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Immunisation Policy VIC V2016.2 IMMUNISATION POLICY SUB CATEGORY: Health, Hygiene and Safety POLICY GOAL To inform parents of the vaccination recommendations and to actively support immunisation of all children attending the service to protect children, as far as possible, from the spread of infectious diseases where there is an outbreak. To encourage educators to participate in the recommended vaccinations to protect themselves and children from the risks associated with vaccine-preventable diseases. RATIONALE “Immunisation is a reliable way to prevent some infections. Immunisation works by giving a person a vaccine—often a dead or modified version of the germ—against a particular disease. This makes the person’s immune system respond in a similar way to how it would respond if they actually had the disease, but with less severe symptoms. If the person comes in contact with that germ in the future, their immune system can rapidly respond and prevent the person becoming ill. Immunisation also protects other people who are not immunised, such as children who are too young to be immunised, or people whose immune systems did not respond to the vaccine. This is because the more people who are immunised against a disease, the lower the chance that a person will ever come into contact with someone who has the disease. The chance of an infection spreading in a community therefore decreases if a large proportion of people are immunised, because the immune people will not become infected and can protect the vulnerable people; this is known as ‘herd immunity’. Educators should ask all parents to provide a copy of their child’s vaccination records. If the child has a vaccination record, make sure they have received all the vaccinations recommended for their age group. If the child has not been medically vaccinated (‘not medically vaccinated’ includes children who may have been naturopathically or homeopathically vaccinated), tell the parents that their child will be excluded from care during outbreaks of some infectious diseases (such as measles and pertussis), even if their child is well. This is because the effectiveness of naturopathic or homeopathic vaccinations has not been scientifically proven.” 1 “Your child needs to be up to date with their immunisations or have an approved exemption to receive Child Care Benefit. All of your children under 7 years of age must meet immunisation requirements. The National Immunisation Program Schedule on the Department of Health Immunise Australia Program website specifies at what ages your child should receive certain vaccines. Most of the immunisations on the National Immunisation Program Schedule are linked to family assistance payments. From 1 January 2016, immunisation requirements for Child Care Benefit are changing and will apply to children and young people under 20 years of age. These changes will also affect 1 “5th Edition Staying Healthy Preventing Infectious Diseases in Early Childhood Education and Care Services” Australian Government National Health and Medical Research Council 2012 Page 1 of 9 Immunisation Policy VIC V2016.2 customers who claim Grandparent Child Care Benefit, Special Child Care Benefit or Jobs, Education and Training Child Care Fee Assistance.” 2 “In an effort to improve childhood immunisation rates, the Victorian Government has amended the Public Health and Wellbeing Act 2008. The amendments will come into effect from 1 January 2016 and will mean that early childhood education and care services cannot confirm enrolment of a child unless the parent/carer has provided documentation that shows the child: • is fully vaccinated for their age; or • is on a recognised catch-up schedule if their child has fallen behind with their vaccinations; or • has a medical reason not to be vaccinated. • ‘Conscientious objection’ to vaccination is not an exemption. . What is an immunisation status certificate? It is a statement showing the vaccines your child has received. The most common type of immunisation status certificate is an Immunisation History Statement from the Australian Childhood Immunisation Register. ‘Homeopathic immunisation’ is not a recognised form of immunisation. What is this document used for? To finalise enrolment. To accept an offered place at a service, you must provide the service with an immunisation status certificate. This would usually be done within two months before your child is due to start at the service. To keep children safe. If there is a disease outbreak at the service, the document is used to identify children at risk (for example, children too young to be fully immunised against a disease) who may need to stay away from the service until it is safe for them to return. Immunisation History Statements can be requested at any time by contacting Medicare: • phone 1800 653 809 • email [email protected] • visit the Medicare website https://www1.medicareaustralia.gov.au/ssl/acircirgcert • visit your local Medicare office. Enrolments for a place at an early childhood service commencing at the beginning of 2016 that are confirmed in writing by the service before the legislation comes into effect will not be impacted by the legislation. Being registered on a waiting list for a place at an early childhood service is not a confirmed enrolment. ”3 “Under the No Jab No Play law, vulnerable and disadvantaged children will be eligible to enrol in a service under a grace period, without having provided proof of up to date immunisation. The grace period provisions allow the family to continue to access early childhood education and care services while receiving information and assistance to get their child’s immunisations up to date and to obtain the required immunisation documentation that needs to be provided to the service. 