San Diego Immunization Branch Melissa Crase, MPH Community Health Promotion Specialist

Transcription

1 California Immunization Requirements: for school staff & childcare providers San Diego Immunization Branch Melissa Crase, MPH Community Health Promotion Specialist

2 Training Outcomes At the end of this training, you will be able to: Correctly complete the California School Immunization Record (CSIR)/Blue Card. Identify acceptable forms of personal immunization records. List the immunization requirements for childcare and school entry. Create a management system for conditional entrants and exemptions. San Diego Immunization Branch

3 No shots? No records? NO SCHOOL/CHILDCARE! San Diego Immunization Branch

4 Why check immunizations? To protect kids from dangerous diseases like chickenpox & measles! To help busy parents keep their kids healthy and on track with shots! BECAUSE IT S THE LAW! San Diego Immunization Branch

5 Vaccine-Preventable Diseases in San Diego Pertussis (Whooping Cough) 2008: 50 cases! 2009: 22 cases as of 5/31/09 Adults spreading sickness to babies Chickenpox 2008: 118 cases in 13 schools 2009: 64 cases in 9 school clusters Most recent cases in Cardiff, Lemon Grove, and SDUSD Meningitis 5 th grade student at Silver Strand Elementary in Coronado Measles Measles outbreak in San Diego during January and February 2008-first measles outbreak since 1991! San Diego Immunization Branch

6 How Can Nurses and Other Staff Help with Compliance Rates? San Diego Immunization Branch

7 CDC Recommendations vs. CA State Law Requirements CDC Recommendations Change yearly Extensive list of immunizations ACIP recommends to stay healthy Based on age and high risk groups across the lifespan CA Requirements Have not changed since 2003 Limited list of vaccines required by age (childcare) or grade level (school) San Diego Immunization Branch

8 Vaccine Recommendations Kids need more shots than just the ones required for child care and school entry Teens need shots too! San Diego Immunization Branch

9 Vaccine good, disease bad! some vaccine-preventable diseases Polio IPV Diptheria, Tetanus, Pertussis DTaP Measles, Mumps, Rubella MMR Haemophilus influenza type B Hib Hepatitis B Hep B Varicella (Chickenpox) VAR Hepatitis A * Hep A Human Papillomavirus * HPV Influenza * Inject/Nasal Meningococcal * MCV Pneumococcal * PPSV/PCV Rotavirus * RV Zoster (Shingles)* VZV * Not required vaccines for school entry, but recommended by ACIP

10 California Immunization Handbook The BLUE BOOK Has helpful information & tools as well as the actual law to use as a reference 7 TH Edition is most recent (July 03) USE THIS ONE!! Please recycle any older editions as the information is out of date Download from our website ( San Diego Immunization Branch

11 SDIR: San Diego Regional Immunization Registry FREE online database of shot records Figures out differences between requirements and recommendations Many private providers and all public providers put shot records into the Registry Available to schools & childcare centers to view shot records CAN PRINT BLUE CARDS! Nancy Knickerbocker (619) San Diego Immunization Branch

12 CAIR Form If a child is not in the registry, parents can fill out this form and send their child s immunization records directly to SDIB to have them entered into the registry San Diego Immunization Branch

13 Helpful Tools IZ Names & Abbreviations Binational Immunization Guide Pages B-34 B-36 of Blue Book San Diego Immunization Branch

14 What ARE the requirements? San Diego Immunization Branch

15 Childcare Requirements 2009 SPECIAL SCHEDULE! Remember: The time intervals are NOT grace periods! Every child within each time interval must be up-todate with those shots! San Diego Immunization Branch

16 Hib Vaccine Shortage & Special Schedule Special Schedule effective Feb., 2008 until further notice, 4 th dose of Hib not being given. Children from 15 months to 5 years old only need proof of ONE DOSE of Hib given at ANY age for entry into child care. San Diego Immunization Branch

17 K-12 Requirements Page B-41 of Blue Book San Diego Immunization Branch

18 7 th Grade Requirements Page D-80 of Blue Book San Diego Immunization Branch

19 Now you re ready to make a BLUE CARD! San Diego Immunization Branch

20 4 Steps to completing the Blue Card 1. Demographic Information 3. Documentation 2. Vaccination History 4. Status of Requirements San Diego Immunization Branch

21 Step 1: Demographic Information Parents may complete this section Make sure they don t accidentally sign the back! Please answer questions in full The State & County use this information to find health disparities You do not have to update address/phone each time it changes San Diego Immunization Branch

22 Step 2: Vaccination History Enter the date each shot was given based on the child s personal shot record COUNT DOSES! School and childcare entry is based on NUMBER of doses Compare doses on Blue Card to the requirements for child s age or grade level You can use the Pink or Purple Windows for help Pages 2-4 of Blue Book San Diego Immunization Branch

23 MMR 4-Day Grace Period Both doses of MMR must be given on or after 1 st birthday *Up to 4 days before the 1 st birthday is OKAY! Date of Birth: January 7, 2007 MMR 1: January 8, 2008 = VALID MMR 1: January 4, 2008 = VALID MMR 1: January 2, 2008 = INVALID MMR must be given again Page 4 of Blue Book San Diego Immunization Branch

