Monday, August 1, 2016

2016 school vaccination requirements

When I was young, Summers were sacred and school started after Labor day. I am not sure when that shifted, but it seems that these days many of our patients start school in mid August. This is the time of year for the panicked parent to call, needing an immediate check up (sorry folks, that is probably not going to happen), sports form, or updated vaccination record prior to school entry.
Below  is the standard form if you lost yours:

Take a deep breath. Most schools will accept a promise of a scheduled check up as long as they have an immunization form that is complete. We are happy to work with our families to at least get you scheduled for some of those shots that are needed even if there isn't an appointment with the doctor available.
As most of you are aware, In June of last year, California Governor Jerry Brown signed Senate Bill (SB) 277 into law.
This law went into effect July 2016. For the school year beginning August/September 2016, all children going into kindergarten, seventh grade or transferring to a new school for the first time will need to be fully vaccinated or have a medical exemption. Personal or religious exemptions will no longer be accepted. 
The law has also tightened up the age requirements.
California law now states that children must be five years old on or before September 1, 2016 to be legally eligible for Kindergarten and six years old on or before September 1, 2016 to be eligible for first grade.
Students who will turn five between September 2nd and December 2nd 2016 are eligible for a transitional Kindergarten program for the 2016-2017 school year. In October, the  children enrolled in the transitional kindergarten program this year will be required to apply for Kindergarten assignment for the 2017-18 school. The vaccine requirements for transitional Kindergarten and Kindergarten are the same.

Here is a list of the shots that San Francisco schools require:   
Before entering kindergarten:
DTaP (Diphtheria, Tetanus, Pertussis): 5 doses
If the 4th dose was given after the age of four, 4 doses is acceptable.
Polio: 4 doses
If the 3rd was given after the age of 4,  3 doses is acceptable
Hepatitis B: 3 doses
While I am completely sympathetic to the parents who don’t want to start the series when they are still in the hospital, I do suggest that you get started with these during the first year.

MMR(measles, mumps and rubella): 2 doses are required
If they got an early dose prior to the first birthday, that doesn't count as one of the doses
Varivax (chickenpox): 1 dose is required. 2 is preferred

Interestingly the Hepatitis A vaccine is not required by school.  We strongly recommend that everyone get that one taken care of as soon as the kids turn 1. 

There is a conditional entry for children who are not fully up to date, but they must have at least
1 Varivax
1 DTaP
1 Polio
1 Hep B.
The schools will be checking in to make sure that the series are completed in a timely manner.
School districts already have their own systems for tracking and following up with kindergartners who are not fully immunized. Whatever systems the districts are already using will remain in place.

Vaccinations are only one of the requirements for school entry.
Kindergartners must have a complete physical examination within 6 months prior to entering school.
We routinely check their vision, hearing and urine as well as reviewing general health and development. In my opinion, this is just as important as getting the shots.
California law also requires that by May 31st each year, students in their first year of public school must submit proof of an oral health assessment performed by a licensed dental health professional.

 Students entering the 7th grade  will need to show proof of a Tdap (Tetanus, Diptheria and Pertussis) booster. They also must show proof of two doses of the MMR vaccines.

7th grade  is also the perfect opportunity to vaccinate with the other ACIP (the Advisory Committee on Immunization Practices) recommended vaccines for 11-12 year olds, including HPV and MCV4 (meningococcal).

Check out this valuable link for a complete list of what is required
.For our younger patients, most licensed day care facilities also have a fairly strict vaccination policy. Those requirements are also listed in the above link. That website also has a feature where you can check out your school or day care to see how well they have been doing in their vaccination efforts.

Routine testing for tuberculosis is not required for SF public schools. Rather than testing every child with a skin or blood test, the San Francisco Department of Public Health strongly supports a medical provider's risk assessment for TB as the universal screening requirement for school entry.  Only children identified as having one or more risk factors for TB infection will need to be tested.
The most common risk factors are
*Contact with a family member with history of or confirmed case of TB
*Foreign born family or adopted  from country with a high-prevalence of TB
*travel to high risk county
*HIV contact
*family member who has been in jail during past 5 years
*frequent exposure to homeless, users of street drugs or residents of nursing homes
*Clinical evidence of TB: Cough lasting  longer than 3 weeks, coughing up blood, night sweats, fever, weight loss.
If you do get your child tested you have 2 options. The PPD is a test applied to the inner arm that needs to be checked 2-3 days after it is placed.
There is also a blood test available.

Some of the private schools insist on TB testing for all of their students, regardless of the recommendation of the SF Public Health Department.  I have gone to the mat with one of the local parochial schools and lost.

Back to school is an exciting time. Try to carve out some extra time during the bedtime routine where you can have your kids tell you all about their day.
Don't fall into this common trap.
"How was your day?"
Ask specific questions such as:
Tell me about the kids in your class.
Tell me about the teachers
 Share something interesting that you learned today

It has been several weeks since I have sent out a post that  mentioned poop. so I will add one more tip.
Please make sure that your kids don't get constipated. Many children will not poop at school until they are really comfortable there. Some mornings are rushed and systems can get backed up. Keep your antenna up.

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