School Immunization
Frequently Asked Questions

Requirements

What are the immunization requirements for all grade school students?

• Four doses of tetanus, diphtheria and acellular pertussis (one dose on or after the fourth birthday) *
• Four doses of polio (fourth dose on or after fourth birthday and at least six months after previous dose given) **
• Two doses of measles, mumps, rubella (MMR)
• Three doses of hepatitis B
• Two doses of varicella (chickenpox) or evidence of immunity

What are the seventh grade school immunization requirements?
In addition to all other required grade school immunizations:

• One dose of tetanus, diphtheria, acellular pertussis (Tdap) on the first day of seventh grade
• One dose of meningococcal conjugate vaccine (MCV) on the first day of seventh grade
  

Note: If a child gains entrance to school in any succeeding year, the same immunizations are required on the first day.

What are the 12th grade school immunization requirements?
In addition to all other required grade school immunizations:

• One dose of meningococcal conjugate vaccine (MCV) on the first day of 12th grade. If one dose was given at 16 years of age or older, that shall count as the 12th grade dose.
  

General Immunization Q&A

I have a transfer student who provided proof of their immunizations 10 days after their enrollment. They still need their second dose of MMR. It is now day 30. Do I give them an extra five days?
No, they do not get an extra five days. They had 30 days to show proof of their immunizations and abide by the immunization requirements or provide paperwork for an exemption.

Is serologic evidence of immunity acceptable for mumps, tetanus, diphtheria or polio?
No.

How are homeschooled students counted on the School Immunization Law Report (SILR)?
Homeschooled students should be added to the school total for the grades the student is enrolled in, or if not schooling by grade the age appropriate grade they would be in if attending public school.

Are students attending classes virtually required to meet the same requirements as they are not in a traditional classroom setting?
Yes, all students regardless of classroom setting must meet the immunization requirements or risk exclusion.

First Day of School 

What happens if a child did not receive a required vaccine of a single-dose series on the first day of school?
If a child has not received a vaccine for which only a single dose is required on the first day of attendance for that school year, the child may not be admitted to school.

What happens if a child did not receive all the required vaccines of a multi-dose series on the first day of school?
If a multi-dose vaccine is medically appropriate at the time of school entry, the child has five days to receive the vaccine or risk exclusion. If the required vaccine is not medically appropriate to be given within the first five days of school, a medical certificate is needed within the first five days of school outlining the plan to receive the required vaccine(s).

If a child has not received all the antigens for a multiple-dose vaccine series that were medically appropriate to be given within those first five days of school, what is the next step?
The administrator in charge of the school or the appointed designee shall undertake exclusion measures until the vaccine requirements are met.

What if a parent says that they cannot go to the physician until November to receive the required vaccine(s) due to insurance issues? Is this acceptable?
No. Under the Patient Protection and Affordable Care Act, enacted March 23, 2010, an insurer is required to cover all immunizations recommended by the Advisory Committee on Immunization Practices (ACIP). Immunizations required for school attendance by the department are ACIP-recommended vaccinations. This should not be an issue.

If a student transfers into our school a week after we start, does he/she have five days to comply?
No. If a child, when moving or transferring into a school in this commonwealth (whether from out-of-state or in-state), is unable to provide immunization records immediately upon enrollment into the school, the child's parent or guardian shall have 30 days to provide immunization records to the school to show proof of immunization as set forth in § 23.83, a medical certificate as set forth in subsection (e) or to satisfy the requirements for an exemption as set forth in § 23.84. A child who is unable to provide the necessary records, medical certificate or exemption may be excluded at the end of the 30-day period and in subsequent school years until the requirements of this subchapter are met.

A current 11th grade student who transferred (in grades eight - 11) from an out-of-state school and has not had any dose of MCV will be entering 12th grade.  Does the five-day provisional apply?
No. Since he/she never received the first dose of the series, it is needed on day one for attendance.

Medical Plan 

What is a medical certificate?
It is also called the red and white card or the medical plan; the medical plan/certificate is an official form furnished by the Division of Immunizations in the Department of Health (Department), outlining a plan to complete the required school immunizations. It must be completed and signed by a physician, certified registered nurse practitioner or physician assistant, or by a public health official when the immunization is provided by the Department or a local health department.

