Schools

Immunization Toolkit

Overview

The steps outlined in this toolkit will help keep students’ immunization records up-to-date and make yearly reports easier to submit.


Immunization Requirements

Immunization Law – The Nuts & Bolts to Know

Refer to Chapter 246-105 WAC Immunization of Child Care and School Children Against Certain Vaccine-Preventable Diseases  for additional information about any of the bulleted points below.

  • Students have the right to attend school without the threat of exposure to certain vaccine-preventable diseases. 
  • Students are required to be vaccinated and submit a completed Certificate of Immunization Status (CIS), or Certificate of Exemption (COE), before attending school. Refer to WAC 246-105-030.
  • State law requires schools to report immunization status by November 1 of every year. Refer to RCW 28A.210.110.
    • All schools are encouraged to submit annual data online via the Washington State Immunization Information System (WAIIS) as a preferred method.
    • Find information about yearly reporting here: Department of Health School Status Reporting.
  • Students not fully immunized, or students attending school under conditional status who fail to make satisfactory progress, must be excluded. Refer to WAC 246-105-080.
  • Schools must maintain immunization records and keep a list of students with exemptions on file. Refer to WAC 246-105-060.
Required Vaccines for Washington State School Attendance

For guidelines on immunizations required for school entry in Washington State for School Year 2017-18, click the Individual Vaccine Requirements Summary to view.

Using this summary, enables staff and those working with student information systems to understand the detailed immunization requirements as well as the immunization schedule based on the recommendations of the Advisory Committee on Immunization Practices (ACIP).  You will find detailed information about the immunization schedule and the exceptions to the schedule that may happen when medical errors occur or when ACIP recommendations are not followed.

2017-18 Grades K-12 Required Vaccine Chart English (PDF)


Immunization Review

This section provides the best-practice timelines for educating staff and communicating with parents regarding necessary immunization documentation prior to school entry.

Step 1: Train school and childcare support staff

Staff training is important to ensure all immunization information is collected and maintained in the same way.

Staff should be trained on the number of doses required of each type of vaccine for childcare/pre-school/school entry. Intervals can be complicated, but it will save follow-up hours with parents later if staff know immunization intervals and invalid doses information. Immunization schedules and easy to read vaccine requirement charts from the Washington State Department of Health can help aid in training.

The Certificate of Immunization Status (CIS) overlay can help with training. This document can be printed on a transparency sheet and then laid over a CIS to ensure dates are provided in the highlighted areas – the transparency file can be found here. Entry requirements can be found here.

Step 2: Educate parents who are already in your district

K-entry - A district may have groups that will automatically be entering into kindergarten such as Head Start/Early Childhood Education and Assistance Program (ECEAP) or pre-school groups. Talking with these parents prior to school helps ensure you are collecting and maintaining immunizations consistently. Cover the topics below with these parents through an in-person meeting.

6th grade - Before school is out every year, send letters home to current parents of 5th grade students letting them know about the Tdap vaccination required for 6th grade school entry. Most staff utilize this mailing to inform parents of the meningococcal and human papillomavirus (HPV) vaccine recommendations, as required by law. Example letters can be found here.

It is also beneficial for staff/volunteers to attend 6th grade orientation and remind parents about the requirement.

Some school districts find it helpful to not assign the student a class schedule until the immunization record is updated.

All grades - Before school is out every year, send letters home to parents that include a back-to-school list that includes immunization information, including required immunizations for school entry.

Have registration packets available for parents prior to school registration. This will help some parents fill out the CIS in advance of attending a registration event—saving you (and the parent) time.

Step 3: Verify immunization at registration event and cross-reference the Washington State Immunization Information System (IIS)

Whether you have a registration event or not, the best time to ensure immunizations are current and accurate is while you have the parent in front of you. Although it may seem time consuming, it is an important step to ensuring childcare attendees and students have the appropriate immunizations prior to  starting. As indicated in step 1, having staff trained to interpret if the child or student has the needed immunizations is critical. Refer to step 1 for training resources.

