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Preschool/Child Care Immunization RequirementsPreschool/Child Care Immunization Requirements

Trang Kuss, RN, MN, MPHTrang Kuss, RN, MN, MPHDepartment of Health Office of Immunization and Child ProfileDepartment of Health Office of Immunization and Child Profile

January 18, 2013January 18, 2013

Contact Information

Dept. of Health Office of Immunization and Child Profile

Trang Kuss, RN, MN, MPHSchool and Child Care [email protected]; 360-236-3760

mailto:[email protected]

Topics to be Covered• What are the child care and preschool immunization

requirements in Washington State?• Complete, Conditional, Out of Compliance: What do they

mean?• How can I use the Washington State Immunization Information

System to help determine if a child is complete?

Immunization RequirementsChildren attending licensed child care must comply with

immunization requirements to protect the health of the public and individuals

Children must be vaccinated against certain vaccine-preventable diseases at ages and intervals according to the national immunization schedule

Parent must submit completed Certificate of Immunization (or Certificate of Exemption)

www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/Regulations.aspx

http://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/Regulations.aspx

http://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/Regulations.aspx

Immunization Requirements

Examples of those not required to comply

• Facilities not required to have a DEL license• Coop preschool• Birth to Three Program

Required Immunizations for Preschool or Child Care Attendance

DTaPHepatitis BHibIPVMMRPCVVaricella

Recommended, but Not Required

Hepatitis ARotavirusFlu

Immunization Status

Complete/Fully ImmunizedConditional

Temporary status to allow child to get fully immunized

Out of ComplianceExempt

www.doh.wa.gov/Portals/1/Documents/Pubs/348-051-ChildcareChart2013-2014.pdf

http://www.doh.wa.gov/Portals/1/Documents/Pubs/348-051-ChildcareChart2013-2014.pdf

www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

http://www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf


DTaP Requirement

VACCINEBy 3 Months(on or before

last day of mo 2)

By 5 Months(on or before last day of mo

4)

By 7 Months(on or before

last day of mo 6)


15)


lastday of mo 18)

Diphtheria, Tetanus, Pertussis(DTaP/DT)

1 dose 2 doses3 doses

May get as early as 6 months.

4 dosesMay get 4th dose as early as 12

months as long as 6 months

separate dose 3 and dose 4.

DTaP Minimum Age and Intervals

Dose # Minimum AgeMinimum Interval Between Doses

1 6 weeks 4 weeks between Dose 1 & 2


3 14 weeks 6 months between Dose 3 & 4

4 12 months6 months between Dose 4 & 5

5 4 years –

DTaP DetailsRoutine schedule: 2, 4, 6, 15-18 months, and

booster dose at 4-6 years6 months interval recommended between dose

3 and 4, but 4 months or more is acceptableDTaP given to children less than 7 years of age;

Td and Tdap given to children 7 years of age or older

What to do if:

If Tdap given for dose 1, 2, or 3 instead of DTaP Repeat with DTaP

If Tdap given for dose 4 or dose 5 instead of DTaP Acceptable

Note red X because Dose

4 given too early

DTaP Example

Dose 4 past due

DTaP Example

Note red X – Tdap given as

dose 2

Hepatitis B Requirement

VACCINE By 3 Months(on or before last day of mo

2)


4)


last day of mo 6)


15)


lastday of mo 18)

Hepatitis B1 dose

May get dose 1at birth.

2 dosesMay get dose 2 as early as 1 month.

3 doses

Hepatitis B Minimum Age and Intervals

Dose #

Minimum Age

Minimum Interval Between Doses

1 Birth4 weeks between Dose 1

& 2

2 4 weeks8 weeks between Dose 2

& 3

3 24 weeks16 weeks between Dose

1 & 3

Hepatitis B DetailsRoutine schedule: birth, 1 month, and 6 monthsPay attention to min age for dose 3 and

minimum intervals between doses

Hib Requirement

VACCINEBy 3

Months(on or

before last day of mo

2)

By 5 Months(on or

before last day of mo 4)

By 7 Months(on or


By 16 Months(on or


15)

By 19 Months

(on or before last

day of mo 18)

Haemophilus influenzae type B(Hib)

1 dose 2 doses 3 doses 4 doses

Hib Minimum Age and Intervals





4 12 months -

Hib DetailsRoutine schedule: 2, 4, 6, and 12-15 monthsNot recommended for children 5 years or olderThe recommended immunization schedule for Hib

vaccines:

Vaccine 2 Months 4 Months 6 Months12-15

Months

PRP-T* (ActHib)

Dose 1 Dose 2 Dose 3 Booster

PRP-OMP (PedvaxHIB)

Dose 1 Dose 2 Booster

Hib Details• Unvaccinated children 7 months of age and older may

not require full series. Total number of doses depends on child’s current age.

• Final booster dose should be given at 12 months or older and a min of 8 weeks after previous dose.

Hib Details• One total dose for unvaccinated child 15-59 months of

age.• Two doses total if Dose 1 given >12 months and Dose 2

given >15 months of age.• Three doses total if 2 doses given before 12 months and

Dose 3 given >12 months.

