School and Child Care Requirements: How to Make

School and Child Care Requirements: How to Make

School and Child Care Requirements: How to Make it Possible July 29, 2016 2016 Pinal County School Health Workshop Brenda Jones, RN, BSN, MA, AzCSN Immunization Program Manager Outline School Requirements Exemptions IDRs Immunization Coverage & Exemption Rates Using ASIIS School Requirements for Children under age 7 Required

Vaccines See below for exceptions requiring fewer or more doses 5/4 DTaP 4 doses OK if at least one dose given at 4+ years 6 doses required if 5th dose given under 4 years 4/3 Polio 4 total doses OK, regardless of when given 3 doses OK if 3rd was given at 4+ years 2 MMR 3 doses required if #1 was given before 12 months of age

3 Hep B 4 doses required if #3 was given before 24 weeks of age 1 Varicella See Varicella information Valid doses are required. A 4-day grace period is allowed. School Requirements for Children 7-10 Required Vaccines 4/3 DTaP/Td 4/3 Polio

See below for exceptions requiring fewer or more doses 3 doses OK if all were given after 12 months 1 Dose of Tdap may be counted as part of these requirements 2 MMR 4 total doses OK, regardless of when given 3 doses OK if 3rd dose given at 4+ years 3 doses required if #1 was given before 12 months of age 3 Hep B 4 doses required if #3 was given before 24 weeks of age 1 Varicella See Varicella Information

Valid doses are required. A 4-day grace period is allowed. School Requirements for Children 11+ years of age, Grade 6th - 12th Required See below for exceptions requiring fewer or more doses 3 DTaP/Td* 3 doses OK if all were given after 12 months 1 Tdap 1 MV/MCV 4/3 Polio

Required unless last DTaP/Td was within past 5 years Required 3 doses OK if 3rd dose given at 4+ years 2 MMR 3 doses required if #1 was given before 12 months of age 3 Hep B 4 doses required if #3 was given before 24 weeks of age 1 Varicella 2 doses if #1 was given at 13+ years of age. See Varicella information

Valid doses are required. A 4-day grace period is allowed. Varicella Vaccination VS. Chickenpox Disease History The law states: Students who enrolled in an Arizona school or preschool before 9/1/2011 may be admitted/continue to attend with parental recall of chickenpox disease. May still have some students in upper grades who enrolled before 9/1/2011 with parental recall; they are able to continue attendance without vaccination or exemption. Varicella Vaccination VS. Chickenpox Disease History The law states: Students who enroll in an Arizona school or preschool after 9/1/2011 must show proof of immunization or obtain medical exemption or sign personal exemption Most new preschool and kinders will be in this time frame,

as well as new-to-Arizona students in all grades Parental recall is no longer acceptable. Refer for medical exemption. Varicella Immunization Flowchart Has Varicella Immunization? If Yes, Admit, Document If No, Refer for Vaccination Parent States History of

Chickenpox Obtain Vaccination Parent Wants Personal Exemption Enrolled prior to 9/1/2011? Enrolled after 9/1/2011? Admit, Document

Provide Personal Exemption Form See next flowchart See next flowchart Admit, Document Chickenpox History Flowchart Enrolled Before 9/1/2011 Enrolled After

9/1/2011 Parent Recall Acceptable Can no longer accept parent recall Admit, Document Keep List, will need for IDR or Outbreak Refer for

Vaccination Parent Wants Personal Exemption Provide Medical Exemption, Refer to HCP Obtain Vaccination Provide Personal Exemption

Form HCP draws serology, obtains lab results Admit, Document Admit, Document Make sure parents have/keep copy of lab results and exemption for their files. Immune?

sign exemption with labs attached Admit, document Not Immune? Gets Vaccinated, admit, document Personal Exemption, admit,

document Varicella Vaccination VS. Chickenpox Disease History If referred to provider Provider may sign medical exemption if there is enough documentation in medical record to support immunity** If not comfortable, provider will not sign; should draw serology Determine plan of action with serology results Immune? Sign Medical Exemption with lab results attached Not Immune? Recommend Vaccination Vaccination VS. Disease History Medical Exemptions should be encouraged for reports of any VPD history **Law states that physician or nurse practitioner may sign a

medical exemption stating a child is immune to a disease, but shall not sign a statement of immunity to measles or rubella or chickenpox without obtaining serologic evidence of immunity. Also states that after 9/1/2011, no student is exempt from the varicella immunization unless the child provides laboratory evidence of immunity to varicella Varicella Vaccination VS. Chickenpox Disease History Educate and Support Parents Strongly suggest serology to prove immunity (versus personal exemption) Student will need this information for future schooling, college, military, employment If parent/student has lab results, immunity is then confirmed, no further efforts needed to prove immunity So WHY are Vaccinations

Important? Vaccines Prevent Disease Current Vaccine Preventable Outbreaks http://www.cfr.org/interactives/GH_Vaccine_Map/#map Red: Measles, Brown: Mumps, Blue: Rubella, Orange: Polio Green: Whooping Cough, Yellow: other We are a Global Community Diseases are just a plane ride away Exemptions in Arizona

