Update
from CA DHS - Immunization Branch
January 2, 2006
Hurricane Katrina Evacuees and Immunization Requirements
Procedures for Immunizing Children with Lost Records
Click
here to download a pdf version of this letter
or read text of letter below:
From:
Howard Backer, M.D., M.P.H., Chief
Immunization Branch
To:
Local Health Department Immunization Coordinators
Local Health Department Health Officers
Public and Private Schools in California
In the
aftermath of Hurricane Katrina, DHS Immunization Branch has
received many inquiries regarding school entry when immunization
records are unavailable. This letter is an update to the September
2005 letter entitled “Hurricane Katrina Evacuees and
Immunization Requirements.”Children relocated
to California by the hurricane whose records cannot be located
must now receive all immunizations specified by California
law."
Recap of California’s school entry requirements
California’s immunization requirements are detailed
in the California School Handbook available at www.dhs.ca.gov/ps/dcdc/izgroup/handbook.htm.
To summarize, California Health and Safety Code Sections 120225-120280
require specific immunizations before entry into child care
and school. The California Code of Regulations (CCR), Title
17, 6000-6075 requires parents (or guardians) of all new school
entrants to present a detailed medical immunization record,
typically the yellow California Immunization Record, which
is available free from local health departments for this purpose.
However, other records supplied by medical providers, including
records from outside California or the U.S., are also acceptable,
so long as the type of vaccine and at least the month and
year of all vaccine doses are included.
The CCR allows all pupils transferring between schools within
California or from another state up to 30 school days to present
a medical immunization record. A school or child care facility
cannot allow a child to register (or unconditionally
continue in school) if the immunization record does not contain
the month and year of each required dose.
Implications for children displaced by Hurricane Katrina
There are no special provisions or exemptions to these laws
and regulations for children affected by natural disaster
or relocation, such as has occurred after Hurricane Katrina.
The immunization records of most children affected by Hurricane
Katrina were in state- maintained Immunization registries.
This information has been very helpful in record reconstruction.
All efforts to obtain immunization records from a registry
or providers should be exhausted before attempting to recreate
the record from verbal histories. Schools and child care centers
must refer children without immunization records or with inadequate
records to a physician or health department to complete their
required immunizations.
If a medical provider consents to a request to reconstruct
immunization records based on the recollection of the parent
or guardian, we recommend:
- If
the parent has no record and the child’s immunization
history is based on parent memory alone, at a minimum
give the child one dose each of:
- MMR
- DTP/DTaP/DT
- Hepatitis
B
- Polio
- Varicella
- Hib,
if child is under 5 years old
- Record
these doses with month, day and year of administration
in the child’s new immunization record.
- If
you are certain that the child has had the other recommended
doses and is thus protected, medical providers may record
the estimated month and year that each vaccine dose was
received upon the yellow California Immunization Record
or similar document. In the “Doctor’s Office
or Clinic” column write “By history”
and add your signature or rubber stamp.
- Obtaining
serum antibody or titer levels to prove immunity and avoid
immunization is discouraged as results may be unreliable
and expensive. If a child has documented antibody to a disease
for which immunization is required, you may grant that child
a written medical exemption to immunization with that specific
vaccine.
- If
you are uncertain whether other vaccine doses have been
received:
-
After receiving the doses recommended above, the child
may be admitted conditionally to a school or child care
facility, but this requires that you have the child
complete the immunization series according to the recommended
schedule.
-
If a pronounced injection site reaction to DTaP/DTP/DT
occurs in a child whose record was lost, this suggests
that the child has received the full series, in which
case you may grant a medical exemption to further doses
of DTaP/DTP/DT until age 11, when a TdaP booster is
indicated.
Thank
you for your help in protecting California children. If you
have any questions, please contact your local health department’s
immunization program, which is listed at http://www.dhs.ca.gov/ps/dcdc/izgroup/provider.htm
under “Vaccine Programs - Local Health Department Listing”.
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For the most up to date and authoritative information on these
and other hurricane-related issues, please visit the federal
Centers for Disease Control and Prevention's, Hurricane
and Health and Safety website at:
http://www.bt.cdc.gov/disasters/hurricane
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Help in Finding Immunization Records
The County
of San Diego Immunization Branch and the San Diego Regional
Immunization Registry (SDIR) are offering help to Hurricane
Katrina evacuees here in San Diego in locating and documenting
immunization history needed for entry into local schools.
The SDIR Help desk currently has access to the immunization
registries from Louisiana, LINKS, and Mississippi,
MSDH Immunization Registry, which contains the records
of many of these children. If you need to get a copy
of an immunization record for a child registering for school
or visiting a clinic for shots, please call the SDIR Help
Desk at (619) 692-5656 and we will get the information to
you if available. **If you are provided with immunization
information for an evacuee from us, please be sure to inform
the parent or guardian that we will also be entering this
information into SDIR.
** Please note that we now also have access to Alabama evacuees'
information via the State Immunization Registry Program so
you can call us to inquire about those records too. If it
becomes necessary, we may also be able to obtain immunization
information from the Texas Registry for Hurricane Rita evacuees.
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