During any kind of registration event, make a computer and printing station available and print completed CIS forms out of the Washington
Immunization Information System (WAIIS) for parents to sign and turn in with registration documents. This will allow the parent to add any immunization that may not be on the CIS from the WAIIS and can minimize mistakes when copying dates onto the CIS.

Another practice found to be beneficial for childcares and school districts during the registration process is to hold immunization clinics to enable same-day
student vaccinations. School districts that have done this successfully worked with partners in the community such as local health departments and/or their Medical Reserve Corps to offer free or low-cost immunizations.

Step 4: Create student profile in Student Information System (SIS)

In many school districts there is a time delay between when the student registers and when they are entered into the Student Information System (SIS).

In order to run reports to find students who registered and are not compliant, the initial data entry is required. The sooner this data is entered the more time school staff have to get students up-to-date before school starts.

Step 5: Call parents of students with missing immunization information

Before school starts, school staff should generate an out-of-compliance report or refer to their tracking sheet, and start calling parents to get updated immunization informationsome school districts allow school nurses or secretarial staff to start half-days before school begins. These staff can then take a full day off during the year by combining it with a naturally-occurring school half day. Other possibilities are to recruit other staff to help, such as detention staff, parent advocates and health clerks, who may not be as busy before school starts.

Keep trying parents. Many times parents are just busy and need reminders.

Find sample phone call scripts here. As records are provided to the school from parents, ensure these updates are added to the SIS.


Out-of-Compliance Review

For those that use computer systems, there should be an option to print out-of-compliance data. It is important to verify that these students are truly out of compliance, as computers are not perfect.

Step 1: Identify out-of-compliance students
Step 2 -Develop a tracking system

Once school staff know who to contact, it is important to track progress and attempts at contacting parents. Find sample tracking sheet here.

Developing a system to keep track of who and when a parent is contacted is critical to the follow-up process.

TIP: Some school nurses use their Outlook calendars to remind themselves who they need to follow-up with that day.

For districts that have computerized records, the system may allow you to put notes on a student’s record.

Step 3- Cross-Reference the Washington Immunization Information System

If a school has access to the Washington State Immunization Information System (IIS), staff can cross-reference a child’s school immunization record with immunization data in this database (FYI- The IIS was also formerly referred to as Child Profile).

Step 4- Send letters or emails to parents of out-of-compliance students

Below is a list of current letters that can be modified to meet your needs, including organization or district logo and contact information. You can find any of these sample letters in Microsoft Word Format in the

“School Sample Letter” section here.

  • Graduating Senior Letter
  • HPV Letter for Private Schools
  • HPV Letter for Public Schools
  • HPV and Meningococcal Letter (combination)
  • Meningococcal Letter
  • Notice of Child’s Conditional Immunization Status (Public and Private Schools)
  • Notice of Exclusion for Immunization Noncompliance (Private Schools)
  • Notice of Exclusion for Immunization Noncompliance (Public Schools)
  • Tdap Letter for 6th grade
  • Tdap for 7th grade
  • Tdap/Varicella Letter (combination)
  • Varicella Requirement Letter for 9th-12th grade

Once the letter is developed, a separate letter for each student will need to be printed out and

  1. mailed
  2. emailed or
  3. sent home with students.

If funds are available, it may help to include a self-addressed stamped envelope for parents to return updated information, as well as updated contact information.

Mailing and calling parents are the most effective methods of contacting parents.

TIP: If a school has parent names and addresses in an exportable form, or if a school has them typed into Excel, they may find Microsoft Word’s mail merge tool useful. The functionality allows staff to create letters and envelopes that are pre-populated with names and address. Click here for more information about Microsoft Mail Merge.

Step 5- Start calling parents

Start calling parents right away. Even though staff know the parents have not received a letter yet, staff can let them know the letter is on its way.

Staff have only 30 days to get the needed immunization information before the child is excluded from school, so it is important to start the follow-up as soon as a student is identified as out-of-compliant.

Keep trying parents. Many times parents are just busy and need reminders.

Sample phone scripts to call parents can be found in here.

As records are provided to the school from the parents, ensure these updates are added to the current system of immunization record keeping.

