California Department of Public Health, Immunization Branch

1. California Department of Public Health, Immunization Branch

3. Tools & Resources Available at Local Health Departments www.ShotsforSchool.org CAIR Blue Card Online and at Local Health Departments www.ShotsforSchool.org

4. Up-to-Date Online Resource

5. What Will I Learn? By the end of this lesson, you’ll be able to: Locate immunization requirements by age and grade Describe the ways children may be admitted Implement immunization requirements Create a year-round immunization plan

6. Locate Immunization Requirements

7. Locate Immunization RequirementsEntry for TK/K-12 * Includes transitional kindergarten (TK). Ages 4-17 years: Entering elementary school (4-6 years)* Transferring into a CA school Entering 7thgrade

8. Locate Immunization RequirementsEntry for TK/K-12 Self Check Jeff is 4 years old and about to enter transitional kindergarten. Which immunizations are required for entry based on his age and grade?

9. What Will I Learn? By the end of this lesson, you’ll be able to: Locate immunization requirements by age and grade Describe the ways children may be admitted Implement immunization requirements Create a year-round immunization plan

10. Describe How Children May Be AdmittedImmunizations Are Current What does this mean? Children who are current on all required immunizations and have no remaining doses for their age or grade may be unconditionally admitted. They do not require follow-up for subsequent immunizations until the next check point. Children may be admitted if they: Are 4 years or older and have received all required immunizations for age and grade.

11. Describe How Children May Be AdmittedPermanent Medical Exemption • What does this mean? • A licensed physician determines that one or more vaccine(s) is not indicated due to a permanent physical condition or medical circumstance. A valid Permanent Medical Exemption requires submission of a licensed physician’s written statement which states: • the physical condition or medical circumstance of the child is such that the required immunization(s) is not indicated, • the vaccine(s) to be exempted, and • the medical exemption is permanent. Children may be admitted if they: Have filed a valid statement of Permanent Medical Exemption and immunization records for all other required doses.

12. Describe How Children May Be AdmittedNo Classroom-Based Instruction (per SB 277) What does this mean? Starting January 1, 2016, SB 277 states that these children do not need to receive the required immunizations in order to be admitted, but parents or guardians must continue to provide immunization records to their schools, and schools must continue to maintain and report records of immunizations that have been received. Students who have an individualized education program (IEP) should continue to receive all necessary services identified in their IEP regardless of their vaccination status. Children may be admitted if they: Attend a home-based private school, or an independent study program and do not receive classroom-based instruction—even if they have not received all required immunizations for age and grade.

13. Describe How Children May Be AdmittedConditional Admission for TK/K-12 California Code of Regulations • A valid Temporary Medical Exemption requires submission of a licensed physician’s written statement which states: • the temporary physical condition or medical circumstance of the child is such that the required immunization(s) is not indicated; • the date when the temporary medical exemption will end, and • the vaccine(s) to be exempted. Children may be admitted if they: Meet one of these conditions for conditional admission:

14. Refer to “Laws” Tab for Details

15. Describe How Children May Be AdmittedTransfers What does this mean? The new school must review the student’s immunization records to make sure all immunization requirements have been met. If a student’s immunization record has not been received by the time of transfer, schools may admit the child for a period of up to (30) school days while waiting for the record to arrive or be submitted to the school. * Exemption for transfer students with PBEs filed prior to 2016 is covered on slide 17. Children may be admitted if they: Are transferring from another school—within California or from another state—and all immunization requirements are met.*

16. Personal Beliefs Exemptions No Longer an Option for New Admissions (Effective 1/1/2016) FAQs are available to assist

17. Describe How Children May Be AdmittedTransfers with PBEs Filed before 2016 (per SB 277) Senate Bill 277 (Pan, 2015) Parents of students in any school or child-care facility are no longer allowed to submit a new personal beliefs exemption (PBE) to a currently required vaccine. For transfer students, a PBE filed before 2016 at: Entry to any grade from TK/K through 6th grade will remain valid until the child completes 6th grade. Entry to any grade from 7th through 12th will remain valid through 12th grade.

