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Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/Preschools
August XX, 2011
School Immunization Requirements Update
Trang Kuss, RN, MN, MPH Department of Health Office of Immunization and Child Profile
February 28, 2013
Topics to be Covered
Vaccine Requirements
Compare Current and Upcoming School Requirements
Reporting
Resources
DTaP
5 doses required for K-12th grades
Exception: 4 doses required if 4th dose given >4th birthday
DTaP for students through age 6
If >7 years old, need Tdap or Td
DTaP
DTaP given to students 7-10 years of age counts for the Tdap dose
• Catch-up schedule for >7 years of age without
any DTaP doses:
• One dose of Tdap followed by 2 doses of Td
(>4 weeks between doses 1 & 2, and >6
months between doses 2 & 3)
Tdap
2012-2013: 1 dose required for 6th to 11th grades
Required for >11 year olds
Two brands:
Boostrix® for >10 year olds;
Adacel® for >11 year olds
Licensed for just one dose
Tdap
No need to wait 5 years between DTaP/Td and Tdap
Students 7-10 years of age not fully vaccinated with DTaP required to get dose of Tdap
Off-label use of Tdap vaccine, but providers follow ACIP recommendations as best medical practice
Only one dose of Tdap required
Patient Name: Rebekah SIIS Patient ID: 5276918
Date of Birth: 05/09/2000 Age: 11 yrs
Vaccination Summary Does not include all vaccination types.
Vaccinations outside the ACIP schedule are marked with an 'X'.
Vaccine Family 1 2 3 4 5 6 7 8
DTaP/DTP/Td 07/01/2000
7 weeks 08/01/2000 12 weeks
10/01/2000 4 months
06/01/2001 12 months
05/09/2004 4 years
Tdap 05/09/2008
8 years
Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule.
Vaccine Family Dose Recommended
Date Minimum
Valid Date Overdue
Date Status
DTaP/DT/Td 7 05/09/2018 05/09/2013 06/08/2018 Up to Date
Tdap Example
Rebekah also
got Tdap at
age 8
Way to go!
Rebekah is
complete with
5 doses of
DTaP
Rebekah is up
to date until
2018
DTaP/Tdap/Td Catch-up Schedule
• DTaP Dose 1 given 7 years of age
(any combination of DTaP, Tdap, and Td)
• Dose 1 - Dose 2: 4 weeks
• Dose 2 - Dose 3: 4 weeks
• Dose 3 - Dose 4: 6 months
DTaP/Tdap/Td Catch-up Schedule
• DTaP/DT Dose 1 given >12 months of age, 3 total
doses needed, as long as Tdap is given >7 years of
age (any combination of DTaP, Tdap, and Td)
• Dose 1 - Dose 2: 4 weeks
• Dose 2 - Dose 3: 6 months
Patient Name: Katey SIIS Patient ID: 5293041
Date of Birth: 08/14/2003 Age: 8 yrs
Vaccination Summary Does not include all vaccination types.
Vaccinations outside the ACIP schedule are marked with an 'X'.
Vaccine Family 1 2 3 4 5 6 7 8
DTaP/DTP/Td 10/14/2003
8 weeks 12/14/2003 4 months
Tdap 08/14/2010
7 years
Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule.
Vaccine Family Dose Recommended
Date Minimum
Valid Date Overdue
Date Status
DTaP/DT/Td 4 02/14/2011 02/14/2011 03/16/2011 Past Due
DTaP/Tdap Example
Tdap given to
kids 7 and
older are
given as a
catch-up dose
Td is past due
IPV
4 doses required for K-12th grades
Exception: 3 doses required if dose 3 given >4 years of age
Either IPV or OPV acceptable
IPV
For K-1st grade only for 2012-2013:
Dose 4, if given on or after Aug 7, 2009, must be given >4 years of age and separated from dose 3 by >6 months
IPV
For 2012-13: 2nd – 12th grades
Don’t need to worry about minimum of 4 years of age for 4th dose and 6 month minimum interval between doses 3 and 4
>4 week minimum interval must separate IPV doses
Dose 4 must be given >18 weeks of age
IPV
Students with 3 doses
4th dose not needed if dose 3 given on or after 4th birthday
If dose 3 given after 4th birthday
If on or after 8/7/09, minimum of 6 months from dose 2
If before 8/7/09, minimum of 4 weeks from dose 2
Patient Name: Frank SIIS Patient ID: 5361747
Date of Birth: 09/20/2006 Age: 292 weeks, 67 months, 5 yrs
Vaccination Summary Does not include all vaccination types.
