immunization requirements for child care

Office of Immunization

IMMUNIZATION REQUIREMENTSFOR CHILD CARE

October 2021

Katherine Graff BSN, RN

School and Child Care Immunization Nurse Consultant

Office of Immunization

Immunization Requirements for Child Care

[email protected]

mailto:[email protected]

Washington State Department of Health | 3

▪ Immunization Laws and Rules

▪ Vaccinations During COVID-19

▪ Immunization Requirements▪ Hib and PCV

▪ DTaP and Tdap

▪ Certificate of Immunization Status (CIS) Versions

▪ Conditional Status Attendance

▪ Certificate of Exemption (COE)

▪ Annual Immunization Status Report

▪ Resources

Today’s Presentation

IMMUNIZATION LAW AND RULES

RCW & WAC


WA State Legislature passes legislation which is signed into law by the Governor

28A.210 RCW--Health - screening and requirements:

• 28A.210.060—through 28A.210.170

Revised Code of Washington (RCW)

https://app.leg.wa.gov/rcw/default.aspx?cite=28A.210

https://app.leg.wa.gov/rcw/default.aspx?cite=28A.210.060

https://app.leg.wa.gov/rcw/default.aspx?cite=28A.210.170


The immunization laws give the WA State Board of Health the authority to determine the immunization rules

246-105 WAC Immunization of childcare and school children against certain vaccine-preventable diseases

• 246-105-010 - through 246-105-090

Washington Administrative Code (WAC)

https://app.leg.wa.gov/wac/default.aspx?cite=246-105

https://app.leg.wa.gov/wac/default.aspx?cite=246-105-010



ACIP Recommended WA State RequiredHepatitis BDTaPTdapIPVMMRVaricellaPCVHibHepatitis AHPVMeningococcalFluRotavirusCOVID-19 (age 12+)

Hepatitis BDTaPTdapIPVMMRVaricellaPCV (preschool/childcare)Hib (preschool/childcare)

Recommended vs. Required


The School and Child Care Immunization page: has links to the RCWs and WACs:

www.doh.wa.gov/SCCI

Links to the RCW and WAC

http://www.doh.wa.gov/SCCI

IMMUNIZATION RATES AND COVID-19


Decline in Vaccines Administered

IMMUNIZATION REQUIREMENTS CHARTS


Vaccines Required forPreschool/Child Care 2021-2022


Vaccines Required forPreschool/Child Care 2021-2022 Spanish


Vaccines Required forK-12 School 2021-2022

Available on our website:

www.doh.wa.gov/SCCI

IVRS: Individual

Vaccine

Requirements

Summary

https://www.doh.wa.gov/SCCI



Number of doses needed depends on which vaccine (for Hib) is used and the age of the child when the vaccine was administered

o In some situations, only 1 dose is needed

Not routinely given to children 5 years and older unless they have certain medical conditions

HAEMOPHILUS INFLUENZAE TYPE B (Hib)and PNEUMOCOCCAL CONJUGATE (PCV)


www.doh.wa.gov/SCCI

IVRS: Hib Chart




www.doh.wa.gov/SCCI

IVRS: PCV Chart




DTaP age 0- 6 years Tdap age 7+years

• Contains more vaccine than Tdap

• Licensed for children though age 6 years

• Is not licensed to be given to children after they turn 7

• If primary DTaP series is incomplete, Tdap and Td are used to complete the series, Tdap must be included

• Tdap booster recommended for all at age 11

Diphtheria, Tetanus and Pertussis

CERTIFICATE OF IMMUNIZATION STATUS (CIS)


A child care provider must have a new medically verified CIS form each year the child is in child care.

Medical Verification for Accuracy:

• CIS printed from the WA Immunization Information System (IIS). o A CIS printed from the IIS is medically verified by the IIS. No additional

parent or health care provider signature is needed to verify the accuracy of the information.

■ Validated CIS

■ CIS printed from MyIR

• Hardcopy Certificate of Immunization Status (CIS) completed by hand:o Verified as accurate with a health care provider signature. OR

o Verified as accurate by a school nurse, administrator, child care health consultant or their designee after comparing the information on the CIS with attached medical vaccination records

Only the hardcopy CIS needs to be medically verified by signature.