24 Documenting Chickenpox Disease X FRIENDLY HILLS PEDIATRICS DISEASE Page 5 of Blue Book History of disease must be documented! San Diego Immunization Branch

25 Acceptable Records! Any written record showing dates the vaccines were administered is acceptable (medical charts, out-of state or international forms, military records, other Blue Cards, etc) MUST HAVE DATES! Signatures or stamps are desired, but not required Page D-81 of Blue Book: Article 5, Section 6065, Paragraph (b) San Diego Immunization Branch

26 The Yellow Card Yellow Cards are best if a parent does not have one, suggest they have their current record transcribed for future convenience San Diego Immunization Branch

27 ACCEPTABLE? YES! Record has dates each vaccine was given Official form from a clinic San Diego Immunization Branch

28 Acceptable? NO! Record is stamped, but does not show dates shots were given Dates trump stamps! San Diego Immunization Branch

29 So what can be done? Option 1: Meet with a physician and have the PHYSICIAN recreate dates for the vaccines based on the parent s best recollection (either at original clinic or doctor nearby) Option 2: If the physician is unable to recreate dates for the vaccines, the child can be revaccinated. San Diego Immunization Branch

30 Confusing Immunization Records? Fax to (619) Call before faxing and use a cover sheet Translation: Unofficial translators are okay (family, friends) If no family member available, suggest a bilingual physician San Diego Immunization Branch

31 Step 3: Documentation Sign & date this section It does not have to be signed by a nurse It should be signed even if the child is NOT up-todate Specify which kind of personal shot record you used to make the Blue Card San Diego Immunization Branch

32 Step 4: Status of Requirements All Requirements are met. (A) Currently up-to-date, but more doses are due later. Needs follow-up. (B) Exemption granted: Medical Reasons- Permanent (C) Medical Reasons- Temporary (D) Personal Beliefs (E) San Diego Immunization Branch

33 Types of Exemptions Permanent Medical (C) Must have written documentation from doctor Keep document with the Blue Card Ex: Child with an allergy to a vaccine Temporary Medical (D) Must have written documentation from doctor with an end-date to exemption Must get shots at end of exemption Ex: Child who was sick at appointment Personal Beliefs (E) Pages 7 & 8 of Blue Book Does not require written documentation Parent must sign back of Blue Card Ex: Parent believes vaccine will cause illness San Diego Immunization Branch

34 What s the big deal about exemptions? There are repercussions to signing a PBE that parents need to be aware of In an outbreak situation, if a child has a PBE and is unvaccinated about the disease, he/she may have to stay out of school/child care for a period of time The County Public Health Officer and the Immunization Branch will work closely with your facility to decide who must be excluded and who doesn t San Diego Immunization Branch

35 Exemptions & Shot Records Permanent Medical & Personal Beliefs Exemptions: Parent should still show their child s shot record! Record any vaccines a child DOES have: Some children only exempt some vaccines Need to know who is not immunized against what Gives the state coverage rates on annual report San Diego Immunization Branch

36 Choosing (B): Conditional Entrants Started but has not completed a series Ex: Started Hepatitis B series 2 weeks prior to start of school You will need to check the intervals on the Requirements Sheet to see when that child needs another dose Temporary Medical Exemptions Must have a note from child s physician Note should state when the child needs another dose Pages 9-11 in Blue Book San Diego Immunization Branch

37 Childcare Time Intervals for Conditional Entrants (B) San Diego Immunization Branch

38 Kindergarten Time Intervals for Conditional Entrants (B) San Diego Immunization Branch

39 Follow-Up Systems: Keep Records Up-to Date! Keep Blue Cards separate Conditional Entrants who need follow-up Kids with exemptions Use a tickler file Use a Calendar Pages of Blue Book San Diego Immunization Branch

40 POP QUIZ! Allergy to a vaccine (has note from physician) Up-to-Date Child had high fever (has note from physician) Parents don t want vaccines (sign back of card) Child is mid-series A (All Requirements Met) B (Will need more doses later) C (Temporary Medical Exemption) D (Permanent Medical Exemption) E (Personal Beliefs Exemption) San Diego Immunization Branch

41 If requirements are not met if you can t mark any of the options Notify parent immediately Do not allow entry San Diego Immunization Branch

42 School Registration & Kindergarten Round-Up You may REGISTER children who are NOT up-to-date They will then have all summer to get shots if registering in the spring. Children may NOT ATTEND CLASS unless they are up-to-date San Diego Immunization Branch

43 Transferring and Storing Records If the student leaves, send the original Blue Card to the new school. Keep a copy of the Blue Card. (3 years) Dispose of old cards by shredding them. San Diego Immunization Branch

44 PRACTICE TIME! San Diego Immunization Branch

45 Example #1-Estevan: Date of Birth: May 17, 2004 MMR & Hib given May 10, 2005 All other required vaccines were given on time and were properly documented. Can he be accepted into kindergarten? San Diego Immunization Branch

