school immunization requirements update implementing ......dtap 5 doses required for k-12th grades...

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 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 2 - Dose 3: 6 months

Patient Name: Katey SIIS Patient ID: 5293041





DTaP/DTP/Td 10/14/2003

8 weeks 12/14/2003 4 months

Tdap 08/14/2010

7 years



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




OPV/IPV 11/20/2006


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.



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




OPV/IPV 11/20/2006


03/20/2007 6 months

09/20/2008 24 months



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






MMR 08/14/2004 12 months

10/14/2004 14 months

Varicella X 08/16/2004

12 months 10/14/2004 14 months



Date Reason

VARICELLA 08/16/2004 Live vaccines not administered on same date must be separated by 28 days.



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






Hep B – 3 Dose 08/14/2003

0 days 10/14/2003 8 weeks

02/10/2004

5 months



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


Guardian: TEST Status: Active




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 Date Reason

VARICELLA 10/09/2004 Live vaccines not administered on same date must be separated by 28 days.



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)


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


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


2 and 3 = 2 months


1 and 3 = 16 weeks

• Min age for dose 3 is 24

weeks

7th-12th grade


1 and 2 = 1 month


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]