Changes to the Georgia DHR Immunization Rules

1
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

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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

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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

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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

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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

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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

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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

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Basis for Change ACIP Recommendations

• What is the ACIP?
• ACIP Recommendations documents
• Published statements http//www.cdc.gov/nip/public
  ations/ACIP-list.htm
• Provisional statements http//www.cdc.gov/nip/recs
  /provisional_recs/default.htm
• Recommended Childhood and Adolescent Immunization
  Schedule

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2007 Recommended Childhood and Adolescent
Immunization Schedules
Ages 0-6 years
Ages 7-18 years
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20th Century Annual and Current Morbidity of
Vaccine-Preventable Diseases
Percent Decrease
20th Century Annual Morbidity
2005
Disease
Diphtheria Measles Mumps Pertussis Polio
(paralytic) Rubella Congenital Rubella
Syndrome Tetanus H. influenzae, type b and
unknown (lt5 yrs)
175,885 503,282 152,209 147,271 16,316 47,745 823
1,314 20,000
0 66 314 25,616 1 11 1 27 226
100 gt99 gt99 83 gt99 gt99 gt99 98 99
Sources CDC. MMWR 1999 48242-264 and MMWR
200655883-893. Data are estimated. Values
in YELLOW at or near record lows in 2005.
Includes serotype b (9) and unknown serotype
(217)
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Low Rates of Childhood Vaccine Preventable
Diseases

• Vaccines work

• Immunization Laws work

• Partnerships work

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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).

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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

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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 gt12 months or 1 school year.

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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

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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

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Changes to DHR Rules Regulations
New Certificate
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Pneumococcal Disease

• Pneumococcal Conjugate Vaccine (PCV) is
  recommended for all children lt24 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
  childs age at the time the series was started
  and on their current age.

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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

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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

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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

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Evidence of Varicella Immunity

• Documentation of age-appropriate vaccination
• Preschool-aged children gt 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

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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

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Form 3231 as of 7-1-07
REQUIRED
RECOMMENDED
Revised 03/07
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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 box

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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 childs age at the time of school attendance
• Each vaccine dose or immunity status must be
  documented on the certificate.

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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

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Immunity and Medical Exemptions
Medical Exemption
Diagnosed
Serology
History
33

• DELETED

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Immunization InventoriesChildcare 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.

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Immunization InventoriesSchools

• 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.

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Immunization InventoriesSchools

• 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 Entrants.

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Top Ten
2006 Top Ten Certificate Bloopers
1 Completing both boxes Should be one or the
other
8 Missing information
2 No dose DTaP after 4th birthday
3 Doses Hep B given too early
5 No 2nd dose MMR documented
4 1st dose MMR given before age 1 yr.
7 Immunity not documented by vaccine or
hx/dx/serology date
6 1st dose varicella given before age 1 yr.
9 Not completed
10 No signature
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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

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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

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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

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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.

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Resources

• Local health department
• District Immunization Coordinator
• GA Immunization Program Office
• On call Help line 404-657-3158
• GRITS Help Line1-888-223-8644
• VFC Help Line1-800-848-3868
• Website www.health.state.ga.us/programs/immunizati
  on
• Your local Immunization Program Consultant (IPC)
• GA Chapter of the AAP
• GA Academy of Family Physicians