2016-2017 MDHHS/MCIR/SIRS

IP-101 Educational Materials

Retain as a Desk Reference

Macomb County Health Department

School Immunization Program

43525 Elizabeth Road

Mount Clemens, MI 48043

Telephone: (586)466-6840

Fax: (586)466-6953

MCIR Helpdesk: 1-888-243-6652

FALL 2016

LIST OF MATERIALS*

CHILDCARE/PRESCHOOL MCIR/SIRS** IP-101 REPORTING

1. Macomb County Health Department (MCHD) Materials

October 2015 Compliancy Waiver Percentage Chart Childcare Bulletin #26 Fall 2016

Q & A for Schools/Preschools/Childcare Centers 08/2016

Q & A for Parents/Guardians or 18 Year Old Students 06/30/2016

Immunization Clinic Hours and Nonmedical Waiver Education Services 06/30/2016

2. Master Forms

MCHD Statement of Varicella Disease (Chickenpox) Revised 6/11

MDHHS Medical Contraindication Form Rev. January 1, 2016

3. Michigan Department of Health and Human Services Department (MDHHS) Materials

MCIR/SIRS Rev. March 31, 2016

Letter To Directors of Preschool Programs and Licensed Childcare Centers July 8, 2016

Required Immunizations for Michigan Childcare/Preschool Attendance Rev. March 31, 2016

The Flu: Information for Daycares & Preschools on Flu Vaccines July 20, 2016

Dear Parent/Guardian: Key Points Related to Claiming a Nonmedical Immunization Waiver for Children Attending Michigan Schools and Licensed Child-Care Centers April 20, 2016

Nonmedical Waiver Rule for Childhood Immunizations in School and Licensed Childcare: Information for Parents/Guardians April 13, 2016

Vaccine Terminology Rev. March 16, 2016

*Please use the materials provided and dispose all outdated versions in your files.

**Michigan Care Improvement Registry/School Immunization Reporting System

Page 1 of 4

MACOMB COUNTY HEALTH DEPARTMENT

SCHOOL IMMUNIZATION PROGRAM

CHILDCARE BULLETIN

NUMBER 26 FALL 2016

MCIR/SIRS ACCESS HAS CHANGED

The Michigan Care Improvement Registry/Schools Immunization Reporting System (MCIR/SIRS) is administered by the Michigan Department of Health and Human Services (MDHHS) and the Michigan Public Health Institute (MPHI).

In the past, access to the MCIR/SIRS was completed by logging on the State of Michigan Single Sign-On (SSO) application.

On July 1, the MDHHS notified the SIP re: the change from the SSO system to MILogin: “On July 26, the Michigan Care Improvement Registry (MCIR) will no longer be accessed through the current SSO application, but will migrate to the State’s new MILogin system.”

The MCIR/SIRS is now accessed by going to MILogin at https://milogintp.michigan.gov OR beginning July 26th, through a link on mcir.org.

MILogin will replace the SSO Login on the mcir.org website.

MILogin is the new State of Michigan Identity, Credential and Access Management (MICAM)

solution. The MILogin solution will provide enhanced single sign-on (SSO) capabilities in addition to meeting many other business requirements and security and compliance needs.

For assistance contact the MCIR Helpdesk at 1-888-243-6652, Monday through Friday from

8:30 a.m. to 4:30 p.m. (except holidays) or go to www.mcir.org for more information. Or, contact the MILogin Client Service Center at 1-800-968-2644 or 517-241-9700.

Page 2 of 4

NONMEDICAL WAIVER EDUCATION IS BY APPOINTMENT ONLY An important request from the School Immunization Program:

Please instruct parents to “Call the SIP for a waiver education appointment.”

Avoid saying, “You have to go to the health department for a waiver.” -The second statement may lead parents to believe that walk-in waiver education Is available like walk-in immunization services.

-The difference in the use of call vs. go can decrease frustration for parents and staff.

For individuals seeking nonmedical waiver information, please copy and provide the SIP Q & A for Parents/Guardians or 18 Year Old Students for information to make a waiver education appointment at the Mount Clemens Health Center.

For individuals asking for MCHD Immunization Clinic services, please copy and provide the Immunization Clinic Hours flyer for information to receive immunization services at 3 MCHD centers.

2016 IMMUNIZATION REQUIREMENTS REMAIN THE SAME

Please see the MDHHS Required Immunizations for Michigan Childcare/Preschool Attendance (Rev. March 31, 2016) for vaccines required for childcare/preschool entrance and attendance.

October 2016 IP-101 REPORTING PROCEDURE

All certified nonmedical and approved medical waiver forms received for children on the current roster, must be faxed or mailed with the following four reports: 1. IP-101 Summary

2. Waivers – only if you have waivered students 3. Provisionals 4. Incompletes

The SIP will review all waiver forms for authenticity.

Nonmedical waivers should no longer be faxed intermittently.

REPORT DUE DATES

Report Period October 2016

Second Report Period Not Required

Earliest date to submit September 15, 2016

Report due date Friday September 30, 2016 @ 5:00 p.m.

Minimum compliance rate 90%

Page 3 of 4

STATE OF MICHIGAN IMMUNIZATION ADMINISTRATIVE RULES CHANGE Effective January 1, 2015, the new Michigan Public Health Code Rule (R325.176) for nonmedical waivers is as follows:

Rule 6 (12) “When presented with a medical, religious or other exemption, the administrator of a child’s school or operator of a child’s group program shall recognize the exemption status of the child. Each nonmedical exemption filed at the child’s school or group program of a child entering a program after December 31, 2014 shall be certified by the local health department (LHD) that the individual received education on the risks of not receiving the vaccines being waived and the benefits of vaccination to the individual and the community. All waivers shall be submitted using the waiver form prescribed by the department.”