18. Describe How Children May Be Admitted No shots? No records? No school. In summary, children may be admitted if they: Are 4 years or older and have received all required immunizations for age and grade. Have filed a valid statement of Permanent Medical Exemption and immunization records for all other required doses. Attend a home-based private school, or an independent study program and do not receive classroom-based instruction—even if they have not received all required immunizations. Qualify to be admitted as conditional entrants. Are transferring from another school—within California or from another state—and meet immunization requirements.

19. Conditional EntrantsFor TK/K-12 Self Check Under which two conditions may children be admitted in TK/K-12 as conditional entrants?

20. What Will I Learn? By the end of this lesson, you’ll be able to: Locate immunization requirements by age and grade Describe the ways children may be admitted Implement immunization requirements Create a year-round immunization plan

21. Implement Immunization RequirementsStep by Step: Preparing for 1st Day Before starting, you’ll need these items: Student’s personal immunization record(yellow card, CAIR, or other record); California School Immunization Record(Blue Card);(Obtain original from their cumulative folder or a blank one to fill out, or print from CAIR.) Guide to Immunizations Required for School Entry; Your school’s follow-up system (to add entries as needed). Tip: The Window for Immunizations is a free resource that helps you identify missing immunizations required for schools.

22. Implement Immunization RequirementsStep by Step: Preparing for 1st Day In preparing for 1st day, school staff needs to: Obtain the child’s personal immunization record—even if the child has an exemption. Complete the top portion of the Blue Card and transfer vaccine dates from child’s personal immunization record. (Or printout from CAIR.)(Follow instructions on the back of the Blue Card.) Determine if requirements are met by comparing number of doses on the Blue Card to the Guide to Immunizations Required for School Entry. If child has a Permanent/ Temporary Medical Exemption, make sure that immunization records are submitted for any vaccines not exempted. Complete the Documentation and Status of Requirements box.(Follow instructions on the back of the Blue Card.) File the completed Blue Card in the child’s cumulative folder.(Schools must keep this record on file for every child enrolled.)

24. Implement Immunization RequirementsStep by Step: Preparing for 1st Day For 2016 only - Special note for kindergarten students previously in TK at an elementary school in 2015-2016: If a student entered an elementary school TK with a valid PBE (signed within 6 months prior to TK entry and filed before January 1, 2016), the PBE remains valid from TK through 6th grade.

25. Implement Immunization RequirementsStep by Step: Preparing for 1st Day Special note for 7th graders: Students entering 7th grade who had a PBE filed for the TK-6th grade span will need to meet all requirements for both 7-17 Years Old and 7th Grade.

26. Implement Immunization RequirementsStep by Step: Preparing for 1st Day 15 02 02 2004 02 01 California Code of Regulations Special note for 7th graders: Document the date of Tdap immunization. Affix and complete Tdap sticker.

27. Implement Immunization RequirementsPreparing for 1stDay: Permanent Medical Exemption California School Immunization Record

28. Implement Immunization RequirementsPreparing for 1st Day: Temporary Medical Exemption California School Immunization Record

29. Implement Immunization RequirementsPreparing for 1stDay: Conditional Admission Missing doses? Look to Table 2 to determine if child may be admitted.

30. Implement Immunization RequirementsPreparing for 1st Day: Conditional Admission • Use Notice of Immunizations Needed letter to notify parents of vaccines due before admission.

31. Implement Immunization Requirements1st Day: Requirements Are Not Met If children are either due for doses or missing documentation on the 1st day: Do NOT admit or allow entry. Refer parents or guardians to primary care provider to receive immunizations (or their local health department for additional resources). You may use the Notice of Immunizations Needed letter and Parents’ Guide to ImmunizationsRequired for School Entry to inform parents of the next doses needed.

