Understanding The New Vaccine Law In California

What is SB 277 and how will it affect your family?

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SB 277

SB 277 is a new California law which will go into effect July 1, 2016. Like AB 2109, passed in 2014, it will require all doses of 10 vaccines for all children enrolled in a public or private daycare, preschool, elementary school, junior high, or high school (35 total doses by Kindergarten). However, what SB277 has done is eliminate religious and philosophical (personal belief) exemptions to vaccination for any child, any dose, throughout the state. After July 01, 2016, only medical exemptions will be accepted for a child to attend school. (Note: while there was no official religious exemption in California previously, those who had religious objections to certain vaccine ingredients or whose religious practices precluded seeing a traditional medical doctor were allowed to opt out of the previous vaccination law.) There are a few limited exceptions to the new vaccine requirements, including a “grandfather” amendment that allows some children to remain partially vaccinated or unvaccinated in school until the next grade span, or checkpoint, which happens at Kindergarten and 7th grade.

This is the first time any California law has created a restriction on who may or may not attend public and private school, and it has many parents extremely and understandably concerned. While the law is slated to go into effect January 1, 2016, it is not to be legally implemented for school attendance until July 1st. This article is intended to help parents understand how this new law will affect their children’s school attendance next year, and in the years to come, as well as describe the options that are still available regarding vaccine decisions and education.

New Mandatory Vaccination Rules in the University of California (UC) System

SB 277 does not apply to colleges, but some colleges are now mandating some vaccines. For a complete discussion on the new requirements for UC schools in California, click here.


Overview of Your Options

Here is a brief overview of the options that parents who prefer to opt out of vaccines in whole or in part can consider (each option will be further discussed following this overview):

  • Continue in school as is without completing all vaccines under the “grandfather” clause, which allows children who are already enrolled to remain in school until the next “checkpoint” (explained below). In order to have been grandfathered in, you must have submitted a Personal Belief Exemption form (PBE) by December 31, 2015, to your daycare or school, or submitted a similar “letter or affidavit stating beliefs opposed to immunization” (exact wording from the law) by that date.  Starting January 01, 2016, newly submitted PBE forms and similar letters and affidavits will no longer be accepted at any daycare or school.
  • Continue in school as a “conditional entrant,” which means obtaining a written vaccination plan from your doctor that outlines when any missing vaccines will be completed.
  • Continue in school utilizing special education services since California is allowing children with special needs who qualify for an Individualized Education Plan, or IEP, to remain in school without adhering to SB 277. Some schools and districts, however, are wrongly choosing to not respect this part of the law and are denying school entry and services to these kids unless they are fully vaccinated.
  • Complete the required number of vaccines prior to entering daycare or school (see catch-up schedules below).
  • Homeschool your child.
  • Continue in school with a medical exemption from a doctor, if your child qualifies.

Official Source of Information

The two sources of information which schools, parents, and children can best rely on for proper implementation of this law are the following:

  1. The language of the law itself, SB 277
  2. The California Public Health Department’s dedicated website, www.ShotsForSchool.org, and  particularly their FAQ section which clarifies many aspects of this law.

The Grandfather Clause, Checkpoints, and Transferring Schools

The “grandfather” clause allows partially vaccinated or unvaccinated children who were already in daycare or school by the end of 2015, and who submitted a PBE form or similar letter or affidavit stating their decision to opt out of full vaccination, to continue in daycare or school until they reach a future checkpoint year. These checkpoints occur at the following two times:

  1. When a child reaches Kindergarten (or Transitional Kindergarten, TK, if a school offers it)
  2. When a child reaches 7th grade.

Children with PBEs are allowed to transfer between daycares, or from a daycare into preschool, or between any schools or school districts within California, and not be subject to the new vaccine requirements, as long as they can provide proof that a PBE or similar letter or affidavit was submitted to the old daycare or school by December 31, 2015 (clarified in the Public Health Dept’s FAQ section, question number 11).

Children who were already in 7th grade and older for the 2015-2016 school year are NOT affected by this law. They can finish Junior High, move into High School, even transfer to a different school, and graduate regardless of their vaccination status.

Examples:

  • A child who was enrolled in TK or Kinder or older by the 2015-2016 school year who does not have all doses of the required vaccines can continue to go to school through 6th grade without further vaccines. Upon enrollment into 7th grade, a child would need to either be caught up on all missing vaccines, begin to catch up on missing vaccines (called a conditional entry, see below), or obtain a medical exemption, if that child qualifies, to continue attending school.
  • A teen enrolled in 7th grade or above for the 2015-2016 school year will not be subject to this law and can continue through high school without further vaccines.
  • Infants who started daycare in 2015 and those who started preschool in 2015 can continue without vaccines until Kindergarten with a filed PBE.

