Georgia Requirements for School and Childcare Attendance

Presentation to:

Presented by:

Date:

Conflicts of Interest and Disclosures• Neither the planners or presenters indicated that they have any

real or perceived vested interest that relate to this presentation nor any relationships with pharmaceutical companies, biomedical device manufacturers, and/or other corporations whose products and services are related to the vaccines we discuss.

• There is no sponsorship or commercial support being received for this activity.

• The mention of specific brands of vaccines in this presentation is for the purpose of providing education and does not constitute endorsement by the provider or ANCC of any commercial products.

• Off Label Use- For certain vaccines a slight departure from or

off-label use of the vaccine package insert guidelines may be discussed during presentation.

Notice of Requirements for successful completion

• To obtain nursing contact hours for this session, you must be present for the entire presentation and complete and submit an evaluation.

• Contact hours for this session will be available from 02/1/2012 until 02/01/2014 only for those who successfully complete this educational activity.

Objectives• Identify vaccine preventable diseases and how

vaccines impact morbidity rates for these preventable diseases in GA

• Recall GA immunization law, DPH rules and regulations for GA immunization certificates and provider, school facilities and parent responsibility to enforce the law

• Describe standards for issuing and filing certificates of immunizations

• Identify valid and invalid GA immunization certificates and how to use filing tickler system

Objectives continued….

• Describe the public health audit process and the responsibilities of school and child care facilities

• Identify common errors seen on GA Immunization certificates

Topics

• Review of childhood vaccine preventable diseases

• Georgia immunization requirements for preschool, child care, and school attendance

• Review policy guide for completing form 3231

• How to monitor, follow up and enforce the requirements for the certificates of attendance

• Resources

Diphtheria• Spread by direct contact

• Incidence in United States has decreased

• Still occurs in other countries

• Disease can be prevented by vaccine

• Vaccine given in combination with tetanus and pertussis (DTaP, DT, Tdap,or Td)

• Required for school and child care attendance

Tetanus• Tetanus germ lives in dirt

and the intestines and feces of animals

• Germ enters the body through cuts, punctures, burns, and other wounds

• Disease can be prevented by vaccine

• Vaccine given in combination with diphtheria and pertussis (DTaP, DT, Tdap, or Td)

• Vaccine needs to be given periodically throughout lifetime

• Required for school and child care attendance

Pertussis

• Pertussis germ lives in mouth, nose, and throat of infected person

• Spread by coughing and sneezing

• Disease can be prevented by vaccine

• Vaccine given in combination with diphtheria and tetanus (DTaP or Tdap)

• Required for school and child care attendance

Hospital Respiratory Ward, 1952

Polio

• Incidence decreasing• Viral infection spread

through direct contact • Disease can be prevented

by vaccine• Vaccinate children up to

age 18 and also some international travelers

• In Georgia, immunization against polio is required for child care and school attendance

Measles

• Viral infection• Spread by coughing,

sneezing, or talking • Disease can be

prevented by vaccine• Vaccine given in

combination with mumps and rubella vaccines (MMR or MMRV)

• Required for school and child care attendance

Mumps

• Viral infection• Spread by coughing,

sneezing, or talking • Disease can be prevented

by vaccine• Vaccine given in

combination with measles and rubella vaccines (MMR or MMRV)

• Proof of immunity or 2 doses of vaccine required for entrance to school after 7-1-07

Rubella• Viral infection• Spread by coughing,

sneezing, or talking • Harmful to unborn infants• Disease can be prevented by

vaccine• Vaccine given in

combination with measles and mumps vaccines (MMR or MMRV)

• In Georgia, immunizations against measles, mumps, and rubella are required for child care attendance and school entrance

Haemophilus influenzae type b (Hib)

• Hib germ enters the body through nose and throat

• Spread by direct contact• Hib vaccine responsible

for dramatic decrease in incidence of disease

• Vaccine given to infants and children under age 5

• Immunization required for child care attendance (includes 4 year Pre-K)

Hepatitis A• Viral infection which attacks

the liver

• Fecal-oral route of infection

• Symptoms may include nausea, anorexia, fever, dark urine, and jaundice of skin and eyes.

