Greetings,
Since 1979, Washington State has welcomed refugees who flee persecution in their home country to rebuild their lives in our local communities. Over the past 10 years, more than 30,000 refugees from over 70 countries have resettled in Washington state through the U.S. Refugee Admissions Program. This includes more than 6,500 Ukrainians who have resettled in our local communities since 2010. We have not yet received information regarding the number of refugee arrivals that are expected to come to Washington.
The federal government has shared current pathways and programs to support displaced Ukrainians, including Temporary Protected Status, Asylum, the US Refugee Admissions Program, Humanitarian Parole, and others. More information is available here. Ukrainians may arrive in local communities with differing immigration statuses and due to this, will be eligible for different benefits and services. If possible, schools should ensure newly arriving children are connected to a local primary care provider. Note, children are potentially eligible for Apple Health. ParentHelp123 can assist families with health insurance connection and can be reached by phone at 1-800-322-2588 or online at http://www.parenthelp123.org/benefit-finder/ Language assistance is available. Clinics in the Vaccines For Children (VFC) program provide childhood vaccines to all persons through age 18 at no cost in the state of Washington, regardless of insurance or immigration status. Clinics can charge an administration fee but they must waive it if asked because of inability to pay. Clinics providing VFC vaccine can be found on this vaccine map: https://fortress.wa.gov/doh/vaccinemap.
Children arriving from Ukraine may have limited access to copies of medical records, including immunization information. Clinicians should review all available vaccine records, perform any testing, and update or revaccinate, as appropriate. Written records of vaccine doses administered outside the United States should be accepted as valid, if the schedule for ages and intervals is compatible with ACIP recommendations. Checking for laboratory evidence of immunity (i.e., antibody levels) is an acceptable alternative to vaccination for some diseases, when previous vaccinations or disease exposure are likely. CDC/ACIP General Best Practice Guidelines: Persons Vaccinated Outside the United States and Unknown or Uncertain Vaccination Status.
There is no language in the school immunization law related to immigration status. In some cases, newly arriving students may be eligible for services under the McKinney-Vento Homeless Assistance Act. See the section on homeless students in the Requirements for Special Situations section of the Immunization Manual for Schools, Preschools, and Child Care Facilities (PDF). It’s DOH’s suggestion that school districts work with parents and providers to get students into compliance with the CDC immunization catch-up schedule as soon as possible. The Individual Vaccine Requirements Summary (IVRS) document is a good reference for the vaccine schedule rules, exceptions to the rules and the catch-up schedules. We update it every school year. You can find the IVRS in the Immunization Requirements section of the School and Child Care Immunization page www.doh.wa.gov/SCCI. The school immunization requirements can be met with positive antibody titers for Diphtheria, Tetanus, Hepatitis B, Measles, Mumps and Rubella. Antibody titers to type 2 poliovirus are no longer available so documenting immunity to polio by titer is no longer an option. There is no acceptable titer for Pertussis.
Additional Resources
- Immunization Action Coalition – Ask the Experts: Documenting Vaccination
- Immunization Action Coalition – Quick Chart of Vaccine Preventable Disease Terms in Multiple Languages
- CDC Pink Book – Appendix B
- Immunization Action Coalition – Vaccine Manufacturers: Contact and Product Information
- CDC – Guidance for Evaluating and Updating Immunizations during the Domestic Medical Examination for Newly Arrived Refugees
Ask the Experts: Vaccine Recommendations (immunize.org)
| Is it standard practice to revaccinate a child who is adopted from another country? |
| No. According to ACIP, vaccines administered outside the U.S. generally can be accepted as valid if the schedule (i.e., minimum ages and intervals) is similar to that recommended in the U.S. However, with the exception of the influenza and pneumococcal polysaccharide vaccines, only written documentation should be accepted as evidence of previous vaccination. In general, if records cannot be located or will definitely not be available anywhere because of the patient’s circumstances, children without adequate documentation should be considered susceptible and should be started on the age-appropriate vaccination schedule. Serologic testing for immunity is an alternative to vaccination for certain antigens. More information is available in the ACIP General Best Practice Guidelines for on Immunization, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/special-situations.html. |
Ask the Experts: Documenting Vaccination (immunize.org)
| We frequently see patients, such as immigrants, who do not have records of past vaccination or who insist they or their children are up to date. Should we accept their undocumented vaccination history? |
| Vaccination providers frequently encounter people who do not have adequate documentation of vaccinations. Providers should only accept written, dated records as evidence of vaccination. With the exception of influenza and pneumococcal polysaccharide vaccines, self-reported doses of vaccine without written documentation should not be accepted. An attempt to locate missing records should be made whenever possible by contacting previous healthcare providers, reviewing state or local immunization information systems, and searching for a personally held record. However, if records cannot be located or will definitely not be available anywhere because of the patient’s circumstances, people without adequate documentation should be considered susceptible and should be started on the age-appropriate vaccination schedule. Serologic testing for immunity is an alternative to vaccination for certain antigens (e.g., measles, rubella, or hepatitis A). |
| In general, although it is not ideal, receiving extra doses of vaccine poses no medical problem. Receiving excessive doses of tetanus toxoid (DTaP, DT, Tdap, or Td) can increase the risk of a local adverse reaction, however. For details, consult the ACIP’s Best Practice Guidelines for Immunization chapter titled Timing and Spacing of Immunobiologics, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html. |
| We sometimes encounter patients with foreign vaccination records. We suspect that some of these records are not valid. What should we do? |
| If a provider suspects an invalid vaccination, including those from persons vaccinated outside the U.S., one of two approaches can be taken. Repeating the vaccinations is an acceptable option. Doing so is generally safe and avoids the need to obtain and interpret serologic tests. If avoiding unnecessary injections is desired, judicious use of serologic testing might be helpful in determining which immunizations are needed. This may be particularly helpful in determining tetanus and diphtheria antitoxin levels for children whose records indicate 3 or more doses of DTP or DTaP. This issue is discussed in detail in the ACIP’s General Best Practice Guidelines for Immunization chapter titled Special Situations, and summarized in Table 9-1, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/special-situations.html. |
| Where can I find names of vaccines used outside the U.S.? |
| Appendix B of the CDC publication Epidemiology and Prevention of Vaccine-Preventable Diseases (“The Pink Book”) contains a list of vaccines used outside the U.S. You’ll find Appendix B at www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/foreign-products-tables.pdf. |
Additional questions can be directed to oischools@doh.wa.gov.
Thank you for all you do to keep our children healthy!
Jasmine and Katherine
Jasmine Matheson, MPH
(she/her/hers)
Refugee Health Coordinator
Refugee and Immigrant Health Program
Washington State Department of Health
360-490-7300 | www.doh.wa.gov/refugeehealth
Katherine Graff BSN, RN
School and Child Care Immunization Nurse Consultant
Office of Immunization
Prevention and Community Health
Washington State Department of Health
360 236-2563 | www.doh.wa.gov/SCCI
