1. IMMMUNIZATION REQUIREMENTS FOR CHILDREN IN CHILD CARE GROUP SETTINGS Phuoc Tran, RN, M.Ed Program Operations Section Manager Division of Immunizations Pennsylvania Department of Health Phone: (717) 787-5681 Fax: (717) 705-5513 E-mail: ptran@state.pa.us

2. 1.Infants and children enrolled in a child care group setting must have completed immunization records; 2.Each child should be immunized in accordance with the current Recommended Childhood Immunization Schedule by the CDC’s ACIP; and 3.The immunization status of each enrolled child should be summarized and reported on an annual basis to the DOH. REGULATIONS:

3. 1.Low level of immunization (78%- 4:3:1:3:3) 2.Hib strikes infants and children five years of age or younger 3.Streptococcal pneumonia: - Leading cause of bacterial meningitis -Responsible for approx. 200 deaths annually in the U.S. 4.32.9 % of confirmed pertussis cases in PA, in 2003, were in children YOUNGER THAN ONE YEAR OF AGE 5.Preventing vaccine preventable diseases among infants and preschool age children WHY DO WE NEED IMMUNIZATION REQUIREMENTS IN CHILD CARE GROUP SETTING:

4. Child care group setting: The premises in which care is provided at any one time to four or more children, unrelated to the operator. Two months of age or older: Two to seventy-one months of age Provisional admission period: 60 days DEFINITIONS:

5. A written objection on religious grounds; An initial verification of the dates the child was vaccinated; permanent or temporary medical condition must be specified; Subsequent verification for outstanding vaccinations CAREGIVER RESPONSIBILITIES: A caregiver must receive one of the following

6. 1.Exclude until receives documentation of vaccination or temporary medical condition still exists, within 30 day period; 2.If temporary condition persists, a new verification is required at 30-day intervals; 3.Exclude and not readmit the child until a verification is submitted. CAREGIVER RESPONSIBILITIES: (Con’t) Temporary Medical Condition:

7. 4.Retain written verification or objection for 60 days; 5.Ensure that certificate of immunization is completed and signed; 6.Immunization status of each child should be summarized and reported. CAREGIVER RESPONSIBILITIES: (Con’t)

8. Kindergarten, elementary school, or high school students Children who are six years of age or older attending kindergarten, elementary school or high school. Doesn’t provide care for at least 40 hours during at least one month. Certification of medical deferment, medical exemption, or religious exemption is accepted. EXEMPTIONS:

10. Distribute Forms to Child Care Group Setting (DOI) Completed form returned to DOI (CCGS) Forms successfully delivered to CCGS Contact CCGS for outstanding form (DIC) Obtain correct address Redistribute forms to CCGS(DOI) Mark CCGS and forward form to IMR (DOI) Immunization data collection process includes: No Yes

11. TIMELINE: 8/15/2003: Approx. 20,000 fact sheets distributed to child care providers, parents, and health care providers 1/12/04: 4,679 forms distributed 2/16/04: 2,838 completed forms submitted 3/05/05: Field staff contacting non-reporting facilities began 4/16/04: Field staff contacting non-reporting facilities ended

12. Non-reporting Facility Follow-up Results Of the 4679 facilities: – 10% closed, wrong address, and inappropriate facilities, – 11% didn’t receive, misplaced, or required additional forms, or will submit – 2% didn’t respond to messages, or refused to submit – 12% didn’t contact

13. Non-reporting Facility Follow-up Results (Con't) 300 additional forms were submitted as the result of field staff contacting child care facilities. Final Compliance rate: 65%

14. 1.A joint letter signed by DOH and DPW will be sent to all non-reporting child care facilities, A meeting among stakeholders will be held to identify best practices and lessons learned, and Promote educational outreach activities with local immunization coalitions. FOLLOW-UP ACTIVITIES

15. Auditing randomly selected child care facilities Targeting low immunization coverage facilities for: -education -promotion -vaccination FUTURE VERIFICATION & INTERVENTION PLAN:

16. THANK YOU Phuoc Tran, RN, M.Ed Program Operations Section Manager Division of Immunizations Pennsylvania Department of Health Phone: (717) 787-5681 Fax: (717) 705-5513 E-mail: ptran@state.pa.us