Symptoms uncommon in children, but can infect others

• As of 7-1-07, required for children born on or after 1-1-06 for school and childcare attendance

Hepatitis B

• Viral disease which attacks the liver

• Spread by contact with infected body fluids or blood

• Person may have disease and not have symptoms

• Disease can be prevented by using universal precautions and by vaccine

• Vaccine recommended for all infants and children and some adults

• Immunization is required for child care attendance and entry to school

Varicella/chickenpox• Spread through coughing,

sneezing, or contact with infected sores

• Can be severe, especially in teens and adults

• Can be prevented by a vaccine

• Vaccine recommended for all persons over one year of age who have not had the disease

• Vaccine or proof of immunity is required • For child care attendance (1

dose)• Entry to school (2 doses)• Entry to 6th grade (2 doses)

Pneumococcal Disease• Caused by Streptococcus

pneumoniae bacterium

• Droplet spread from person to person

• Invasive pneumococcal disease can result in pneumonia, bacteremia, or meningitis

• Pneumococcal disease kills more people in the United States each year than all other vaccine-preventable diseases combined

• As of 7-1-07 PCV13 vaccine is a requirement for all children under 5 years of age who attend child care facilities

20th Century Peak & Current Morbidity for VPDs

Prevaccine (in peak year)

2011 % Reduction of Cases

Diphtheria 30, 508 0 100

Measles 763,094 222 99.9

Mumps 212,932 404 99.8

Pertussis 265,269 18,719 92.9

Paralytic polio 63,302 0 100

Rubella 488,796 4 99.9

Tetanus 601 36 94.0

Hib, type b(age < 5 yrs)

20,000 (yearly average in 1980’s)

4, plus 226 of unknown type

>99.8

MMWR (Weekly), August 17, 2012, 61(32); 624-637

Low Rates of Childhood Vaccine Preventable Diseases

• Vaccines work Goal of 100% compliance level*

• Immunization Laws work

• Partnerships work

*http://health.state.ga.us/pdfs/prevention/immunization/Georgia%20Immunization%20Program%20Manual%20Complete%20Oct%202012.pdf

Georgia Requirements• Georgia law requires that all children attending a facility or school

must be immunized according to the rules and regulations established by the Department of Public Health (DPH)

• “Facility” is defined as any public or private child care center or nursery intended for the care, supervision, or instruction of children

• “School” is defined as any public or private educational program or institution instructing children at any level or levels, kindergarten through twelfth grade

• “New entrant” means any child entering any school or facility in GA for the 1st time or entering after having been absent from a GA school or facility for >12 mos. or 1 school year.

DPH Rules and Regulations

• Provide definition of terms• Stipulate the specific requirements

– List required vaccines or – Acceptable proof of immunity – Define medical and religious

exemptions

• Provide directions for issuing, maintaining, and inspecting certificates

Responsibilities Associated withImmunization Requirements

• Physicians and Public Health Clinics:– Know current legal requirements for attendance and accurately

completing the certificate

– Administering immunizations according to the current Recommended Childhood and Adolescent Immunization Schedule

– Report the occurrence of any disease listed on the “Notifiable Disease List”

– Report any adverse event following the administration of a vaccine to VAERS

• Child Care and School :– Review the certificates for validity prior to accepting

– Develop a system for immunization certificate management/Tickler system

– Have certificates available for inspection and audit by health officials

– Report the occurrence of any disease listed on the “Notifiable Disease List”

Responsibilities of Parents or Caregivers

• Take child to health care provider well check ups and immunizations at the recommended times

• Review all vaccine facts that they receive before their child is immunized

• Discuss any questions or concerns about vaccines with the child’s doctor or nurse

• Keep child’s personal immunization record and take it with them on each visit to the health care provider to be assessed and updated

• Mark the child’s vaccination due date and stay on schedule• Obtain appropriate certificate for child care and school attendance

from health care provider• Give a copy of the certificate to each facility the child attends

Vaccine Requirements• Consistent with the Recommended Childhood and Adolescent

Immunization Schedule• Children are required to be age appropriately immunized against each of

these diseases:

Hepatitis B Polio

Diphtheria Measles

Tetanus Mumps*

Pertussis Rubella

Haemophilus Influenzae type b Hepatitis A

Varicella (chicken pox)* Pneumococcal disease

• AS OF 7-1-07 *2 doses Mumps PCV13 if <5 yrs. old

*2 doses Varicella Hep A if born after 1-1-06

School Vaccine Requirements

• A “new entrant” enrolling in a Georgia school at any grade or level, must be age appropriately immunized with all the required vaccines.