NOTE: Parents/Guardians should present a certified nonmedical Immunization Waiver Form or Medical

Contraindication Form at the time of registration to a school, preschool or childcare center. For the purpose

of reporting to Macomb County Health Department, a child without a waiver can be admitted and attend,

but must submit a waiver within 30 days of the first date of attendance. A school, preschool or childcare

center may have more stringent program admittance and waiver submission rules. Waiver education

appointments may not be immediately available in such cases.

NONMEDICAL WAIVERS “A nonmedical waiver is a parent’s/guardian’s written statement

indicating the religious or philosophical (other) objections to a particular vaccination(s).” (MI FAQ) The State of Michigan nonmedical Immunization Waiver Form (Rev. January 1, 2016) must be used. All LHDs across the state must provide nonmedical waiver education services and provide a certified

nonmedical waiver following a waiver education appointment. Nonmedical waivers are no longer approved or denied. Physicians cannot provide nonmedical waiver education or certify nonmedical waivers. Nonmedical waiver education sessions are by appointment only at the Mount Clemens Health Center. Individuals can call (586)466-6840 to schedule an appointment. Public Health Nurses provide the 1-on-1 waiver education session.

Not a Class - Not a Video - Not a Lecture – Not a Power Point Presentation. 20-30 minutes needed. Reason for waiver can be stated as religious or other objection to immunization. The LHD will waive the vaccines appropriate for the child’s age and program requirements. Upon completion of the waiver education session, the Immunization Waiver Form is completed

and signed by the parent/guardian and signed and stamped (certified) by a Public Health Nurse. Parents/guardians are required to take the certified waiver to their school or program.

MEDICAL WAIVERS “A medical waiver is a signed statement from the physician that the child

cannot receive a certain vaccine due to a true contraindication or precaution to the vaccine or a vaccine component.” (MI FAQ)

The State of Michigan Medical Contraindication Form (Rev. January 1, 2016) must be used. English and Spanish versions are available online at www.michigan.gov/immunize>Local Health

Departments>Immunization Waiver Information>Health Care Providers Section. Physicians should only check boxes for vaccines that are medically contraindicated. Reason, physician name, address, signature and date is required. Parents/guardians are required to take the completed form to the school or program. Schools, preschools and childcare centers must record the non-administered vaccines into MCIR indicating

medical as the reason. Fax or mail a copy of the medical waiver form to the SIP. The MCHD Medical Director reviews medical waivers for valid medical contraindications. The SIP will fax or mail the approved or denied medical waiver back to the program with a follow–up letter

and instructions. Denied medical waiver disposition forms will no longer be used.

Page 4 of 4

WEEKLY COMMUNICABLE DISEASE ONLINE REPORTING IS REQUIRED

The CD Program is responsible for public health efforts in communicable disease and influenza prevention, surveillance and control.

In 2010, the Communicable Disease (CD) Program implemented an online system at https://weeklycdreporting.macombcountymi.gov/SchoolCDForm.aspx.

Paper reports are no longer used. Visit: http://health.macombgov.org/Health-Programs-HPDC-CommunicableDiseases Call the CD Program for questions or problems at: Macomb County Health Department Telephone: (586)783-8190 Communicable Disease Program Fax: (586)493-0075 43525 Elizabeth Road Mount Clemens, MI 48043

SCHOOL IMMUNIZATION PROGRAM WEBSITE TOPICS Immunization Waiver Update

Kindergarten Entry Booklet

Childcare/School August Mailing Packets

Forms

Childcare/School Immunization Procedure Manuals

Childcare/School Compliancy Rates

County Quarterly Immunization Report Card Visit: http://health.macombgov.org/Health-Programs-HPDC-SchoolImmunization

CALL THE SIP FOR MCIR/SIRS IP-100 Reporting QUESTIONS or PROBLEMS Macomb County Health Department Telephone: (586)466-6840 School Immunization Program Fax: (586)466-6953 43525 Elizabeth Road Mount Clemens, MI 48043

CALL THE MCIR/SIRS HELPDESK @ 1-888-243-6652 to obtain web access or technical assistance for the MCIR/SIRS.

Follow the Macomb County Health Department on Facebook

08/2016 SIP Page 1 of 2

Macomb County Health Department (MCHD)

School Immunization Program (SIP)

43525 Elizabeth Road

Mount Clemens, MI 48043

Q & A for Schools/Preschools/Childcare Centers

What current information is available for medical and nonmedical waivers? For all children through age 18 years, Michigan Public Health Code requires waivers be signed in the

year in which a child’s immunization status is assessed and reported for school and childcare purposes:

this includes children entering a licensed childcare center, preschool, Head Start, and school-aged

children who are new entrants to a school district, in kindergarten, or in 7th

grade.*

Parents/Guardians/18 year old students should present a certified nonmedical Immunization Waiver Form

or Medical Contraindication Form at the time of registration to a school, preschool or childcare center. For

the purpose of reporting to Macomb County Health Dept., a child without a waiver can be admitted and

attend, but must submit a waiver within 30 days of the first date of attendance. A school, preschool or

childcare center may have more stringent program admittance and waiver submission rules. Waiver

education appointments may not be immediately available in such cases.

Schools, preschools and childcare centers remain responsible for entering all waivered vaccines

into a child’s MCIR/SIRS record.

Place a waiver copy in the child’s record and one copy in the master file of all children with waivers.

Previously approved MCHD medical or parental waivers remain valid until the child reaches a new

immunization assessment, e.g., preschool to kindergarten, students entering 7th

grade or new to district

or childcare program. A certified nonmedical or medical waiver is now needed.

If the child has a certified nonmedical waiver for all age appropriate and required vaccines, a new

waiver is not needed when:

o A child was reported on an IP-100 for developmental kindergarten, and remains in the same

school district for kindergarten entry. The child does not need a new waiver or be reported again

on the IP-100 for kindergarten entry.

o A child moves to any new school, preschool or childcare center, and is not entering

developmental kindergarten, kindergarten, or 7th

grade. The certified waiver can be accepted at a

new school, preschool or childcare center. The name of the new school or program does not need

to be on the form.

o A child remains enrolled at the same school, preschool or childcare center for consecutive years.

