DAYCARE AND PRESCHOOL SPECIFICS RE PBEs

  • Posted by Dr. Jay Gordon

There are no levels of school or daycare allowed–at the present time–to exclude children with Personal Belief Exemptions.

” . . .or who has documented a permanent medical exemption or a personal beliefs exemption to immunization in accordance with Section 6051, shall be admitted unconditionally as a pupil to a given public or private elementary or secondary school, child care center, day nursery, nursery school, family day care home, or development center.”

CALIFORNIA CODE OF REGULATIONS
TITLE 17, DIVISION 1, CHAPTER 4
Subchapter 8. Immunization Against Poliomyelitis, Diphtheria, Pertussis, Tetanus, Measles (Rubeola), Haemophilus influenzae Type B (Hib), and Mumps

Article 1. Definitions §6000. Admission.

“Admission” means a pupil’s first entry in a given public or private elementary or secondary school, child care center, day nursery, nursery school, family day care home, or development center. “Admission” also denotes a pupil’s re-entry to one of these institutions after withdrawing from a previous enrollment.

  1. (a) “Unconditional admission” is admission based upon documentation of receipt of all required immunizations or upon documentation of a permanent medical exemption or of a personal beliefs exemption to immunization in accordance with Section 6051.
  2. (b) “Conditional admission” is admission based upon either documentation of having received some but not all required immunizations and of not being due for any vaccine dose at the time of entry or upon documentation of a temporary medical exemption to immunization in accordance with Section 6050. Continued attendance after conditional admission is contingent upon receipt of the remaining required immunizations in accordance with Sections 6020 and 6035.

§ 6015. Pupil.

“Pupil” means a person under age 18 years admitted to or seeking admission to any private or public elementary or secondary school, child care center, day nursery, nursery school, family day care home, or development center.

Article 2. Required Immunizations
§ 6020. Required Immunizations.

  1. (a) The required immunizations for admission to and attendance at a public or private elementary or secondary school, child care center, day nursery, nursery school, family day care home, or developmental center shall be those set forth, according to age, in Table 1.
  2. (b) In Table 1 of Section 6020 and in Table 2 of Section 6035, DTP (or DPT) means diphtheria and tetanus toxoids and pertussis vaccine, including DTaP vaccine. Tdap means tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine. DT (or TD) and Td (or dT) means diphtheria and tetanus toxoids.
  3. (c) For pupils who have reached their seventh birthday, a history of any preparations containing diphtheria and tetanus toxoids and pertussis vaccine (DTP, DT, Td, Tdap, etc.) shall be acceptable as meeting the requirement for tetanus and diphtheria toxoids and pertussis vaccine that is set forth in Table 1.
  4. (d) Pupils who have reached their seventh birthday shall be exempt from the mumps immunization requirements.

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  1. (e) Combination vaccines that include measles, mumps, and rubella components shall be acceptable as meeting the requirements for these vaccines that are set forth in Table 1.
  2. (f) For pupils entering or advancing to the seventh grade, immunization requirements are set forth in Table 1.
  3. (g) Pupils already admitted to California public and private schools at the Kindergarten level or above before July 1, 2001 are exempt from the Varicella (chickenpox) requirement as set forth in Table 1.
  4. (h) For pupils entering or advancing into the eighth through twelfth grades, the immunization requirement is set forth in Table 1 of Section 6020.

Table 1: Immunization Requirements

Institution

Age

Vaccine Total Doses Received

Less than 2 months

None

2-3 months

Polio1 1 dose

DTP 1 dose

Hib 1 dose

Hepatitis B 1 dose

4-5 months

Polio1 2 doses

DTP, or combination of DTP and 2 doses diphtheria-tetanus toxoids

Hib 2 doses

Hepatitis B 2 doses

Child care center,
day nursery,
nursery school,
family day care home, development center

6-14 months

Polio1 2 doses

DTP, or combination of DTP and 3 doses diphtheria-tetanus toxoids

Hib 2 doses

Hepatitis B 2 doses

15-17 months

Polio1 3 doses

DTP, or combination of DTP and 3 doses diphtheria-tetanus toxoids

Measles, rubella, and mumps 1 dose of each separately or combined on or after the 1st birthday

Hib 1 dose on or after the 1st birthday

Hepatitis B 2 doses

18 months to 5 years

Polio1 3 doses

DTP, or combination of DTP and 4 doses diphtheria-tetanus toxoids

Measles, rubella, and mumps 1 dose of each separately or combined on or after the 1st birthday.

