1. New California Immunization Law SB 277 Effective January 1, 2016

2. This PowerPoint® was prepared to assist schools in Siskiyou County in understanding and complying with the changes in the California immunization law which goes into effect on January 1, 2016. Resources that will be helpful to you in understanding and complying with the law are: The California Immunization Handbook (Aug. 2015): http://eziz.org/assets/docs/shotsforschool/IMM-365.pdf The California Department of Public Health Immunization Website for schools and parents: www.shotsforschool.org/k-12/ California immunization law (including explanation of conditional admissions): http://eziz.org/assets/docs/IMM-1080.pdf

3. New California Immunization Law Questions Answered:  What is new?  Who is affected by the new law?  What is a medical exemption?  What do we do about existing Personal Belief’s Exemptions (PBEs)?  What is the school’s responsibility? o Kindergarten/Transitional Kindergarten students  Conditional Admissions o Students entering seventh grade o Transfer students  California  Out of State o Homeless and foster youth o Students with Individualized Education Plans (IEPs)

4. What is new? Beginning January 1, 2016:  Parents or guardians of students in any school or child-care facility, whether public or private, will no longer be allowed to submit a personal beliefs exemption to a currently-required vaccine.  No distinction is made between exemptions based on religious beliefs and other personal beliefs. Exemptions for religious or other personal beliefs will no longer be an option for the vaccines that are currently required for entry into school or child care in California.  The only exemptions to immunizations that will be allowed for school entry are Medical Exemptions (permanent or temporary) that are written by a licensed Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO).

5. Who is affected by the law?  All California schools (public and private), and child-care facilities, including child-care centers, day nurseries, nursery schools, family day care homes, and development centers, are subject to new and existing laws in California.

6. Medical Exemptions:  What’s required for a medical exemption to a required immunization?  A parent or guardian must submit a written statement from a licensed physician (M.D. or D.O.) which states:  That the physical condition or medical circumstances of the child are such that the required immunization(s) is not indicated.  Which vaccines are being exempted.  Whether the medical exemption is permanent or temporary.  The expiration date, if the exemption is temporary.  Only a licensed Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) may provide a medical exemption. A Nurse Practitioner, Physician Assistant, Naturopathic Doctor, or School Nurse may not provide medical exemptions.

7. Existing Personal Belief’s Exemptions (PBEs):  PBEs filed at a school or child-care facility before January 1, 2016 will remain valid until the student enrolls in the next grade span, typically at kindergarten (or transitional kindergarten) or 7th grade.  A PBE filed before 2016 at:  Entry to any grade from transitional kindergarten/kindergarten through 6 th grade will remain valid until the child completes 6 th grade.  Entry to any grade from 7th through 12th will remain valid through 12th grade..

8. Existing PBEs:  PBEs filed in 2015 are only valid when signed by both an authorized health care provider and a parent/guardian no more than 6 months prior to first entry into school or child care or a new grade span. Therefore, PBEs filed in 2015 are invalid for children first entering school in California in the fall of 2016.  A PBE filed in 2015 at entry into transitional kindergarten may remain valid until the completion of 6 th grade.  PBEs may be transferred between schools in California, both within and across school districts.  PBEs from other states are not valid in California.

9. More about existing PBEs: What will happen in future years when children with a prior personal beliefs exemption enter their next grade span in primary or secondary school (typically kindergarten or 7th grade)?  Children with a valid PBE filed before 2016 who enter a new grade span will have to meet all age-appropriate immunization requirements for admission into primary or secondary school (K- 12th grade) or be enrolled in an independent study program with no classroom-based instruction or in a home-based private school.  The immunization requirements can be found with this link: www.shotsforschool.org/k-12/

10. What is the school’s responsibility?  Kindergarten/Transitional Kindergarten:  When parents/guardians come to the school to pick up a registration packet, be sure to inform them of the immunization laws. Let them know that their child cannot be enrolled in school if any of the required immunizations are missing (this is not a new requirement).  Always get a copy of the immunization record when the parent turns in the registration packet.  Check the immunization handbook, Appendix B, page 20: http://eziz.org/assets/docs/shotsforschool/IMM-365.pdf  Or the following website: www.shotsforschool.org/k-12/