32. Conditional EntrantsThroughout the Year Determine timing for the next dose in a series:

33. Conditional EntrantsThroughout the Year Step by Step: • Create a reminder entry in your follow-up system to notify parents or guardians when next shots are due. • You may use the Notice of Immunizations Needed letter and Parents’ Guide to ImmunizationsRequired for School Entry to inform parents of the next doses needed. Please make sure you include the deadline. • Recommend that the child receive the next dose at the beginning of the vaccine’s time interval from Table 2. • Review records every (30) days. If you discover a child has missed the next dose and was not excluded, schools must notice parents or guardians and may give them up to (10) school days to comply before the child is excluded.

34. Conditional EntrantsFor TK/K-12 Steps No.  You will count doses on the Blue Card and compare to the Guide to Immunizations Required for School Entry. She is behind on DTaP. Compare the immunization dates on the Blue Card to Table 2 for interval timing to determine if the next dose must be administered before starting school. The third dose is due “before admission if 8 or more weeks have elapsed since the 2nd dose at the time of admission.” What are your next steps? Self Check Today is July 25, 2016. Anna is five years old and is starting kindergarten in 1 month.  Her last (2nd) dose of DTaP was 5 months ago.  Can she start classes in a month?

35. TransfersThroughout the Year • * For children entering any grade from out of the country, do not allow additional days to await records. Review immunization records before admission and refer family to their physician or public health department as needed. Step by Step for transfers (including homeless and foster children): • Review Blue Card from previous school, or • May ask parents or guardians to provide immunization records as soon as possible (or check CAIR). • If no records, can admit child for up to (30) school days while waiting for records.* • Follow up as necessary. • Complete Blue Card when records are received.

36. TransfersPersonal Beliefs Exemption – Filed Prior to 2016 (per SB 277) II. Affidavit California School Immunization Record

37. TransfersPersonal Beliefs Exemption – Filed Prior to 2016 (per SB 277) PBE forms filed in 2014 and 2015 are only valid when: signed by both an authorized health-care practitioner and a parent/guardian, and no more than 6 months prior to first entry into school or a new grade span (if the "religious beliefs" box was checked, then a practitioner signature was not required). For PBEs filed prior to 2014: The personal beliefs affidavit on the back of the Blue Card, or similar PBE affidavit (including Tdap PBE form CDPH 8261), must be signed and dated by the parent/guardian.

38. What Will I Learn? By the end of this lesson, you’ll be able to: Locate immunization requirements by age and grade Describe the ways children may be admitted Implement immunization requirements Create a year-round immunization plan

39. Create an Immunization PlanBest Practices

40. Create an Immunization PlanFollow-up for Conditional Entrants James Doe 2nd MMR Jane Doe 3rd DTP Set a schedule and check your follow-up system every 30 days for children with pending vaccinations.

41. Create an Immunization PlanComplete Annual Immunization Reporting Complete and submit the annual immunization reporting for Kindergarten and 7th Grade each fall.

42. How is Your Facility Doing?Based on Fall Immunization Reporting

43. Create an Immunization PlanReportable Diseases California Code of Regulations Schools must report incidents of certain infectious diseases to the local health department as soon as identified.

44. Questions? No shots? No records? No school. You should now be able to: Locate immunization requirements by age and grade Describe the ways children may be admitted Implement immunization requirements Create a year-round immunization plan

45. Personal Beliefs Exemptions No Longer an Option for New Admissions (Effective 1/1/2016) Summary of Senate Bill 277 (Pan, 2015) Effective January 1, 2016, parents of students in any school or child-care facility are no longer allowed to submit a new personal beliefs exemption (PBE) to a currently required vaccine. A PBE filed before 2016 at: A child-care facility will remain valid until the child first enters the span between TK/K through 6th grade. Entry to any grade from TK/K through 6th grade will remain valid until the child completes 6th grade. Entry to any grade from 7th through 12th will remain valid through 12th grade. Students are no longer required to have immunizations for entry if they attend a home-based private school or an independent study program and do not receive classroom-based instruction. For these students, parents must continue to provide immunization records to their schools and schools must continue to maintain and report records of immunizations. Students who have an individualized education program (IEP) should continue to receive all necessary services identified in their IEP regardless of their vaccination status.