Hib3 1 dose on or after the 1st birthday

Hepatitis B2 3 doses

Varicella 1 dose


Table 1: Immunization Requirements (continued)

Institution Age

Vaccine

Total Doses Received

Elementary school at kindergarten level and above

4-6 years

Polio1

4 doses, except that a total of 3 doses is acceptable if at least one dose was given on or after the 4th birthday

DTP, or combination of DTP and diphtheria-tetanus toxoids

5 doses, except that a total of 4 doses is acceptable if at least one dose was given on or after the 4th birthday

Measles, rubella, and mumps 1 dose of each, separately or combined, on or after the 1st birthday. Pupils entering a kindergarten (or first grade kindergarten skipped) are required to have 2 doses of measles-containing vaccine, both given on or after the first birthday
Hepatitis B2 3 doses
Varicella

1 dose

Elementary school, secondary school

7-17 years

Polio1

4 doses, except that a total of 3 doses is acceptable if at least one dose was given on or after the 2nd birthday

Diphtheria and tetanus toxoids and pertussis vaccine given as DTP, DT, Td, or Tdap

At least 3 doses. One more dose is required if the last dose was given before the 2nd birthday

Measles and rubella (mumps not required) 1 dose of each, separately or combined, on or after the 1st birthday. (See below for additional requirements for 7th grade enrollment, effective 7/1/99.)
Varicella5 1 dose aged 7 through 12 years for students not admitted to California schools before July 1, 2001. 2 doses for students aged 13 through 17 years not admitted to California schools before July 1, 2001.
Seventh Grade

Any

Tdap6,7 1 dose on or after the 7th birthday
Measles4

2 doses of measles -containing vaccine, both given on or after the first birthday.

Eighth through Twelfth Grades8 Any pupil under 18 years Tdap6,7 1 dose on or after the 7th birthday
Any 18 years ad older

None

  1. 1 Oral polio vaccine (OPV) or inactivated polio vaccine (IPV) or any combination of these vaccines is acceptable.
  2. 2 Applies only to children entering at kindergarten level (or at first grade level if kindergarten skipped) or below on or after August 1, 1997.Applies only to children entering at kindergarten level (or at first grade level if kindergarten skipped) or below on or after August 1, 1997.
  3. 3 Required only for children who have not reached the age of 4 years 6 months.
  4. 4 Applies only to children (of any age) entering or advancing to the seventh grade on or after July 1, 1999.
  5. 5 Children admitted to California schools at the Kindergarten level or above before July 1, 2001 are exempt from this requirement.
  6. 6 Pupils must have received at least one dose of Tdap prior to admission or advancement into the 7th through 12th grades.
  7. 7 If DTP was given on or after age 7 years instead of Tdap, this dose may also be counted as a valid dose for this requirement.
  8. 8 This requirement is effective July 1, 2011, through June 30, 2012.

Article 3. Admission to School, Child Care Center, Day Nursery, Nursery School, Family Day Care Home, or Development Center

§ 6025. Unconditional Admission.

Any pupil age 18 months or older who has received all the immunizations against poliomyelitis, diphtheria, tetanus, pertussis, measles (rubeola), rubella, Haemophilus influenzae type B, mumps, hepatitis B and varicella (chickenpox) required for his or her age, as defined in Table 1, Section 6020, or who has documented a permanent medical exemption or a personal beliefs exemption to immunization in accordance with Section 6051, shall be admitted unconditionally as a pupil to a given public or private elementary or secondary school, child care center, day nursery, nursery school, family day care home, or development center. However, for some pupils admitted unconditionally to a child care center, day nursery, nursery school, family day care home, or development center, an additional dose of DTP and/or polio vaccine will be required for admission to school at kindergarten level and above, as indicated in Table 1, Section 6020.