Waivers do not need to be signed on a yearly basis. According to the Michigan Department of Health and Human Services (MDHHS) Division of Immunizations:

*‘Students in Special Education that are not identified with a grade would be reported either as

SE=Special Education or at the age appropriate for the average student in kindergarten (5 y/o) and 7th

grade (12 y/o). ECDD or PPI students 5 y/o or older should be assessed as school age students. ECDD

students < 5 y/o should be assessed as though they are childcare and reported through the IP-101.’

‘McKinney Vento – is a child who is homeless and would not be required upon entry to receive the

waiver education. The child would be marked as McKinney Vento for the November and February

reporting period.’ Schools are responsible to ensure the McKinney Vento Act rules are followed.

‘Exchange students need to comply with the rule change and receive waiver education just as any other

student attending school in Michigan.’

Alterations of the Immunization Waiver Form constitutes an invalid waiver. A school, preschool or

childcare center cannot accept forms that have information crossed out or words, statements or

objections added to the Instructions to Parents or Guardians section on the form.

08/2016 SIP Page 2 of 2

All certified nonmedical and approved medical waiver forms received for children on the current roster, must be

faxed or mailed with the following four reports: 1. IP-100/101 Summary

2. Waivers – only if you have waivered students

3. Provisionals

4. Incompletes

The SIP will review all waiver forms for authenticity.

Nonmedical waivers should no longer be faxed intermittently.

NONMEDICAL WAIVERS: The State of Michigan Immunization Waiver Form (Rev. January 1, 2016) will be used,

signed and stamped (certified) by a LHD. Nonmedical waivers are no longer approved or denied, but are issued

upon completion of the waiver education session at a LHD.

It is preferred that all Macomb County residents receive waivers from the Macomb SIP, but

waivers certified by any LHD in the state are acceptable.

MEDICAL WAIVERS: The procedures to process a medical waiver remain the same, except the State of

Michigan Medical Contraindication Form (Rev. January 1, 2016) is now required.

When a parent/guardian or 18 year old student submits a medical waiver to the office, please check all

areas of the form, especially that it has been signed by a physician with the reason for exemption section

completed.

Enter the vaccines to be waived in the child’s MCIR/SIRS record and fax the medical waiver to the SIP.

The Macomb County Health Department Medical Director continues to review all medical waivers for

valid medical contraindications to the vaccines checked and will approve or deny the medical waiver.

The SIP will fax the medical waiver form reviewed and signed by the medical director (disposition

forms will no longer be used) back to the school, preschool or childcare center.

If the waiver was approved, keep a copy in the child’s record and one in the school’s or program’s

master file of children with waivers.

If the waiver was disapproved, remove the waivered vaccines from the child’s MCIR/SIRS record and

contact the parent/guardian or 18 year old student that the waiver was not approved for the reason the

medical director provided on the form.

A letter and instruction sheet will be faxed with each disapproved medical waiver to be used in guiding

the parent/guardian or 18 year old student on the next steps they must take.

STATEMENT of VARICELLA DISEASE: The form should be placed in the child’s record and a copy in

school’s or program’s master file of children with waivers.

FINDING WAIVER FORMS ONLINE: www.michigan.gov/immunize>Local Health Departments >

Immunization Waiver Information

A BLANK Immunization Waiver Form is not available. Previously dated versions of this form are not

acceptable for use.

A BLANK Medical Contraindication Form (Rev. January 1, 2016) is in the Health Care Providers section.

A BLANK Statement of Varicella Disease form (Revised 6/11) is available from the SIP.

o These two forms were provided in the 2016 August Mailing Packet.

Call the SIP at (586)466-6840 for questions or assistance. Fax reports and waiver forms to (586)466-6953.

Visit the SIP website at: http://health.macombgov.org/Health-Programs-HPDC-SchoolImmunization.

Follow the Macomb County Health Department on Facebook

06/30/2016 Schools, Preschools, Childcare Centers and Clinics:

PLEASE COPY AND DISTRIBUTE THIS FLYER TO PARENTS/GUARDIANS/STUDENTS

Macomb County Health Department (MCHD)

School Immunization Program (SIP)

43525 Elizabeth Road

Mount Clemens, MI 48043

Call (586)466-6840 TO SCHEDULE A WAIVER EDUCATION APPOINTMENT

Q & A for Parents/Guardians or 18 Year Old Students

What steps are needed to obtain a certified nonmedical Immunization Waiver Form?

Michigan Public Health Code requires waivers be signed in the year in which a child’s immunization

status is assessed and reported for school and childcare purposes which includes attendance in:

o A licensed childcare center

o Preschool or Head Start

o Kindergarten or developmental kindergarten

o 7th

grade

o School-aged children who are new entrants to a school district

Parents/guardians/18 y/o students must receive waiver education at a local health department on the:

o benefits of vaccination

o risks of vaccine-preventable diseases to the individual and community

Call the School Immunization Program at (586)466-6840.

Waiver education appointments are available for Macomb County residents and those attending

Macomb County schools, preschools or childcare centers.

Appointments are one-on-one with a public health nurse at the Mount Clemens Health Center.

Walk-in requests for waiver education are not available.

A nonmedical immunization waiver cannot be issued through a school, preschool, or childcare center.

Upon completion of the required waiver education, parents/guardians/18 y/o students will:

o Receive a certified waiver (MCHD employee signature, address stamp, and date) on the

State of Michigan Immunization Waiver Form (Rev. January 1, 2016).

o Be required to take the certified nonmedical waiver form to the school, preschool or childcare

center. Copies of the waiver will be made and placed in the child’s record and one in the school’s

or program’s master file of children with waivers.

o Be responsible to retain the original waiver form and keep it safe, like an original birth

certificate.

Written alteration of the Instructions to Parents or Guardians section on the Immunization Waiver

Form, constitutes an invalid waiver and cannot be accepted by a school, preschool or childcare center.