2 Department of Human Services (accessed on-line April 2016 http://www.humanservices.gov.au/customer/subjects/immunising-yourchildren?gclid=CIDH46qF2skCFViXvQod9cAJEQ ) 3 “Starting Childcare or Kindergarten? Immunisation Information for parents enrolling a child”, Victoria Health (accessed on-line April 2016 https://www2.health.vic.gov.au/about/publications/factsheets/Parent-brochurestarting-childcare-or-kindergarten ) Page 2 of 9 Immunisation Policy VIC V2016.2 Children eligible to be enrolled under the grace period include: children evacuated from their place of residence due to an emergency such as a flood or bushfire; children in emergency care within the meaning of section 3(1) of the Children, Youth and Families Act 2005; Children in the care of an adult who are not the child’s parent due to exceptional circumstances such as illness or incapacity; Children identified as Aboriginal or Torres Strait Islander Children whose parents hold a health care card, a pensioner concession card, a Veterans Affairs Gold or White card; Children from a multiple birth of triplets or more Any other circumstance specified in the guidelines made by the Secretary to the Department of Health and Human Services. The grace period is for 16 weeks commencing from the date that the child first attends the service. During the 16 week grace period, early childhood education and care services are required to take reasonable steps to obtain the required immunisation documentation.”4 “Immunisation protects not only staff, but also the young children they work with, who may be more vulnerable to vaccine-preventable diseases, and may have more serious outcomes if they do contract a vaccine-preventable disease. People conducting a business or undertaking in education and care services have a duty of care to ensure, as far as is reasonably practicable, the work health and safety of educators and other staff who are at risk of exposure to diseases that are preventable by vaccination. Immunisation of educators and other staff is an effective way to manage the risk in education and care services, because many diseases are infectious before the onset of symptoms. Educators and other staff who are not immunised place children—especially younger age groups—at greater risk of acquiring a vaccine-preventable disease. All education and care service staff should be advised of the potential consequences if they refuse reasonable requests for immunisation. These include: o being restricted to working with children over 12 months old o potentially having to take antibiotics during outbreaks of bacterial diseases that are vaccine preventable, even if the educator is not ill o being excluded from work during outbreaks of vaccine-preventable diseases. Employers should: o develop a staff immunisation policy that states the immunisation requirements for educators and other staff o develop a staff immunisation record that documents each staff member’s previous infection or immunisation for the diseases listed below o require all new and current staff to complete the staff immunisation record o regularly update staff immunisation records as staff become vaccinated o provide staff with information about vaccine-preventable diseases—for example, through in-service training and written material, such as fact sheets o take all reasonable steps to encourage non-immune staff to be vaccinated. Advice given to educators and other staff, and any refusal to comply with vaccination requests, should be documented. 4 “About the ‘No Jab, No Play’ Law”, Health Victoria (accessed on-line April 2016 https://www2.health.vic.gov.au/about/publications/factsheets/no-jab-no-play-frequently-asked-questions ) Page 3 of 9 Immunisation Policy VIC V2016.2 Recommended vaccinations for educators and other staff The National Health and Medical Research Council (NH MRC) recommends that all educators and other staff are immunised against: • pertussis—this is especially important for educators and other staff caring for the youngest children who are not fully vaccinated. Even if the adult was vaccinated in childhood, booster vaccination may be necessary because immunity to pertussis decreases over time • measles–mumps–rubella (MMR) for educators and other staff born during or since 1966 who do not have vaccination records of two doses of MMR, or do not have antibodies against rubella • varicella for educators and other staff who have not previously had varicella (a blood test is required to prove previous infection) • hepatitis A, because young children can be infectious even if they are not showing any symptoms. All staff should also consider having yearly influenza vaccinations. Influenza is very infectious and can spread through the air by coughing and sneezing, as well as by hands, cups and other objects that have been in contact with an infected person’s mouth or nose. Additional vaccinations are recommended for special categories of educators and other staff:24 • Hepatitis B for educators and other staff who care for children with intellectual disabilities. Although the risk is low, seek advice about hepatitis B immunisation if the children are not immunised. Immunisation of the children should be encouraged. • Japanese encephalitis for educators and other staff who work in the outer Torres Strait islands for one month or more during the wet season. Educators and other staff who are pregnant or immunocompromised (i.e. have a weakened immune system) should seek advice from their doctor about vaccinations. Some vaccinations are not recommended during pregnancy, or if a person has a disease or is undergoing treatment that affects their immune system.”5 IMPLEMENTATION Children From January 1 an enrolment cannot be finalised without an approved Immunisation Status Certificate – see examples above unless there are grounds for a Grace Period. Should a Grace Period