• The number of doses for each vaccine depends on the child’s age at the time of school entry*

• Once enrolled and a “Complete for School” certificate is on file, further immunizations may be recommended but are not required.– Exception: Recheck measles, mumps, varicella immunity

status at entry to 6th grade

Child Care Vaccine Requirements• The number of doses for each required

vaccine depends on the child’s age at the time of child care attendance.– If under 4 years of age, child will always need

more doses and Certificate of Immunization should have a current “Expiration Date” indicated.

– If 4 years or older, and has met all requirements, and has

a Certificate of Immunization marked as “Complete for School,” child is considered adequate for both school and child care.

2013 Immunization Schedules

Children • 0-18 years• Catch-Up schedule for children

4 months -18 years

Be sure to review the “Notes” section – many changes

REQUIRED

RECOMMENDED

Form 3231 as of 8-1-12

Policy Guide 3231 REQ

Policy Guide 3231 REQ

Standards for Issuing and Filing Certificates of Immunization

(Policy Guide 3231 INS and 3231 REQ)• Who is required to have a certificate• Who may issue certificates• How certificates are to be reviewed, filed and

maintained• How health care providers are to complete the

certificates• What exemptions are acceptable• How health care providers may order certificates• Required doses for each of the vaccines

Certificate of Immunization (Form 3231)

• A child must have a certificate on file at each facility or school he attends

• Photocopies of appropriately completed and signed certificates are acceptable

• If a certificate is not on file for each child attending, the facility is held legally responsible

• A licensed Georgia physician, APRN, PA or public health official is responsible for the interpretation of and compliance with the requirements for vaccines and completing the certificate

• Only physician offices and health clinics can obtain blank certificates

Policy Guide 3231 INS

Age of Child “Marks the Spot”• If child is under four years of age, a certificate:

– Must be marked with a “Date of Expiration”– Must have vaccine administration dates, year of

diagnosis, positive serology, disease history, or medical exemption

• If child is over four years of age, a certificate must be completed with:– Vaccine administration dates, and /or year of

disease diagnosis, positive serology, disease history, or medical exemption; and

– A “Date of Expiration”; or– A mark in the “Complete for School Attendance”

box

Certificate Expiration Date• Expires on the date entered as “Expiration Date”• Must be replaced with a current certificate within 30 days

after the expiration date, or child is excluded from attending

• Allows for a child who does not meet all the immunization requirements to attend child care or school while he is catching up

• Required for all children under four years of age• Required if a medical exemption for a vaccine(s) is marked• Should not be completed if “Complete for School” is

marked

Certificates Marked “Complete for School Attendance”

• Do not expire• May be issued only to children who:

– Are four years of age or older; and– Have met all the requirements for school

attendance as outlined in the Policy Guide 3231REQ; and

– Have all the required vaccine administration dates or natural immunity dates filled in; and

– Do not have a “Date of Expiration” completed

Immunity and Medical Exemptions

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Exemptions• Medical:

– Should be used only when there is a physical disability or condition that contraindicates immunization for that specific vaccine

– Should be documented in the medical exemption box indicated for each vaccine

– Should be reviewed annually

Exemptions• Religious:

– Not documented on the certificate– No special certificate available or needed– Documented by a notarized affidavit stating

that immunization conflicts with the parent/guardian’s religious belief

– Notarized statement should be kept on file by the school or facility in lieu of a Certificate of Immunization

– Do not expire

Evidence of Varicella Immunity• Documentation of age-appropriate vaccination:

– Preschool-aged children > 12 months: 1 dose– School-aged children, adolescents and adults: 2 doses

• Laboratory evidence of immunity or laboratory confirmation of disease• Born in US before 1980• A healthcare provider diagnosis or verification of varicella or

healthcare provider verification of history of varicella disease. For mild or atypical case:– Assessment by physician is recommended to determine:

• Epidemiological link to typical case• Laboratory evidence of immunity if titer done at time of disease

• History of herpes zoster based on healthcare provider diagnosis

Guidelines for Public Health Clinics Documentation of Varicella Immunity

• Documentation of age-appropriate immunization• Laboratory evidence of immunity • Born in the US before 1980• Licensed healthcare provider diagnosis of disease or

documentation of history of disease– Typical case history

• Recollection of typical symptoms• Documentation made by LICENSED medical personnel

– Mild or atypical case history• Assessment should be made by licensed med. personnel

– Epidemiology link to a typical case or lab-confirmed atypical case

• History of shingles based on healthcare provider diagnosis

6th Grade Requirement

• Proof of Measles, Mumps, and Varicella Immunity required for all students entering 6th grade or age equivalent grade

• Supplemental Certificate, Form 3189, no longer needed. Document on Form 3231.