Vaccinations outside the ACIP schedule are marked with an 'X'.
Vaccine Family 1 2 3 4 5 6 7 8
OPV/IPV 11/20/2006
8 weeks 01/20/2007 4 months
03/25/2007 6 months
X 09/21/2009 3 years
Invalid Vaccinations
Invalid Vaccinations Date Reason
POLIO 09/21/2009 Minimum age for this dose not met.
Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule.
Vaccine Family Dose Recommended
Date Minimum Valid Date
Overdue Date
Status
POLIO 4 09/20/2010 09/20/2010 09/20/2013 Due Now
IPV Example 1
IPV Dose 4
marked with a
red X
IPV dose 4
needs to be
repeated and
is due now
IPV Example 2
Name: Isabella SIIS Patient ID: 5361747
Date of Birth: 04/17/2006 Age: 296 weeks, 68 months, 5 yrs
Vaccination Summary Does not include all vaccination types.
Vaccinations outside the ACIP schedule are marked with an 'X'.
Vaccine Family 1 2 3 4 5 6 7 8
OPV/IPV 11/20/2006
8 weeks 01/22/2007 4 months
03/20/2007 6 months
09/20/2008 24 months
Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule.
Vaccine Family Dose Recommended
Date Minimum
Valid Date Overdue
Date Status
IPV Dose 4
valid at age 24
months since
given before
8/7/09
MMR
2 doses required for K-12th grade
Blood test showing immunity to measles, mumps, and rubella acceptable
MMR
Dose 1 given 28 days
The second vaccine given is not valid and should be repeated
4 day grace DOES NOT apply between live vaccines not given at the same time
Patient Name: Katey SIIS Patient ID: 5293041
Date of Birth: 08/14/2003 Age: 8 yrs
Vaccination Summary Does not include all vaccination types.
Vaccinations outside the ACIP schedule are marked with an 'X'.
Vaccine Family 1 2 3 4 5 6 7 8
MMR 08/14/2004 12 months
10/14/2004 14 months
Varicella X 08/16/2004
12 months 10/14/2004 14 months
Invalid Vaccinations
Invalid Vaccinations
Date Reason
VARICELLA 08/16/2004 Live vaccines not administered on same date must be separated by 28 days.
Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule.
Vaccine Family Dose Recommended
Date Minimum Valid Date
Overdue Date
Status
VARICELLA 2 08/14/2007 01/14/2005 08/14/2010 Past Due
MMR Example
Note red X.
Varicella not
given same
day as MMR
Implementation plan, 2008:
Roll-up requirement, one grade per year for 2 doses
By 2020, 2 doses required for K-12th grade
• 2012-2013 school year: 2
doses required for K-4th grade
Varicella
Varicella
If not given on same day, minimum interval between varicella and MMR is >28 days
4 day grace DOES NOT apply between live vaccines not given at the same time
Minimum interval between dose 1 & 2 = 3 months.
4 Day Grace Period
Vaccines given
Patient Name: Katey SIIS Patient ID: 5293041
Date of Birth: 08/14/2003 Age: 8 yrs
Vaccination Summary Does not include all vaccination types.
Vaccinations outside the ACIP schedule are marked with an 'X'.
Vaccine Family 1 2 3 4 5 6 7 8
Hep B – 3 Dose 08/14/2003
0 days 10/14/2003 8 weeks
02/10/2004
5 months
Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule.
Vaccine Family Dose Recommended
Date Minimum
Valid Date Overdue
Date Status
4 Day Grace Example 1
Hep B Dose 3
given 4 days
earlier than 6
months of age
Dose 3 is valid
and doesn’t
need to be
repeated
4 Day Grace Example 2 Patient Name: Katey SIIS Patient ID: 5293041
Date of Birth: 08/14/2003 Age: 8 yrs
Guardian: TEST Status: Active
Vaccination Summary Does not include all vaccination types.