§ 6035. Conditional Admission.

  1. (a) Any pupil seeking admission to a given public or private elementary or secondary school, child care center, day nursery, nursery school, family day care home, or development center who lacks documentation of having received all the required vaccine doses against poliomyelitis, diphtheria, tetanus, pertussis, measles, rubella, Haemophilus influenzae type B, mumps, hepatitis B and varicella (chickenpox) as specified in Table 1, Section 6020, and has not obtained a permanent medical exemption or a personal beliefs exemption to immunization in accordance with Section 6051, may be admitted conditionally if:

    (1) he or she has not received all the immunizations required for his or her age group but has commenced receiving doses of all the vaccines in accordance with Table 2, is not currently due for any doses at the time of admission (if he or she is due for any doses at this time they must be obtained before admission), and the pupil’s parent or guardian is notified of the date by which the pupil must complete all the required immunizations in accordance with Table 2;

    or
    (2) he or she is under age 18 months and has received all the immunizations required for

    his or her age group but will require additional vaccine doses at an older age, and the pupil’s parent or guardian is notified of the date by which the pupil must complete all the remaining doses when they become due in accordance with Table 1, Section 6020; or

    (3) he or she has obtained a temporary medical exemption from immunization in accordance with Section 6050, and the pupil’s parent or guardian is notified of the date by which the pupil must complete all the required immunizations when the temporary exemption terminates;
    or

    (4) he or she is a pupil entering a child care center governed by Education Code Section 8263(c), where a different deadline for obtaining all required immunizations may apply.

  2. (b) The public or private elementary or secondary school, child care center, day nursery, nursery school, family day care home, or development center shall not allow the admission of any pupil seeking entry who does not meet the requirements for admission under Section 6025 or 6035. The principal or administrator shall advise the pupil, or the parent or guardian, to contact a physician or agency that provides immunizations.

Table 2: Conditional Admission Immunization Schedule

Vaccine

Dose Time Intervals

Polio1

1st dose Before admission

2nd dose As early as 6 weeks but no later than 10 weeks after the 1st dose. Before admission if 10 or more weeks have elapsed since the 1st dose at the

time of admission.

3rd dose As early as 6 weeks but no later than 12 months after the 2nd dose. Before admission if 12 or more months have elapsed since the 2nd dose

at the time of admission.

4th dose (Required only for entry to kindergarten level or above)

Age 4-6 years: If the 3rd dose was given before the 4th birthday one more dose is required before admission. Age 7-17 years: If the 3rd dose was given before the 2nd birthday, one more dose is required before admission.

Diphtheria, Tetanus, and Pertussis
FOR PUPILS UNDER AGE 7 YEARS: Diphtheria-tetanus- pertussis (DTP) or combination of DTP and diphtheria-tetanus toxoids

1st dose Before admission.

2nd dose As early as 4 weeks but no later than 8 weeks after the 1st dose. Before admission if 8 or more weeks have elapsed since the 1st dose at the time

of admission.

3rd dose As early as 4 weeks but no later than 8 weeks after the 2nd dose. Before admission if 8 or more weeks have elapsed since the 2nd dose at the

time of admission.

4th dose As early as 6 months but no later than 12 months after the 3rd dose. Before admission if 12 or more months have elapsed since the 3rd dose

at the time of admission.

5th dose (Required If the 4th dose was given before the 4th birthday, one more dose is only for pupils ages 4- required before admission.
6 years for entry to
kindergarten level and

above)

OR

FOR PUPILS AGE 7 YEARS AND OLDER:

Diphtheria-tetanus- pertussis (DTP, Tdap) and diphtheria-tetanus toxoids

1st dose Before admission.

2nd dose As early as 4 weeks but no later than 8 weeks after the 1st dose. Before admission if 8 or more weeks have elapsed since the 1st dose at the time

of admission.

3rd dose As early as 6 months but no later than 12 months after the 2nd dose. Before admission if 12 or more months have elapsed since the 2nd dose

at the time of admission.

