Changes to the Georgia DHR
Immunization Rules & Regulations for
Childcare and School
March 1, 2007
Video Interactive Conference System (VICS)
Georgia CTAE Resource Network
Instructional Resources Office
Disclosure Statements
•
Neither the planners of this session nor I have any financial
relationship with pharmaceutical companies, biomedical device
manufacturers, or corporations whose products and services are
related to the vaccines we discuss.
•
There is no commercial support being received for this event.
•
The mention of specific brands of vaccines in this presentation is for
the purpose of providing education and does not constitute
endorsement.
•
The GA Immunization Program utilizes ACIP recommendations as
the basis for this presentation and for our guidelines, policies, and
recommendations
2
Discussion Topics
• Background and processes
• Basis for changing the rules and
regulations
• Changes to the rules and regulations
• Documentation on the revised Certificate
of Immunization (Form 3231)
• Resources
3
Background & Process
• Summer and Fall 2006
 Drafted new rules, gained stakeholder input, briefed
Division of Public Health
• November 2006
 Submitted proposed changes and justification to DHR
Public Health Sub-committee for review
• December 2006
 PH Committee proposed rules changes to DHR Board
• January 2007
 Period of public comment opened for 1 month
 Notices sent to stakeholders
4
Process continued……….
• February 2007
 February 2---Public hearing
 February 5---Close of public comment period
 February 9---Summary of Public Comments
sent to PH Committee and DHR Board for
review
 February 21---DHR Board approved
Immunization Rules Changes
 February 22---began notification to
stakeholders
5
Stakeholder Input
•
Before presentation to
PH Committee
 Had discussions with
stakeholders before
proposed changes
 Received 17 letters of
support before Nov. from
organizations including:
GA AAP, DHR Family
Health, GA DOE, GA
HMHB, GA DECAL,
CHOA, School Nurse
Association and private
practice physicians
• During the Public
Comment period
 Received letter of support
from Every Child by Two,
GA AFP, National HMHB
Coalition
 At the Public Hearing,
Georgia Academy of
Family Physicians read
letter of support and Dr.
Keyserling, Emory
University (AAP ID
Committee) presented
supporting evidence for
changes
6
Getting the word out !!!
• News Release
• Blast faxes
 Providers
• Letters and/or Emails:
 Over 600 public health and private providers
 Approximately 200 school superintendents and 2500 principals
of public and private schools
 Home School Association
 Approximately 10,,00 directors of licensed and family child care
facilities, including 4 year old Pre K and Head start programs
 School Nurse Association
• Articles in professional and parent newsletters
• Georgia Immunization Program Web site
7
Basis for Change:
ACIP Recommendations
• What is the ACIP?
• ACIP Recommendations documents
 Published statements
http://www.cdc.gov/nip/publications/ACIP-list.htm
 Provisional statements
http://www.cdc.gov/nip/recs/provisional_recs/def
ault.htm
• Recommended Childhood and Adolescent
Immunization Schedule
8
2007
Recommended
Childhood and
Adolescent
Immunization
Schedules
Ages 0-6 years
Ages 7-18 years
20th Century Annual and Current Morbidity of
Vaccine-Preventable Diseases
Disease
20th Century
Annual Morbidity†
2005†
Percent
Decrease
Diphtheria
175,885
0
100%
Measles
503,282
66
>99%
Mumps
152,209
314
>99%
Pertussis
147,271
25,616
83%
Polio (paralytic)
16,316
1
>99%
Rubella
47,745
11
>99%
823
1
>99%
1,314
27
98%
20,000‡
226**
99%
Congenital Rubella Syndrome
Tetanus
H. influenzae,
type b and unknown (<5 yrs)
†
Sources: CDC. MMWR 1999; 48:242-264 and MMWR 2006;55:883-893.
‡ Data are estimated. Values in YELLOW = at or near record lows in 2005.
** Includes serotype b (9) and unknown serotype (217)
Low Rates of Childhood