CIS Medical Verification

https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/DataReportingandRetrieval/ImmunizationInformationSystem#records

https://www.doh.wa.gov/Portals/1/Documents/Pubs/348-389-CIS-PrintingInstructions.pdf

https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDEsInVyaSI6ImJwMjpjbGljayIsImJ1bGxldGluX2lkIjoiMjAyMDAyMjIuMTc2MDQwMDEiLCJ1cmwiOiJodHRwczovL3dhLm15aXIubmV0LyJ9.jz7ZJQGzM0HV2J_MzssMFItbUv7LOzqI_M_y2ck0Dpo/br/75289987688-l

https://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization#cis

VALIDATED CIS


Validated CIS


Validation is:

• Complete

• Not Complete

• Conditional

Validated CIS


Validation is:

• Complete

• Not Complete

• Conditional

For series selected

• Age for Child Care

• Preschool

• Grade K-6

• Grade 7-8

• Grade 9-12

Validated CIS


Shows date CIS was printed and validated

No provider or parent validation signature is needed

Validated CIS


Place for parent/guardian to give permission to add info to the IIS

Needed if using the IIS School Module IF info is missing in the IIS

Signature is optional

Validated CIS


Place for parent/guardian to acknowledge child’s conditional status entry

Signature is required if the child will be attending in conditional status

Validated CIS


Immunity:

Lab evidence of immunity entered in the IIS will display on the Positive Titer column.

This is considered provider verification of immunity.

Validated CIS


History of Chickenpox Disease:

Checks the box on Varicella line if history of chickenpox disease is entered in the IIS.

This is considered provider verification.

Validated CIS


Validated CIS – Page 2 Action Report


Lists:

• Missing required vaccinations



Lists:

• Recommended but not required vaccinations



Lists:

• Invalid doses with reason invalid

• Invalid doses not print on the CIS page 1

• If a repeat dose is needed it will be in the required or recommended boxes


MYIR CIS


Currently using the previous version of the WAIIS CIS.

Can still accept this as a valid medically verified CIS form

Prints valid and invalid dates. Check date for age and interval

MyIR CIS


History of Chickenpox Disease:

Checks the box in section 1 of chickenpox disease section if history of chickenpox disease is entered in the IIS.

This is considered provider verification.

MyIR CIS


Parents can register to use MyIR to view immunization records and print a CIS:

How to Register

• Consumers can self-register: https://myirmobile.com/, or

• Contact our office for help with registration, a release form is required: [email protected]

Flyer for parents:

• https://www.doh.wa.gov/Portals/1/Documents/Pubs/348-519-WA-MyIR-card.pdf

• Order by sending an email to: [email protected]

MyIR CIS

https://myirmobile.com/


https://www.doh.wa.gov/Portals/1/Documents/Pubs/348-519-WA-MyIR-card.pdf


HARDCOPY CIS


Hardcopy CIS


Hardcopy CIS

Must be medically verified for accuracy by:

• A health care provider • Licensed, certified or registered in a profession listed in RCW 18.130.040(2), if

administering vaccinations is within the profession's scope of practice. • If signed by a health care provider, no medical immunization records need to be

attached to the CIS.OR• A school nurse, administrator, child care health consultant or their designee.

• Before signing they must determine the information on the CIS is accurate after comparing it with the attached medical vaccination records.

• If not signed by a health care provider must have medical vaccination records attached before they can be turned in to the school or child care.

http://app.leg.wa.gov/RCW/default.aspx?cite=18.130.040


Medical Vaccination Records Include:o Provider records

o Another state registry: https://www.cdc.gov/vaccines/programs/iis/contacts-locate-records.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fprograms%2Fiis%2Fcontacts-registry-staff.html

o Lifetime Immunization record completed by provider

More examples in the Acceptable Versions of a Certificate of Immunization Status (PDF)

Medical Vaccination Records

https://www.cdc.gov/vaccines/programs/iis/contacts-locate-records.html?CDC_AA_refVal=https://www.cdc.gov/vaccines/programs/iis/contacts-registry-staff.html

https://www.doh.wa.gov/Portals/1/Documents/Pubs/348-764-AcceptableVersionsCIS.pdf

Medically Verified Immunization Records

Immunization Record printed from a healthcare provider, clinic or hospital’s Electronic Health Record


Immunization Record printed from the WA IIS or the IIS of another state


Official lifetime immunization record from WA or another state with a unique healthcare provider or clinic stamp, or another form of written healthcare provider documentation, such as a provider signature.


Hardcopy CIS

Has a place for provider to• Verify history of chickenpox

disease• Verify lab evidence of

immunity


Hardcopy CIS


Hardcopy CIS

Cat Sparky M 02/01/2019


Hardcopy CIS


4/1/19 6/1/19 8/1/19 8/1/20

2/1/19 4/1/19 8/1/194/1/19 6/1/19 2/1/204/1/19 6/1/19 8/1/19

2/1/203/1/21

2/1/20


Hardcopy CIS


4/1/19 6/1/19 8/1/19 8/1/20

2/1/19 4/1/19 8/1/194/1/19 6/1/19 2/1/204/1/19 6/1/19 8/1/19

2/1/203/1/21

2/1/20

Katherine Graff Katherine Graff 9/1/21


Attached Immunization Record printed from a healthcare provider, clinic or hospital’s Electronic Health Record


Hardcopy CIS


4/1/19 6/1/19 8/1/19 8/1/20

2/1/19 4/1/19 8/1/194/1/19 6/1/19 2/1/204/1/19 6/1/19 8/1/19

2/1/203/1/21

2/1/20

Katherine Graff Katherine Graff 9/1/21


Hardcopy CIS

CONDITIONAL STATUS


New WAC language clarifies “Conditional Status”

In the past:

• Parents/Guardians had 30 days from 1st day of attendance to turn in their child’s immunization documentation.

