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Doctor Recommended Immunizations Required for California State Schools


School and parents are figuring out the nuances of California’s new vaccination law, which went into effect July 1. Gov. Jerry Brown signed into law on June 30, 2015 Senate Bill 277, which says parents can no longer refuse to vaccinate their children in public or private schools and child care centers based on their personal opposition.

As of Jan. 1, 2016, parents can no longer obtain a personal belief exemption to 10 school-required vaccinations. As of July 1, 2016, students must meet the vaccination requirements at certain vaccination check points, unless they have a medical exemption or are attending school at home or independently with no classroom instruction.

Most school districts in California are affected, with 47 out of 58 California counties in 2014-15 reporting they had kindergartners with personal belief exemptions to school-required vaccinations.  Still, the numbers are small. Statewide, more than 13,500 kindergartners held personal belief exemptions in 2014-15, a sliver of the state’s kindergarten enrollment of 500,000. And the numbers ranged widely across the state, from two kindergartners in Colusa County to 2,100 kindergartners in Los Angeles County.

“It’s important to note that vaccinating children will reduce the threat of losing herd immunity,” states Richard Kang, MD, Medical Director, Pediatrics ICU, Dignity Health – Northridge Hospital. “The Center for Disease Control estimates that infections can spread within a community when the vaccination rate drops below 90 to 95%. Loss of ‘herd immunity’ will leave the unvaccinated members of the community unprotected. Moreover, unvaccinated children will become a future unvaccinated adult risk pool. This law will help reduce that risk.” – this was Northridge’s statement

The California Department of Public Health, in conjunction with the California Department of Education, has issued guidance to schools, but its most recent guidance in April didn’t clarify the issue of whether students enrolled in special education are exempt from the immunization requirement, some lawyers said. At this point, here are answers to frequently asked questions, as explained in the text of the legislation, analysis by the lawmakers and the latest guidance.

WHAT DOES THE LAW SAY?

Private or public child care centers, preschools, elementary schools and secondary schools cannot admit children unless they are immunized against 10 diseases: diphtheria, Haemophilus influenzae type b (bacterial meningitis), measles, mumps, pertussis (whooping cough), polio, rubella, tetanus, hepatitis B and chicken pox.

If the California Department of Public Health decides to add other vaccination requirements, parents will be allowed to obtain personal belief exemptions for those new vaccinations.

WHAT DID THE LAW CHANGE?

The law eliminated the personal belief exemption for required vaccinations. This exemption allowed parents to opt out of vaccinating their children by completing a form, signed by a health care practitioner, attesting that vaccinations were counter to their personal beliefs.

The law also overrode an allowance for religious exemptions to vaccinations that Brown had inserted three years ago into a California Department of Public Health form. The religious exemption was not part of state law.

ARE THERE EXEMPTIONS TO THE NEW LAW? WHAT ABOUT SPECIAL EDUCATION?

Yes, there are at least two: a medical exemption and an exemption for students who are enrolled in homeschooling or independent study without classroom instruction. It is unclear how the law will apply to unvaccinated students who receive special education services. Some districts may consider those students exempt.

Medical: Young children and students may obtain a written medical exemption to vaccinations from a licensed physician medical doctor (M.D.) or doctor of osteopathic medicine (D.O.) There is no standard medical exemption form but the statement must say:

  • That the physical condition or medical circumstances of the child, which may include family medical history, are such that the required immunization(s) is not indicated
  • Which vaccines are being exempted
  • Whether the medical exemption is permanent or temporary
  • The expiration date, if the exemption is temporary.

 

Homeschooling or independent study: Starting July 1, 2016, students who attend a home-based private school or an independent study program without classroom-based instruction are not subject to immunization requirements for entry. Home schools and independent study programs are obligated to maintain records of students’ immunization status.

Independent study with classroom instruction: As of July 1, 2016, students in independent study programs that include classroom-based instruction must meet immunization requirements.

Special Education: Senate Bill 277 states that it “does not prohibit” a student with an individualized education program from “accessing any special education and related services required by his or her individualized education program.” Exactly how the federal right to special education services will mesh with the state immunization law has yet to be fully clarified by the California Department of Public Health and the California Department of Education. Districts have beensorting this out on their own. The Los Angeles Unified School District has said the number of unvaccinated students in special education is low and they will be allowed to attend school. The Orange County Office of Education has said all students at school must be vaccinated, unless they have a medical exemption.