Maintenance of Certificates• To be valid, certificates must be

current– Certificate becomes invalid on

the “Date of Expiration”

– Child must submit a current certificate within 30 days after the expiration date or be excluded from attendance

– Facility or school is responsible for notifying parent/guardian of an upcoming expiration date and requesting a current certificate be submitted

– Any school/facility official who does not enforce the requirements shall be guilty of a misdemeanor

Filing of Certificates• All children enrolled must have a valid Certificate of

Immunization on file

• Certificates must be available for inspection by health officials

• If child attends more than one facility, a photocopy to the second facility is acceptable

• If child leaves or transfers to another school or facility, the certificate should be given to a parent/guardian or sent to the new school/facility

• In the case of religious exemption, a dated notarized statement must be on file

Tickler Filing System• Immunization Guidelines for Child Care Facility

Operators & School Personnel (Form 3258) provides “how to” instructions

• Tickler system is method for filing and maintaining current certificates (set up by month and year)

• Remind parents or care givers

• Give parents information sheet about requirements

• Document follow-up

• Enforce requirements

Public Health Responsibilities

• Auditing child care facilities and schools • Educating all partners regarding

recommended schedule and requirements for attendance

• Providing surveillance and outbreak control of all “notifiable diseases”

Immunization Audits• What is the total number of children enrolled?• How many children have “valid” certificates (up to date)

certificates?– For a child care, how many children have a certificate marked

with a current “Date of Expiration”?– For a child care/ school facility, how many children are marked

as “Complete for School Attendance”?• How many children have certificates with expired “Date of

Expiration”?• How many children have certificates “Complete” but

missing required doses?• For a child care facility or school, how many have been

enrolled less than the allowed waiver time period? • How many children have nothing on file?• How many children have religious exemptions?• How many medical exemptions?

Immunization InventoriesChildcare Facilities

• Prior to 07/01/2007:– Based on rules and regulations in operation at that time

– Educate operators and parents of new requirements

• On or After 07-01-2007:– Base on the revised rules and regulations and

documentation should be on Form 3231 (Revised 8/2012) with following exceptions:

• Children who have certificates that will expire after 7/1/07 are considered to be current until the “Date of Expiration”.

• Children who are enrolled in both school and child care or “after school” programs and have “Complete for School” certificates on file at both facilities, do not need to obtain a revised certificate.

School Immunization Inventories

• On or after 7-1-07:– For children entering kindergarten, 6th grade and all “new

entrants”, base on the revised rules and regulations.

• Documentation should be on Form 3231 (Revised 8/2012) with following exception:– If student has a Form 3231 (revised 03/2007) that is

marked as “Complete for School Attendance” and the new requirements for 2 doses of varicella and mumps vaccines or proof of immunity are appropriately documented.

• Children who have certificates that will expire after 7/1/07 are considered to be current until the “Date of Expiration”.

• Children who are enrolled in both school and child care or “after school” programs and have “Complete for School” certificates on file at both facilities, do not need to obtain a revised certificate.

School Immunization Inventories

• Children currently enrolled in schools, who have a valid certificate on file, – will not be required to meet the new rules and

regulations and– will not be required to obtain the revised

Certificate of Immunization dated 8/2012.

• Exceptions are:– Students entering 6th grade– Students who do not have a certificate on file– Students who leave and return as “New

Entrants”

School & Child Care Requirements

• Some of the new vaccines that are RECOMMENDED for particular age groups, may NOT BE REQUIRED for school or child care attendance.

• Remember, GRITS– Calculates validity based on

recommendations– Prints certificates based on

requirements

New Child Care Requirements(Includes Head Start and 4 year old Pre-k)

• Hepatitis A vaccination if born 1-1-2006 or later or proof of immunity

• Pneumococcal vaccination (If under 5 years of age)

• Documentation should be on Revised Form 3231 (8/2012) with following exceptions:– Children enrolled prior to 7/1/07 who have certificates

with current expiration dates are considered “current” until the “Date of Expiration.”

