Georgia Immunization Requirements for School and Childcare Attendance

Georgia Immunization Requirements for School and Childcare Attendance Presentation to: Presented by: Date:

Objectives At the end of this presentation, participants will be able to: • Recall the role vaccines have played in preventing diseases • Discuss GA Immunization law and DPH rules and regulations for schools and child care attendance • Review process for maintaining immunization certificates • Discuss reliable immunization resources

The Impact of Vaccines Disease Average Annual Reported Cases Pre-vaccine* Smallpox Diphtheria Measles 48, 164 175, 885 503, 282 Mumps Pertussis Polio (paralytic) Rubella Congenital Rubella Syndrome Tetanus 152, 209 147, 271 16, 316 47, 745 823 1, 196 32, 118 0 6 1 1, 057 18, 166 0 5 1 99. 3% 87. 7% 100% >99. 9% 1, 314 20, 000 23 40 25 23 98. 1% 99. 9% H. Influenzae Type b Age<5 years *MMWR 48(12); 243 -248 April 2, 1999 Cases in U. S. 2014** Provisional Cases in U. S. 2015** Provisional % Reduction In U. S. 2015 Eradicated worldwide in 1980 1 0 100% 667 189 >99. 9% **MMWR 64(52), ND-923 -ND-940, January 8, 2016

VPD Vaccination Rate Needed for Herd Immunity Measles 92 -94% Pertussis 92 -94% Diphtheria 83 -85% Rubella 83 -85% Mumps 75 -86% Influenza 30 -75%

Advisory Committee on Immunization Practices (ACIP) • 15 voting members with expertise in one or more of the following: Ø Vaccinology Ø Immunology Ø Infectious diseases Ø Pediatrics Ø Internal Medicine Ø Preventive medicine Ø Public health Ø Consumer perspectives and/or social and community aspects of immunization programs • ACIP develops recommendations and schedules for the use of licensed vaccines

Immunization Schedule Updates • All staff must use the same immunization schedule • Schedules: § Children & Adolescents 0 through 18 years § Catch-up schedule for ages 4 months -18 years § Children and Adolescents 18 years or younger based on medical indications § Adult 19 years and older § Adult based on medical and other indications READ THE FOOTNOTES http: //www. cdc. gov/vaccines/schedules/hcp/child-adolescent. html http: //www. cdc. gov/vaccines/schedules/hcp/adult. html

Indication Recommendation Requirement Indication • -Information about the appropriate use of the vaccine Recommendation • -ACIP statement that broadens and further delineates the • Indication found in the package insert -Basis for standards for best practice Requirement • -Mandate by a state that a particular vaccine must be administered and documented before entrance to child care and/or school

Diphtheria, Tetanus and Pertussis Vaccines ACIP recommends: A 5 dose series of DTa. P: Administered at 2, 4, 6, 15 -18 months and 4 -6 years (Do not administer after age 6) one dose of Tdap: For children and adolescents starting at 11 or 12 years of age For all adults aged 19 years and older who have not had Tdap previously MMWR, September 23, 2011, Vol 60, #37 MMWR, January 14, 2011, Vol 60, #01 MMWR, June 29, 2012 Vol 61, #25

Hepatitis B Vaccine • Dose 1 @ birth • Dose 2 @ 4 months of age – at least 1 month after first dose • Dose 3 @ 6 -18 months of age: – Minimum of 4 months after the first dose – Minimum of 2 months after the second dose but not before an infant is 24 weeks of age

Hepatitis A Vaccine ACIP recommends 2 doses of hepatitis A vaccine for: • All children 12 through 23 months of age • Any child or adolescent 2 through 18 years, not previously vaccinated • Caretakers who will have contact with adoptees from countries with high rates of hepatitis A MMWR, May 19, 2006, Vol 55, #RR-07

Haemophilus influenzae type b (Hib) ACIP recommends: 3 -4 doses of Hib (depending on brand) • Dose 1 @ 2 months of age • Dose 2 @ 4 months of age • Dose 3 @ 6 months of age (Not required if Pedvax HIB® is administered at 2 and 4 months of age) • Booster dose at 12 through 15 months of age **Hiberix has been added to the list of vaccines that may be used for the primary vaccination series. MMWR, February 28, 2014, Vol 63, #RR 01

Polio ACIP recommends: • 4 - dose series at 2, 4, 6 through 18 months, and 4 through 6 years • Final dose after the fourth birthday and at least 6 months after the previous dose Evaluate travelers for the need of polio vaccine if traveling to endemic countries.

Measles, Mumps, Rubella ACIP recommends: • 2 - dose series at ages 12 through 15 months and 4 through 6 years • at least 4 weeks between first and second dose MMWR, June 14, 2013, Vol 62, #RR-04

Varicella ACIP recommends: • 2 -dose series at 12 through 15 months and 4 through 6 years • Second dose may be administered before age 4 years, provided 3 months have elapsed since the first dose

Pneumococcal Conjugate Vaccine (PCV 13) ACIP recommends: • 4 - dose series at ages 2, 4, and 6 months and at 12 through 15 months • 1 - dose to catch-up all healthy children 24 through 59 months – Children 60 through 71 months who have underlying medical conditions that increase their risk of pneumococcal disease or complications and have not previously received PCV 13 – Children and adolescents aged 6 through 18 years with: • immunocompromising conditions • functional or anatomic asplenia • CSF leaks or cochlear implants, • solid organ transplants or chronic renal failure who have not previously received PCV 13 MMWR, December 10, 2010, Vo 1 59, #RR-11 MMWR, June 28, 2013, Vol 62, #25