Vaccine Preventable Diseases
• Vaccines work
• Immunization Laws work
• Partnerships work
13
Georgia Law
All children attending a facility or school
must be immunized according to the
rules and regulations established by the
Georgia Department of Human
Resources (DHR).
14
DHR Rules and Regulations
• Provide definition of terms
• Determine the specific requirements for
immunization based on an immunization regimen
equivalent to the current immunization schedule
developed by the ACIP and adopted by DHR.
• Stipulate which immunizations are required
• Provide acceptable means for documentation of
immunity and for medical and religious exemptions
• Provide directions for issuing, maintaining, and
inspecting certificates
15
Changes to DHR
Rules & Regulations:
New Definition Added
• “New entrant” means any child entering any
school or facility in GA for the 1st time or
entering after having been absent from a GA
school or facility for >12 months or 1 school
year.
16
Changes to DHR
Rules & Regulations:
Immunization against 2 additional
diseases:
• Pneumococcal: Pneumococcal Conjugate
Vaccine (PCV)
• Hepatitis A: Hepatitis A Vaccine
Additional dose requirements to 2
existing required vaccines:
• Mumps: 2nd dose
• Varicella: 2nd dose
17
Vaccine Requirements
• Consistent with the Recommended Childhood and Adolescent
Immunization Schedule
• Children are required to be age appropriately immunized
against each of these diseases:
Hepatitis B
Polio
Diphtheria
Measles
Tetanus
Mumps*
Pertussis
Rubella
Haemophilus Influenzae type b
Hepatitis A
Varicella (chicken pox)*
Pneumococcal disease
* 2 doses required
18
Changes to DHR Rules & Regulations:
New Certificate
Pneumococcal Disease
•Pneumococcal Conjugate Vaccine (PCV) is
recommended for all children <24 mos. of age and
those 24-59 mos. with certain risk factors.
• PCV is now required for all children under 5
years of age who attend child care facilities.
• The number of doses needed depends on the
child’s age at the time the series was started and
on their current age.
22
Hepatitis A
• Hepatitis A Vaccine
is recommended for all
children 12-23 mos. of age with catch-up
vaccination of older children as indicated.
• Immunity will be required for children attending
school and child care and who were born on or
after 1-1-06.
•2 doses of vaccine administered on or after the first
birthday and at least 6 months apart
•Date of positive serology
23
Mumps
• 2 doses of mumps vaccine are recommended
•
•
for school aged children and adults at high risk
2 doses of vaccine or serologic proof of
immunity is now required for:
• Entry to Kindergarten
• Entry to 6th grade
• A “New Entrant” at any grade
Vaccine doses must be administered on or after
the first birthday and at least 28 days apart 24
Varicella/Chickenpox
• Vaccine is recommended for all persons over
•
one year of age who have not had the disease
2 doses of vaccine or proof of immunity is now
required for:
• Entry to Kindergarten
• Entry to 6th grade
• A “New Entrant” at any grade
25
Evidence of Varicella Immunity
• Documentation of age-appropriate vaccination:
 Preschool-aged children > 12 months: 1 dose
 School-aged children, adolescents and adults: 2 doses
 If under 13 years of age, a minimum of 3 months apart
 If 13 years of age or older, a minimum of 1 month apart
• Laboratory evidence of immunity or laboratory confirmation of
disease
• History of herpes zoster or shingles
• A healthcare provider diagnosis of varicella or healthcare
provider verification of history of varicella disease. For mild or
atypical case:
 Assessment by physician is recommended to determine:
 Epidemiological link to typical case
 Laboratory evidence of immunity if titer done at time of disease
26
New School/ Child Care
Requirements Effective 7-1-07
For children attending child care facilities