– Children enrolled in both school and child care or “after school” programs prior to 7/1/07 and have “Complete for School” certificates on file at both facilities.

School Requirements effective 7/1/07

• Children entering kindergarten, sixth grade and new entrants at any grade – Vaccination with 2nd dose of mumps and

varicella vaccines or proof of immunity

• Children enrolled in schools prior to 7/1/07, who have a valid certificate on file – Are not required to meet the new rules and

regulations and– Are not required to obtain the revised

Certificate of Immunization dated 8/2012

Availability of Required Vaccines from GA VFC Program

• All required vaccines are available through the GA VFC Program for VFC eligible children.

• If experiencing varicella vaccine shipping delay:

– Providers should print out new certificate, enter expiration date to allow for receipt of vaccine, initial and document vaccine delay

– Schools/ Facilities should keep tickler file – Providers should keep recall list – Both providers and schools/facilities need to send

reminder notices

Revised Certificates of Immunization (Form 3231)

• Are available from the GA Immunization Program Office

• Can be printed from the GA Registry of Immunization Transactions and Services (GRITS)

• Can be printed from office software systems– If a provider requests permission and receives

approval for the certificate from the Georgia Immunization Program

– If provider is an active participant in GRITS– Certificate must include exact information and have

same appearance as DPH Certificate to be approved

3: Completing both boxes:Should be one or the other

2: Doses Hep B spaced incorrectly

9: No dose DTaP after 4th birthday

5: Varicella Immunity not documented by vaccine or hx/dx/serology date

7: 1st dose MMR given before age 1 yr.

6: 1st dose varicella given before age 1 yr.

4: Address and/or contact information not completed

1: No physician, APRN or PA signature

Top Ten Certificate “Bloopers”

8: No 2nd dose varicella documented

10: “Complete for School” checked for child under age 4

Case #1: Elizabeth• Birth Date: July 1, 2009• Purpose of Visit: Well check up (3/11/11)

and will be

entering child care on 3/12/11; will be attending different day care facilities

• Medical History:Well today; no known allergies or problems with previous vaccines

• Vaccine History: DTaP: 9/1/09

Hep B: 7/01/09, 9/1/09

Hib: 9/1/09

IPV: 9/1/09

Case #1: Elizabeth…. continued• Can a certificate be issued today without

administering any vaccines?– No

• Which tables on the policy guide should be utilized to determine the required vaccines for child care attendance and minimal time intervals for doses if indicated?– Required Doses for Attendance in Facilities and

Schools For Children Who Started Immunization Before Age 7 Years; and

– Minimal Intervals Between Doses• What vaccines if any should routinely be given

today?– #2 DTaP; #2 HIB, #3 Hep B, #2 IPV, #1 MMR, #1

Varicella, #1 PCV13 , and #1 Hep A

Kim and Zach Jones

Elizabeth Jones

10/01/2003

GA Immunization Program#2 Peachtree StreetAtlanta, GA 30303404-657-3158

03/11/11

07/01/09 04/08/11

Penny Conner RN

9/1/093/11/11

7/1/09 9/1/09 3/11/11

9/1/09 3/11/119/1/09 3/11/11

3/11/11

3/11/11

3/11/11

3/11/11

3/11/11

3/11/11

Case #2: Zachary

• Birth Date: January 15, 2007 (age 4 years)• Purpose of Visit: Well check up 3/11/11 and entering Pre-K

8/12/11; will be attending 2 child care facilities• Medical History:Well today; no known allergies or problems with previous vaccines. Parent thinks child had chickenpox in July 2009, no known exposure to a case. Had several blister like sores on arms and legs.• Vaccine History:DTaP: 3/17/07; 5/17/07; 7/20/07; 7/12/08

Hepatitis B: 1/15/07; 3/17/07; 5/17/07Hib: 3/17/07; 5/17/07; 7/20/07IPV: 3/17/07; 5/17/07; 7/12/08MMR: 2/12/08

Case #2: Zachary…continued• Can a certificate be issued today without

administering any vaccines?– No

• Which tables in the policy guide should be utilized to determine the required vaccines for PreK attendance and minimal time intervals for doses if indicated?– Required Doses for Attendance in Facilities and Schools For