4th dose If the 3rd dose was given before the 2nd birthday, one more dose is

required before admission.

One dose only

Measles0

Note: For children entering kindergarten (or first grade if kindergarten is skipped) on or after August 1, 1997, two doses are required. For children entering 7th grade on or after July 1, 1999, the series shall be in process or completed.

Rubella

One Tdap dose

1st dose

2nd dose

One dose only

Before 7th through 12th grade entry.

Before admission. If the pupil is under age 15 months, this dose is required when age 15 months is reached.

Before admission.

As early as 1 month but no later than 3 months after the 1st dose.

Before admission. If the pupil is under age 15 months, this dose is required when age 15 months is reached.

Table 2: Conditional Admission Immunization Schedule (continued)

Vaccine Dose

Time Intervals

Mumps (Not required for pupils age 7 years and older) One dose only

Before admission. If the pupil is under age 15 months, this dose is required when age 15 months is reached.

Hib

Children 2-14 months old

Two doses 1st dose before admission. 2nd dose as early as 2 months but no later than 3 months after the 1st dose.
Children 15 months-4 1/2 years old One dose Before admission.
Hepatitis B

For children entering at kindergarten level (or first grade if kindergarten skipped) or below on or after August 1, 1997.

1st dose Before admission.
2nd dose

As early as 1 month but no later than 2 months after the first dose.

3rd dose Infants and children under age 18 months: As early as 2 months but no later than 12 months after the 2nd dose. Also, no earlier than 4 months after the 1st dose. Children age 18 months and older: As early as 2 months but no later than 6 months after the 2nd dose. Also, no earlier than 4 months after the 1st dose.
Varicella2

For children aged 13 through 17 years not admitted to California schools before July 1, 2001.

1st dose Before admission.
2nd dose As early as 4 weeks but no longer than 3 months after first dose.
  1. 1 Oral polio vaccine (OPV) or inactivated polio vaccine (IPV) or any combination of these vaccines is acceptable.
  2. 2 Children admitted to California schools at the Kindergarten level or above before July 1, 2001 are exempt from this requirement.

    Note: Authority cited: Sections 120330, 120335 and 131200, Health and Safety Code. Reference: Sections 120325, 120335, 120370 and 120375, Health and Safety Code.

§ 6040. Requirements for Continued Attendance.

An already admitted pupil who is subsequently discovered not to have received all the immunizations which were required before admission or who is subsequently discovered not to have complied with the requirements for conditional admission specified in Section 6035 shall continue in attendance only if he or she receives all vaccine doses for which he or she is currently due and provides documentation of having received such doses no later than 10 school days after he or she or the parent or guardian is notified. The school, child care center, day nursery, nursery school, family day care home, or development center shall notify the pupil or the parent or guardian of the time period (no longer than 10 school days) within which the doses must be received.

§ 6045. Special Immunization Schedules.

(a) Immunization schedules not conforming to those specified in Sections 6020 and 6035 may be approved by the State Department of Health Services when substantial medical or other conditions warrant, such as during an outbreak or epidemic of a particular disease.

§ 6050. Conditional Admission with Temporary Medical Exemption.

A pupil who is temporarily exempt from immunization for medical reasons shall be admitted on condition that required immunizations are obtained at the termination of the exemption; the fact of the temporary medical exemption shall be recorded in accordance with Section 6070. A pupil with a temporary medical exemption may be subject to exclusion pursuant to Section 6060.

§ 6051. Unconditional Admission with Permanent Medical Exemption or Personal Beliefs Exemption.

A pupil with a permanent medical exemption or a personal beliefs exemption to immunization shall be admitted unconditionally. A pupil with an exemption which is not based on pre-existing immunity to disease may be subject to exclusion pursuant to Section 6060.