Medical Exemptions: must be completed by childs physician or nurse practitioner and signed by the parent/guardian Permanent: Medical condition that contraindicates administration of one or more immunizations Temporary: Temporary medical condition that contraindicates the administration of one or more immunizations Lab Evidence of Immunity: if the child has had the vaccine preventable disease. Laboratory proof of immunity must be submitted Child Care, Pre-K, Head-Start, and K-12 Exemptions in Arizona

Personal Belief Exemptions: Immunizations are against the personal beliefs of the parent. Only available for grades K-12 Religious Exemptions: Immunizations are against the religious beliefs of the parent. Only available for Child Care, Pre- School and Head Start Immunization Data Report Exemption Trends State-wide Coverage rates for state-mandated immunizations remain high

Non-Medical Exemption rates have been increasing over the last decade Charter, public, and private schools have different exemption rates As exemption rates increase, vaccination coverage rates decrease School # Kinder Year # Schools Student Region 2015-16 64 4,226 Pinal 2015-16 1,362 83,586 Arizona

94.6% 94.2% 95.0% 94.7% DTaP 94.6% 94.2% 94.8% 94.2% Polio 95.0% 94.7%

96.0% 95.5% MMR 94.8% 94.2% Hep B 96.0% 95.5% Var 1+ & Hx 96.5% 96.7%

PBE 4.1% 4.5% Pinal 96.7% 96.5% Exempt All 2.0% 2.2% Arizona K

IDR Final submission as of 0531-16 DTap Polio MMR Hep B Var 1+ & Hx 4.1%4.5% 2.0%2.2%

PBE Exempt All School #6 Year # Schools Students Region DTaP Tdap MCV MMR

Hep B Var1+ & Hx PBE Exempt All 2015-16 60 4,312

Pinal 97.4% 88.2% 88.0% 97.1% 97.4% 97.6% 4.4% 1.7%

2015-16 1,182 88,101 Arizona 97.2% 90.4% 90.3% 97.3%

97.4% 97.9% 4.5% 1.6% 97.3% 97.1% 97.4% 97.2% 90.4% 88.2% 97.4%

97.4% 97.9% 97.6% Pinal Arizona 90.3% 88.0% 6 th IDR Final Submission

as of 05-31-16 4.5% 4.4% DTaP Tdap MCV MMR Hep B Var1+ & Hx PBE

1.7% 1.6% Exempt All State Total 2.1% Private 6th Graders exempt from every state required Immunization 1.1% 2.7%

Charte r 0.8% Public State 4.4%Total 6th Graders with Personal Belief Exemption to 1 or more required immunizations 6.0% Private 9.3%

Charte r 3.4% Public Kindergarteners exempt from every state required Immunization State Total 1.8% 3.7% Private 3.6% Charter

1.3% Publi c Kindergarteners with Personal Belief Exemption to 1 or more required immunizations 4.5% State Tota l 7.4% Private

8.7% Charter 3.3% Public 0.0% 1.0% 2.0% 3.0% 4.0% 5.0%

6.0% 7.0% 8.0% 9.0% 10.0% 4.7% 4.6% Kindergarten Personal Belief Exemption Rate 4.5%

Sixth Grade Personal Belief Exemption Rate 2014-2015 2015-2016 County Level School Specific What can we do? Continue to assess and educate using best practices Work together with other organizations such as our County Health Departments and The

Arizona Partnership for Immunization (TAPI) to develop resources to reach the community Constantly evaluate these techniques and those used by other states to identify new and/or improved methods How to use ASIIS Arizona State Immunization Information System (ASIIS) School staff can enroll in ASIIS to look up and print out the immunization records of students ASIIS information is only as good as what immunization providers put in it we collect and store but do not enter data After enrollment paperwork has been completed, you will receive a log-in and password

When searching ASIIS, use minimal information to increase chances of locating childs record ASIIS helpline email [email protected] or http://www.azdhs.gov/phs/asiis/enrollment.htm to enroll in ASIIS MYIR My Immunization Record Parents/Individuals can request own IZ record, print at home Link on the ADHS Website Updated self-validation method

Printed record will look very much like ASIIS record, will have MyIR information on it Acceptable for immunization documentation Scientific Technologies Corporation 37 MYIR HOME PAGE REDESIGN Less words, sleeker design. This will take the user directly to either the MyIR Registration page or Help page Scientific Technologies Corporation

38 ARIZONA IMMUNIZATION PROGRAM HOME PAGE REDESIGN Making MyIR more understandable and Linking closer to ASIIS Adding box for MyIR Scientific Technologies Corporation 39 MYIR REGISTRATION PAGE

Scientific Technologies Corporation 40 MYIR HELP PAGE Scientific Technologies Corporation 41 MYIR Phone App Release planned for October Customer Support System Arizona Consumer Marketing Campaigns with TAPI and Public Health Departments

Scientific Technologies Corporation 42 AIPO Website http://www.azdhs.gov/phs/immun/back2school.htm THANK YOU Brenda Jones, RN, BSN, MA, AzCSN | Immunization Program Manager [email protected] | 602- 364-3626 Or Rose Ann Beans | Assessment/AFIX Program Specialist [email protected] | 602-364-3633

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