Immunisation Guidelines for Early Childhood Services and Primary Schools – English version - HE1106

Immunisation
The childhood immunisation programme
Health (Immunisation) Regulations 1995
Responsibilities under the regulations
The Immunisation Certificate
School immunisation registers
Completing school immunisation registers
The Aotearoa Immunisation Register
Outbreak control
Privacy
Responsibilities

Early childhood services and primary schools have an important role in protecting the health and wellbeing of the children in their care. Diseases can spread easily when a large number of children are spending time in close proximity, for example, when they are at an early childhood service or school. Immunisation is a proven way of preventing diseases from spreading.

This booklet explains the requirements that the Health (Immunisation) Regulations 1995 place on staff and boards of trustees of early childhood services and primary schools.

Immunisation

Te Manatū Hauora (Ministry of Health) and Te Whatu Ora (Health New Zealand) encourages parents and guardians to make sure their children have completed their immunisations on time, particularly before they start at an early childhood service or school. Completing the full course of immunisations provides the best possible protection against diseases such as whooping cough and measles, both for children, whānau and the wider community and the people in contact with them. While nearly all children receive some level of immunisation, some delay or do not complete all their recommended immunisations. In December 2022, 89% of 12 month old children were fully immunised for their age but only 82% of 5 year old children had received all their immunisations. This leaves early childhood services and schools vulnerable to outbreaks of vaccine-preventable disease.

The childhood immunisation programme

Immunisation is free and available to protect children from these serious diseases.

• Rotavirus (for babies under 25 weeks of age)
• Diphtheria
• Pertussis (whooping cough)
• Tetanus
• Hepatitis B
• Hib (Haemophilus influenzae type b, which was the most common cause of meningitis before the Hib vaccine became available)
• Polio
• Pneumococcal disease
• Meningococcal B disease
• Measles
• Mumps
• Rubella
• Human papillomavirus (HPV)
• Chickenpox (varicella)

The early childhood immunisations are given at 6 weeks, 3 months, 5 months, 12 months, 15 months and 4 years of age, before the child starts school. It is important that children complete their immunisation course to get full protection. Other immunisations are given to children in school years 7 and 8 either at the school, at their general practice or other immunisation service.

More detailed information on immunisation, including the risks associated with the diseases compared with the risks associated with immunisation, is available in the Childhood Immunisation booklet (code HE1323) available from the HealthEd website.

Health (Immunisation) Regulations 1995

These regulations require all early childhood services and primary schools to keep an immunisation register of children attending, born from 1 January 1995. The register can help reduce the spread of vaccine-preventable diseases in early childhood services or primary schools as well as the wider community, by providing an ongoing record of who has been immunised for what and when. It also encourages completion of the immunisations where parents or guardians may need a reminder to catch up with their children’s immunisations

Responsibilities under the regulations

The regulations cover all early childhood services and primary schools, including independent schools and kura kaupapa Māori. Early childhood services and schools must keep an immunisation register, where they copy the information from a child’s Immunisation Certificate. Only information from the certificate can be recorded on the register, and exactly as shown on the certificate. If parents or guardians have not provided a child’s certificate, then this should be recorded on the register.

Early childhood services or primary schools can ask a child’s parents or guardians to contact their family doctor or vaccinator to have the child’s immunisations brought up to date and/or a certificate completed.

Having records up to date means that public health services can act quickly to support the educational facility to identify those at risk if a contact with a disease (eg measles) is reported to have attended the facility while contagious. It is also recommended that facilities encourage staff to ensure they are up to date with their vaccinations.

The Immunisation Certificate

The Immunisation Certificate shows which, if any, of the diseases a child has been immunised against and if they have been fully immunised.

The Immunisation Certificate must be completed and signed by the child’s family doctor, nurse or vaccinator. The Immunisation Certificate is completed when the child is 15 months of age and again after they have been immunised at 4 years of age, before the child starts school.

The Immunisation Certificate is the only source of information that can be used when entering the child’s immunisation status on the school’s immunisation register.

The Immunisation Certificate can be found in the Well Child Tamariki Ora My Health Book that every parent or guardian receives at the birth of every child. If the book is lost, parents and guardians can get another book or separate certificate from their family doctor, nurse or vaccinator. A book and/or certificate can be obtained at any time for a child, including for those born overseas.

School immunisation registers

School immunisation registers provide information about the immunisation status (ie, what diseases a child has been immunised against) of each child enrolled at early childhood services or primary schools.

