age. It is important to note that this needle must be given after their first birthday. According to the Ontario Ministry of Health, if it is given earlier, it is not valid and must be repeated. 3. The Eighteen-Month Booster All children require a booster of diphtheria, pertussis, tetanus, polio and haemophilus influenzae b at eighteen months of age. This one needle contains all five components. The second dose of measles, mumps, and rubella should also be given at this time. 4. The Four to Six Year Needle Between the ages of four and six years of age, children require a booster for diphtheria, pertussis, tetanus and polio. This needle can be given any time between the ages of four and six. It does not have to be given prior to enrolling in elementary school. Voluntary Vaccines: You may see records which may include the following vaccines: Hepatitis B Pneumococcal Conjugate Influenza Meningococcal Conjugate Varicella You may find that some children will have slight variations in the timing of their injections. If you have an immunization record that you are having trouble interpreting, call Peel Public Health at and a public health nurse will be able to provide you with assistance Created by Region of Peel Public Health April 2006

11 KEEP ON TRACK It is the responsibility of the parent to keep an immunization record of the child, to ensure that each immunization received is recorded on the yellow immunization card and to contact Peel Public Health whenever a vaccine has been administered to the child. Age Diphtheria Routine Immunizations Pertussis Tetanus Polio - IPV or OPV 3 2 mos 4 mos 6 mos Hib 4 1 year 1 15 mos 2 Measles Mumps 18 mos 4-6 yrs 5 & 8 Age 12(grade 7) yrs 7 Every 10 years Annually after age 6 months 1. Measles, Mumps and Rubella (MMR) must be given after the first birthday. 2.These vaccines can be given as early as 12 months. 3. Polio vaccine can be IPV or OPV. Children with immunization records from other countries may have OPV (oral vaccine) recorded. 4. Haemophilus influenzae type b (Hib). Hib is routinely given to children under five (5) years of age. 5. MMR- Dose #2 must be given a minimum of 29 days after Dose #1. 6. If child has not had the Meningococcal Conjugate vaccine (at one year of age), then he/she can receive the vaccine at 12 years of age in grade 7, or 15 through 19 years of age. 7. Although only Diphtheria and Tetanus are required, Pertussis vaccination is also recommended at this time. Therefore, vaccination with dtap (Diphtheria, Tetanus and Acellular Pertussis) may be offered and is publicly funded. 8. Children who have not had chicken pox disease or the Varicella vaccine when they were 15 months old are eligible to receive Varicella vaccine at five years of age. *Voluntary vaccinations: Check with your physician or call Peel Public Health at for more info. Rubella Hepatitis B* Influenza* Varicella* Pneumococcal Conj* Meningococcal Conj* April 2006 Created by Region of Peel Public Health 3-11

12 KEEP ON TRACK IMMUNIZATION CLINIC SERVICES FOR NEW IMMIGRANTS TO CANADA Peel Public Health offers free immunizations for children who are new immigrants to Canada who require a record of immunization to be registered into child care or school. In order to make an appointment at the clinic, the child must: be new to Canada be attempting to register for child care or school have no Ontario Health Card be at least one year of age have no record of immunization from their country of origin 3-12 Created by Region of Peel Public Health April 2006

13 KEEP ON TRACK RESOURCES 1. Immunization Records for Child Care Facility. This is a sample of the form you are required to distribute to all children in your centre. (see plastic sleeve). 2. Notice of Incomplete Immunization sample form. This form will be sent to the parent/guardian of any child with incomplete immunization (see plastic sleeve). 3. Sample Immunization Program Exemption from Immunization Requirements (see Appendix #1). 4. Sample certificate to indicate percentage of children with complete immunization (see Appendix #2). 5. Immunization Information Sheet A Guide for Parents (see Appendix #3). April 2006 Created by Region of Peel Public Health 3-13

14 KEEP ON TRACK Appendix #1 CONFIRMATION OF EXEMPTION FROM IMMUNIZATION REQUIREMENTS February 23, 2006 Date Issued Student s Name Date of Birth Please be advised that the above named child/student has provided Peel Public Health with information that exempts him or her from the immunization requirements of the Immunization of School Pupils Act or the Day Nurseries Act. The student may now attend school or day care. Please feel free to contact me should you have any questions. Thank you. IMMUNIZATION PROGRAM STAFF Peel Public Health Ext. April 2006 Created by Region of Peel Public Health 3-15

15 Appendix #2 IMMUNIZATION RECORD CERTIFICATE (CENTRE) Immunization Records The Ontario Ministry of Health goal is to have 95% of children in licensed facilities with up to date vaccination. 100% of children over 2 years at have up-to-date immunization. Dated: Medical Officer of Health

16 Appendix #2 IMMUNIZATION RECORD CERTIFICATE (CENTRE) Immunization Records The Ontario Ministry of Health goal is to have 95% of children in licensed facilities with up to date vaccination. 100% of children over 2 years at have up-to-date immunization. Dated: Medical Officer of Health

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