Meningococcal Conjugate Vaccine (MCV 4) (Men A, C, Y, W-135) Menactra licensed for 9 mos. through 55 years Menveo® licensed for ages 2 mos. through 55 years ACIP recommends: • First dose at age 11 or 12 years and a booster dose at 16 years. • If first dose is at 13 -15 years, give booster dose 5 years after the first dose or sooner if entering college or technical school. • If first dose is received ≥ 16 years of age, a 2 nd dose is not needed. • Persons aged 21 years or younger attending school or college should have documentation of one dose of MCV 4 not more than 5 years before enrollment. MMWR, March 22, 2013, Vol 62, #RR 02

Requirements for School and Childcare Attendance

Goal • Vaccines work Goal 100 % compliance rate • Immunization Laws work • Partnerships work

DPH Rules and Regulations • Provide definition of terms • Stipulate the specific requirements – List required vaccines or – Acceptable proof of immunity – Define medical and religious exemptions • Provide directions for issuing, maintaining, and inspecting certificates GA Rules and Regulations updated for the 2014 -2015 school year to reflect the new school requirements. (511 -2 -2)

Job Aids

3231 REQ

3231 INS

Certificate of Immunization (Form 3231) • Certificate on file at each facility or school • Photocopies acceptable • A licensed Georgia physician, APRN, PA or public health official is responsible for completing the certificate • Only physician offices and health clinics can obtain blank certificates

Valid Certificates • All certificates must be marked with : – Child’s name – Birth date – Name and Address of Physician, APRN, PA, Qualified Board of Health official or State Immunization Office Official – Certified Signature – Date of Issue

“X” Marks the Spot

Expiration Date • Expires on the date entered as “Expiration Date” • Must be replaced with a current certificate within 30 days • Required for all children four years and older who have not completed vaccine requirement for 7 th grade • Required if a medical exemption for a vaccine(s) is marked

“Complete for School Attendance” • Do not expire • Issued only to children who: – Are four years of age or older; and – Have met all the requirements for school attendance as outlined in the Policy Guide 3231 REQ; and – Have all the required vaccine administration dates or natural immunity dates filled in; and – Do not have a “Date of Expiration”

Exemptions Medical: • Physical disability or condition • Documented in the medical exemption box indicated for each vaccine • Reviewed annually

Exemptions Religious: • Documented on form 2208 • Form kept on file by the school or facility in lieu of a Certificate of Immunization (form 3231) • Do not expire

Child Care Requirements • Number of vaccine doses • Always need more doses • Must have a current “expiration date”

School Requirements • Any “new entrant” enrolling in a Georgia school at any grade or level, must be age appropriately immunized with required vaccines • Number of doses depends on the child’s age • “Complete for 7 th Grade or higher ” is marked; certificate is complete

Immunization Assessments The following information is recorded during the immunization assessment: Ø Number of children enrolled Ø Number of children who have valid current certificates Ø Number of children with expired certificates Ø Number of children with current 30 -day waivers Ø Number of children with religious exemptions Ø Number of children with medical exemptions Ø Number of children with certificates marked “complete” but missing required doses Ø Number of children with no documentation on file

3: Completing both boxes: When all requirements have not been met 10: “Complete for School” checked for child under age 4 9: No dose DTa. P after 4 th birthday 2: Doses Hep B spaced incorrectly 11. No dose of Tdap or MCV 4 for students born on or after 1 -1 -2002 entering 7 th grade or “new entrants” 7: 1 st dose MMR given before age 1 yr. 6: 1 st dose varicella given before age 1 yr. 8: No 2 nd dose varicella documented 5: Varicella Immunity not documented by vaccine or hx/dx/serology date 4: Address and/or contact information not completed 1: No physician, APRN or PA signature

Filing of Certificates • Available for inspection by health officials • Photocopy acceptable • Send copy to the new school/facility • In the case of religious exemption, form 2208 must be on file in lieu of form 3231

Tickler Filing System Instructions located in the Immunization Guidelines for Child Care Facility Operators & School Personnel (Form 3258) • Set up by month and year • Parent reminders • Summary of GA Immunization requirements • Document follow-up • Enforce requirements

GRITS

Responsibilities • Physicians and Public Health Clinics • Child Care and School • Parent/Caregiver

VAERS • What can be reported to VAERS? • Who reports to VAERS? • Does VAERS provide general vaccine information?

Healthcare Personnel (HCP) and Other Adults Need These Immunizations: • Annual influenza vaccine • Tdap or Td • Hepatitis B (exposure risk) Check immunity Validate immune status of: • Varicella • Measles, Mumps & Rubella(MMR) Are YOU up to date?

State Resources • Local health department • District Immunization Coordinator • GA Immunization Program Office – On call Help line: 404 -657 -3158 – GRITS Help Line: 1 -866 -483 -2958 – VFC Help Line: 1 -800 -848 -3868 – Website http: //dph. georgia. gov/immunization-section – Your local Immunization Regional Program Consultant (IRC) – Epidemiology: 1 -866 -782 -4584 • GA Chapter of the AAP • GA Academy of Family Physicians

It’s a Team Effort! High Immunization rates begin with a team designed plan! What can your team do to improve rates?