Step 6- Mail or hand-deliver exclusion letters

Within 30 days, complete the phone follow-up and update tracking sheet. According to the WAC, schools are obligated to exclude these children until a completed Certificate of Immunization Status (CIS) or a completed Certificate of Exemption (COE) is provided. Parents are notified that their child will be excluded by mailing an Exclusion Letter, which must be sent by Certified Mail, or hand-delivering an Exclusion Letter. The child is excluded upon receipt of the letter, until the child is compliant. Many school districts will utilize resource officers to hand-deliver letters, or even distribute them during parent-teacher conference

events.

If a parent requests a Certificate of Exemption, there are two ways this form can be completed:

  1. Most will need a healthcare provider signature on the form before it can be accepted by the school.
  2. There is an option on the form to claim a religious exemption for affiliation with a religious entity that does not believe in medical care. If this section of the Certificate of Exemption is filled out, the parent can sign the form.


Exemption Review

Immunization Exemptions

A parent or guardian may choose to exempt their child from one or more of the immunization requirements for school. However, the child may be
at risk for disease.

Children with exemptions have contributed to disease outbreaks of vaccine-preventable diseases throughout the state of Washington as well as the nation. These outbreaks put children, their family members, and community members (sometimes too young or unable to be vaccinated) at risk.

The Washington State Administrative Code 246-110 allows a health officer to exclude children from school or childcare during an outbreak of vaccine-preventable disease if the child has not been fully immunized due to a medical, religious, philosophical, or personal exemption.

Immunization Exemption Law

On May 10, 2011, Governor Gregoire signed a bill that requires a licensed health care provider to sign the Certificate of Exemption, for a parent or guardian to exempt their child from school and child care immunization requirements.

The signature verifies that the provider gave the parent or guardian information about the benefits and risks of immunization.

A health care provider doesn’t need to sign the form for parents or guardians who demonstrate membership in a church or religious group that does not allow a health care provider to provide medical treatment to a child. (please note: this is different than a religious exemption)

Step 1- Gather a list of students who are exempt from one or more vaccines

Students who are exempt from one or more vaccines must have a current Certificate of Exemption on file.

There are several ways to gather a list of students depending on how a school stores immunization information.

For schools that are using paper, staff will need to manually go through and determine those exempt. According to Washington state law, a school must keep a current list of exempted students.

Sometimes it is helpful to put them in categories by grade or school.

Determine from which vaccines a student has an exemption- this step is especially critical for case management and notification during a potential vaccine-preventable disease outbreak (i.e measles or chickenpox).

For schools that use a computer system, there should be a report that can be printed to show students who are exempt for one or more vaccines.

It is still important for you to verify the accuracy of this information, as computers are not perfect.

Step 2- Develop a tracking system

Once you know who to contact, it is important to track progress and attempts at contacting parents. Find Sample Tracking Sheet here.

Developing a system to keep track of who and when in terms of contacting parents is critical to the follow-up process.

TIPS: Some school nurses use their Outlook calendars to remind them who they need to follow-up with that day.

For districts that have computerized records, there may be a place to put notes on a student’s record.

In Skyward, some schools use the “office visit section” to make notes and run reports.

Step 3- Cross-reference the Washington State Immunization Information System (IIS) or (WAIIS)

If a school has access to the Washington State Immunization Information System (IIS), staff can cross-reference a child’s school exemption with immunization data in the IIS (formerly known as Child Profile).

Step 4- Start calling parents

The purpose of these calls is to see if the information a school has on file is correct.

Having an exemption for one or more vaccines is within the law to attend school; however, many times students eventually receive vaccines after an exemption was signed. Sample phone scripts to call parents can be found here.

Step 5-Determine end date

Give ample time to the follow-up process. Although it may be tedious, it is the backbone to ensuring success of this process. Allow 3-4 weeks to follow-up with parents by phone to inquire about the accuracy of exemptions on files.

Please note that a school cannot exclude students who have a current and correctly-signed Certificate of Exemption. These students are permitted to attend school with this signed document.