State School Immunization Requirements and Vaccine ...

1 State School Immunization Requirements and Vaccine Exemption LawsState laws establish vaccination Requirements for School children. These vaccination laws often apply not only to children attending public schools, but also to those attending private, parochial, and other types of State laws also offer exemptions to School vaccination Requirements , including medical, religious, and philosophical exemptions or some combination of these The Centers for Disease Control and Prevention s (CDC s) Public Health Law Program (PHLP), within the Center for State , Tribal, Local, and Territorial Support, has conducted an assessment of State statutes, regulations, and State health department policies (collectively referred to as laws ) regarding School vaccinations. This document is a 2019 update3 of State vaccination laws originally collected in 2015 and updated previously in 2017.

2 This 2019 assessment addresses vaccinations required for grades K-12; it does not include vaccinations required for preschool children only or for higher education. Each section of the menu below provides examples of State laws on School vaccination Requirements or examples of laws about exemptions from those Requirements . The appendices provide data on laws from all fifty states collected in the 2019 assessment. For questions related to this document or to request updates to relevant Immunization laws for your State , please email PHLP at Note that the information contained in this document was collected for research and educational purposes. Please contact your local or State health department for School vaccination Requirements that may apply to your individual circumstances. State Vaccination Requirements in K-12 Schools All states require children to be vaccinated against certain communicable diseases as a condition for School Most State School vaccination laws expressly apply to both public and private Homeschools are expressly covered by School vaccination Requirements in several 1 See, , Colo.

3 Rev. Stat. 25-4-901; Haw. Rev. Stat. 302A-901; Public Health Law 2164; Cent. Code ; Tenn. Comp. R. & Regs. ; Wash. Rev. Code Ann. See, , Ala. Code 16-30-3; Cal. Health & Safety Code 120370; Haw. Rev. Stat. 302A-1156; Neb. Rev. Stat. 79-221; Ohio Rev. Code Ann. (B)(4), (5); W. Va. Code PHLP collected statutes and regulations using a search in the legal database Westlaw on July 8-9, 2019. Policydocuments for the 2019 2020 School year were collected from State websites between January and March See, , Fla. Stat. ; Nev. Rev. Stat. ; Va. Code. Ann. See, , Ala. Code 160-30-4; Mich. Comp. Laws ; Gen. Stat. See, , Minn. Stat. ; Tenn. Code Ann. 49-6-3050; Va. Code Ann. Additional jurisdictionsmay have vaccination Requirements for homeschools; PHLP did not conduct a 50- State assessment on coverage ofhomeschools by State School vaccination 20222 Required Vaccines for Entry into Kindergarten and Later Grades Four common childhood vaccines DTaP, MMR, polio, and varicella are required for children to enroll in kindergarten in almost every Many states require the meningococcal (meningitis) Vaccine for entry into later grades, often at 7th grade.

4 8 Some states require additional vaccines, either for entry into kindergarten or for entry into later grades. Alaska is one of several states that require hepatitis A and hepatitis B vaccines for entry into kindergarten: Before entry in a State public School district or nonpublic School offering pre-elementary education through the 12th grade, or any combination of these grades, a child shall be immunized against (1) diphtheria, tetanus, polio, pertussis, measles, mumps, hepatitis A, hepatitis B, and rubella, except rubella is not required in children 12 years of age or older; and (2) beginning July 1, 2009, varicella. 9 For entry into later grades, Rhode Island requires the human papillomavirus (HPV) Vaccine , according to the following schedule: Beginning August 1, 2015, all students entering seventh (7th) grade shall be required to have at least one (1) dose of the HPV Vaccine series.

5 Beginning August 1, 2016, all students entering eighth (8th) grade shall be required to have at least two (2) doses of the HPV Vaccine series. Beginning August 1, 2017, all students entering ninth (9th) grade shall be required to have completed the HPV Vaccine series (3 doses). 10 Acceptable Proof of Immunization State laws vary on the types of acceptable proof of Immunization for enrollment in grades K-12. Among the different types of acceptable documentation are medical records, a health department or School form, information from the State s Immunization Information System (IIS), or a certificate of Immunization , which may be issued by, for example, a State health department or a physician s In a few states, a parental report is Kentucky requires a current Commonwealth of Kentucky Certificate of Immunization , which shall be issued by: (a) A physician licensed in any State ; (b) An advanced practice registered nurse licensed in any State ; (c) A physician assistant licensed in Kentucky; (d) A pharmacist licensed in Kentucky; (e) A local health department in Kentucky; (f) A licensed healthcare facility administering immunizations in Kentucky; or (g) An authorized user of the Kentucky Immunization Registry.

