The Bulletin, April, 1997

Provided by the Department of Public Health, County of San Bernardino

Changes in Immunization Requirements for Entry to School and Child Care

The California Department of Health Services outlined changes in school and child care entry immunizations requirements in letters to private health care providers throughout California in December 1996.Major changes in requirements include a second MMR at kindergarten, a complete series of hepatitis B at school and/or child care entry and Hib for child care. The Hib requirement became effective in 1996. The new MMR requirement will apply to all children entering kindergarten after August 1, 1997 as well as first graders entering after that date who have skipped kindergarten. The hepatitis B requirement will apply to children entering kindergarten or in Child care after August 1,1997.

One note is child care requirements apply equally to both child care centers and licensed family day care providers. Providers of child care are now required to assess immunization records and follow up with incomplete children until the children have completed all required immunizations. The following is a summary of the changes. If providers have questions or want a copy of the new California Immunization Handbook for School and Child Care 5th Edition they should contact the San Bernardino County Department of Public Health Immunization Program at 1-800-722-4794 or the California Immunization Branch at (510)540-2065.

MMR

All children who enter kindergarten after August 1, 1997 will need two doses of measles-containing vaccine, at least one of which must be MMR. Both doses of measles-containing vaccine must be given on or after the first birthday. Those children of kindergarten age who have just received their first MMR dose can enter school on the condition that they receive a second dose of measles-containing vaccine one to three months after the first dose.

These changes in MMR immunization requirements came about because of health care providers’ concerns over the inadequacy of the previous one dose measles strategy in preventing measles disease. In light of the thousands of measles cases and deaths in the 1989-91 measles outbreak in California this inadequacy is a critical problem in California. Since 1990 the American Academy of Pediatrics (AAP), the American Academy of Family Physicians(AAFP) and Advisory Committee on Immunization Practices (ACIP) have recommended that all children receive two doses of measles containing vaccine. The California Department of Health Services physician consultative committee on immunization has now recommended the second dose be given at elementary school entry rather than at middle school entry.

Hepatitis B

A three dose series of hepatitis B will be required for all entrants to kindergartens and children in child care after August 1, 1997. Children entering kindergarten and child care will need to receive hepatitis B according to their age at entry. If the child is:

Children who are only receiving the first dose at entry will have to complete the series within appropriate time intervals. The child who enters should receive the second dose one to two months after the first dose. The third dose time requirement depends on the child's age:

The hepatitis B requirement is meant to ensure coverage of all children with hepatitis B vaccine. This is of particular concern as California as a state accounts for almost 30 percent of hepatitis B infections in children in the United States. School entry requirements will be effective in assuring high immunization rates for hepatitis B among children. The hepatitis B vaccine has been universally recommended and offered for children born after November 1991.

Hib meningitis

In child care and licensed family home care providers Hib immunizations are now required depending on the age of the child. For a child:

Send mail to Bulletin Managing Editor with questions or comments about the publication.

Send mail to with questions or comments about this web site.

Copyright © 1997