Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
CALIFORNIA IMMUNIZATION REQUIREMENTS CHILD CARE/PRESCHOOL PROGRAMS
Jennifer Sterling San Diego Immunization Program
County of San Diego Health and Human Services Agency
www.sdiz.org
2018
List immunization requirements for childcare
Identify acceptable forms of immunization records
Complete the California School Immunization Record (CSIR)/Blue
Card correctly
Create a tracking system for conditional entrants and exemptions
How to submit the state immunization report to CDPH accurately
At the end of this training, you will be able to:
TRAINING OBJECTIVES
Spread of Disease is just a Cough, Sneeze or Handshake away
Immunizations help prevent the spread of communicable diseases
Cover mouth (w/arm) when coughing or sneezing
Wash hands w/ soap & water
Avoid contact with people who are sick
These signs along with many others are available at www.sdiz.org
PREVENTION OF DISEASE - SIMPLE
WHY CHECK IMMUNIZATION RECORDS?
To prevent children from serious diseases like chicken pox and measles.
To help parents keep their kids healthy and on track with their shots.
The California School Immunization Law requires school & child care providers to enforce immunization requirements!!
Advisory Committee of Immunization Practices (ACIP) Recommendations
Change yearly
Based on valid doses Extensive list of immunizations ACIP recommends to stay
healthy Based on age and high risk groups across the lifespan CA Requirements Have had minimal changes since 2003: Based on a number of doses Limited list of vaccines required by age and/or grade level
ACIP RECOMMENDATIONS VS STATE LAW REQUIREMENTS
1. Obtain the child’s personal immunization record
Must identify the student by name and DOB
Must show the date each required vaccine dose was received
Acceptable records: medical charts, out-of-state or international records, military records, other Blue Cards, etc.
2. Complete a California School Immunization Record (Blue
Card). A blue card must be on file for every student regardless
of immunization status
IMPLEMENTING IMMUNIZATION REQUIREMENTS
CA REQUIRED VACCINES – CHILD CARE/PRESCHOOL
IMM 230 Every child must
be up-to-date with their immunizations
VACCINE COMBINATIONS
Available for download at: www.sdiz.org
HELPFUL TOOLS
Admitting under Conditional and
follow-up schedule
CONDITIONAL SCHEDULE
Students who do not have an immunization history should be referred to a physician.
WHAT CAN BE DONE
Yellow Cards are best – if a parent does not have one, suggest they have their current record transcribed for future convenience
THE YELLOW CARD
ACCEPTABLE?
YES! Record has dates each
vaccine was given Official form from a
clinic
Jane Doe
MEDICAL RECORDS
Acceptable???
NO! Record is stamped but
does not show dates each vaccine was given
Official Mexico Immunization Record
Hernandez, Jose
12/12/2006
MEDICAL RECORDS CONTINUED
Family, friends, etc. can be used as unofficial translators
If no one is available, suggest a bilingual physician
Fax the record to: Jennifer Sterling @ 619-692-6619
CONFUSING IMMUNIZATION RECORDS
HOW TO COMPLETE THE CALIFORNIA SCHOOL BLUE CARD
1. Demographic Information
2. Vaccination History
3. Documentation
4. Status of Requirements
Completing the California School Immunization Record (Blue Card)
BLUE CARD
Parents may complete this section Don’t send home – form should be completed in front of you
Please answer questions in full The State & County use this information to find health
disparities
Ethnicity is an important part of the card
You do not have to update address/phone each time it changes
STEP 1: DEMOGRAPHIC INFORMATION
STEP 2: VACCINATION HISTORY
Children Entering your program from another country without vaccine history:
Do not allow any grace period Refer family to their physician or public health dept.
Children Entering your program from another preschool program without vaccine history:
There is no grace period for this situation.
Children who have received vaccine doses up to (and including) 4 days before the recommended age or required intervals will not have to repeat the doses.
MMR: must be given on or after the 1st birthday
Up to 4 days before the birthday is okay!
