Understanding California's Child Care and School Immunization Requirements and Medical Exemptions May 24, 2019 Tag 1054 This article is designed to help health care providers understand and navigate California's child care and school immunization requirements (which will change on July 1, 2019) and use an evidence-based approach to immunizations and medical exemptions to ensure the best health for their patients. Pediatric immunization coverage levels in Los Angeles County have increased since personal beliefs exemptions (PBEs) for child care and school immunization requirements were eliminated as of January 1, 2016.1,2 Medical exemptions to required immunizations, however, have simultaneously increased. For instance, over the same timeframe, there was a 5-fold increase (0.1% to 0.5%) in permanent medical exemptions (PMEs) for LA County students entering kindergarten1,2 This article covers the following topics: Benefits of Maintaining High Immunization Rates Immunization Requirements for Child Care and School Attendance Unconditional and Conditional Admission Special Considerations Required Immunizations for Future School Years Screening for Required Immunizations Medical Exemptions to Required Immunizations Documenting Medical Exemptions Guidance for Contraindications and Precautions Misperceptions Regarding Contraindications Screening for Contraindications and Precautions Resources Note: This article is not intended to be an exhaustive review, but rather a summary of key requirements and expert guidance. Providers are encouraged to use their clinical judgment and consult evidence-based guidelines. For reference, links to recommendations from the Advisory Committee on Immunization Practices (ACIP), which have been adopted by the Centers for Disease Control and Prevention (CDC), and recommendations from the American Academy of Pediatrics (AAP), are included throughout. Benefits of Maintaining High Immunization Rates Maintaining high immunization rates protects immunized individuals from vaccine preventable diseases (VPD) and prevents the spread of these diseases to people who cannot be immunized. Examples of those who cannot be immunized include young infants as well as persons for whom immunization is contraindicated due to serious medical conditions and/or immunosuppression related to HIV, cancer, or other conditions. High coverage levels prevent VPD cases and outbreaks, decrease morbidity and mortality, and reduce absenteeism from school or work for people who were exposed to cases. Providers should adhere to the ACIP recommended immunization schedules and follow expert guidance on vaccine contraindications and precautions to maintain high rates of immunization in Los Angeles County. It also remains vital for providers to openly discuss the benefits of immunizations and parents'/caregivers' concerns and fears, including the possibility of adverse events.3 See the Rx for Prevention article, "Measles Outbreak: Communicating with Parents and Patients about Immunizations" for measles immunization talking points, a brief summary of vaccine communication techniques recommended by the CDC, and supporting resources. To read the rest of this article, take a look at the original Rx for Prevention article.