Vaccinations outside the ACIP schedule are marked with an 'X'.
Vaccine Family 1 2 3 4 5 6 7 8
MMR 08/14/2004 12 months
09/14/2004 13 months
Varicella 08/14/2004 12 months
X 10/09/2004 13 months
Invalid Vaccinations
Invalid Vaccinations Date Reason
VARICELLA 10/09/2004 Live vaccines not administered on same date must be separated by 28 days.
Vaccination Forecast The forecast automatically switches to the accelerated schedule when a patient is behind schedule.
Vaccine Family Dose Recommended
Date Minimum
Valid Date Overdue
Date Status
VARICELLA 2 01/09/2005 01/09/2005 08/14/2010 Past Due
Varicella Dose
2 given 5 days
before it was
due
School Immunization Requirements
2012-13 School Year
• DTaP: 5 doses (4 doses
acceptable if dose 4 given on
or after the 4th birthday)
• Hep B: 3 doses
• Tdap: 1 dose for 6th-11th
grade (>11 years of age)
2013-14 School Year
• DTaP: no change
• Hep B: change in
requirements
• Tdap: 1 dose for 6th-12th
grade (>11 years of age)
School Immunization Requirements
2012-13 School Year
• IPV: 4 doses (3 doses
acceptable if dose 3 given on
or after the 4th birthday)
• Kindergarten-1st grade: final
dose given after 8/7/09 must be
given at a min of 4 years of age
AND min interval of 6 months
from the previous dose
• MMR: 2 doses
2013-14 School Year
• IPV: no change EXCEPT
• Kindergarten-2nd grade: final dose given after 8/7/09 must be
given at a min of 4 years of age
AND min interval of 6 months
from the previous dose
• MMR: no change
School Immunization Requirements
2012-13 School Year
• Varicella: 2 doses:
Kindergarten-4th grade
• 1 dose: 5th-6th grade
• Recommended, but not
required: 7th-12th grade
2013-14 School Year
• Varicella: 2 doses:
Kindergarten-5th grade
• 1 dose: 6th grade
• Recommended, but not
required: 7th-12th grade
2013-14 Immunization Requirements: Hep B Changes
• ACIP recommendations in 1994
• Dose 3: min age of 4 months
• Recommendations updated 2002
• Dose 3: min age of 24 weeks
• Min interval between Dose 1 and 3 is 16 weeks
• Many older students out of compliance
2013-14 Immunization Requirements: Hep B Changes
K-6th grade
• Min interval between doses
1 and 2 = 1 month
• Min interval between doses
2 and 3 = 2 months
• Min interval between doses
1 and 3 = 16 weeks
• Min age for dose 3 is 24
weeks
7th-12th grade
• Min interval between doses
1 and 2 = 1 month
• Min interval between doses
2 and 3 = 2 months
• No min interval between
doses 1 and 3
• Min age for dose 3 is 4
months
Reporting Update
About 91% of all schools reported
In the fall, use the IIS to report OR send Skyward export to [email protected]
For those using the IIS:
Registration/contact info changes in spring and fall
We’re working on login issues (one username, forgot password)
Child care reporting (not through the IIS)
mailto:[email protected]
Resources www.doh.wa.gov/immunization/schoolandchildcare School Training Videos:
www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization.aspx
Individual Vaccine Requirements Summary: www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf
Vaccines Required for School Attendance chart: www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/VaccineRequirements.aspx
Immunization Manual for Schools and Child Cares: www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/SchoolManual.aspx
http://www.doh.wa.gov/immunization/schoolandchildcarehttp://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization.aspxhttp://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization.aspxhttp://www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdfhttp://www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdfhttp://www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdfhttp://www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdfhttp://www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdfhttp://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/VaccineRequirements.aspxhttp://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/VaccineRequirements.aspxhttp://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/SchoolManual.aspxhttp://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/SchoolManual.aspx
Contact Information
• Trang Kuss, RN, MN, MPH
School and Child Care Coordinator
[email protected]; 360-236-3760
mailto:[email protected]