Catch up vaccinations for students new to the US

jnemartin, BSN, RN · Aug 16, 2019

My school has a very high international population, including about 25 boarding students and 25 international students who stay with host families. Sometimes (often) the immunization records they provide are extremely difficult to interpret. I've gotten good at translating them and there is usually a key that designates the English translation, but determining if they are UTD based an USA/Arizona school standards can be really hard. If there is any question, I learned to "take the monkey off my back" and refer to a pediatrician for an immunization review/consult.

UrbanHealthRN, BSN, RN · Aug 16, 2019

I used to work in health centers that had a TON of international kiddos, and I loved figuring out their vaccine records! (nerdy, I know lol). If you've got a K kid with one of each vaccine, here's what you're looking to do at this point, in a get-down-to-it nutshell:

Hep B- needs 2 more doses. Wait 4 weeks after the 1st dose before giving the 2nd dose. Wait 8 weeks after the 2nd dose before giving the 3rd dose.

DTaP- needs 3 more doses. Wait 4 weeks after the 1st dose before giving the 2nd dose, wait 4 weeks after the 2nd dose before giving the 3rd dose, and then wait 6 months after the 3rd dose before giving the 4th dose.

Polio- needs 2 more doses. Wait 4 weeks after the 1st dose before giving the 2nd dose. Wait 6 months after the 2nd dose before giving the 3rd dose.

MMR- needs another dose. Wait 4 weeks after the 1st dose before giving the 2nd dose.

Varicella- needs another dose. Wait 3 months after the 1st dose before giving the 2nd dose, and make sure no live virus vaccine (MMR or live intranasal flu) was given in the 4 weeks before getting the 2nd varicella.

Hepatitis A- needs another dose. Wait 6 months before giving the 2nd dose.

Rotavirus, Hib, and Pneumococcal- assuming this kid's over 5, these vaccines aren't indicated anymore- Rotavirus is only for babies, and Hib and Pneumococcal are given up until the 5th birthday.

Also, keep in mind that a lot of these vaccines come combined with others, so the pedi may figure out some clever timelines for grouping these vaccines together, while still fulfilling the catch-up guidelines. As long as the kid is keeping up with appointments, trust that all the shots will eventually be done by springtime, then re-evaluate at that time.

lifelearningrn, BSN, RN · Aug 16, 2019

Enroll the student. The second round of vaccines are due 30 days after the first. DTaP, Hep B, Polio, MMR. Varicella is due 3 months after the first dose, and Hep A is due 6 months after the first dose. The third dose of Polio and DTaP are given 6 months after the second, and Hep B's third dose 2 months after the second (or at least 16 weeks after the first). I believe DTaP has another booster after 6 months.

With this student, you just have to stay on top of the parents to stick to the schedule, and exclude according to your state laws.

RNTadaaaa · Aug 16, 2019

3 hours ago, UrbanHealthRN said:
I used to work in health centers that had a TON of international kiddos, and I loved figuring out their vaccine records! (nerdy, I know lol). If you've got a K kid with one of each vaccine, here's what you're looking to do at this point, in a get-down-to-it nutshell:
Hep B- needs 2 more doses. Wait 4 weeks after the 1st dose before giving the 2nd dose. Wait 8 weeks after the 2nd dose before giving the 3rd dose.
DTaP- needs 3 more doses. Wait 4 weeks after the 1st dose before giving the 2nd dose, wait 4 weeks after the 2nd dose before giving the 3rd dose, and then wait 6 months after the 3rd dose before giving the 4th dose.
Polio- needs 2 more doses. Wait 4 weeks after the 1st dose before giving the 2nd dose. Wait 6 months after the 2nd dose before giving the 3rd dose.
MMR- needs another dose. Wait 4 weeks after the 1st dose before giving the 2nd dose.
Varicella- needs another dose. Wait 3 months after the 1st dose before giving the 2nd dose, and make sure no live virus vaccine (MMR or live intranasal flu) was given in the 4 weeks before getting the 2nd varicella.
Hepatitis A- needs another dose. Wait 6 months before giving the 2nd dose.
Rotavirus, Hib, and Pneumococcal- assuming this kid's over 5, these vaccines aren't indicated anymore- Rotavirus is only for babies, and Hib and Pneumococcal are given up until the 5th birthday.
Also, keep in mind that a lot of these vaccines come combined with others, so the pedi may figure out some clever timelines for grouping these vaccines together, while still fulfilling the catch-up guidelines. As long as the kid is keeping up with appointments, trust that all the shots will eventually be done by springtime, then re-evaluate at that time.

Excellent! You are so thorough and you made it easier to understand. Thank you very much!!

RNTadaaaa · Aug 16, 2019

1 hour ago, lifelearningrn said:
Enroll the student. The second round of vaccines are due 30 days after the first. DTaP, Hep B, Polio, MMR. Varicella is due 3 months after the first dose, and Hep A is due 6 months after the first dose. The third dose of Polio and DTaP are given 6 months after the second, and Hep B's third dose 2 months after the second (or at least 16 weeks after the first). I believe DTaP has another booster after 6 months.
With this student, you just have to stay on top of the parents to stick to the schedule, and exclude according to your state laws.

Enroll the student! Exclude according to state laws and non adherence to the schedule. Will do and thank you!

RNTadaaaa · Aug 16, 2019

5 hours ago, jnemartin said:
My school has a very high international population, including about 25 boarding students and 25 international students who stay with host families. Sometimes (often) the immunization records they provide are extremely difficult to interpret. I've gotten good at translating them and there is usually a key that designates the English translation, but determining if they are UTD based an USA/Arizona school standards can be really hard. If there is any question, I learned to "take the monkey off my back" and refer to a pediatrician for an immunization review/consult.

Wow! That sounds a bit exciting and also exasperating! ?

I did ask for them to have their pediatrician provide documentation of the vaccination schedule they'll be following to catch up. (for documentation purposes if the state stops by)

Thank you very much!

ChristmasNurse · Aug 16, 2019

7 hours ago, UrbanHealthRN said:
"I used to work in health centers that had a TON of international kiddos, and I loved figuring out their vaccine records! (nerdy, I know lol)."
LOL. The first time I ran a vaccine clinic (primary customers were newly immigrated families), I was a nervous wreck. But by the end of the day, I was enjoying the brain game.

ruby_jane, BSN, RN · Aug 20, 2019

Your EMR should have a way for you to "future" vaccinations. After I clear Skyward of all the new/within Texas records I future every month to the 15th and then the 30th of each month so I am not surprised....

I also tell families that this is not the only shot(s) they'll need and that we will send notes home. I usually do this with a translator and I document so the parent can't say they were unaware...