Date of Birth: January 7, 2009
MMR 1: January 8, 2010 = VALID
MMR 1: January 4, 2010 = VALID
MMR 1: January 2, 2010 = INVALID*
*MMR must be given again
4-DAY GRACE PERIOD
DISEASE *
*History of disease must be documented!
X
Dr. Disease History
Titers Pediatrics
619-999-9999
DOCUMENTING CHICKEN POX DISEASE
1. Sign and Date this section. a) It does not have to be
signed by a nurse b) It should be signed
even if the child is NOT up-to-date
2. Specify which kind of
personal shot record you used to make the blue card
STEP 3: DOCUMENTATION
(a) All requirements are met
(b) Currently up-to-date, but more doses are due later. Requires follow-up
Exemption was granted for:
(c) Medical Reason - Permanent
(d) Medical Reason – Temporary
(e) No longer to be used for new
records
STEP 4: STATUS OF REQUIREMENTS
Status (A) Students who are up-to-date on all their vaccines for the grade level they attend are considered “All Requirements Met” Date the documentation section of the card and place in the student’s permanent folder.
ALL REQUIREMENTS MET
Children currently are up-to-date (next doses not yet due) These children will be admitted on the condition that they will receive still-needed doses as they become due in the future.
Staff must follow-up by:
Notifying parents: Notice of Immunizations Needed
Checking documentation that the needed immunizations were received
Adding the new dates to the Blue Card
ADMITTING CHILDREN “ON CONDITION” STATUS (B)
Children with health insurance should receive immunizations through their healthcare provider or local pharmacy
Immunizations may be provided at Public Health Centers for children who meet vaccine eligibility criteria:
Covered by Medi-Cal Uninsured
WHERE TO RECEIVE IMMUNIZATIONS
Permanent Medical (C) Must have written documentation from
doctor*
Must identify student by name and DOB
Keep document with the Blue Card
Ex: Child with an allergy to a vaccine or 4-day rule violation
* Must be licensed MD or DO
STATUS OF REQUIREMENTS EXEMPTIONS: STATUS (C)
Temporary Medical (D)
Must have written documentation from doctor*
with an end-date to exemption
Must identify student by name and DOB
Must get shots at end of exemption Ex: Child who was sick at appointment
* Must be licensed MD or DO
STATUS OF REQUIREMENTS EXEMPTIONS: STATUS (D)
STATUS OF REQUIREMENTS EXEMPTIONS: STATUS (E)
*Personal Beliefs (PBE) (E)
• Requires specific form CDPH 8262 be signed prior to January 1,
2016 • Requires signature by provider and parent on the form
acknowledging consent • Not acceptable for first time registrants
*Religious Belief • Requires documentation on CDPH 8262 • Requires the form be signed prior to January 1, 2016 • Requires parent signature
• Not acceptable for first time registrants
The Law
SENATE BILL 277
This bill eliminated the personal belief and religious belief exemption from existing for specified immunization requirements.
SB277 took affect on July 1, 2016. This affected the 2016/2017
childcare year Students who have had CDPH form 8262 signed prior to January 1,
2016, will be grandfathered in until child advances into TK/Kinder *Define “grade span” as: a) birth to preschool; b) kindergarten (including transitional kindergarten) to grade 6; or c) grades 7 to 12.
Keep Blue Cards separate Conditional Entrants who need follow-up
Kids with exemptions
Ensure that your system is secure
from public viewing – be HIPPA
Compliant!
Use a Calendar
Use a tickler file
FOLLOW-UP SYSTEMS
The child has 10 business days to receive the needed
immunizations.
Choose vaccines they need
Provide “END” date for receiving vaccines
IF REQUIREMENT IS NOT MET
TRANSFERRING RECORDS
Child Care Centers: The original “Blue Card” or a copy of it
must be kept with the child’s file during the period of enrollment and for three years after the child leaves your care.