New Students and New Daycare Enrollees Beginning in 2016

Infants and children who were not enrolled into any institution by the end of 2015 will become subject to the new CA vaccine law when they enroll into a daycare or school for the first time, regardless of their age, after July 01, 2016. (See Vaccine Schedules below to view the vaccination requirements). Homeschoolers who have previously registered a PBE or letter to any official homeschool organization, and now wish to enroll into a regular school, should be grandfathered in under the above guidelines until the next checkpoint.

Conditional Entry Vaccination Plans

Some states (like California) allow what is called a “conditional” entry into school. This means that a child who has not met the vaccine requirements can still be enrolled as long as a schedule to eventually complete vaccination is in place. This option would apply to those who do not qualify for a medical exemption, do not have an IEP, and have no other option but to either begin vaccination or be homeschooled. Such cases would need a written letter from the child’s doctor that outlines the plan. The intent of Conditional plans is to have a child catch-up with all missing vaccines as quickly as possible, which is generally within 6 months. Children may be able to spread the required vaccines out over a few years and proceed gradually if the school is flexible.

Immunity Education Group has received information from school administrators who have attended California Department of Public Health training sessions on how to implement the new vaccine law. According to this information, the Public Health Department will be targeting public and charter schools with high numbers of prior personal belief exemptions and auditing them to make sure all their students are in compliance with the new law in a timely fashion. The Department will insist that all Conditional Entry students be fully caught up on all vaccines as quickly as possible, which means a previously unvaccinated child will be expected to receive as many as 37 doses of missing vaccinations all within the first 6 months of school. The Department informed the school administrators that if their school receives public funding, they could be charged with committing fraud against the state government if they fail to enforce a rapid catch-up vaccination schedule; they would be mis-handling public funds by allowing unvaccinated students to continue in school without catching up on vaccines. For this reason, parents may find it difficult to exercise this option in a public or charter school. Private schools (which don’t receive public funding) may have more flexibility on how they enforce Conditional Entry plans.


Children with Individualized Education Plans (IEP)

An amendment was added to the California law that states children who qualify for an Individualized Education Plan (IEP) would not be subject to the mandatory vaccination law. This was intended to allow children with special needs (mainly for intellectual impairments or learning disorders) to continue in school regardless of vaccine status. Certain federal laws (called IDEA) were already in place which protect the rights of such kids to have equal access to education, prohibiting anything from interfering with their educational placement.

Many schools are properly following this law and are NOT prohibiting IEP students from receiving all of their educational services. However, some school districts are wrongly interpreting this amendment and are trying to enforce vaccination on their students with IEPs. They claim that the language of the amendment isn’t clear. Efforts are underway to ensure that all CA schools properly follow the IEP amendment and allow all IEP kids to have a fair and equal education in schools.

Even the California Department of Public Health has made it very clear on their website that children with IEPs should continue to receive all services “regardless of their vaccination status” in their FAQ section FAQ section here, question number 3.

Here is the language of the amendment:

Section 2 (h): This section does not prohibit a pupil who qualifies for an IEP, pursuant to federal law and Section 56206 of the Education Code, from accessing special education and related services required by his or her IEP.”

Here are several statements made during the California Assembly Hearing in June which clarified this amendment:

Assembly-member Waldron, regarding the IEP Amendment: “Question to the representative from the Department of Education. I believe the amendment that you took would address this and answer it, but just for clarification with SB 277 and the amendment regarding Individualized Education Program or an IEP, would that apply to all aspects of special needs child’s education?  In other words, would a Special Ed student be allowed to take part in normal classroom activities with all other kids in that general setting if they’ve had the exemption?”

Fred Balcom, Director of Special Education, CA Board of Education: “Yes. They would”

Waldron: “And that’s just with that amendment that allows that.”

Balcom: “Yes.”

Senator Allen also stated:

“Can I just make two comments? First of all, about the IDEA issue. It’s possible that the speaker hasn’t, I don’t know if you have a copy of the amendments, but I think that the amendments that were made with respect to the IEPs, were absolutely dead on to address the IDEA concern. That nothing in this section shall prohibit a pupil that qualifies for an IEP, pursuant to Federal Law and Section 56026 of the Education Code from accessing any special education and related services required by the Individualized Education Program.