11. What is the school’s responsibility?  Kindergarten/Transitional Kindergarten continued::  Looking at the immunizations:  Immunizations complete- student may be enrolled in school  Immunizations incomplete-  Student may be enrolled conditionally* (see next slide) if no doses are currently due  Student may not be enrolled if immunizations are currently due and missing  Students with missing immunizations and a valid medical exemption may be admitted  Temporary medical exemptions- students are admitted conditionally*  Permanent medical exemptions- students are admitted Note: Children who were admitted into transitional kindergarten (TK) in 2015 and are now beginning kindergarten in 2016 were required to meet the same immunization requirements for school entry as kindergarten students. If a student who was previously in TK had a valid PBE when they entered school in 2015, the waiver is valid in California schools until that child enters seventh grade.

12. *Conditional Admissions to School:  *Students admitted to school conditionally:  Schools must have a system in place for tracking when students are due for their next immunizations  Students who are attending school conditionally must be excluded if they do not receive immunizations when they are due Refer to: http://www.shotsforschool.org/laws/conditional-admission/ Or to the immunization handbook, page 8: http://eziz.org/assets/docs/shotsforschool/IMM-365.pdf

13. What is the school’s responsibility?  Students entering seventh grade:  All students entering seventh grade will be required to have the Tdap (whooping cough) immunization. This is not new, this law has been in place since 2011.  This is new:  Seventh grade is considered a “new grade span”. Any PBE on file for any previous immunization(s) is/are no longer valid.  Students entering seventh grade will have to meet all age appropriate immunization requirements which can be found on the following website : www.shotsforschool.org/k-12/ www.shotsforschool.org/k-12/

14. What is the school’s responsibility?  Students entering seventh grade:  School staff must begin reviewing immunization records when students are in sixth grade (most schools have attendance software that they can use for this). If students are missing immunizations and do not have a valid medical exemption on file for the missing immunization(s), then they must have received the missing dose(s) before entering school in seventh grade.  Have a system in place for notifying parents of immunizations that will be required before entry into seventh grade.  Give parents as much notice as possible. They may need to make appointments with their health care providers to have the immunization(s).  Give parents a clear deadline for when the school must have the immunization record in order for their child to attend seventh grade on the first day of school.  Exclusion from school for failure to get the required immunizations is an unexcused absence. Note: Students without Tdap never qualify for conditional admission. This immunization can be given any time on or after the child’s 7 th birthday.

15. Conditional Admissions to School:  If a student has not received all of their immunizations previously, they may need multiple immunizations to be up to date before entering seventh grade. Those students may be admitted conditionally if they are in the process of being immunized and do not currently have a dose due.  Students admitted to school conditionally:  Schools must have a system in place for tracking when students are due for their next immunizations  Students who are attending school conditionally must be excluded if they do not receive immunizations when they are due Refer to the shots for school website: http://www.shotsforschool.org/laws/conditional-admission/http://www.shotsforschool.org/laws/conditional-admission/ Or the immunization handbook, page 8: http://eziz.org/assets/docs/shotsforschool/IMM-365.pdf

16. What is the school’s responsibility?  California Transfer Students:  A student who has already been attending school in California and transfers to another California school should already meet the immunization requirements for the grade they are transferring into:  Always get a copy of the student’s immunization record before allowing the student to enroll in school.  The parents/guardians are responsible for supplying this record. If they do not have a current copy of the record, you can ask them to request it from the previous school and have it FAXed to you.

17. What is the school’s responsibility?  California Transfer Students:  If the student meets the immunization requirements for the grade they are transferring to- enroll in school  If the student does not meet the immunization requirements but has a valid PBE or a valid Medical Exemption- enroll in school  If the student does not meet all of the immunization requirements for their grade or age and do not have a valid PBE or Medical Exemption-do not enroll student  These students must meet the immunization requirements before they can be admitted into school  Once they have received all of the immunizations that are currently due, they can be admitted conditionally if they will have more doses due in the future.  Students admitted conditionally must be tracked and present a record of immunization each time a shot is due until they are up to date. Students who are transferring to another California school and are in a transitional kindergarten, kindergarten or seventh grade will not have a valid PBE. These students must meet the immunization requirements for their age and grade.