Hepatitis A vaccination if born 1-1-2006 or
later or proof of immunity
Pneumococcal vaccination (If under 5 years
of age)
For children entering kindergarten, sixth
grade and new entrants into Georgia schools

Vaccination with 2nd dose of mumps and
varicella vaccines or proof of immunity
27
Form 3231
as of
7-1-07
REQUIRED
RECOMMENDED
Revised 03/07
Age of Child “Marks the Spot”
• If child is under four years of age, a certificate:
• Must be marked with a “Date of Expiration”
• Must have vaccine administration dates, year of
diagnosis, positive serology, disease history,
or medical exemption
• If child is over four years of age, a certificate must
be completed with:
• Vaccine administration dates, and /or year of disease
•
•
diagnosis, positive serology,disease history, or medical
exemption; and
A “Date of Expiration”; or
A mark in the “Complete for School Attendance” box29
Vaccine Requirements
• A “new entrant” enrolling in a Georgia school
at any grade or level, must be age
appropriately immunized with all the required
vaccines.
• The number of doses for each vaccine
depends on the child’s age at the time of
school attendance
• Each vaccine dose or immunity status must
be documented on the certificate.
30
Documentation of Additional
Requirements
Additional Required
Vaccines:
•Pneumococcal
conjugate vaccine
(PCV)
(If under age 5 years)
•Hepatitis A
(Born on or after 1/1/06)
Additional Dose
Requirements :
•Mumps: 2nd dose
•Varicella: 2nd dose
Immunity and Medical Exemptions
Immunization Inventories
Childcare Facilities

Prior to 07/01/2007:



Base on current rules and regulations
Educate operators and parents of new requirements
On or After 07-01-2007:

Base on the revised rules and regulations and documentation
should be on Form 3231 (Revised 3/2007) with following
exceptions:
 Children who have certificates that will expire after 7/1/07 are
considered to be current until the “Date of Expiration”.
 Children who are enrolled in both school and child care or “after
school” programs and and have “Complete for School”
certificates on file at both facilities, do not need to obtain a
revised certificate.
34
Immunization Inventories
Schools
On or after 7-1-07:
 For children entering kindergarten, 6th grade
and all “new entrants”, base on the revised
rules and regulations.
 Documentation should be on Form 3231
(Revised 3/2007) with following exception:

If student has a Form 3231 (revised 10/2003)
that is marked as “Complete for School
Attendance” and the new requirements for 2
doses of varicella and mumps vaccines or proof
of immunity are appropriately documented.
35
Immunization Inventories
Schools

Children currently enrolled in schools, who
have a valid certificate on file,



will not be required to meet the new rules and
regulations and
will not be required to obtain the revised
Certificate of Immunization dated 3/2007.
Exceptions are:



Students entering 6th grade
Students who do not have a certificate on file
Students who leave and return as “New
36
Entrants”.
Top
Ten
2006 Top Ten Certificate “Bloopers”
8: Missing information
1: Completing both boxes:
Should be one or the other
2: No dose DTaP after 4th birthday
3: Doses Hep B given too early
4: 1st dose MMR given before age 1 yr.
6: 1st dose varicella given before age 1 yr.
5: No 2nd dose MMR documented
7: Immunity not documented by
vaccine or hx/dx/serology date
9: Not completed
10: No signature
Availability of Vaccines from VFC
Program for VFC Eligible Children
• PCV:
 All children 6 weeks through 23 months of age
 Children 24-59 months of age with moderate and
high risk conditions (This includes children who
attend child care)
• Hepatitis A:
 All children 12 months through 18 years of age
• Mumps vaccine:
 All children 12 months through 18 years of age
38
Availability of Vaccines from VFC
Program for VFC Eligible Children
• Varicella Vaccine:
 Two doses for all children 12 months through 18
years of age, including:
 2nd dose for children age 4-6 receiving boosters for
kindergarten
 2nd dose for children entering 6th grade
 2nd dose for “new entrants”
 Two doses for adolescents ≤18 years of age entering
college if not already received
39
Possible Vaccine
Supply Issues
• MMRV:
 Anticipate short supply in 3rd and 4th quarter
of 2007
• Varicella:
 Do not anticipate supply issues with single
antigen varicella vaccine
40
Revised Certificates of
Immunization (Form 3231)



Are available from the GA Immunization Program
Office
Can be printed from the GA Registry of
Immunization Transactions and Services (GRITS)
Can be printed from office software systems



If a provider requests permission and receives approval
for the certificate from the Georgia Immunization
Program
If provider is active participant in GRITS
Certificate must include exact information and have
same appearance as DHR Certificate to be approved.
41
Resources
• Local health department
• District Immunization Coordinator
• GA Immunization Program Office
 On call Help line: 404-657-3158
 GRITS Help Line:1-888-223-8644
 VFC Help Line:1-800-848-3868
 Website www.health.state.ga.us/programs/immunization
 Your local Immunization Program Consultant (IPC)
• GA Chapter of the AAP
• GA Academy of Family Physicians