apply, Nominated Supervisors must use the Grace Period Eligibility Assessment Form from Health Victoria to document https://www2.health.vic.gov.au/about/publications/formsandtemplates/grace-period-eligibilityassessment-form There is no change to families already enrolled at the service, immunisation records should still be maintained. Where an approved exemption applies relevant documentation must be kept. Children who have not been medically vaccinated (‘not medically vaccinated’ includes children who may have been naturopathically or homeopathically vaccinated) must be excluded in the event of a vaccine-preventable disease being present at the centre, even if their child is well, normal booking charges will apply for exclusion. A list of vaccine-preventable diseases can be found in “Staying Healthy Edition 5”. Upon enrolment families will be advised of the immunisation requirements. 5 “5th Edition Staying Healthy Preventing Infectious Diseases in Early Childhood Education and Care Services” Australian Government National Health and Medical Research Council 2012 Page 4 of 9 Immunisation Policy VIC V2016.2 Nominated Supervisors will contact their local Public Health Unit for advice when they are informed of a case of a vaccine-preventable disease. Parents will be encouraged to vaccinate as per the schedule by; o putting up wall charts about immunisation o reviewing which children are behind in their vaccinations each month o being provided with information from recognised authorities o reminders in newsletters and individual communication o downloading the Vaxontime app on their smart phone or device to manage their child’s immunisation. https://www2.health.vic.gov.au/about/publications/formsandtemplates/VaxOnTimeVictoria-app-promotional-card Staff The National Health and Medical Research Council (NH MRC) recommends that all educators and other staff are immunised against: o pertussis—this is especially important for educators and other staff caring for the youngest children who are not fully vaccinated. Even if the adult was vaccinated in childhood, booster vaccination may be necessary because immunity to pertussis decreases over time o measles–mumps–rubella (MMR) for educators and other staff born during or since 1966 who do not have vaccination records of two doses of MMR, or do not have antibodies against rubella o varicella for educators and other staff who have not previously had varicella (a blood test is required to prove previous infection) o hepatitis A, because young children can be infectious even if they are not showing any symptoms. All staff should also consider having yearly influenza vaccinations. Influenza is very infectious and can spread through the air by coughing and sneezing, as well as by hands, cups and other objects that have been in contact with an infected person’s mouth or nose. We strongly encourage team members to follow the National Health and Medical Research Council’s recommendations for immunisation. Educators who are not immunised must understand the potential consequences if they refuse reasonable requests for immunisation. These may include: o being restricted to working with children over 12 months old o potentially having to take antibiotics during outbreaks of bacterial diseases that are vaccine preventable, even if the educator is not ill o being excluded from work during outbreaks of vaccine-preventable diseases. We request that educators working with babies are vaccinated for Pertussis (Whooping Cough). Team Members should seek advice from their Medical Practitioner based on their individual circumstances. All team members are required to complete the Immunisation Record and keep this up to date. This should be reviewed annually. Where team members are not immune as per the recommendations they should be supplied with a letter to take to their medical practitioner to ensure that they are aware of all risks associated. The Centre will provide information about diseases that are preventable by immunisation. Page 5 of 9 Immunisation Policy VIC V2016.2 In the event of an outbreak of a vaccine-preventable disease, unimmunised team members may be excluded based on advice from Public Health. Where unimmunised, employees are excluded from the centre at the direction of Public Health this period of exclusion will be without pay. The employer will invoke the stand-down provisions of the Fair Work Act 2009, Part 3-5 Section 524 (3) which states; “An employer may, under this subsection, stand down an employee during a period in which the employee cannot usefully be employed because of one of the following circumstances:..... c) A stoppage of work for any cause for which the employer cannot reasonably be held responsible.”6 Personal leave is only to be used if the employee is sick or injured and unless the employee meets the aforementioned conditions, it cannot be used during a stand-down period. The employer may approve the use of annual or long service leave accrual if available. Staff will be responsible for cost of all immunizations, and other associated medical expenses. Services should check the Immunise Australia Program website (immunise.health.gov.au) and the relevant state or territory health department’s website on a regular basis (e.g. once a year) for any changes to the immunisation schedule. COMMUNICATION AND CONSULTATION Educators and Families will have access to this policy at all times. Educators and families will be provided with opportunities to be involved in the review of this policy. Families will be advised upon enrolment about the contents of this policy. Educators and other employees will be advised of the content of this policy upon commencement Information will be available to educators and families from recognised authorities RELATED FORMS AND DOCUMENTS 6 Child Enrolment Form Pregnancy and CMV Policy