18. What is the school’s responsibility?  Out of State Transfer Students:  Students transferring from a school in a state other than California must meet all of the immunization requirements for their age and grade. Out of State PBEs are not valid.  Always get a copy of the student’s immunization record before allowing the student to enroll in school.  The parents/guardians are responsible for supplying this record. If they do not have a current copy of the record, you can ask them to request it from the previous school and have it FAXed to you.

19. What is the school’s responsibility?  Out of State Transfer Students:  If the student meets the immunization requirements for the grade they are transferring to- enroll in school  If the student does not meet all of the immunization requirements for their grade or age and do not have a Medical Exemption-do not enroll student  These students must meet the immunization requirements before they can be admitted into school  Once they have received all of the immunizations that are currently due, they can be admitted conditionally if they will have more doses due in the future.  Students admitted conditionally must be tracked and present a record of immunization each time a shot is due until they are up to date. Students who are transferring from out of state must always meet all of the immunization requirements for California. The only exception is a student with a valid Medical Exemption (signed by a licensed M.D. or D.O.)

20. What is the school’s responsibility?  Homeless and foster youth:  The federal McKinney-Vento Homeless Assistance Act requires schools to enroll new students who are homeless even if their immunization records are missing or unavailable at the time of enrollment. California law requires schools to immediately enroll foster children transferring to their school even if a foster child is unable to produce immunization records normally required for school entry. Once a homeless student or a foster child is enrolled, school staff should work with the school or foster family where the student was transferred from to obtain the student’s immunization records quickly. The school staff person should also work with Child Protective Services and Colette Bradley with Foster Youth Services at Siskiyou County Office of Education to ensure these students receive any vaccinations they may need.  The law still requires that the school obtain the student’s immunization record and ensure that the foster student has met all immunization requirements.

21. What is the school’s responsibility?  Students on Individualized Education Plans (IEPs):  The following is the language in SB 277: The immunization requirements do not prohibit pupils from accessing special education and related services required by their individualized education programs. The California Department of Public Health, Immunization Branch has not been able to clarify what this means. Some schools districts have imposed the same requirements for students on IEPs as all other students. The advice from the CDPH has been for each Local Education Agency to consult their attorneys. Our SELPA Director is consulting with other SELPA Directors and an attorney to clarify this issue. I will keep you up to date with any new information.

22. What is the school’s responsibility?  Every school in California is required to follow the California immunization law.  Never allow a student to begin attending school without an immunization record. The only exception to this rule is a student who is homeless or in foster care. See the immunization handbook or previous slides for more information on this situation.  School Nurses can consult with school staff to assist them in understanding the immunization laws, but are not responsible for enforcing the law or submitting the immunization reports.  Every school district must have a person assigned to review the immunization records of students who are enrolling in school.  Each school administrator is responsible for immunization compliance and excluding non-compliant students at their school sites.

23. What is the school’s responsibility?  There are online reporting requirements for kindergarten and seventh grade immunizations.  Schools who do not file a report or have a high number of conditional entrants may be subject to an audit by the California State Controller’s Office.  If a school is found to have allowed students who were not appropriately immunized to attend school, the school may have their apportionment adjusted for the amount of the average daily attendance that they would have received for that student for every day the student attended school without the required immunization.

24. More Useful Information:  Parents/guardians who choose not to fully immunize their children have the following options:  Home-based private school  Independent study program with no classroom-based instruction  Parents or guardians of these children must provide records to the schools of any required immunizations received by these students.  Home-based private schools and independent study programs with no classroom-based instruction will still need to:  Record immunizations for all students at entry.  Report on the immunization status of all students at the checkpoints of child care, kindergarten, and 7th grade.

25. More Useful Information and Resources:  California Immunization Handbook, eighth edition, August 2015: http://eziz.org/assets/docs/shotsforschool/IMM-365.pdf  Appendix B: Samples and Materials to Help You Implement the Law  Appendix C: Sample Materials for Parents and Students  The language of Senate Bill 277 (Pan, 2015) is available at: https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277  Senate Bill 277 Frequently Asked Questions: http://www.shotsforschool.org/laws/sb277faq/

26. Developed and submitted by: Patty Morris, MSN/RN/PHN Director of Health Services Siskiyou County Office of Education (530) 842-8425 pmorris@siskiyoucoe.net January 2, 2016 pmorris@siskiyoucoe.net