Doses beforeage 12 months

Doses on or afterage 12 months Status

3 1 Complete

2 1 Complete

1 1 Needs 1 Booster Dose(If Last Dose Given Before 15

Months)

0 1 Needs 1 Booster Dose(If Last Dose Given Before 15

Months)

3 0 Needs 1 Booster Dose



0 0 Needs 1 Dose

Hib Doses Required Chart

Hib Example

IPV Requirement

VACCINE


last day of mo 2)


4)


last day of mo 6)

By 16 Months(on or


15)

By 19 Months

(on or before last day of

mo 18)

Polio(IPV or OPV)

1 dose 2 dosesMay get as early as 4 months.

3 doses

IPV Minimum Age and Intervals




3 14 weeks 6 months between Dose 3 & 4

IPV DetailsRoutine schedule: 2, 4, 6-18 months, and

booster at 4-6 years.IPV used routinely in US for polio vaccination,

but students coming from a foreign country may get OPV

Any combination of IPV or OPV valid

MMR RequirementVACCINE By 3 Months

(on or before last day of mo

2)


4)


6)


last day of mo 15)


last day of mo 18)

Measles, Mumps, Rubella (MMR)

Not given before 12 months of age. 1 dose

MMR Minimum Age and Intervals

Dose #

Minimum Age

Minimum Interval Between Doses

1 12 months4 weeks between Dose 1 & 2

MMR Details

Routine schedule: 12-15 months and 4-6 yearsDose 1 given <12 months of age must be repeated

(4 day grace applies)MMR or MMRV can be usedIf not given on same day, minimum interval

between MMR and varicella is >28 dayso The second vaccine given is not valid and should

be repeated

MMR Example

Note red X – MMR given 5

days too early

Pneumococcal Conjugate (PCV) Requirement

VACCINEBy 3

Months(on or


2)

By 5 Months(on or


By 7 Months(on or


By 16 Months(on or


15)

By 19 Months

(on or before last

day of mo 18)

Pneumococcal Conjugate(PCV7 or PCV13)

1 dose 2 doses 3 doses 4 doses**Some children may get 5 total doses. A single supplemental dose of PCV13 is recommended, but not required, for all children aged 14–59 months who got 4 doses of PCV7.

PCV Minimum Age and Intervals





4 12 months -

PCV DetailsRoutine schedule: 2, 4, 6, and 12-15 monthsA single supplemental dose of PCV13 is

recommended, but not required, for all children aged 14–59 months who got 4 doses of PCV7o PCV13 replaced PCV7 in 2010

PCV Details• 1 total dose only on or after 24 months unless

high risk.• Two doses total if both received between 12-24

months, given >8 weeks apart. • Three doses total if 2 doses given <12 months

and Dose 3 given at >12 months.

PCV Doses Required Chart

Doses before Age 12 months

Doses on or after Age 12

monthsStatus

3 1Complete

(If PCV7 given, needs one additional dose of PCV13)

21 (8 weeks after # 2)

Complete

0 2 Complete1 2 Complete1 1 Needs 1 dose 8 weeks after Dose 2

0 1Needs 1 dose 8 weeks after Dose 1

if # 1 received at age ≤ 24 months

3 0 Needs 1 dose 8 weeks after Dose 32 0 Needs 1 dose 8 weeks after Dose 2

1 0Needs 2 doses (8 weeks apart) if age 12 -

24 monthsNeeds 1 dose if age ≥ 24 - 59 months

0 0Needs 2 doses (8 weeks apart) if age 12 -

24 monthsNeeds 1 dose if age ≥ 24 - 59 months

PCV Example

Katey is complete

with 3 doses!

Varicella Requirement

VACCINE


last day of mo 2)

By 5 Months(on or



last day of mo 6)

By 16 Months(on or


15)

By 19 Months

(on or before last

day of mo 18)

Varicella

Not given before 12 months of age.

1 doseRequired: if

unvaccinated, health care provider must verify

disease.

Varicella Minimum Age and Intervals


1 12 months 3 months between Dose 1 & 2

Varicella Details

Routine schedule: 12-15 months and 4-6 years of age

If not given on same day, minimum interval between varicella and MMR is >28 days

Varicella Example

Note red X – Varicella not given same day as MMR

4 Day Grace PeriodVaccines given <4 days before the minimum

interval or age are validApplies to all inactivated vaccines before

minimum intervals OR agesGrace period applies if live vaccines given at

the same visit

4 Day Grace Example

Dose 3 valid given 3 days

before 6 months of age

ResourcesIndividual Vaccine Requirements Summary:

www.doh.wa.gov/Portals/1/Documents/Pubs/348-284-IndividualVaccineRequirements.pdf

Vaccines Required for Preschool/Child Care 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/CommunityandEnvironment/Schools/Immunization/VaccineRequirements.aspx

http://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/VaccineRequirements.aspx

Implementing WA New State Exemption Requirements - Implementing WA New State Exemption Requirements - Training for Schools and Child Cares/PreschoolsTraining for Schools and Child Cares/Preschools

August XX, 2011August XX, 2011

Thank you for all you do!