VIII. IMMUNIZATION RECORD AND SCHEDULE
Performance Standard 1304.20(a) (1) (ii)
POLICY
Head Start and Early Head Start will adhere to the Minimum State Vaccine Requirements for Texas Children as recommended by the Texas Department of State Health Services. Early Head Start will adhere to Texas minimum State Requirements for Children Attending Child Care Facilities. Head Start of Greater Dallas will adhere to Texas Minimum State Vaccine Requirements for Students Grades K-12. These immunizations provide children with protection against many communicable diseases. To go directly to the Texas Code information the web address box is:
http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPag?s1=R&app=9&p_dir=$p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=25&pt=1&ch=97&rl=63
All centers are required to maintain a record of the immunization status of each child enrolled. The record must be made available for inspection.
A child will not be permitted to enroll in the center if immunizations have not started or are delinquent. There is not a 30-day grace period for children who have not received any immunizations or whose immunizations are delinquent. A child will be dropped or placed on hold if immunizations are not updated per TDH requirements. All immunization records must be validated by a physician’s signature or health clinic stamp. The month, day, and year must be indicated on the record.
All immunization information will be entered on the data base system ASAP but no later than Friday of each week.
IMMUNIZATION REQUIREMENTS
HEAD START & EARLY HEAD START PROGRAM
§ DIPHTHERIA - TETANUS – PERTUSSIS
A total of five (5) doses of the Dtap is required, effective August 19, 2003.
The following guidelines are recommended:
1) Ages 0-3 year, four (4) doses are needed in order to be up-to date.
2) By age 4, the fifth dose is required in order to be complete.
3) Four doses of Dtap are acceptable if one of the doses is given after the fourth (4th) birthday. In this case, the 5th dose of Dtap is not required.
4) Td is required one every ten (10) years thereafter
Effective September 1, 2004
Receipt of the booster dose of Dtap (DT, DTP) is acceptable if administered four days prior to the 4th birthday.
§ POLIO - (To Age 18 years) Effective September 1, 2004
A total of four (4) doses of the vaccine with one (of the 4 doses) given since the fourth (4th) birthday. Three doses are acceptable if the third dose was given after the fourth birthday. Receipt of the booster dose of IPV/Polio DTP) is acceptable if administered four days prior to the 4th birthday.
§ MEASLES
One (1) dose administered on or after the first birthday. The dose will be considered valid if administered less than or equal to four days prior to the first (1st) birthday or physician validated history of disease or blood test proof of measles immunity/protection.
Children Age Four (4): Two (2) doses of vaccine. The first dose administered must adhere to the requirement stated previously and the second dose is acceptable if administered at least 30 days after the first dose, or by the fourth birthday. A physician validated history of disease or blood test proof of measles immunity will also be considered a validation for the measles requirement.
§ RUBELLA
One (1) dose of vaccine since the first (1st) birthday or blood test proof of rubella immunity/protection. The dose will be considered valid if administered less than or equal to four days prior to the first (1st) birthday or physician validated history of disease or blood test proof of measles immunity/protection.
§ MUMPS
One (1) dose of vaccine since the first (1st) birthday or physician validated history of disease or blood test proof of immunity. The dose will be considered valid if administered less than or equal to four days prior to the first (1st) birthday or physician validated history of disease or blood test proof of measles immunity/protection.
§ HAEMOPHILUS INFLUENZA (HIB)
Dec. 20, 2007, the Texas Department of State Health Services issued a memo to providers with policy guidelines to immediately defer the routine booster dose of HIB vaccine as recommended. Please note the following:
Non-risk children should not received the booster dose at 12-15 months. High risk children should receive the booster dose at 12-15 months.
Based on this event, child care facilities and schools should defer the enforcement of the routine HIB booster does required at 12-15 months of age. Therefore in reviewing immunization histories the following is acceptable during the temporary deferral. This will remain in effect until further guidance from DSHS.
Two or three doses before 12 months of age are acceptable.