46 Example #2: Kimberly Date of birth: Feb. 2, 2004 She has all required vaccines EXCEPT for MMR & Varicella. No history of disease. Her parents are afraid that the MMR and Varicella vaccines cause autism. Can you enroll her into kindergarten? San Diego Immunization Branch

47 Example #3: John Date of Birth: February 1, 2009 How old is he TODAY? He has 2 doses each of Polio, DTaP, Hib and Hepatitis B Can he come into child care? Will he need more shots? San Diego Immunization Branch

48 Example #3: Wendy Date of Birth: November 5, 2007 How old is she TODAY? Started child care February 15, 2009 with 3 doses each of Polio and DTaP; 2 doses each of Hep B and Hib and 1 MMR (given 11/6/08) Was she up-to-date when she enrolled? Does she need more vaccines? San Diego Immunization Branch

49 Example #3: Alex Date of birth: February 15, 2005 He has the following shots: 3 Polio, 4 DTaP, and 3 Hep B He has a note signed by his doctor that he will not receive any more vaccines because he has a chronic medical condition Can you enroll him? San Diego Immunization Branch

50 Required Annual Reporting State of California requires the Annual Immunization Assessment be completed each fall DUE to the State IZ Branch on: October 15 Child Care Centers (kids ages 2-5) October 15 Kindergarten Report Submitted to CDPH through Starting 2008: No Follow-Up or Infant Reports! San Diego Immunization Branch

51 Why is the Annual Report Needed? Nationwide reporting system All schools and childcare centers must file a report It is the responsibility of the school to ensure that children are up-to-date Helps prepare facilities for the Selective Review Schools are chosen at random by the State Review occurs in Spring every year San Diego Immunization Branch

52 Selective Review Spring Audits of Childcare Centers, and Kindergartens Collect information from Blue Cards to compare to Fall Reports Help sites troubleshoot any problems they are having San Diego Immunization Branch

53 Disease Reporting School Nurses are State-mandated reporters for cases of infectious diseases in schools List of diseases you must report to local health department under State guidelines Page D-74 in Blue Book Varicella: San Diego 5 cases in one location is reportable San Diego Immunization Branch

54 Measles Outbreak! 12 cases in people quarantined San Diego Immunization Branch

55 Measles Rash San Diego Immunization Branch

56 Immunization News & Updates Infants & Children Rotavirus (RV): 3 dose series for infants Start series at age 6 through 14 weeks Hepatitis A: age limit lowered from 2 years to 1 year Protects against food-borne disease Varicella: 2nd dose for kids 4 18 years Seeing many cases of breakthrough disease Hib: 4th dose deferred San Diego Immunization Branch

57 Immunization News & Updates Infants and Children Combinations Pediarix: DTaP/Polio/Hepatitis B Kinrix: DTaP/Polio Pentacel: DTaP/Polio/Hib New vaccine abbreviations: Rotavirus (RV) Pneumococcal Polysaccharide (PPSV) Meningococcal Polysaccharide (MCV) San Diego Immunization Branch

58 Immunization News & Updates FLU SHOT RECOMMENDED YEARLY ALL children 6 months 18 years Kids under 9 years getting the flu shot for the first time should have 2 doses School staff need it, too! FIND A PUBLIC HEALTH CENTER AND COMMUNITY CLINIC NEAR YOU! CHIP: San Diego Immunization Branch

59 Vaccines Recommended for Teens and Adults Tdap is a one-dose booster Needed to decrease transmission of whooping cough from adults to children (important for care providers) HPV is a three-dose series (Complete the whole series) Protects against 4 strains most commonly responsible for cervical cancer Meningococcal is a one-dose vaccine Protects teens against meningitis which is rare but often deadly Zoster one-dose for shingles Recommended for adults over 60 Pneumococcal (PPSV) one dose vaccine Recommended for adults over 65 San Diego Immunization Branch

60 Prevention of Disease Simple!! Cover mouth (w/arm) when coughing or sneezing. Wash hands w/ soap & water Avoid contact with bodily fluids or people who are sick. Immunizations help prevent the spread of communicable diseases. Get vaccinated! San Diego Immunization Branch

61 Immunization Resources You Can Use San Diego Immunization Branch California Immunization Coalition Centers for Disease Control and Prevention American Academy of Pediatrics Institute for Vaccine Safety The Vaccine Page National Network for Immunization Information (NNii) Vaccine Education Center San Diego Immunization Branch

62 Other Health Department Programs Oral Health Assessment Requirement All Kindergarteners need an assessment within 12 months of school by licensed California dentist (for forms) Share the Care: San Diego Kids Health Assurance Network Links families to no/low cost dental & medical or Erin Piskura: Tuberculosis Branch: Childhood Lead Poisoning Prevention Program San Diego Immunization Branch

63 Contact Information County IZ Branch Main line 619/ Fax 619/ Website Melissa Crase, MPH Community Health Promotion Specialist Florencia Sisterson, PHN Public Health Nurse Nancy Knickerbocker, Registry Liaison San Diego Immunization Registry San Diego Immunization Branch

64 THANK YOU for what you do to protect our children, families, and community from disease! San Diego Immunization Branch