Educator Induction Checklist Educator Immunisation Form Letter for Medical Practitioner relating to staff immunisation Australian Immunisation Program Schedule (note various versions) http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10home Parent Enrolment Letter Template (Health Victoria) https://www2.health.vic.gov.au/about/publications/formsandtemplates/parent-enrolmentletter-template Grace Period Eligibility Assessment Form (Health Victoria) https://www2.health.vic.gov.au/about/publications/formsandtemplates/grace-period-eligibilityassessment-form Fair Work Act 2009, Australian Federal Government as provided by Australian Community Services Employers Association (ACSEA) July 2012 Page 6 of 9 Immunisation Policy VIC V2016.2 SCOPE AND ENFORCEMENT The Failure of any person to comply with this policy in its entirety may lead to; Termination of Child Enrolment Performance Management of an employee which may lead to Termination RECOGNISED AUTHORITIES AND DOCUMENTS WHICH GUIDE POLICY “5th Edition Staying Healthy Preventing Infectious Diseases in Early Childhood Education and Care Services” Australian Government National Health and Medical Research Council 2012 “Guide to the Education and Care Services National Law and the Education and Care Services National Regulations 2011” Australian Children’s Education and Care Quality Authority (June 2014) “Guide to the National Quality Standard”, Australian Children’s Education and Care Quality Authority (Sept 2013) “Child Care Service Handbook 2013-2014”, Australian Government Department of Education “The Australian Immunisation Handbook 10th Edition”, National Health & Medical Research Council Commonwealth of Australia (accessed on-line April 2016) http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10home ) Australian Community Services Employers Association (ACSEA) Immunisation Information provided July 2012 Parent Enrolment Letter Template (Health Victoria) https://www2.health.vic.gov.au/about/publications/formsandtemplates/parent-enrolmentletter-template “Starting Childcare or Kindergarten? Immunisation Information for parents enrolling a child”, Victoria Health (accessed on-line April 2016) https://www2.health.vic.gov.au/about/publications/factsheets/Parent-brochure-startingchildcare-or-kindergarten ) “About the ‘No Jab, No Play’ Law”, Health Victoria (accessed on-line April 2016) https://www2.health.vic.gov.au/about/publications/factsheets/no-jab-no-play-frequentlyasked-questions ) Department of Human Services (accessed on-line April 2016) http://www.humanservices.gov.au/customer/subjects/immunising-yourchildren?gclid=CIDH46qF2skCFViXvQod9cAJEQ ) DATE CREATED: November 2011 REVIEW DETAILS: Review Date Details of Changes July 2012 January 2013 March 2013 Information around stand down provisions when unimmunised employees are required to be excluded from the centre. Inclusion of Refusal of Immunisation letter for Medical Practitioner for staff not immune as per recommendations. Added “letter attached for doctor” under the Related Forms and Document heading This policy has been updated with current information from“5th Edition Staying Healthy Preventing Infectious Diseases in Early Childhood Education and Care Services” Australian Government National Health and Medical Research Council Page 7 of 9 Immunisation Policy VIC V2016.2 January 2014 May 2015 January 2016 April 2016 2012. Review child and staff immunisations annually Inclusion of non-medically immunised children for exclusion in the event of a vaccine-preventable diseases being present. Updated immunisation program schedules available on website Inclusions of potential consequences for educators who refuse reasonable requests for immunisation. These may include: o being restricted to working with children over 12 months old o potentially having to take antibiotics during outbreaks of bacterial diseases that are vaccine preventable, even if the educator is not ill o being excluded from work during outbreaks of vaccine-preventable diseases. No changes made, sources updated where applicable No changes made, sources updated where applicable Updated to include new government policies including “No Jab, No Pay” (Australian Federal Government) and “No Jab, No Play” (Victorian Government) information including relevant grace periods. Further information about suitable records for immunisation proof included. Updated to include new Vaxontime app and sources updated where applicable Page 8 of 9 Immunisation Policy VIC V2016.2 LETTER FOR MEDICAL PRACTIONER RE VACCINATIONS Date: ______________ Dear Medical Practitioner, Our staff member, ________________________, who is employed to work with children at our early education and care service, has decided against immunisation for the following diseases; ___________________________________________________________________________ ___________________________________________________________________________ We are asking her/him to discuss this decision with you, their medical practitioner. We wish to ensure that they are aware of what risk to their health these diseases could pose. Contracting one of these diseases would also mean time off work (perhaps extended) as will exclusion from work for their own protection if there is an outbreak in the service. It is our duty of care to do everything in our power to protect our workers. Having said this, we do also recognise their rights to make their own decisions regarding their own health. We are not qualified to put the medical evidence about all the risks that diseases pose to adult workers and hope that you could do so in an effort to keep them as well protected as possible. Could we also ask you to give us written assurance that you have discussed this with them and what their decision was? Yours sincerely, _________________ Centre Director/Nominated Supervisor Page 9 of 9