REQUIRED ANNUAL REPORTING
Annual Assessments
Completed each fall
Child care centers (ages 2 – 4 yrs 11 months)
No infant reports
Submitted online to the California Department of Public Health
Selective Review
Spring review of specific cohort will be checked every year (childcare, kinder and 7th grade)
Collect information from Blue Cards to compare to fall report
Provide assistance
REPORTING
Reporting to the state is a mandatory activity. Reporting will be completed online. It is recommended that you familiarize yourself with the website and expectations.
http://reporting.shotsforschool.org/CC/login.aspx
ANNUAL REPORTING CONTINUED
Reporting usually starts in September and you are notified via the California Department of Public Health, Immunization Branch, via email and letter.
Child Care Centers ages 2-5 report first
It is up to you to update your contact information if you have had a staff change at your facility
REPORTING
REPORTING CHILD CARE
Child Care Worksheet Allows you to calculate Auto sums if use
online tool
REPORTING CHILD CARE WORKSHEET
REPORTING CHILD CARE SUMMARY
Total Number of Children • Total number of children in your facility aged 2-5
years
(A)Unconditional Admission
• Total number of children in your facility, aged 2-5 years, that require no additional doses of vaccine
REPORTING CHILD CARE
Personal belief prior to January 1, 2016 Must have Form 8262 onsite Form must be signed prior to 1/1/16
Permanent Medical Exemptions Must have written letter on doctor letterhead that states
which vaccines and identify the student by name and DOB. This letter can only be signed by a MD or DO
Others: Active Individual Education Plan (IEP)
Everything under the blue line is for children who are missing immunizations and the reason they are missing
Requirements Met, But Missing Doses
Personal Belief Exemption E 0
Permanent Medical Exemption C 0
Others:
IEP Services F1 0
pre-
2016
REQUIREMENTS MET, BUT MISSING DOSES
Conditional Admission, Needs Follow-up
Conditional entrant As Up to Date as possible with vaccines, more needed later
Temporary Medical Exemption Must have written letter on doctor letterhead that states which
vaccines and identify the student by name and DOB. This letter can only be signed by a MD or DO and must have an end date
CONDITIONAL ADMISSION, NEED FOLLOW-UP
Conditional Entrant B 0
Temporary Medical Exemption D 0
CONDITIONAL ADMISSION – NEEDS FOLLOW UP
Requirements NOT met, Missing Doses A child in this section can be enrolled in your
program but not attending. These children need to be as up to date as possible to attend your program
REQUIREMENTS NOT MET, MISSING DOSES
Overdue- Enrolled but Not Attending G 0
OVERDUE!
Missing Doses By Vaccine:
Children that are missing doses (below the blue line). Please total the number of
students missing each vaccine:
Polio 0 Hep B 0
DTP 0 Varicella 0
MMR 0
Any missing immunizations for a child must be documented.
Document the children who are missing doses
REQUIREMENTS MET, BUT MISSING DOSES
Note for children who meet criteria in multiple categories:
If a child has an exemption and is also a conditional entrant, please report the child as having the exemption only.
MEET MULTIPLE CRITERIA
All schools and child care centers are mandated to report certain diseases to your local health department. List of diseases you must report to local health department under State guidelines
*CDPH 110a lists all diseases that need to be reported and how you should report Epidemiology Department 619-692-8499
DISEASE REPORTING
WHAT’S NEWS
PROPOSED REGS CHANGES - EXEMPTIONS
Deletes the personal belief exemption pursuant to statutory changes in SB 277 (Stats. 2015, ch. 35)
Clarifies requirements of a medical exemption:
Must be signed
California-licensed MD/DO
WHAT’S NEWS
PROPOSED REGS CHANGES – IMMUNIZATION RECORD
CA School Immunization Record/Blue Card:
No PBE boxes
New layout
Record on file must contain all elements (Blue Card available but optional)
1. Can I let a child with an active PBE transfer into my facility If a child has a CHDP 8262 signed, prior to 2016, from another California
childcare program, they may transfer to your facility
Can I accept a medical waiver from a doctor in Mexico No, the medical exemption is only acceptable from a provider (MD or DO)licensed
in the United States 3. Can I accept a medical waiver from any doctor in the United States
Yes, as long as the provider is a MD or DO. Physician Assistants or Nurse Practitioner cannot sign the letter.