  1. (a) A permanent medical exemption shall be granted upon the filing with the governing authority of a written statement from a licensed physician to the effect that the physical condition of the pupil or medical circumstances relating to the pupil are such that immunization is permanently not indicated. The fact of the permanent medical exemption shall be recorded accordance with Section 6070. A permanent medical exemption may be provided for one or more vaccines. A physician may provide a written statement that the pupil is medically exempt from the measles (rubeola) and/or varicella (chickenpox) requirements as a result of having had measles (rubeola) and/or varicella (chickenpox) disease, respectively. A physician may provide a written statement that the pupil is medically exempt from the rubella and/or mumps requirement as a result of having had laboratory confirmed illness with the corresponding disease.
  2. (b) A personal beliefs exemption shall be granted upon the filing with the governing authority documentation in accordance with the requirements of Health and Safety Code Section 120365 on form CDPH 8262. The fact of the personal beliefs exemption shall be recorded in accordance with Section 6070. The fact of a personal beliefs exemption for the pertussis booster immunization requirement in Section 120335(d), Health and Safety Code, shall be recorded on the Tdap (Pertussis Booster) Requirement sticker, PM 286 S (01/11).

Article 4. Exclusion
§ 6055. Conditions for Admission Not Fulfilled.

The governing authority of the school, child care center, day nursery, nursery school, family day care home, or development center shall exclude from further attendance any pupil who fails to obtain the required immunizations within no more than 10 school days following receipt of the notice provided pursuant to Section 6040, unless the pupil is exempt for medical reasons or personal beliefs, until the pupil provides written evidence that he or she has received another dose of each required vaccine due at that time. Any pupil so excluded shall be reported to the attendance supervisor or to the building administrator.

§ 6060. Pupil Not Completely Immunized and Exposed to Communicable Disease.

Whenever the governing authority has good cause to believe that a pupil who is not completely immunized against a particular communicable disease may have been exposed to that disease, that information shall be reported by the governing authority immediately by telephone to the local health officer. The local health officer shall determine whether the pupil is at risk of developing the disease and, if so, may require the exclusion of the pupil from that school, child care center, day

nursery, nursery school, family day care home, or development center until the completion of the incubation period and the period of communicability of the disease.

Article 5. Records as Evidence of Immunization § 6065. Documentary Proof.

  1. (a) There shall be a written record given to the person immunized or to his or her parent or guardian, by the physician or agency performing the immunization which shall contain the following information:

    (1) Name of the person.
    (2) Birthdate.
    (3) Type of vaccine administered.
    (4) Month, day, and year of each immunization.
    (5) Name of the physician or agency administering the vaccine.

  2. (b) The written record shall be shown by the parent, guardian or person immunized to the governing authority of the school, child care center, day nursery, nursery school, family day care home, or development center at the time of the pupil’s admission and at subsequent times when required by the governing authority to determine the pupil’s immunization status. For the pupil to be admitted, the written record shall show at least the month and year of each required vaccine dose. For doses of measles, rubella and mumps vaccine given during the month of the first birthday the record shall also show the specific date (i.e., month, day and year) of immunization. For a dose of Tdap given during the month of the pupil’s 7th birthday, the record shall also show the specific date (i.e., month, day and year) of immunization.
  3. (c) When such written records are not available, the pupil shall not be admitted and the parent or guardian shall be referred to a physician or nurse for review of his or her immunization history and provision of immunizations as needed.

§ 6070. School/Child Care Facility Immunization Record.

  1. a) The governing authority of each school, child care center, day nursery, nursery school, family day care home, or development center shall record each pupil’s immunizations on the California School Immunization Record, CDPH 286 (01/14), hereby incorporated by reference which, at kindergarten level and above, shall be part of the mandatory permanent pupil record as defined in Section 430 of Title 5, California Code of Regulations.
  2. b) The governing authority may continue recording immunizations on the California School Immunization Record, PM 286 (1/02), hereby incorporated by reference, for students admitted prior to May 5, 2014.
  3. c) Eachpupil’simmunizationrecordshallcontain: (1) Name of pupil.
    (2) Birthdate (month, day and year).

(3) Date of unconditional or conditional admission (month, day, and year).