Here is the updated guidance from the state health department issued in April: “Students who have an individualized education program (IEP) should continue to receive all necessary services identified in their IEP regardless of their vaccination status. However, parents or guardians must continue to provide immunization records for these students to their schools, and schools must continue to maintain and report records of immunizations that have been received for these students (emphasis in the original).”

Some district lawyers said they were hoping the guidance would state explicitly whether students with individualized education programs must be vaccinated to attend school.

WHEN DID THE LAW GO INTO EFFECT?

July 1, 2016, for school enrollment immunization requirements. Jan. 1, 2016 marked the end of the ability to file a personal belief exemption.

WILL KINDERGARTNERS BE ALLOWED TO ENROLL “CONDITIONALLY” IF THEY HAVE NOT YET COMPLETED ALL OF THE REQUIRED VACCINATIONS?

Yes, if they meet certain requirements. Kindergartners must have a mumps and a rubella vaccination before enrolling — there is no conditional enrollment involving the mumps and rubella vaccinations. Kindergartners also must be as current as possible with other immunizations, given the need to space out certain vaccine doses.

Kindergartners may be conditionally admitted with at least one dose of the following vaccines: polio; diphtheria, tetanus and pertussis; measles; hepatitus B; and varicella (chicken pox.)

School districts already have their own systems for tracking and following up with kindergartners who are not fully immunized. Whatever systems districts are currently using remain in place.

If students are entering the public school system as transitional kindergartners, these conditional immunization rules apply to them as well.

WHAT ABOUT CHILDREN WHO CURRENTLY HAVE PERSONAL BELIEF EXEMPTIONS ON FILE?

Children who before Jan. 1, 2016 held personal belief exemptions to vaccinations are not subject to the new law until they reach their next vaccination checkpoint.

The law defines these checkpoints as “grade spans,” as follows:

  • Birth to preschool,
  • Kindergarten and grades 1 to 6, inclusive, including transitional kindergarten,
  • Grades 7 to 12, inclusive.

For example, a 6th grade student with a personal belief exemption in December 2015 will still have to comply with vaccination requirements upon entering 7th grade, which is a vaccination checkpoint.

If a child has been exposed to one of the 10 diseases named in the immunization requirements and does not have proof of immunization, the child temporarily may be kept out of school.

WILL UNVACCINATED CHILDREN WHO MOVE FROM ONE CALIFORNIA SCHOOL OR DISTRICT TO ANOTHER HAVE TO MEET THE VACCINATION REQUIREMENTS OF NEW STUDENTS?

Not unless the student is entering a vaccination checkpoint grade span — a child care facility or preschool; a transitional kindergarten or kindergarten; or seventh grade. Personal belief exemptions can be transferred between child care facilities and schools in California, both within and across school districts, according to the state. Personal belief exemptions from another state or country are not valid.

WHAT VACCINATIONS ARE REQUIRED OF UNVACCINATED STUDENTS BEFORE ENTERING 7TH GRADE?

As of July 1, 2016, all previously unvaccinated students entering 7th grade must provide documentation of the vaccines needed for school entry based on age. These include the polio series, the diphtheria/tetanus/pertussis series, the varicella (chicken pox) vaccine and two doses of MMR, according to the California Department of Public Health.

But while immunization against hepatitis B is required for entry to lower grades, the law states that it is not required for entry to 7th grade.

WHAT ARE THE OPTIONS FOR PARENTS WHO DO NOT WANT TO HAVE THEIR CHILDREN VACCINATED?

Parents who do not want to vaccinate have two options for their kindergartners and seventh graders in fall 2016: obtain a medical exemption to vaccinations or enroll in homeschooling or independent study without classroom instruction. If children receive special education services, they may be exempt from immunization requirements, but that policy varies from district to district. See the special education question above.

WHAT IS HOMESCHOOLING AND INDEPENDENT STUDY?

According to the California Homeschool Network, parents who wish to homeschool have four options:

The first is to establish their own private home school by filing a private school affidavit. Parents are free to collaborate with other homeschools. Homeschools are required to teach California mandated subject areas, but have latitude as to when and how such subjects are taught.

The second option is to join another private home school and become a “satellite” home school.

Third, parents may enroll in a district or charter public school that offers independent study. The student receives assignments from a teacher but fulfills most of the work independently.

The fourth option is to homeschool a child by hiring a credentialed tutor.

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