Additional notes

Children that do not have the required doses of vaccines (unless they have provisional status) and do not

have a waiver on file, must be EXCLUDED from the school, preschool or childcare center.

Medical waivers, for valid health contraindications, require the State of Michigan Medical

Contraindication Form (Rev. January 1, 2016). The form is available at a school, preschool, childcare center

or online. Parents/guardians/18 y/o students are responsible to have their physician (M.D., D.O., P.A. or

N.P.) complete and sign the required sections and take the form to the school, preschool or childcare

center. The form will then be faxed to the SIP for review by the MCHD Medical Director.

Macomb County Health Department 1. Immunization OR 2. Nonmedical Waiver Education Services

THESE SERVICES ARE CONDUCTED BY TWO SEPARATE COUNTY PROGRAMS. PLEASE READ EACH SECTION CAREFULLY TO CONTACT THE PROGRAM YOU NEED.

06/30/2016

Schools, Preschools, Childcare Centers and Clinics: PLEASE COPY AND DISTRIBUTE THIS FLYER TO PARENTS/GUARDIANS/STUDENTS

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

Mt. Clemens Health Center 43525 Elizabeth Road Mt. Clemens, MI 48043

(586) 469-5372

Closed

Closed

Open 8:30-4:30

Open 8:30-6:30

Open 8:30-4:30

TB testing 8:30-4:30

TB testing 8:30-4:30

No TB testing

Southwest Health Center 27690 Van Dyke, Ste. B Warren, MI 48093

(586) 465-8537

Closed Open

8:30-4:30 Open

8:30-4:30 Open

8:30-6:30 Open

8:30-4:30

TB testing 8:30-4:30

TB testing 8:30-4:30

No TB testing TB testing 8:30-4:30

Southeast Health Center 25401 Harper Avenue St. Clair Shores, MI 48081

(586) 466-6800

Closed Closed

Open 8:30-6:30

Open 8:30-4:30

Open 8:30-4:30

TB testing 8:30-4:30

TB testing 8:30-4:30

TB testing 8:30-4:30

2. Information for NONMEDICAL WAIVER EDUCATION SERVICES ONLY

• For parents, guardians or 18 year old students seeking a nonmedical immunization waiver, a waiver education session is available by

appointment only through the School Immunization Program.

• Please call (586) 466-6840 to schedule an appointment.

• The waiver education session is one-on-one with a public health nurse. • The Immunization Waiver Form (nonmedical waiver form) is not available online or at your school or childcare center office. • The public health code requires waivers be signed in the year in which

a child’s immunization status is assessed and reported for school and childcare purposes:, which includes: all children in a licensed childcare center, preschool, Head Start; and school-aged children who are new entrants to a school district, in kindergarten or developmental kindergarten, or in the 7th grade, including children in special education programs.

• Per the requirements of the Michigan Public Health Code, R325.176(12), all nonmedical Immunization waivers “shall be certified by the local health department (LHD) that the individual received education on the risks of not receiving vaccines being waived and the benefits of vaccination to the individual and the community.” • The Medical Contraindication Form (medical waiver form for valid

medical contraindications to vaccines), is available online or at your school or childcare center office. Contact the office for information about obtaining and submitting a medical waiver for review by the Macomb County Health Department Medical Director.

1. Information for IMMUNIZATION CLINIC SERVICES ONLY

A PARENT OR GUARDIAN MUST be available to complete & sign immunization consent forms for each child. FORMS ARE AVAILABLE AT: http://health.macombgov.org/Health-Programs-FamilyHealthServices-ImmunizationClinic PLEASE BRING WITH YOU TO THE HEALTH CENTER: IMMUNIZATION RECORD(S) for all persons being immunized INSURANCE CARD(S) for all persons being immunized There may be monetary charges for vaccine administration, payable by CASH or CHECK ONLY. Medicaid/Medicare will be billed for approved vaccines. Macomb County Health Department can bill some commercial insurances for immunization services. Please contact one of our health centers above to check if the Macomb Health Department accepts your insurance.

STATEMENT

OF

VARICELLA DISEASE

(CHICKENPOX)

Macomb County Immunization Regulations require all children admitted to

any public, private, or parochial elementary or secondary school, day care

center, camp, or any other organized care or educational facility operating

in Macomb County to present a certificate indicating dates of all required

immunizations.

Complete the portion below only if your child has had varicella

(chickenpox) disease. This must be signed and witnessed at your child’s

school/child care program.

I certify my child:____________________________________________ Last Name First Name M.I.

____________________________________________ Birth Date Grade Date of School Enrollment

has had varicella disease ______________________________________ (When did varicella occur: age or date)

Signature: _________________________ Date: _________________ (Parent or Legal Guardian)

Witnessed by: ______________________ Date: _________________ (School/Program Staff)

School District: ______________________________________________

School/Child Care Program: ___________________________________

PLACE IN CHILD’S PERMANENT RECORD

MCHD/SIP 6/99, Revised 6/11

DCH-0713 AUTHORITY: P.A. 368, PART 92, 1978, as amended Rev. January 1, 2016

2 01 T O W N S E N D S T R E E T LA N S I N G , M I C H IG A N 4 8 91 3

www.michigan.gov/mdhhs 517-373-3740

RICK SNYDER

GOVERNOR

STATE OF MICHIGAN

DEPARTMENT OF HEALTH AND HUMAN SERVICES

LANSING

NICK LYON

DIRECTOR

Medical Contraindication Form

Michigan immunization law requires that a child enrolled in a school or childcare center be immunized against the diseases specified unless a valid exemption applies. A child is exempt from these requirements for any specific immunization for any period of time for which a physician certifies that a specific immunization is or may be detrimental to the child's health. Any child with a medical contraindication to a particular vaccination is considered susceptible to that vaccine-preventable disease, and is subject to exclusion from school or childcare center if an outbreak of the disease occurs in the school or center. PLEASE PRINT:

NAME OF CHILD (Last, First, Middle Initial)

BIRTH DATE (Mo/Day/Yr)

Preschool Program Or Childcare Center or School Name:

The following immunization(s) are medically contraindicated:

☐ DTaP, DT, Td, Tdap (Diphtheria, Tetanus, Pertussis) ☐ Haemophilus influenzae type b

☐ Polio ☐ Pneumococcal Conjugate

☐ Hepatitis B ☐ Varicella (chickenpox)

☐ MMR (Measles, Mumps, Rubella) ☐ Meningococcal Conjugate

Reason for exemption_______________________________________________________________________________

The exemption shall continue until (Mo/Day/Yr): _________________________________________________________

PRINT NAME & ADDRESS OF PHYSICIAN

TELEPHONE

( )

PHYSICIAN’S SIGNATURE (REQUIRED)

DATE

School and Childcare Staff: File in the child’s permanent record and send a copy to your local health department. *Condition of acceptance is based on local health department policies.

RICK SNYDER GOVERNOR

STATE OF MICHIGAN

DEPARTMENT OF HEAL TH AND HUMAN SERVICES LANSING

NICK LYON DIRECTOR

July 8, 2016

Re: Immunization Requirements for Children Attending Michigan Preschool Programs or Licensed Childcare Centers during the 2016 Calendar Year

Dear Directors of Preschool Programs and Licensed Childcare Centers:

Immunizations are one of the most effective measures to protect children from harmful diseases and even death. All children who attend preschool programs or licensed childcare centers in Michigan are required by state law to be fully immunized. Reporting of immunization data to the local health department is required under the Michigan Public Health Code, and requires all children in a program to have an up-to-date immunization history or a valid waiver at their childcare center or preschool. A child who fails to meet immunization requirements shall not be admitted into the program. It is the responsibility of the parent/guardian for ensuring that their child has received all required vaccine doses.

There are three circumstances in which a required vaccine may be waived or delayed:

1. The child has received at least one dose of required vaccine(s) and the next dose(s) are not yet due. These children are considered to be in a "provisional" status. Childcare centers are required to follow-up with these children to be sure subsequent doses of vaccine are received until they are complete for all required vaccines.

2. The child has a medical contraindication to a vaccine, in which case a Medical Contraindication Form is required to be completed and signed by the child's primary care physician. The form shall state the medical contraindication(s), the vaccine(s) involved, and the time period during which the child is precluded from receiving the vaccine(s);

3. A parent or guardian holds a religious or philosophical ("other") belief which preclude receipt of vaccination(s). These are the nonmedical exemptions and require certification at the local health department. This will be discussed later in the letter.

A summary of requirements and supporting information is included in this packet and is also posted online at www.mcir.org under the School/Childcare section. All necessary materials are provided in this packet. Please review this important information to assist you with completion of the immunization reporting of your attendees. A request for additional informational materials should be directed to your local health department.

333 SOUTH GRAND AVENUE• PO BOX 30195 •LANSING, MICHIGAN 48909

www.michigan.gov/mdhhs • 517-373-3740

Directors of Preschool Programs and Licensed Childcare Centers July 8, 2016 Page 2

To obtain technical assistance or to enroll as a Michigan Care Improvement Registry/Schools Immunization Reporting System (MCIR/SIRS) user, please contact your local health department or the MCIR Help Desk At 888-243-6652.

Since January 1, 2015, Michigan parents/caregivers who waive vaccinations for their child are required to obtain a current Nonmedical Waiver Form from their local health department before their child enters a childcare program.

The Joint Committee on Administrative Rules requires parents/guardians to speak with a health care professional from their local health department about their concerns and questions, along with receiving education on the benefits of vaccination and the risks of disease, before obtaining the signed certified Nonmedica/ Waiver Form. The parent/guardian will receive a current, certified (stamped and signed) State of Michigan Nonmedica/ Waiver Form to bring to the childcare/preschool for entry into MCIR/SIRS. Childcare centers should no longer distribute Nonmedical Waiver Forms to families, and accept only waiver forms that are stamped/certified by the local health department.

For those individual programs without internet access, please contact the local health department for approval and guidance to report using the handwritten IP-1001101 Immunization Reporting Form.

Proper maintenance of up-to-date immunization records is critical in the event of an outbreak of vaccine preventable disease, or if an audit is conducted by your local health department or the Michigan Department of Health and Human Services.

Copies of the Nonmedical Waiver and Medical Contraindication Forms must be submitted no later than October 1, 2016, to the jurisdictional local health department.

Thank you for your continued support and cooperation in ensuring that Michigan's children are properly immunized to avoid the threat of communicability and illness associated with vaccine preventable diseases.

Sincerely,

~~ Nick Lyon Director

NL:jj

Enclosures

c: Local Health Departments

Rev. March 31, 2016

Toll-free MCIR helpdesk number is ………….. 1-888-243-6652

The following materials can be found on www.MCIR.org and should be reviewed.

Childcare packet: School packet:

MCIR/SIRS Information Sheet

Childcare Cover Letter

Required Immunization Chart for

Childcare

Influenza Information for Childcare

Centers

Waiver Key Point Flyer

Waiver FAQ for Parents

Vaccine Terminology

MCIR/SIRS Information Sheet

School Cover Letter

Information for Parents – Teen Vaccines

Papillomavirus, Meningococcal &

Vaccines for Pre-Teens and Teens

Influenza Information for Schools

Vision Screening Information

Required Immunization Chart for

Schools

Waiver Key Point Flyer

Waiver FAQ for Parents

Vaccine Terminology

January – December: Build your roster, making sure that appropriate reporting period

and grade is marked for each student. Use current grade, or

roundup for kindergarten in the Spring and Summer of 2016 – all

students will be advanced automatically on August 1st.

October 1st: Childcare closes the report period by going into IP Status and clicking on

the “close period” button on October 2nd. (The button will not be

highlighted and you will not be able to close the period if you are not at

90% compliancy.) Continue to update immunization records until you

reach at least 90% compliancy.