Starting 08/01/2020:

• Immunization documentation must be turned in before the can start child care or school.

• There is no longer an automatic 30-day conditional period from the first day.

• Children must have all vaccinations they are eligible to receive on or before the first day of attendance

Conditional Status


A 19 month old child with history of chickenpox disease entering child care has all of their infant vaccinations but is missing their age 12 month and older vaccines

• they must get the missing DTaP, MMR, varicella, Hib and PCV13 before starting child care.

All of the Doses - Examples


Lists:




If more doses needed after having all the doses they are eligible to receive:

• Child can attend child care in “Conditional Status”

• Parent/guardian must acknowledge conditional status entry and timelines on the CIS

Conditional Status


A 3 year old child starting child care only has 1 dose of Hepatitis B vaccine. Dose 1 was administered one day before starting child care:

• They can start in conditional status until the dose 2 recommended date plus an additional 30 days in which to get the dose.

Conditional Status - Example


Validated CIS


Lists:



Student stays in child care until next dose is due.

Dates follow the recommended dates of the ACIP Catch-Up Schedules.

Conditional Status

https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html


Validated CIS

Parent has 30 days from due date to turn in paperwork.

Conditional Status continues until all of the series are complete.

Conditional Status

If the 30 days expires without documentation of immunization or an exemption the child is out of compliance

Children out of compliance must be excluded. RCW 28A.210.120

Conditional Status

X

http://app.leg.wa.gov/RCW/default.aspx?cite=28A.210.120

EXEMPTIONS FROM THE SCHOOL AND CHILDCARE IMMUNIZATION REQUIREMENTS

AND THE CERTIFICATE OF EXEMPTION (COE)


A child may be exempted from one or more required immunizations, RCW 28A.210.090.

To request an exemption, a parent/guardian must turn in a completed and signed Certificate of Exemption (COE) to the school or childcare.

The COE is created by the Department of Health.

It can be downloaded from this website: https://www.doh.wa.gov/SCCI

Certificate of Exemption (COE)

http://app.leg.wa.gov/rcw/default.aspx?cite=28A.210.090



• Personal or philosophical exemption • not allowed for measles, mumps or rubella immunization

requirements

• Religious

• Religious membership

• Medical

Types of Exemptions for Children


Personal or Philosophical Exemption:

• To be used when the parent/guardian has a personal or philosophical objection to the immunization of the child.

• Cannot be used for the measles, mumps and rubella immunization requirements.

Religious Exemption:

• To be used when the parent/guardian has a religious belief that is contrary to the required immunization.

There is no requirement for a parent to validate or prove their personal or religious beliefs.

Philosophical/Personal and Religious


Personal or Religious Exemption

Use for parent-requested exemptions or alternate schedules

Needs parent and health care practitioner signatures


Philosophical/Personal and Religious Exemptions must have the signature of a health care practitioner that he or she

“provided the signator with information about the benefits and risks of immunization to the child.”

Health care practitioner is a physician (MD, DO), Naturopath (ND), Physician Assistant (PA) or Advanced Registered Nurse Practitioner (ARNP) licensed in WA State

RCW28A.210.090

Clinician and child care or school staff have no role in assessing parents’ personal or religious beliefs.

Education Requirement

https://app.leg.wa.gov/RCW/default.aspx?cite=28A.210.090


To be used when the parent/guardian affirms membership in a church or religious body that does not allow their child to get medical treatment by a health care practitioner.

• No health care practitioner signature is required.

• If the parent or guardian takes their child to see a health care practitioner for things like illness, and injury care they cannot use this exemption. They need to use the Religious or Personal Exemption area of the COE which must have a health care practitioner signature.

Religious Membership Exemption


Religious Membership Exemption

Parent affirms they belongs to a church or religion that does not allow ANY medical treatment by a health care practitioner

Child Care or school does NOT need to verify the religious beliefs.

Needs parent signature but does not need health care practitioner signature


Granted by a health care practitioner when in their judgement the vaccine is not advisable for the child.

Guidance about contraindications to vaccination:

• Recommendations of the Advisory Committee on Immunization Practices: www.cdc.gov/vaccines/recs/vac-admin/contraindications.htm

• Vaccine manufacturer’s package insert

Permanent or Temporary:

• Both require health care practitioner and parent/guardian signatures.

