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Catch up vaccinations for students new to the US

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RNTadaaaa has 13 years experience and specializes in Telemetry, Orthopedic, M Surg, School RN.

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It seems I have a kindergarten student that is new to the US preparing to enroll this semester. The student has one of each vaccine according to the Immunization record. 

I have read the catch up schedule...but I am still a bit...just a bit...confused about how to accommodate the student.  

https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup-shell.html

Should I request a letter from the pediatrician indicating the timeline for the remaining vaccines?

 And remind parent that until all the age appropriate vaccines are obtained the child will be excluded if a major outbreak of disease occurs? 

 

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277 Posts; 2,857 Profile Views

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. 

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UrbanHealthRN has 8 years experience as a BSN, RN and specializes in Pediatric/ Community and Public Health.

206 Posts; 3,172 Profile Views

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. 

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lifelearningrn has 6 years experience as a BSN, RN and specializes in School Nursing.

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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.

Edited by lifelearningrn

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RNTadaaaa has 13 years experience and specializes in Telemetry, Orthopedic, M Surg, School RN.

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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!!

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RNTadaaaa has 13 years experience and specializes in Telemetry, Orthopedic, M Surg, School RN.

96 Posts; 1,916 Profile Views

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!  

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RNTadaaaa has 13 years experience and specializes in Telemetry, Orthopedic, M Surg, School RN.

96 Posts; 1,916 Profile Views

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! 

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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.  

 

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ruby_jane has 10 years experience as a BSN, RN and specializes in ICU/community health/school nursing.

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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...

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