November 1st: School closes the report period by going into IP Status and clicking on

the close period button. (The button will not be highlighted and you will

not be able to close the period if you have not obtained at least 90%

compliancy). Submit vision report for all kindergarten students.

Continue to update immunization records until you reach at least 90%

compliancy.

February 1st: School closes the report period by going into IP Status and clicking on the

“close period" button. (The button will not be highlighted and you will

not be able to close the period if you are not at 95% compliancy).

Continue to update immunization records until you reach at least 95%

compliancy. Contact your local health department or the help desk if you

have any questions about reporting.

Req

uired

Imm

un

izatio

ns fo

r Mich

igan

Ch

ildca

re/Presch

oo

l Atten

da

nce

Com

municab

le disease ru

les are the m

inim

um

standard

for p

reven

ting d

isease outb

reaks in

child

care settings.

Health

care pro

fessionals in

Mich

igan

should

follo

w th

e

2016 R

ecom

men

ded

Imm

unizatio

n S

ched

ule at w

ww

.cdc.g

ov/v

accines o

r ww

w.m

ichig

an.g

ov/im

munize to

pro

tect patien

ts from

all diseases

**A

ll doses o

f vaccin

es mu

st be g

iven

with

ap

pro

pria

te spacin

g b

etwee

n d

oses a

nd

at a

pp

rop

riate a

ges to

be co

nsid

ered

valid

.

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e

Vaccin

e**

Ch

ildca

re/Presch

oo

l En

try R

equ

irem

en

ts

Birth

thro

ug

h

1 m

on

th

2 m

on

ths

thro

ug

h

3 m

on

ths

4 m

on

ths

thro

ug

h

5 m

on

ths

6 m

on

ths

thro

ug

h

15

mo

nth

s

16

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nth

s

thro

ug

h

18

mo

nth

s

19

mo

nth

s

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ug

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4 y

ears

5 y

ears

Dip

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Tetan

us,

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ssis

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aP

2 d

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aP

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Pn

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(PC

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after 24

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OR

age ap

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fluen

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R ag

e app

rop

riate com

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series

No

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lio

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ose

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oses

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Mu

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bella

*

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atitis B*

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accinatio

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istered, cu

rrent lab

orato

ry ev

idence o

f imm

unity

is required

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† H

epatitis B

may b

e adm

inistered

as early as b

irth. T

his tab

le represen

ts the m

inim

um

req

uired

imm

unizatio

ns fo

r child

care centers.

Paren

ts/guard

ians m

ust o

btain

a certified n

on

med

ical waiv

er from

a local h

ealth d

epartm

ent.

Rev

. March

31, 2

01

6

Is flu vaccine recommended for children in daycare and preschool? Yes. The Centers for Disease Control and Prevention (CDC) and Michigan Department of Health and Human Services (MDHHS) recommend that all children 6 months of age and older receive flu vaccine every year to help them stay healthy.

How can children be protected from the flu?Flu vaccine is the single best way to protect children and adults from getting the flu. Flu vaccine is recommended every year for everyone 6 months of age and older. It is also very important to make sure children stay home if they are sick.

What can I do to protect my daycare/preschool children?Get a flu vaccine and encourage others in contact with children to get vaccinated – parents, siblings, teachers and other day care/preschool staff. Getting vaccinated is especially important for those who take care of infants less than 6 months of age because these babies are too young to get a flu vaccine.

What kinds of flu vaccine can children get?All children 6 months and older can get a flu shot. Some children may need 2 doses of flu vaccine. Healthcare providers can best determine the vaccination needs for children.

Why is the nasal spray flu vaccine no longer available?FluMist®, the nasal spray flu vaccine, was found to be ineffective in preventing the flu in the past three flu seasons. Health officials

closely monitor vaccine effectiveness, and want to ensure that people are receiving the best protection against the flu.

This is an example of improving public health policies based on new data.

The Flu: Information for Daycares & Preschools on Flu Vaccines

July 20, 2016

How often should children be vaccinated with flu vaccine?Flu vaccines change from year to year, so children and adults need to get a flu vaccine every year. The vaccine can be given as soon as it becomes available (as early as August) and should be given throughout the entire flu season until the vaccine expires (typically June 30).

Are flu vaccines safe?Yes, flu vaccines are safe and can be given with other vaccines. It is safer to get the flu vaccine than it is to get the flu.

Are there side effects from the flu vaccine?Most children and adults have little or no problems after getting a flu vaccine. Side effects are often mild, like soreness or redness in the arm where the child received the shot.

What if a child’s family cannot afford vaccine?Children 18 years of age and younger may be eligible to receive publicly purchased vaccines through the Vaccines for Children (VFC) program. To learn more about the VFC program, contact your local health department or healthcare provider.

What is influenza or “the flu”? The flu is an infection of the nose, throat, and lungs that is caused by flu viruses. There are many different flu viruses that make people sick and spread easily through coughing and sneezing. Many people get the flu every year. Some people can get very sick, and some even die.

What are the symptoms of the flu?People who have the flu often get sick very fast with a high fever, headache, muscle aches, dry cough, and sore throat. Some people who get the flu have NO symptoms at all, but they can still spread the flu to others.

For more information about the flu and flu vaccines, contact your healthcare provider or local health department.

Additional information is available:Centers for Disease Control & Prevention: cdc.gov/fluMichigan Department of Health and Human Services: michigan.gov/fluChildhood Influenza Coalition: preventchildhoodinfluenza.orgFamilies Fighting Flu: familiesfightingflu.org July 20, 2016

April 20, 2016

Dear Parent/Guardian:

Key Points Related to Claiming a Nonmedical Immunization Waiver

for Children Attending Michigan Schools and Licensed Child-Care Centers

In early 2015, Michigan instituted an administrative rule change on nonmedical waivers for childhood

immunizations. Parents/guardians seeking to obtain a nonmedical immunization waiver on behalf of their

child/children who are enrolled in school or licensed child-care programs are required to attend an

educational session where they are provided with information about vaccine-preventable diseases and

vaccinations.