6 13 Minnesota allows for substitution of a parental report in place of other records: A person who is enrolling or enrolled in an elementary or secondary School .. may substitute a statement from .. a parent or guardian if the person is a minor child in lieu of the statement from a physician or public clinic which provides immunizations. If the statement is from a parent or guardian or emancipated person, the statement must indicate the month and year of each Immunization 7 See, , Ark. Code R. ; 6 Colo. Code. Regs 1009-2; Ga. Comp. R. & Regs. ; Md. Code Regs. DTaP protects against diphtheria, tetanus, and pertussis (whooping cough); MMR protects against measles, mumps, and rubella. The only State that does not require all the listed vaccines is Iowa, which does not require a mumps Vaccine . Iowa Code 8 , Del. Admin. Code 804; 05-071-26 Me. Code R. 5; 216 Code R.

7 9 Alaska Admin. Code tit 4, (a)(1). 10 216 Code R. 11 See, , Alaska Admin. Code tit. 4, ; Ark. Admin. Code ; 902 Ky. Admin. Regs 2:060; Code Ann. Regs. R. 61-8; Vt. Admin. Code 12-5-5 12 See, , Minn. Stat. ( ); Or. Rev. Stat. (1)(a). 13 902 Ky. Admin. Regs 2:060. 14 Minn. Stat. ( ). 3 See APPENDIX A, Tables A1 and A2, for State data on Vaccine Requirements and acceptable proof of vaccination. State Laws Regarding School Vaccination Exemptions State laws also establish exemptions for School vaccination Requirements , including Requirements regarding the exemption application process. The graph below and this document explore several attributes of State laws on School vaccination exemptions. These include whether a State : 1. Permits medical exemptions only 2. Permits medical and religious exemptions 3. Permits medical, religious, and philosophical exemptions 4.

8 Requires parental acknowledgment during the exemption application process that exempted students can be excluded from School during outbreaks 5. Establishes that exemptions might not be recognized in the event of an outbreak 6. Requires notarization of documents in the exemption application process 7. Requires parental education on vaccinations in the exemption application process 8. Addresses the duration of medical exemptions ( , temporary or permanent) Types of School Vaccination Exemptions There are three principal types of exemptions from School vaccination Requirements : medical, religious, and philosophical15 exemptions. All states offer medical exemptions but there is variation among the 15 Philosophical exemptions are based on personal or moral grounds, rather than strictly religious beliefs. 4 states on the types of non-medical exemptions offered. In addition, most states allow students to be exempt from only certain vaccination Requirements ; often the State will require the physician or parent to specify which vaccines are to be considered in the exemption process.

9 16 On occasion, a State will prohibit non-medical exemptions from specific vaccines. 17 California allows only medical exemptions: If the parent or guardian files with the governing authority a written statement by a licensed physician to the effect that 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 medical history, for which the physician does not recommend Immunization , that child shall be exempt from the Requirements of Chapter 1 .. to the extent indicated by the physician s statement. 18 North Dakota, which allows medical and religious exemptions, requires the physician or parent to specify the vaccines: A child with a medical or a beliefs exemption is exempt from any one or all of the Immunization Requirements .

10 A physician must sign an exemption form indicating the vaccines that are included in the medical exemption. A parent or guardian must sign an exemption form stating that the child has a beliefs exemption and indicate which vaccines are exempt because of beliefs. 19 Washington State allows medical, religious, and philosophical exemptions, but it does not allow philosophical exemptions for the MMR Vaccine . A child will be exempt from the State s School vaccination Requirements for philosophical reasons upon the presentation of .. [a] written certification signed by any parent or legal guardian of the child or any adult in loco parentis to the child that the signator has either a philosophical or personal objection to the Immunization of the child. A philosophical or personal objection may not be used to exempt a child from the measles, mumps, and rubella Vaccine . 20 Parental Acknowledgement of Exclusion from School During an Outbreak State laws often require parental acknowledgment during the exemption application process that exempted students can be excluded from School during an outbreak or Under Arkansas law, exemption applications require parents to sign a statement of understanding that [a]t the discretion of the Department of Health, the unimmunized child or individual may be removed from day care or School during an outbreak if the child or individual is not fully vaccinated .