Q: Where do I get blue cards?
A: Public Schools: You can obtain blue cards (free of charge) from your school district office.
Private schools: You can obtain blue cards (free of charge) from the County of San Diego Immunization Branch by calling our Yellow and Blue Card Hotline at (619) 692-8663. Please leave a detailed message with the school's name, mailing address, contact phone number, and how many blue cards you need. You can also order blue cards online by clicking here.
Q: What if the first dose of MMR was given before the first birthday?
A: There is a 4-day rule that allows the first dose of MMR to be given up to 4 days before the first birthday. If the MMR vaccine was given more than 4 days before the first birthday it is considered invalid and must be repeated.
Q: Is a TB skin test required for children to enter school and child care?
A: The TB skin test is not a vaccine; therefore, it is not part of the California School Immunization Law. Please ask your school administrator about your school's policy regarding TB skin testing.
Lorena Gonzalez-Fabiny with the County of San Diego Tuberculosis Control Program at (619)
692-8292 can answer specific school questions or visit the website at http://www.sandiegotbcontrol.org. To view or download more information on TB screening guidelines, click on the link below:
FAQs for Tuberculosis (TB) Screening Guidelines for Schools and
Child Care Facilities in San Diego County
Q: Are CHDP (Child Health and Disability Prevention Program) and other California physical exam forms acceptable records of immunization history?
A: Yes. A child needs to have a provider-documented immunization record with the name of the vaccine and the date each dose was given.
Q: What if a parent says they can't find their child's shot record?
A: If the child’s healthcare provider is a member of the San Diego Regional Immunization Registry (SDIR), the child’s immunization record may be available in the (SDIR) database. Public Health Centers and private clinics throughout San Diego County regularly use the registry. Many school districts now have access to the SDIR. If you have access to the immunization registry, look to see if the child’s information is available. If a child’s information is found in the registry, a blue card can be printed off of the registry using this information. If you do not have access to the registry, refer the family to the child’s healthcare provider to obtain an official immunization record.
There may be situations when the child’s immunization record is not in the registry, is incomplete, or cannot be verified; refer the child’s parents to their doctor or clinic to receive more shots and/or obtain another copy of the immunization record. If a child does not have a pediatrician, the child can go to a regional Public Health Center for his/her shots. No appointment is needed and all shots given at one visit are only $10! Click below to locate a clinic near you.
For more information about how your school can use the San Diego Regional Immunization Registry (SDIR), click here.
Remind parents that the shot record is an important document, and they need to keep it safe and have it available for child care and school entry, doctor visits, etc.
Q: What type of documentation is accepted for chickenpox disease?
A: If a child has already had chickenpox disease, a doctor will need to check the “Had disease” box in the varicella section on the child's California immunization record and sign or stamp the physician’s office or clinic name in the space next to it. A letter on the doctor's letterhead stating that the child had the disease is also acceptable. You cannot accept a verbal or written statement from the parent.
Q: How do we document chickenpox disease on the blue card?
A: Write the words "had disease" in the varicella section of the blue card, specifically where the date of the shot would normally be written.
Q: What is the Varicella (Chickenpox) Vaccine Requirement for school and child care entry?
A: The varicella (chickenpox) vaccine requirement for school/child care entry became effective July 1, 2001. The requirement is for one dose of varicella vaccine or evidence of past chickenpox disease for children 18 months and older, except that two doses are required if an unimmunized child is 13 years or older.
For more information on the Varicella (Chickenpox) Vaccine, visit the Centers for Disease Control and Prevention at: http://www.cdc.gov/vaccines/vpd-vac/varicella/default.htm#vacc
Q: How long does the vaccine protect someone against chickenpox?
A: Research has shown that protection has lasted as long as the vaccinated persons have been studied so far (25 years in Japan, and more than 10 years in the U.S.) More studies are being done.
Q: Can you still get chickenpox disease if you have had the shot?
A: After vaccination, about 1 in 10 persons do not develop enough protection to completely prevent them from getting chickenpox disease. If they come in close contact with a person with chickenpox, they may develop a mild case of chickenpox with less than 50 blisters. (This kind of chickenpox is called breakthrough disease.) It will usually last only a few days, with no or low fever and few other symptoms. They may miss no school or 1-2 days of school (these children should stay home until the blisters have formed scabs or if there are no blisters present, until no new spots or bumps are forming). The number of children with breakthrough disease should diminish as they receive a second dose of the vaccine.
Q: Can the 2-dose hepatitis B vaccine schedule be used for kindergarten?
A: No. Younger children must get the 3-dose hepatitis B series. The special 2-dose series has only been approved for children 11-15 years old. When used on 11-15 year olds, this special 2-dose hepatitis B series must be appropriately noted by the physician in the child's immunization record.
Q: Can a child be exempted from California School Immunization Law requirements for child care?
A: There are two situations where the law allows a child to be exempted from the immunization requirements. These are known as Medical Exemptions and Personal Beliefs Exemptions.
Medical Exemptions: A medical exemption is granted when a child should not get some or all shots for temporary or permanent medical reasons. To grant a Temporary Medical Exemption (TME), ask the parent to bring in an official doctor's note, on letterhead. This official letter must state which vaccine(s) the child cannot have at this time, and indicate a future date when the vaccine(s) will be given. Attach the letter to the blue card (CSIR) and note the follow-up date on your calendar. It's the school's responsibility to remind the parent before the exemption expires (the next shot is due). The parent must then either:
- Present another official letter extending the Temporary Medical Exemption (TME)
or
- Provide proof (usually on a yellow card) that the child received the needed shot(s)
**To grant a Permanent Medical Exemption (PME), ask the parent to bring in an official doctor's note, on letterhead stating which vaccines the child is permanently unable to receive. Attach this letter to the blue card and then note the exemption on the front of the blue card.
Personal Beliefs Exemptions: Although it is strongly advised that children be immunized, the final decision to immunize or not is that of the parent or guardian. They may choose not to immunize in accordance with religious or personal beliefs. The Personal Beliefs Exemption is to be granted to parents/guardians only for reasons of personal/religious belief, and not as a matter of convenience! Not finding the immunization record, or not having time to take the child to get the shots are not personal or religious beliefs so the waiver cannot be signed in these instances. If parents oppose some or all immunizations, they must sign the Personal Beliefs Affidavit on the back of the blue card. By signing this waiver, parents acknowledge that if there is an outbreak of any disease the child is not protected against, the County Health Officer may issue an order excluding those unimmunized children from attending school. These intentionally unimmunized children will not be able to return to school until the Health Officer determines that the outbreak is over or if the parent/guardian decides to immunize the child and thus presents acceptable proof (usually in the form of a Yellow Card).
Q: What happens when a child is found to be out of compliance in the middle of the school year?
A: The child’s guardian is notified that he/she is out of compliance using the form “Notice of Immunizations Needed.” The guardian has 10 business days to provide documentation to the school that the vaccine was administered. If documentation is not provided at the end of the 10 days, then the child is excluded from school or child care.
Q: Whom can I contact for more information about school immunization requirements?
A: For more information about school immunization requirements contact:
Jennifer Sterling
Phone: (619) 692-8366
Email: Jennifer.Sterling@sdcounty.ca.gov
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