  1. (4) Type of vaccine and date (month, day, and year) each dose was administered. Although month, day and year of vaccine administration should be recorded, showing only month and year of vaccine dose(s) shall be allowed, except for records showing measles, rubella, and/or mumps vaccine doses given during the month of the first birthday or Tdap dose given during the month of the 7th birthday, the date of immunization shall also be recorded.
  2. (5) Date and type of exemption for each exempted immunization, if any.
  1. d) The immunization record shall be transferred with the mandatory permanent pupil record.
  2. e) For pupils at kindergarten level and above transferring between school campuses within California or from a school in another state to a school in California, if the mandatory permanent pupil record or other immunization record has not been received at the time of entry to the new school, the governing authority of the school may admit the pupil for a period of up to 30 school days. If the mandatory permanent record or other immunization record has not arrived by the end of this period, the governing authority shall require the parent or guardian to present a written immunization record, as described in Section 6065, documenting that all currently due required immunizations have been received. If such a record is not presented, the pupil shall be excluded from further attendance until he or she comes into compliance with the immunization requirements, as outlined in Sections 6020, 6035, and 6065.
  3. f) The governing authority shall see that the immunization record of each pupil admitted conditionally is reviewed every 30 days until that pupil has received all the required immunizations. Any immunizations received subsequent to conditional admission shall be entered in the pupil’s immunization record.
  4. g) For pupils who are being admitted or are advancing into the 7th through 12th grades beginning July 1, 2011, the governing authority shall record each pupil’s Tdap dose, given on or after the 7th birthday, on the supplemental sticker form Tdap (Pertussis Booster) Requirement [PM 286 S (01/11)]. This form is hereby incorporated by reference. The governing authority shall affix the PM 286 S (01/11) to the front of the pupil’s California School Immunization Record, PM 286 (1/02) or CDPH 286 (01/14).

6075. Reporting.

(a) The governing authority of each school, child care center, day nursery, nursery school, family day care home, or development center shall file a report with the state and local health departments on the immunization status of new entrants annually or when needed to determine immunization status such as during an epidemic or potential epidemic. The forms to be used for these reports are:

(1) Schools with kindergartens: IMMUNIZATION ASSESSMENT OF KINDERGARTEN STUDENTS – ANNUAL REPORT [PM 236 (3/01)] and this form in its entirety is incorporated by reference.

(2) Schools with seventh grades: PERTUSSIS BOOSTER IMMUNIZATION ASSESSMENT OF SEVENTH GRADE STUDENTS [CDPH 8259 (9/11)]. This form is hereby incorporated by reference.

(3) Child care centers, day nurseries, nursery schools and development centers: ANNUAL IMMUNIZATION REPORT ON CHILDREN ENROLLED IN CHILD CARE CENTERS [DHS
8018 (3/01)] and this form is in its entirety incorporated by reference or ANNUAL IMMUNIZATION ASSESSMENT REPORT OF CHILDREN ENROLLED IN CHILD CARE CENTERS – LINE LISTING [DHS 8387 (3/94)]. The Department of Health Services or the local health department will provide the appropriate reporting form.

(4) Family day care homes: ANNUAL FAMILY DAY CARE HOME IMMUNIZATION SURVEY [DHS 8529 (10/00)] and this form is in its entirety incorporated by reference.

(5) Schools with any grade from the 7th through 12th grade shall report data on Tdap immunization: PERTUSSIS (Tdap) ASSESSMENT OF 7-12th GRADE STUDENTS 2011- 2012 SCHOOL SUMMARY SHEET [CDPH 8260 (01/11)]. This form is hereby incorporated by reference.

(b) The annual report shall contain at least the following information on new entrants in kindergarten or lower level classes only:

  1. (1) Enrollment as of date of report.
  2. (2) Number of new entrants admitted unconditionally specifying the number who have received all immunizations, the number who are medically exempt and the number who are exempt for personal beliefs.
  3. (3) Number of new entrants admitted conditionally specifying the number of doses received of poliomyelitis, diphtheria, tetanus, pertussis, measles, rubella, Haemophilus influenza type b (Hib), mumps, hepatitis B, and varicella (chickenpox) vaccines.
  4. (4) Other information requested by the State Department of Health Services.

(c) Additional reports which include new entrants in all grades may be requested during an epidemic or potential epidemic.

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