Michigan has one of the highest immunization waiver rates in the country, with select counties

reporting waiver rates up to 12.5% (that is, more than 12% of school-age students in these places

have not received all vaccinations) and individual school buildings reporting even higher waiver

rates

Key Points

The rule applies to parents seeking an immunization waiver on behalf of their children enrolled in

a public or private:

o Licensed childcare, preschool, and Head Start programs

o Kindergarten, 7th grade, and any newly enrolled student into the school district

This rule preserves your ability to obtain a nonmedical waiver.

Nonmedical waivers (religious or philosophical/other objections) are now available at your

county health department and cannot be found at schools/child-care centers.

Parents/Guardians are required to follow these steps when seeking a nonmedical waiver:

1. Contact your county health department for an appointment to speak with a health educator.

2. During the visit, immunization-related questions and concerns of the parents/guardians can

be brought up for discussion with the county health department staff. The staff will present

evidence-based information regarding the risks of vaccine-preventable diseases and the

benefits/risks (mostly moderate side-effects) of vaccination.

3. If, at the end of the visit, you request a nonmedical waiver for your child, you will receive a

copy of the current, certified (stamped and signed) State of Michigan Nonmedical Waiver

Form.

Schools/childcare centers will only accept the current, official State of Michigan

form (Current date: January 1, 2016).

Forms cannot be altered in any way (such as crossing information out).

4. Take current, certified waiver form to your child’s school or childcare center.

If your child has a medical reason (that is, a true contraindication or precaution) for not receiving

a vaccine, a physician must sign the State of Michigan Medical Contraindication Form, available

at your doctor’s office (not the county health department).

Based on the public health code, a child without either an up-to-date immunization record, a

certified nonmedical waiver form, or a physician-signed medical waiver form can be excluded

from school/childcare.

For more information, please visit www.michigan.gov/immunize > then click on Local Health

Departments > then click on Immunization Waiver Information. On this website, there is a link to a list of

all the county health departments, along with their addresses and phone numbers.

April 13, 2016

Nonmedical Waiver Rule for Childhood Immunizations:

Information for Schools and Childcare Centers

In early 2015, Michigan instituted an administrative rule change on nonmedical waivers for childhood

immunizations. Parents/guardians seeking to obtain a nonmedical immunization waiver on behalf of their

child/children who are enrolled in school or licensed child-care programs are required to attend an

educational session, where they are provided with information about vaccine-preventable diseases and

vaccinations.

Frequently Asked Questions:

Why is this rule important?

Michigan has one of the highest immunization waiver rates in the country, with some counties reporting

waiver rates up to 12.5% (that is, more than 12% of school-age students in these places have not received

all vaccinations). In addition, individual school buildings have reported even higher waiver rates. High

nonmedical waiver rates can leave communities susceptible to the entry of diseases such as measles,

chickenpox, and pertussis (whooping cough) by undermining community or “herd” immunity that

protects vulnerable children (for example, children who cannot be vaccinated for medical reasons and

children with compromised immune systems). Herd immunity can also slow the spread of disease if a

high proportion of individuals are immune to the disease in a community. Immunization is one of the

most effective ways to protect children from harmful diseases and even death.

What does the rule change? Parents/guardians seeking to claim a nonmedical waiver are required to participate in an immunization-

focused discussion with county health department staff. During the discussion, immunization-related

questions and concerns of parents/guardians can be brought up for discussion with the county health

department staff. The staff will present evidence-based information regarding the risks of vaccine-

preventable diseases and the benefits/risks (mostly moderate side-effects) of vaccination. This rule

preserves the ability of parents/guardians to obtain a nonmedical waiver following completion of this

required educational session.

What is a nonmedical immunization waiver? A nonmedical waiver is a written statement by parents/guardians describing their religious or

philosophical (other) objections to specific vaccine/vaccines, on a form provided by the county health

department.

How does this rule affect Michigan’s schools and licensed childcare centers? • The rule requires schools and child care centers to refer parents/guardians seeking a nonmedical

waiver for immunizations to the county health department for immunization waiver education and

waiver certification.

• Schools and childcare centers can only accept a current, certified State of Michigan Immunization

Waiver Form.

Who does this rule apply to?

The rule applies to parents seeking an immunization waiver on behalf of their children who are enrolling

in a public or private:

• Licensed child-care, preschool, and Head Start programs

• Kindergarten, 7th grade, and any newly enrolled student into the school district

April 13, 2016

What is considered a certified nonmedical waiver? A certified nonmedical waiver is the State of Michigan Immunization Waiver Form with a revision date of

January 1, 2016, displaying the county health department stamp and signatures of the authorizing agent

completing the immunization education and the parent/guardian.

Can a parent/guardian obtain a certified nonmedical waiver form from a school,

childcare center, or healthcare provider? No, a certified nonmedical waiver can only be obtained at a county health department.

How does a parent/guardian obtain a certified nonmedical waiver?

Based on the rule, parents/guardians are no longer permitted to submit an uncertified Immunization

Waiver Form to the school or child-care center attended by their child/children. Parents/guardians are

required to:

1. Contact their county health department to receive immunization waiver education and to obtain a

certified State of Michigan Immunization Waiver Form.

2. Submit the certified State of Michigan Immunization Waiver Form to the school or child-care

center attended by their child/children.

3. Waiver forms that are altered in any fashion (for example, information on the form is crossed out)

cannot be accepted by schools or child-care centers.

What documentation are parents/guardians required to submit (to the school or

child-care center attended by their child/children)?

Parents/guardians are required to submit a current, certified nonmedical immunization waiver form and/or

completed immunization record. Students without a completed immunization record and/or a certified

waiver form are subject to exclusion from school or childcare, unless student is in a “provisional”

category. (Provisional is defined as a child who has received 1 or more doses of vaccine, however they

need to wait the recommended time to receive the next dose)

What if a child has a medical contraindication to a vaccine?