4. Can I accept a new enrollment whose parents tell me they have any appointment next month for vaccines. No. This child would need to start their vaccine series prior to coming in to your
facility.
TOP EXEMPT QUESTIONS
Meet Penny, Patty and Maddie
• All 3 girls are coming from an offsite Preschool to your preschool program this year.
• Penny & Maddie are fully vaccinated. Patty has no history of MMR.
• Can Patty start Kindergarten with no doses of MMR today?
No – You will need to follow-up with Patty’s parents to ensure
that she goes to her next appointment.
TEST YOUR KNOWLEDGE
TEST YOUR KNOWLEDGE
Meet Parker
Parker had a confirmed case of pertussis last year
Parker’s doctor put “disease history” in the DTaP field on the yellow card
Does Parker need to finish his DTaP series?
YES – or…Parker would need a doctor’s note on doctor’s letterhead stating he will not vaccinate Parker with DTaP
OUT OF STATE
Meet Lilly Lilly was in a preschool program in another state
Lilly’s mom is trying to register her at your school
Lilly’s mom had a active personal belief waiver in the state
Can Lilly start at your school?
No Being homeschooled at the last grade span to bypass vaccines does
not exempt a student. Lilly will be required to start the 7-17 age group vaccines .
MMR DILEMMA
Meet Frankie
Frankie is 19 months old and is registering for your program
Frankie has had the individual vaccines for 1 measles, 1 mumps and 1 rubella after his first birthday
Knowing this information, can Frankie start in your program today?
YES – The individual vaccines meet the requirement for the 1 dose of MMR
Under SB 792, day care centers and family day care homes, as part of their licensure requirements, will have to maintain vaccination records for their employees and volunteers for influenza, pertussis, and measles. SB 792 went into effect September 1, 2016. This allowed day care centers a year from the time of its signing to the time of its implementation.
SB 792 (MENDOZA) VACCINES FOR DAY CARE WORKERS
SECTION 1. Section 1596.7995 is added to the Health and Safety Code
Under the new section of the H&S code, childcare staff will be required to show proof of:
1 – Tdap Booster 1 – MMR (a second dose may be needed. Consult with your healthcare provider to determine your level of risk) 1 – Influenza vaccine given between August 1 and December 1 of each year Failure to maintain accurate records will be treated like any other
violation of licensure requirements.
SECTION 1596.7995 REVISION
SB 792 also allows a 30-day grace period of conditional employment.
Staff and Volunteers have 30-days from
day of hire to retrieve or receive required vaccines
EMPLOYEE GRACE PERIOD
A person is medically exempt from the requirements of this section only under any of the following circumstances:
(1) The person submits a written statement from a licensed physician including: Declaring physical/medical Indicate the probable duration of the medical condition
(2) The person submits a written statement from a licensed physician providing that the person has evidence of current immunity to the diseases described in subdivision(a).
MEDICAL EXEMPTION TO THE LAW
A person can have a personal exempt from the influenza requirement only under the following circumstances: (1) The person submits a written declaration that he or she has
declined the influenza vaccination. This exemption applies only to the influenza vaccine. (2) The person was hired after December 1 of the previous year and before August 1 of the current year. This exemption applies only to the influenza vaccine.
PERSONAL EXEMPTION TO THE LAW
San Diego Immunization Branch www.sdiz.org
Shots for School www.shotsforschool.org
California Immunization Coalition www.ImmunizeCa.org
Centers for Disease Control and Prevention www.cdc.gov/vaccines/
American Academy of Pediatrics www.aap.org
Institute for Vaccine Safety www.vaccinesafety.edu
National Network for Immunization Information (NNii) www.immunizationinfo.org
IMMUNIZATION RESOURCES YOU CAN USE
THANK YOU for all you do to protect
our children, families, and community
from disease!
Jennifer Sterling School and Childcare Coordinator
619-692-8366 [email protected]
Contact Information