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New Jersey School Immunization Requirementsand UpdatesJenish Sudhakaran, MPHJennifer Smith, MPH, CHESVaccine Preventable Disease ProgramPhone: 609-826-4861

Questionsduring thewebinar? All attendee lines are muted. Please use the“Questions” or “Chat” boxes to ask a question We reserved time at the end of the webinar to answerquestions.

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ObjectivesBy the end of this program, attendees will be able to:123Explain why immunizations should be an importantpriority for child care facilities and schoolsIdentify immunization requirements for entry andattendanceInterpret and apply New Jersey’s immunizationrequirements

IMMUNIZATIONS- A /StudentLocalHealthSchools,Preschooland ChildCare

N.J.A.C. 8:57-4New Jersey AdministrativeCode Title 8: Health Chapter 57:Communicable Disease Subchapter 4:Immunization ofPupils in School

Purpose of N.J.A.C. 8:57-4To establish minimumimmunizationrequirements forattendance in NewJersey schools

Enrollment vs. AttendanceSchool Districts may not deny enrollment;attendance can be deferred until studentcomplies with immunization rules.

Are Immunization Requirements Waivedduring COVID-19 Pandemic? Immunization requirements are in effect for the2020-2021 school year Applicable to student participating in-person orremotely Students must be compliant with age appropriateimmunization requirements, have applicableexemptions, or satisfy the provisional admittancedefinition.

Why Require Vaccine for RemoteLearners? N.J.A.C, 8:57-4 requires ALL students attending aNJ school to be vaccinatedCannot restrict remote learners from intermixingwith hybrid students and/or congregating incommunitiesReceiving timely immunizations and ensuringcompliance is key Drops in immunization coverage can lead to increase in VPDoutbreaks in schools and communities

Accessed: e2-H.pdfMMWR / May 15, 2020 / Vol. 69 / No. 19 US Department of Health and Human Services/Centers for Disease Control andPrevention

Religious ExemptionsParent or guardian must provide a signed written statement requesting anexemption “on the ground that the immunization interferes with the freeexercise of the pupil’s religious rights”Religious affiliated schools can grant or deny religious exemptions fromthe required immunizations for pupils entering or attending theirinstitutionsThe religious exemption does not need to state the child’s religion orspecific tenants, notarized, or signed by a religious leaderNo annual update is required

Medical ExemptionsCan only be written by a medical doctor, doctor of osteopathic medicine or an advancedpractice nurse licensed to practice in the United StatesMust indicate a specific time periodReason(s) for medical contraindication must be enumerated by the AdvisoryCommittee on Immunization Practices (ACIP) and the American Academy ofPediatrics (AAP)Do not necessarily need to be renewed, but must be reviewed annuallyMedical Exemption Template Form: https://www.nj.gov/health/forms/imm-53.pdf

Exempted StudentsThose children who have been grantedmedical and/or religious exemptions may beexcluded from the school, preschool, orchildcare facility during a vaccine preventabledisease outbreak (as determined by the Stateand Local Health Department). N.J.AC. 8:574.3 (d) and 8:57-4.4 (d)

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Provisional AdmissionStudents must: Have at least one dose of each required vaccine Be actively in process of completing series as rapidly as medically feasibleChildren five years of age: allowed up toseventeen months to completeChildren five years of age and older:allowed up to twelve months to complete

Out of ComplianceThe student does not have an immunization record, RE or ME onfile, or does not meet the provisional definition since the interval toreceive the next dose in the vaccination series has been exceededStudents should not be allowed to attend school until they have aminimum of one dose in the vaccine series and are on schedule to receivesubsequent doses consistent with the ACIP catch-up schedule

Immunization Coverage and ExemptionData by County, New Jersey AnnualImmunization Status Report, 2019-2020100%98%96%94%92%90%88%86%Meeting All Immunization RequirementsProvisional AdmittanceReligious ExemptionsMedical ExemptionsOut of Compliance

30-Day Grace PeriodApplies only to out-of-state orout-of-country transferstudentsThe student shall be admittedtemporarily for up to 30 days ifacceptable evidence ofvaccination is not availableIf after the 30 days haveelapsed and no documentationof previous vaccination isprovided, the child may notattend school until one dose ofall age-appropriate requiredvaccines are received beforebeing provisionally admitted

Four-Day Grace PeriodAll doses administered less than or equal to four daysbefore either the specified minimum age or dosespacing interval shall be counted as valid andrevaccination would not be required

Official Immunization RecordPresented on thefirst day ofschoolList the type ofimmunizationand the date ofadministrationVaccineadministrationdates should belisted by month,day and year.Documentationof only monthand year areacceptable if theminimumintervals can bedetermined.

Acceptable ImmunizationDocumentationYellow Card (IMM-8)NJIISHealth History andAppraisal Form(A-45)

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Foreign Immunization RecordsAccept with proper written documentation seal or stamp OR signed and dated by health care providerMatch with U.S. requirements (specifically NJ)Revaccinate in accordance with the ACIP recommended schedule(may be simpler) or do serology (when possible)Translation of foreign ds/appendices/B/foreign- products-tables.pdfSee AAP’s Red Book or the ACIP for further guidance

New Jersey ImmunizationInformation System (NJIIS)Consolidates immunization information from all providers intoone record to provide an accurate immunization assessment andeliminate the use of manual vaccine administration logsAssists federal, state and local public health agencies withpopulation assessments in the event of a preventable diseaseoutbreakHelps communities assess their immunization coverage andidentify pockets of need

NJIIS Mandatory ParticipationN.J.A.C. 8:57-3.16 a :Every healthcare provideradministering vaccines to childrenless than seven years of age shallregister as an NJIIS site andauthorized user and commenceonline reporting of vaccinationsprior to December 31, 2011, incompliance with this subchapter