Senator Allen says more: “I think that the amendment that clarified the fact that NOTHING IN THIS BILL should impact the ability of a kid to get the FULL PROGRAM afforded to them in their IEP is an important change that I very much welcome.”

Here is video footage of the key parts of the Assembly Hearing:

 

Medical Exemptions to Vaccination

The guidelines for providing medical exemptions are broader in the new California law, because of an added amendment. It is up to the personal judgment of each physician and patient to work together to determine if a child qualifies for a medical exemption. The California bill declares that an exemption can be granted if “the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances including, but not limited to, family history, for which the physician does not recommend immunization . . .”

Realize that qualifying for a medical exemption is very different than determining if a child has a contraindication to vaccination. The term contraindication is a medical term that applies to any medical treatment which a person has had a prior life-threatening reaction to or which is highly likely to cause a severe reaction. A contraindicated treatment is one which should never be given to a person under any circumstances. For example, if a person suffered a life-threatening anaphylactic allergic reaction to penicillin, then future treatments with penicillin would be contraindicated in that person. Another example: someone with a severe immune deficiency or a person on chemotherapy should not receive a live-virus vaccine because that live-virus would likely infect and possibly kill the patient.

Medical exemption, on the other hand, is a judgement made by a doctor that a particular person’s medical history, current medical status, or family medical history has some circumstances for which vaccination is not considered safe. Such a person could still receive vaccinations if the situation warranted it and he or she is willing to accept the higher risk of a severe reaction, since it is not a contraindication.

Here are some of the circumstances which might prompt a doctor to grant a legitimate exemption for a child or family:

  • A child with a previous severe vaccine reaction.
  • Siblings of a child who had a severe reaction.
  • Children of a parent who had a severe reaction.
  • More distant relatives with a severe reaction. Reactions that occur in grandparents, aunts and uncles, or cousin are still a potential concern.
  • Current severe medical conditions or chronic conditions. Children with any chronic medical condition or temporary moderate to severe condition can discuss with a doctor whether or not that condition warrants temporary or permanent exemption.
  • Family history of severe medical conditions. There is a growing body of research which is finding a small link between vaccination and increased risk of autoimmune disease. Families with autoimmune disorders such as lupus, rheumatoid arthritis, celiac disease, fibromyalgia, multiple sclerosis, type I diabetes, psoriasis, and other autoimmune conditions can discuss exemptions. Families with neurodevelopmental, psychiatric, or inflammatory bowel conditions can also discuss this with their doctor. The greater the number of familial diseases, and the closer in the family they occur to the child in question, the more likely is the need to consider medical exemption.
  • Autism in the family. Despite the lack of published mainstream evidence of a connection between vaccines and autism, many families will consider seeking exemptions for a child with autism and the rest of their children. Autism in more distant relatives would be less of a concern for a baby but can be considered.
  • Other learning and behavioral disorders in the family. Disorders that are less severe than autism, such as ADHD, ODD, and others, are less of a concern but warrant consideration by families and their doctors.

In California, no specific form for a medical exemption exists at this time; the exemption is simply a letter from the doctor. It must specify the reason for the medical exemption (for example, the child has a family history of autoimmune disorders) and the duration of the exemption (for example, for the rest of childhood or for only a few years).

Two final points of clarification: Schools are not instructed to determine if the medical exemption is medically appropriate or not. The school is directed to accept the letter and the doctor’s opinion, as long as the letter has the required information. Second, a child may follow a partial or a delayed vaccination schedule and still receive a medical exemption for other aspects of the vaccination schedule.


Homeschooling

Home-based education was already becoming more popular before mandatory vaccination laws were introduced. Some families embrace this lifestyle, and many children and families thrive outside of standard educational systems. This new law will prompt more families to make this choice because vaccination requirements do not apply to homeschooled children.

Homeschoolers don’t necessarily need to be isolated and educated alone one-on-one with a parent as a full-time teacher. Co-op programs, in which families group their children together for educational, social, athletic, and cultural experiences will become more popular. Parents won’t be the only ones responsible for teaching; they can share duties with other parents, tutors, even private teachers, and such costs can be shared among many families. Parents should be able to work part-time outside the home if desire or needed.

Hybrid programs, in which a child has some days at home and some within a school-like classroom environment with other kids, are claiming that they are officially a type of home-schooling and therefore not subject to the law. Some believe that as long as these children are being taught by non-licensed teachers (teachers fully trained, but not officially credentialed), that they are considered to be in a home-school program. Investigate such programs in your area to see if there is one that is right for your child.