The fourth dose is not required at age 12-15 months. If the child received PedvaxHIB (2 doses) or Comvax (2 doses) at both 2 and 4 months, these are the only doses needed. A minimum of two doses, two months apart constitutes a series.
If the child received has only received 1 dose of either PedvaxHIB or Comvax and the time period is longer than 2 months, they must get two more doses with the 3rd dose being given at 6 months or at least 4 weeks from the 2nd dose.
Late/Unvaccinated children 12 to 14 months should receive a total of one dose. The second dose is deferred.
Unvaccinated children 15 -59 months of age and older (until age 5) should receive a total of one dose.
§ HEPATITIS B (HBV)
A total of three (3) doses of vaccine are required.
If the child missES a dose or getS behind, The next dose is required as soon as possible. There is no need to start again. After the first (1st) dose, a month interval should be between the 1st and the 2nd dose. An interval of five (5) months should be between the 1st and the 3rd dose.
For infants born to a mother who tests positive for HBsAG during the pregnancy or whose status is unknown, infants may receive a 4th dose. This would depend on the type of vaccine used. If using Pediarix or Comvax then a fourth dose is needed. If using a single dose (monovalent vaccine) then only three doses are required.
VARICELLA (CHICKENPOX)
One (1) dose is recommended by age one or after age one. The dose is valid if administered within less than or equal to four days of the interval age of 12 months.
· Effective August 1, 2000, children attending childcare facilities will be required to be vaccinated against Varicella as follows: Children born on or after September 2, 1994, who are one year old, will be required to have one dose of Varicella vaccine or provide documentation of previous Varicella illness. (See Varicella Form)
· Second Dose Recommended. Effective Aug 1, 2009 all children entering Kindergarten will be required to have 2 doses of varicella vaccine. HSGD will recommend the second dose of Varicella to be given by the 4th birthday.
· A written statement from a parent (or legal guardian or managing conservator), school nurse, or physician attesting to the child’s positive history of varicella disease (chicken pox) or varicella immunity is acceptable in lieu of either dose of varicella.
HEPATITIS A
Hepatitis A (September 1, 2005)
A total of two doses of vaccine are required.
Effective July 2005, children born on or after September 2, 1992 will be required to have two doses of Hepatitis A. The first dose should be administered by their 1st birthday and the second dose at least six months later. Unvaccinated children older than 2 years should received both doses of Hepatitis A at least six months apart.
§ PREVNAR VACCINE
Prevnar (September 1, 2005)
Prevnar is indicated for active immunization against invasive disease caused by 7 strains of Streptococcus Pneumonia. Children under 2 years-old are at the highest risk. It is recommended in a series of four doses given at ages 2, 4, 6, and 12-15 months. PVC-7 or PCV-23 is acceptable vaccines for this immunization requirement.
To determine if a vaccine is acceptable, staff must look at the birthday and the date of the last dose.
· Late/Unvaccinated children, ages 7-11 months, should receive a total of three (3) doses by the age of twelve (12) months. The 1st and 2nd dose should be given two (2) months apart. The third should be given after 12 months. The third dose is valid if given within less than or equal to four days of the interval age of 12 months.
Late/Unvaccinated children 12 to 23 months should receive a total of two doses. An interval of two months should be between the 1st and the 2nd dose.
Late/Unvaccinated children 24 months of age and older (until age 5) should receive a total of one dose.
Vaccinated Children ages 7-12 months should received a total of three doses with the last dose being given after the 12 month ( 1 yr. old birthday)
Vaccinated children ages 12 month to 23 months should receive a total of two doses with an interval of two months between the first and second dose.
IMMUNIZATION REQUIREMENTS
EARLY HEAD START PROGRAM
Children enrolled in the Early Head Start program will also adhere to Minimum State Vaccine Requirements for Texas Children, as recommended by the Texas Department of State Health Services, as described per age group upon entering the centers.