This rule does not change the existing process for medical contraindications to vaccination. A current

State of Michigan Medical Contraindication Form (available at doctors’ offices, not county health

departments) must be completed and signed by a physician and submitted to the school or child-care

center.

Will the schools/childcare centers need to document the certified nonmedical waiver

into the Michigan Care Improvement Registry (MCIR) under the School

Immunization Record Keeping System (SIRS)? Yes, the school or childcare center will need to:

1. Enter (record) the certified nonmedical waiver into SIRS.

2. Send a copy of the certified nonmedical waiver to the county health department with the

immunization report and waiver report.

3. Maintain the certified nonmedical waiver form on file with immunization records.

CDC

Abbreviation Vaccine Common Names, Synonyms, Brand Names

BCG Bacillus Calmette-Guerin (Tuberculosis)

DT Diphtheria & Tetanus DT pediatric

DTaP Diphtheria, Tetanus, & acellular Pertussis Daptacel®, Infanrix®, Tripedia®

DTaP-HepB-IPV Diphtheria, Tetanus & acellular Pertussis, Hepatitis

B & Inactivated Polio Pediarix®

DTaP-IPV/Hib Diphtheria, Tetanus, acellular Pertussis &

Haemophilus influenza type B & Inactivated Polio Pentacel®

DTaP-IPV Diphtheria, Tetanus & acellular Pertussis,

Inactivated Polio Kinrix™ , Quadracel®

Td Tetanus, diphtheria Td (adolescent/adult), Tenivac,

Tdap Tetanus, diphtheria, & acellular Pertussis Adacel, Boostrix®

HepA Hepatitis A Havrix®, Vaqta®, HAV

HepA-HepB Hepatitis A and Hepatitis B Twinrix®

HepB Hepatitis B Engerix-B®, Recombivax HB®, HBV, HB vaccine

Hib-HepB Haemophilus influenzae type b & Hepatitis B Comvax®

Hib Haemophilus influenzae type b ActHIB®, Hiberix®, PedvaxHIB®

2vHPV Human papillomavirus (bivalent) Cervarix® , HPV2

4vHPV Human papillomavirus (quadrivalent) Gardasil®, HPV4

9vHPV Human papillomavirus (9-valent) Gardasil 9®, HPV9

IIV Inactivated Influenza Vaccine

IIV3 (TIV) Trivalent options Afluria®, Fluarix®, FluLaval®, Fluvirin®, Fluzone®

ccIIV3, RIV3 Trivalent options Flublok ® (RIV3) Flucelvax® (ccIIV3)

IIV3 ID Inactivated Influenza Vaccine (intradermal) Fluzone® Intradermal

IIV4 (QIV) Quadrivalent options Fluarix®, FluLaval®, Fluzone®

LAIV, LAIV4 Live, attenuated influenza (nasal spray) FluMist®

IPV Inactivated Polio IPOL®, eIPV, IPV, Salk Inactivated

MMR Measles, Mumps and Rubella MMR-II®, MMR

MMRV Measles, Mumps, Rubella & Varicella ProQuad®

MPSV4 Meningococcal Polysaccharide Menomune™

MenACWY or

MCV4 Meningococcal Conjugate (4 serotypes) Menactra™ (MenACWY-D) , Menveo® (MenACWY-CRM)

Hib-MenCY Haemophilus influenzae type B & Meningococcal

Conjugate C and Y Menhibrix, HibMen CY-TT

MenB Meningococcal Serogroup B Trumenba™ (MenB-FHbp). Bexsero® (MenB-4C)

PCV13 Pneumococcal Conjugate, 13-valent Prevnar13®

PPSV23 Pneumococcal Polysaccharide, 23-valent Pneumovax®

RV5, RV1 Rotavirus RotaTeq™ (RV5) Rotarix® (RV1)

TT Tetanus Toxoid Tetanus toxoid

VAR Varicella Varivax® *Chickenpox vaccine)

Zoster or HZV Herpes Zoster Vaccine Zostavax® (Shingles vaccine)

Vaccine Vaccine Terminology

erminology

DCH-0715 AUTHORITY: PA 368 of 1978 as amended Rev. March 14, 2014

*Discontinued Vaccines That May Be On Immunization Records

CDC

Abbreviation Vaccine Common Names, Synonyms, Brand Names

DTP* Diphtheria, Tetanus, & Pertussis* Tri-Immunol*, DTwP*

DTaP* Diphtheria, Teatunus & acellular Pertussis* Tripedia*, Acel-Imune*, Certiva*

DTP-HIB*

Diphtheria, Tetanus, Pertussis, & Haemophilus

influenzae type B* Tetramune*, DTP/ActHib*

DTaP-HIB*

Diphtheria, Tetanus, acellular Pertussis &

Haemophilus influenzae type B* TriHIBit*

Hib* Haemophilus influenzae type b* HibTITER*, ProHIBit*, OmniHIB*

IIV* Inactivated Influenza Vaccine* Fluogen*, FluShield*

IPV* Inactivated Polio* Poliovax*

Measles* Measles (Rubeola)* Attenuvax*

Mumps* Mumps* MumpsVax*

Rubella* Rubella (German Measles)* Meruvax*, Meruvax II*

Measles-Rubella* Measles -Rubella* M-R-VAX II*

Mumps-Rubella* Mumps-Rubella * Biavax II*

OPV* Oral Polio Vaccine* TOPV* Trivalent oral polio vaccine*, Sabin*, Orimune*

PCV7* Pneumococcal Conjugate, 7-valent* Prevnar7*

PPV* Pneumococcal Polysaccharide* PNU-Immune 23*

Td* Tetanus, diphtheria* Decavac*

DCH-0715 AUTHORITY: PA 368 of 1978 as amended Rev. March 16, 2016