REPORTINGREQUIREMENTSAnnual Immunization Status Report andLocal Health Immunization Audit

Annual Immunization Status Report(ASR)

ASR Reporting TimelineEarlyNovJan 1Feb 1Feb 1MidFebMidMarMarApril Packets are mailed in of the respective academic year Accessible at:http://www.nj.gov/health/cd/imm requirements/annualstatusrpt.shtml Initial Due Date Delinquent notice to schools and LHDs; Notification of extension date 2nd delinquent list shared with Health Officers for appropriate follow-upand final disposition Data cleaned and analyzed; Data submitted to CDC

Immunization Audits Resume for the 2020-2021 academic yearLocal health departments will need to work withschools to determine the best method to conductimmunization audits

Audit TimelineInitial Audit(Sept 1-June 30) Anytime after school opensRe-Audit(Sept 1-June 30) 30 days from the original auditAudits entered online No later than June 30(By June 30)Audit SubmissionUpdate (May) List of audits received by midMay sent to health officersClose of Submission Cleaning and analysis of dataPeriod (June 30)

Violation to the State Sanitary CodeEach violation of any provision of theState Sanitary Code shall constitute aseparate offense and shall bepunishable by a penalty of not less than 50 nor more than 1000N.J.S.A. 26:1A-10

NJ School Immunization Requirements

DTaP VaccineChild Care/Preschool:A minimum of four doses of a DTaP-containing vaccine or fewer as appropriatefor the child’s age per the ACIP Recommended ScheduleAt this age the studentshould have receivedthe following vaccine:2 mos.4 mos.6 mos.Diphtheria, tetanus &acellular pertussis(DTaP)Dose #1Dose #2Dose #312 mos.15 mos.18 mos.19 mos.20-59 mos.Dose #4Kindergarten/First Grade:A total of 4 doses with one of these doses on or after the 4th birthday OR any 5dosesSecond Grade and Higher (at least seven years of age):A minimum of three doses of a DTaP-containing vaccine

Tdap VaccineSixth Grade and Higher:Those children born on or after January 1, 1997 AND who are at least 11years of age and older are required to receive a one-time dose of tetanus,diphtheria, acellular pertussis (Tdap) vaccine at the six grade or highergrade level

A seven-year-old received a DTaP at age 2 and a Tdap today. Is shedue for any more vaccines?

UPDATE According to the current ACIP recommendation, doses of Tdap should be givenon or after the 10th birthday to count towards the adolescent dose routinelygiven between ages 11-12. Beginning the 2020-2021 school year, children who receive a Tdap beforeage 10 would need to receive an additional dose to meet NJ’simmunization requirements for sixth grade and higher and as long as fiveyears have elapsed from the last DTP/DTaP or Td dose Detailed guidance specific to DTaP/DT/Td/Tdap catch-up by age groupsis accessible at chup.html

Polio VaccineChild Care/Preschool:A minimum of 3 doses of a polio-containing vaccine or fewer as appropriatefor the child’s age as per the ACIP Recommended ScheduleAt this age the studentshould have received thefollowing vaccine:2 mos.4 mos.Inactivated Polio Virus(IPV)Dose #1Dose #26 mos.12 mos.15 mos.18 mos.19 mos.20-59mos.Dose #3Kindergarten/First GradeA total of 3 doses with one of these doses given on or after the 4th birthdayOR any 4 doses

Polio VaccineThere are two types of vaccine that protect against polio: inactivatedpoliovirus vaccine (IPV) and oral poliovirus vaccine (OPV). IPV protectsagainst poliovirus types 1, 2, and 3. OPV is used in other countries.Before April 1, 2016, OPV also helped to protect against the three typesof poliovirus. Last year, all countries that use OPV switched to using anOPV that only protects against types 1 and 3.Only the following conditions would satisfy the polio vaccinationrequirements for school attendance in NJ: OPV doses given before April 1, 2016 – OR Inactivated Polio Vaccine (IPV) doses

Polio VaccineSecond grade and Higher (at least seven years of age):Children who are seven years of age and older are required to have aminimum of three doses of polioDetailed guidance specific to Polio vaccine catch-up is available atchup.htmlPolio vaccine is not required for students 18 years of age and older

Measles, Mumps, Rubella VaccineChild Care/Preschool:A minimum of one dose of MMR vaccine by 15 months of ageTravel Recommendation: 6 months through 11 months of agewho will be traveling internationally This dose would notcount towards completion of the routine schedule.Kindergarten-Twelfth Grade:Two doses of measles, one dose of mumps, and one dose of rubella

Haemophilis influenzae type b (Hib) VaccineChild Care/Preschool:Children who are 2 - 11 months of age: Minimum of 2 age-appropriate dosesChildren who are 12 - 59 months of age: Minimum of 1 dose on or after the first birthdayAt this age the studentshould have received thefollowing vaccine:Haemophilus influenzaetype b (Hib)2 mos.Dose #14 mos.Dose #2Kindergarten-Twelfth Grade:Not Required6mos.12 mos.1-4 doses15mos.18 mos.At least onedose given onor after thefirst birthday19mos.20-59mos.

Hepatitis B VaccineChild Care/Preschool:Not requiredKindergarten-Twelfth Grade: Three doses of hepatitis B vaccine or any vaccine combinationcontaining hepatitis B virusOR An approved 2-dose adolescent vaccine is available for use at 11-15 years

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Varicella (Chickenpox) VaccineChild Care/Preschool:A minimum of one dose of varicella vaccine by 19 months of age (for childrenborn on or after January 1, 1998)Kindergarten-Twelfth Grade:At least one dose of varicella vaccine