Children Who Started Immunization Before Age 7 Years and

– Minimal Intervals Between Doses

• What vaccines if any should routinely be given today?– #5 DTaP; #4 hepatitis B; #4 Hib; #4 IPV; #2 MMR; #1

Varicella, #1 PCV13, and #1 Hep A

Kim and Zach Barnes

Zachary Barnes

GA Immunization Program2 Peachtree St., NW, Ste. 13-476Atlanta, GA 30303404-657-3158

3/11/11Penny Conner, RN

01/15/07 7/01/12

3/17/03 5/17/03 7/20/07 7/12/08 3/11/11

115/073 17 07 51707

3/17/07

2/12/08 3/11/11

3/11/11 3/11/11

5/17/07

3/17/037 5/17/07 7/20/07 3/11/11

3/17/07 5/17/07 7/12/07 3/11/11

3/11/11

Case #3: Carlos• Birth Date: February 2, 2000 (age 11yrs)• Purpose of Visit: Currently enrolled in 5th grade in GA.

Needs certificate to enter 6th grade.• Medical History: Well today; no known allergies. Parent

recalls child had chickenpox in spring 2006. Exposed to children in same kindergarten class. Had several blister like sores all over his body. Out of school for over one week.

• Vaccine History: DTaP: 4/5/00, 6/12/00, 8/4/00, 3/28/01, 4/15/04

OPV: 4/5/00, 6/12/00, 3/28/01

IPV: 4/15/04

MMR: 3/28/01

Hep B: 4/5/00, 6/12/00, 8/14/00

Case #3: Carlos…continued• What vaccines should routinely be administered today for

Carlos to be given a certificate?– # 2 MMR

• How should immunity to varicella be documented?– Enter in date of history of varicella disease (year)

• Are there any other vaccines recommended for Carlos that are not required? If so what?– Yes : MCV4

Hep A

Tdap

HPV

• What form should be used to document Carlos’ immunity to measles and varicella?

• Form 3231, revised 8/12

GA Immunization Program2 Peachtree St., NW, Ste. 13-476Atlanta, GA 30303404-657-3158

Penny Conner, RN 3/11/11

Smith, Carlos

Tom and Ethel Smith2/2/00 X

4/5/00 6/12/00 8/14/00 4/5/00 6/12/00 3/28/01

4/15/04

3/28/01 3/11/113/28/11 3/11/11

3/28/11 3/11/11

2002

3/11/11

3/11/11

3/11/07

4 5 00 6 1200 8 4 00 3 2801 4 15 04

3/11/11

3/11/11

Healthcare Worker Immunization

• HCW immunization is an important safety measure

• Medical facilities providing direct patient care should formulate an immunization policy for their employees.

Recommended for Healthcare Workers

Recommended for HCWs with Other Risk Factors

Hepatitis B Hepatitis A

Flu Pneumococcal

MMR Meningococcal

Varicella

Diphtheria,Tetanus, & Pertussis

Other Considerations for HCW Immunization Plan/Policy

• Immunization/immunity record maintained by the facility on each HCW

• Catch-up programs for current employees and policies for newly-hired workers

• Work restriction policies for susceptible workers after exposure

• Management and control of outbreaks

• Options for refusal of vaccination by employees

Vaccine Adverse Event Reporting System

The Vaccine Adverse Event Reporting System (VAERS) is a national vaccine safety surveillance program co-sponsored by the Centers for Disease Control and Prevention and the Food and Drug Administration.

• What Can Be Reported to VAERS? • Who Reports to VAERS? • Does VAERS Provide General Vaccine

Information?

http://vaers.hhs.gov/ or 1-800-822-7967

National Vaccine Injury Compensation Program (VICP)

• National Vaccine Injury Compensation Program provides compensation to individuals found to be injured by or have died from certain childhood vaccines.– Established in 1988 by NCVIA– Federal “no fault” system to compensate those

injured– Claim must be filed by individual, parent or

guardian– Must show that injury is on “Vaccine Injury Table”

Resources• Local health department

• District Immunization Coordinator• GA Immunization Program Office

– On call Help line: 404-657-3158– GRITS Help Line:1-866-483-2958– VFC Help Line:1-800-848-3868– Website http://health.state.ga.us/programs/immunization– Your local Immunization Program Consultant (IPC)

• GA Chapter of the AAP

• GA Academy of Family Physicians

http://health.state.ga.us/programs/immunization