Vaccine Schedules to Meet Daycare and School Requirements

The list of vaccines required for school is actually shorter than the number of vaccines on the full CDC recommended schedule. For example, in California six out of the twelve vaccines (covering 10 diseases) are required: DTaP, Polio, Hib, Hep B, MMR, and Chickenpox. The other six vaccines recommended by the CDC are optional (Rotavirus, PCV, Hep A, Flu, HPV, and Meningococcal).

Still, 37 doses of vaccination are now mandated for daycare and school entry in California, if one were to receive every required dose starting in infancy. However, states which mandate vaccines for daycare or school attendance cannot actually mandate vaccination during infancy. The mandates are only enforced when a child is enrolled into a daycare or school. Families who prefer not to vaccinate during infancy do not need to do so; vaccines can be deferred until a later date as detailed below. When an unvaccinated or partially-vaccinated child does eventually need to begin or resume vaccines at an older age, fewer doses are needed – in some cases, far fewer than the mandated 37 doses. And remember, parents who suddenly find themselves needing to register a partially vaccinated or unvaccinated child for daycare or preschool may be able to begin school with a “conditional entry.” In this case, kids don’t not need to wait until all doses are complete before they enter school.

The following section discusses the vaccine requirements for children who have not received all the usual vaccines during infancy and toddlerhood and who need to begin vaccines in order to enter school:

Source: CDC Catch-up Vaccine Schedule and the California Department of Public Health website www.ShotsforSchool.org 

Vaccines needed to meet daycare or preschool requirements:

  • 4 DTaP*
  • 3 Polio
  • 3 Hepatitis B
  • 1 HIB**
  • 1 MMR*
  • 1 Chicken pox

*Note: DTaP is one injection that contains combined antigens for THREE different diseases: diphtheria, tetanus, and pertussis.  MMR is one injection that contains combined antigens for THREE different diseases: measles, mumps, and rubella.

**Note: The normal vaccine schedule calls for 4 HIB doses (2, 4, 6, and 15 months). For those who skip vaccines during infancy, only 1 HIB is needed if given at 15 months and older. This 1-dose requirement is confirmed under the Child Care tab of the ShotsforSchool.org website

This schedule could be started at any age in preparation for daycare or preschool. The spacing between any of these doses should be worked out between you and your doctor, following the CDC Guidelines. The spacing between doses can be prolonged without compromising effectiveness. If a child already had some vaccines during infancy, but then the process was halted, parents would cross each previously-administered vaccine off of the above list and simply begin the schedule with whatever is remaining.

If done in the fastest manner possible, this schedule could be completed within 9 months. Discuss spacing this out and slowing it down as much as possible with your doctor.

Vaccines needed to meet kindergarten requirements:

  • 4 DTaP*
  • 3 Polio*
  • 3 Hepatitis B
  • 1 MMR**
  • 1 Chicken pox**
  • 1 HIB***

*Note: Normally DTaP has 5 doses and Polio vaccine has 4, given during infancy and toddlerhood, with a booster dose of each at age 5. But, for those who don’t receive all doses, only 4 doses of DTaP and 3 doses of Polio are necessary for full immunity, as long as the final doses are given as booster doses at age 4 or older. Discuss this with your doctor. This reduced-dose schedule option is confirmed on the K – 12 tab on the ShotsforSchool.org website

**Note: For kindergarten, two doses of MMR and Chickenpox are indicated on the CDC vaccine schedule (age 1 and age 5). However, for most children, one dose works well enough, and the ShotsforSchool website (under the K – 12 tab) only lists 1 Chickenpox required for Kindergarten entry. Families who are trying to minimize the number of vaccines can get a blood test a few months after the first MMR dose to see if it worked, and only have to get 1 Chickenpox dose (instead of the CDC-recommended 2). If the blood test shows the first MMR dose failed, the second dose can be given at any time thereafter.

***Note: HIB is only approved by the FDA to be given prior to a child’s 5th birthday. If a child turns five before this school requirement is enforced, he or she won’t need this vaccine. The ShotsforSchool.org website lists HIB as a requirement for daycare and preschool, but not for children 4 to 6 years old (the age of Kindergarten entry) under the K – 12 tab. So even though SB 277 requires HIB vaccination for school entry, this requirement doesn’t extend into age 5. Therefore, it’s not part of the Kindergarten (age 4 to 6) requirement.