Early childhood services or primary schools are responsible for:

• maintaining an up-to-date immunisation register
• ensuring that the parents or guardians of a child are asked to provide the Immunisation Certificate for each child attending their service or school
• recording the information from the Immunisation Certificate (or the fact that it was not shown) on the school immunisation register.

Completing the school immunisation register

Supplies of the recommended immunisation register forms (code HE1111 or HE1112) are available from HealthEd.

Early childhood services and schools may choose to develop their own immunisation register. However, the same information must be recorded in a form that can be quickly found and read.

The service or school can use enrolment software as an immunisation register, when the software has been suitably modified to include all the required information.

If an early childhood service or school uses their own immunisation register system, the information should be transferred when a child moves to another early childhood service or school. The early childhood service or school can remove any names of children from their immunisation register once the child has left their service or school.

The Aotearoa Immunisation Register

All children born in New Zealand are enrolled at birth on the National Immunisation Register (NIR).

The NIR provides a record of a child’s immunisations. This does not affect the requirement to keep a school immunisation register. For further information on the NIR, talk to your public health service or see National Immunisation Register – Te Whatu Ora - Health New Zealand

From 2023 the Aotearoa Immunisation Register (AIR) will be phased in to replace the NIR. For further information, see the Te Whatu Ora website at The Aotearoa Immunisation Register (AIR) – Te Whatu Ora - Health New Zealand

Outbreak control

If a child in an early childhood service or primary school develops a vaccine-preventable disease (except tetanus and hepatitis B), then all other children who have not been immunised against that disease may be at risk. In case of an outbreak of one of these diseases, (eg, measles or whooping cough), early childhood services or primary school principals and the Medical Officer of Health have the authority to require that the child with the illness remain at home to prevent the spread of infection*.

Doctors are required to notify their local Medical Officer of Health if they suspect that a person has a notifiable disease, which includes most of the immunisation schedule diseases. The Medical Officer of Health, or their representative, can look at the early childhood service or school immunisation register to identify children who are not immunised or do not have an Immunisation Certificate. The Medical Officer of Health will then contact the parents or guardians of these children, and offer immunisation to protect the children and prevent the spread of infection.

Unimmunised children exposed to measles, diphtheria and whooping cough under certain circumstances are required by regulation to be excluded from an early childhood service or school. When the Medical Officer of Health has identified those who should stay at home, it then becomes the responsibility of parents and the school Principal or early childhood service to comply with the instructions.

Privacy

Early childhood services and primary schools are required to maintain confidentiality of information recorded on the school immunisation register.

Parents or guardians have the right to view information on the register that relates only to their own children. The information must remain confidential to the parents or guardians of each child. Information for a particular child should be copied and given to the parents or guardians, or it can be shown while covering the information of other children, so that the other information remains confidential.

Who is allowed to look at the school immunisation register?

• Only the Medical Officer of Health, or an authorised representative, may view the information on the school immunisation register without parental consent.
• The Education Review Office (ERO) may check to ensure that the format of the school immunisation register complies with the regulations.
• Parents or guardians are allowed to view their own children’s records only.

Responsibilities

There are no penalties imposed on parents or guardians who choose not to immunise their children. The regulations cannot be used to prevent a child being enrolled at an early childhood service or school.

An early childhood service or primary school’s compliance with the regulations (ie, keeping an immunisation register for all eligible children in an appropriate format) will be included in the ERO general audit of that service or school. The ERO may comment on an early childhood service or school’s compliance.

What happens if an early childhood service or primary school does not record information on the immunisation register?

When information is not recorded on the immunisation register, it makes it harder to identify children who may be unprotected and at risk of vaccine-preventable disease.

Non-compliance with the Health (Immunisation) Regulations 1995 may be recorded during the ERO accountability review.

If every child in a school of 500 children had not been immunised and there were an outbreak of measles:

• nearly every child would come down with measles
• 20 children would get pneumonia
• there is a 25% chance that one child in the school would develop encephalitis (inflammation of the brain) as the result of measles.

If every child in the school were immunised correctly with MMR vaccine, on average, there would be one case of encephalitis caused by the immunisation every 2000 years.

[Source: Department of Health and Ageing Publications. 2012 Understanding Childhood Immunisation: Immunise Australia program. Canberra: Department of Health and Ageing Publications.]

For more information about immunisation

• Order copies of Childhood Immunisation (code HE1323) and other resources from HealthEd
• Speak to your local public health service
• Visit the Te Whatu Ora childhood immunisation webpage at Immunise | Te Whatu Ora
• Call Healthline 24/7 on 0800 611 116

ISBN 978-0-478-41143-0 (print). ISBN 978-0-478-41144-7 (online).