MINIMUM STATE VACCINE REQUIREMENTS FOR TEXAS FOR CHILDREN ATTENDING CHILD-CARE
FACILITIES
VACCINE REQUIREMENT
Younger than 2 months No Vaccines required
2 months through 3 months One dose Polio vaccine
One dose DTP/Dtap vaccine
One dose Hib vaccine
One dose of PCV
One dose of HBV
4 months through 5 months Two doses Polio vaccine
Two doses DTP/Dtap vaccine
Two doses Hib vaccine
Two doses PCV
Two doses HBV
6 months through 11 months Two doses Polio vaccine
Two doses Hib vaccine
Three doses DTP/Dtap vaccine
Three doses of PCV
Three doses of HBV
12 months through 14 months One dose MMR vaccine received on or after 1st birthday
(Doses are valid if given 4 days prior Two doses Hib vaccine
to their 12month birthday) Three doses DTP/Dtap vaccine
(Effective 8/1/2000) One dose of Varicella vaccine received on or after 1st birthday
Two doses of PCV
One dose of Hep. A
15 months through 4 years One dose MMR vaccine received on or after 1st birthday
One dose Hib vaccine on or after 15 months of age, unless a primary series and booster have been completed
Three doses Polio vaccine
Four doses DTP/Dtap (Fourth dose not required until 18 months.) Effective 8/1/2000)
One dose of Varicella vaccine received on or after 1st birthday.
(Required) One dose of Hepatitis A received by 12 months and the second dose received by 18 months.
One dose of PCV after age two
1) IMMUNIZATION PROCEDURE
POLICY
The Health Staff will notify parents of immunizations at least one month before the due date. A maximum of three notices will be given to the parent prior to the child becoming delinquent. If a child is more than 30 days delinquent and the family has been notified properly, the child should be dropped from the agency. .
The Health Specialist or Health Assistant will notify parents of immunizations during enrollment (1st notice) or as they become due during the year. It is the parents' responsibility to bring all updated immunization records to the Health Specialist or Health Assistant in order for them to document the updated information on the child's immunization record on the data system. Original documents will be returned to the parents after they are recorded.
PROCEDURE
1) All parents must be notified when a child’s immunizations are due.
(Immunization Notice Form HC-11)
2) Health Staff should refer parent to a community clinic/private provider for their immunization. Health Staff should provide information concerning immunization clinics located near the center. A special scheduling with the Nurse Practitioner may be done as a last option.
3) If the parents utilize a community immunization clinic or private provider, Health Staff should give parents an Immunization Notice Form identifying which immunizations are needed based on the agency’s information.
4) If the child is overdue (more than 30 days) and the parent has received two notices (30 days prior to the due date) then the child may be excluded with the 3rd notice. The child may not return until he/she has received the needed immunizations. The child may be dropped if the parent does not comply with requirements.
5) Updated information obtained from parents must be documented on the data system immediately or within five working days of receiving.
6) Children are excused from receiving the required immunizations on an individual basis for medical contradictions, religious conflicts or conscientious objection to vaccination. Children in these categories must submit evidence for exclusion from compliance (see exemptions).
2) SPECIAL REMARKS: IMMUNIZATION REQUIREMENTS
§ Since there are many types of immunization records in use, all documents will be accepted provided that a physician or public health personnel have validated the information. The month, day and year that the vaccination was received must be recorded on all immunizations created or updated since September 1, 1991.
§ When a validated immunization record contains only one vaccine date for OPV, IPV or DTP/DT/Dtap, and a "B" or the word "booster," or the words "series completed" (or similar wording) appears by the immunization date, assume that three doses of OPV, IPV (or four doses of conventional IPV) or DTP/DT/Td had been administered.
§ If the date is within four days prior to, or of, the fourth birthday, then the requirement for a dose on or after the fourth birthday is met under these circumstances.
§ Authorities in childcare facilities are required by Health and Safety Code to report all suspected or known cases of vaccine-preventable diseases which occur among children or staff on the day of recognition to the local health authority. The city or county health department/district, the city or county health officer, the public health regional office, or the Texas Department of State Health Services in Austin, will then alert health officials to possible outbreaks of these diseases.