Vaccines needed to meet requirements for kids seven years and older:

Unvaccinated children who are entering school at age 7 or older don’t need to catch up on most of their missing shots. Only the following are required under the new CA law according to the ShotsforSchool website:

  • 1 Tdap*
  • 3 Polio
  • 1 MMR**
  • 1 Chicken pox***

*Note: Children 7 years and older can’t get DTaP (it isn’t FDA approved past 6 years of age), and they can’t get a series of Tdap. Tdap is only approved as a single dose. This page on the ShotsforSchool.org website is misleading. It says that 3 or 4 DTaP doses are needed to enter school at this age. But doctors aren’t allowed to give DTaP after age 6. And only 1 Tdap is allowed. Therefore the CA Department of Public Health’s note saying 3 or 4 DTaPs should be given to 7 year olds goes against FDA and CDC guidelines. The bottom line is that only 1 Tdap can be given once a child turns 7 years. However, some school districts are insisting that these children also get two doses of Td (tetanus/diphtheria) in addition to the one Tdap in order to meet the CDC guidelines that recommend 3 total tetanus and 3 total diphtheria doses for this age group. Your school may insist on that. It’s unfortunate, because tetanus isn’t a contagious disease, so vaccination status shouldn’t matter for school. And we don’t have diphtheria in the United States anymore, but even if we did, that is one of several types of vaccines that doesn’t prevent disease transmission (it doesn’t prevent someone from catching the infection and spreading it to others – it only helps reduce symptom severity), so vaccination status shouldn’t mattet for school attendence. But then again, we wouldn’t expect every aspect of this new vaccine law to make sense. 

**Note: Under the K – 12 tab on ShotsforSchool.org, for kids ages 7 to 17 entering school, only 1 MMR is indicated at first, then a second dose by 7th grade. Or, a blood test to confirm the 1 dose worked would get a 7th grader out of the second dose.

***Note: The same page on the ShotsforSchool.org website states that only 1 Chickenpox vaccine is needed for ages 7 to 12; two doses are needed for kids admitted at 13 and older. A blood test could be done to determine the need for the second dose.

Also note that Hepatitis B is taken off the required list starting at age 7. The K – 12 tab does not list Hepatitis B as a requirement for children once they turn 7 years of age. The language of SB 277 also confirms that children don’t need Hep B vaccine for 7th grade entry.

What to do if you do not qualify for a medical exemption, are choosing to still opt out of some vaccines, are unable to homeschool for long, and can’t move?

Ultimately, some families will be out of luck and will need to either move or work with the system within the confines of the law. Here are some suggestions:

  • Homeschool during preschool and kindergarten since full vaccination isn’t a consideration for you.
  • Explore the schools in the area to learn which are more friendly toward families who submit Conditional Entry plans (such as small private or religious schools).
  • Enroll the child into school around seven years of age with a conditional entry plan from the doctor which outlines a vaccine plan which will begin at some point in the near future. Kids who don’t begin vaccines until age seven have aged-out of the DTaP, HIB, and Hep B series of vaccines, so the number of required vaccines will be much less.
  • When the school insists that the child begin following the conditional entry plan, do the first vaccine on the seven-year-old schedule above, which could typically be either Polio or Tdap.
  • If the child has a moderate to severe reaction, discuss medical exemption from further vaccines with the doctor.
  • If no significant reaction occurs, which is more likely to be the case, wait until the school indicates it is time to continue the written plan and then do the next vaccine, such as a second Polio or the first and only Tdap. Continue slowly vaccinating as the school prompts you to. Remember, school officials are busy and may not have the time to keep on top of your child’s plan. It’s your responsibility as a parent to make sure you keep checking the vaccine plan so your child doesn’t fall behind. 
  • If you proceed with MMR and Chicken pox vaccine, you will need a blood test prior to entering 7th grade to see if a second MMR dose is needed. 
  • At any point along the way, if the child catches Chicken pox, be sure to have it documented with an in-person visit to the doctor (who will usually see the child outside the office to avoid spread of the disease). The vaccine will then not be needed. If repeated exposures to chickenpox have occurred, and the child has not caught chickenpox, a blood test to check immunity could be done in lieu of vaccination.
  • The child will eventually meet all the vaccination requirements (1 Tdap, 1 or 2 MMR, 3 Polios, and possibly 1 Chickenpox) and continue to remain in school.

We want to make it very clear that it is important to work within the guidelines of all rules and laws regarding vaccines and education. Work closely with your school administrators and medical providers to find the best educational option for your family.