• When a temporary exemption ends the child has 30 days to get the vaccine or another exemption.

Medical Exemption

http://www.cdc.gov/vaccines/recs/vac-admin/contraindications.htm


Medical Exemption Exemption

Indicates for each disease whether the child is not exempt, permanently exempt or temporarily exempt.

If temporarily exempt it must have an expiration date.


• New form should be used for all NEW exemptions

• Children with existing exemptions DO NOT need to resubmit a new COE

• Incomplete or improperly completed forms should be returned to the parent or HCP to complete

• If an exemption is no longer needed because the child has received the needed immunizations remove the exemption from your tracking system

• Additional exemption information including a fact sheet and FAQs: www.doh.wa.gov/SCCI

Exemption Considerations


ANNUAL SCHOOL REPORTING


Childcare centers, preschools and K-2 public/private schools are required to report the immunization status of their students each year; RCW 28A.210.110and WAC 246-105-060 .

Reporting is required for:• Licensed child care center with 13 or more children • Preschool located at a public or private school • Head Start, ECEAP programs

Reporting is optional for:• Licensed family home child care with 12 or fewer children • Private preschools not located at a public or private school • Co-Op preschool

The Department of Health (DOH) collects the reports and processes the data.

OVERVIEW OF IMMUNIZATION REPORTING

https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu18251113.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DRNnMZ51drJMkQdB-2BvJO-2Bgk3XaBaOHLkjXqOM4CadPnAaRVab2biDGH2gofVzER94BDOt567UDtIJmjv3amrOaUPFvWeFo4-2BT5fDGvD6FEx8-3D3d-k_ogVswMxWJueqVT-2Fhwnq5PDk2wuDBJbnEJLln7PgfHCOoa8EmWF9kdPmcPR74wxfK1LK4JPsNWazae-2FEsvF8jclZsoNEisLwa-2Bvg3kej2wZgTu6PAQysaN4LqUT7t9JF0z-2BMsGmUIP-2FU8xTPgqvDc5FLBen1fXgEbnYAWcPCfevXi4HWRxRMZNu4lhAY4aMGjEl3drLpI-2BAY1419GSmQcWQFmNtv0J-2BnAq1lsJkQ3E5o-3D&data=04%7C01%7Ckatherine.graff%40doh.wa.gov%7Ccae7bf1aef614c137f4a08d8ee42f30c%7C11d0e217264e400a8ba057dcc127d72d%7C0%7C0%7C637521318609930760%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=xvbJMBQbyYzb7D%2FIyIPpmQnSEK3Mx2mADNtZmYzPUbY%3D&reserved=0



For the 2021-22 school year

• Reporting opens on 11/01/2021

• Reports are due by 12/01/2021

Report in one of the following ways

• School Module

• Complete online survey

IMMUNIZATION REPORTING FOR 2021-22


Reporting: School Module

A preschool or child care center with an active School Module doesn’t have to report. DOH can pull the report from the module itself

A School Module is considered active if:

• the roster is kept up to date,

• missing immunization dates and exemptions are entered.

More info about the School Module: https://www.doh.wa.gov/SchoolModule

https://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/SchoolModule


Reporting: Online Survey

By Nov 1, 2021 DOH will:

• Add the online survey link, training guide and the instructions/worksheet to the preschool/child care reporting website: https://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/ChildCareStatusReporting

• Email info to those on Listerv: http://public.govdelivery.com/accounts/WADOH/subscriber/new?preferences=true#tab1

Person reporting:

1. Reviews the Report Training Guide

2. Gathers information needed on the Reporting Instructions/Worksheet

3. Clicks on survey link on the website and completes the survey

4. Check survey for error messages and corrects as needed

5. Submits

6. Receives a confirmation email with a copy of the report submitted

https://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/ChildCareStatusReporting

http://public.govdelivery.com/accounts/WADOH/subscriber/new?preferences=true#tab1

Resources


Website:

www.doh.wa.gov/SCCI

Questions?

Feedback!

Email us at:

[email protected]

School and Child Care Immunization Page




Child Care Immunization Resource Flyer (PDF)

Resources

https://www.doh.wa.gov/Portals/1/Documents/Pubs/348-849ChildCareImmunizationResourceFlyer.pdf


http://bit.ly/2HybXYS

1. Sign in with email and name

2. Click Add Subscriptions button

3. Click the + to open Immunization

4. Check School Nurses and/or Childcare and Preschool

5. Click Submit

School and Child Care Listserve

http://bit.ly/2HybXYS

For persons with disabilities, this document is available in other formats.Please call 711 Washington Relay Service or email [email protected].