Can a parent use the medical plan/certificate when the student needs a dose of a vaccination series and it is medically appropriate during the five-day period and the child does not receive the dose or cannot get an appointment?
No, the child needs to receive vaccine(s) within the five days or risk exclusion. Children may not use the medical plan/certificate to buy them time if the next dose is medically appropriate.

What if a child does not receive the vaccines on the dates as documented in the medical plan/ certificate?
The administrator in charge of the school or the appointed designee shall undertake exclusion measures until the vaccine requirements are met.

What if a child does not receive all the medically appropriate required vaccines at their 5-year-old well-child visit and insurance only pays for one well-child visit/year? Is a "scheduled appointment" for the remaining doses at the next well-child visit acceptable?
No. Under the Patient Protection and Affordable Care Act (ACA) (Pub.L. No. 111-148), enacted March 23, 2010, an insurer is required to cover all immunizations recommended by ACIP. See section 2713(a)(2) of the ACA (42 U.S.C.A. § 300gg-13(a)(2)), regarding coverage of preventative health services. The immunizations required for school attendance by the Department are ACIP-recommended vaccinations.

Exemptions 

Do statements of religious or strong moral or ethical conviction opposing immunizations, which are submitted in writing and signed by the parent, guardian or emancipated student, need to be renewed yearly?
No. A space on the certificate of immunization (green and white card) is provided for this purpose as a one-time statement.  Additionally, a signed letter by the parent can be acceptable and must be retained in their file.

Polio

A fourth-grade student has three doses of polio vaccine; one dose at 2 months of age; one dose at 12 months of age and the last dose at 4 years of age. Does he/she still need a fourth dose of polio vaccine to be compliant or up to date?
No. Per the catch-up schedule of the ACIP of the Centers for Disease Control and Prevention (CDC), a fourth dose is not necessary if the third dose was administered at age 4 years or older and at least six months after the previous dose. The student is considered up-to-date and compliant.

A student received four doses of polio vaccine before age 4. Does he/she still need another dose of polio vaccine to be compliant or up to date?
Yes, per the immunization schedule of the ACIP of the CDC; if four or more doses of polio vaccine are administered before age 4, an additional dose should be administered at age 4 through 6 years or older and at least six months after the previous dose.

I have an 11th grade student whose immunization record indicates the fourth polio was administered two days prior to the fourth birthday. Is this acceptable?
Yes, this would count due to the four-day grace period.

MMR

If a child received his/her first dose of MMR four days prior to the first birthday, does the child need another dose, since it was prior to the first birthday?
No. A vaccine dose administered within the four-day period prior to the minimum age for the vaccination or prior to the end of the minimum interval between doses shall be considered a valid dose of the vaccine for purposes of this spacing. A dose administered greater than four days prior to immunization age or interval for a dose is invalid and shall be repeated. Note: The grace period may not be used with the 28-day minimum interval between two live vaccines.

Do doses of live injectable vaccines from our school immunization requirements (MMR, MMRV and varicella) need to be either given on the same date or separated by 28 days to be valid?
Yes, if those live vaccines are not administered at the same visit, they should be separated by at least four weeks. This interval is intended to reduce or eliminate interference from the vaccine given first on the vaccine given later. If two of those live vaccines are administered at an interval of less than four weeks, then the vaccine given second should be repeated in four weeks.

Chickenpox (Varicella)

Can we accept a written statement from parents that their child had chickenpox or is verification needed from a doctor?
Yes, acceptable varicella (chickenpox) guidance is one of the following:
(a) Varicella vaccine, meaning two properly spaced doses of varicella vaccine, the first dose administered at 12 months of age or older. Varicella vaccine may be administered as a single antigen vaccine or in a combination form.
(b) Evidence of immunity, which may be shown by one of the following:
        (i)  Laboratory evidence of immunity or laboratory confirmation of disease.
       (ii)  A written statement of a history of chickenpox disease from a parent, guardian, physician, certified registered nurse practitioner or physician assistant

A child had one dose of varicella at age 1 and then had chickenpox at age 3. Does the child still need a second dose of varicella to be compliant?
No. Since the child acquired varicella disease, he/she does not need the second dose and would be counted in the "Varicella had Disease Column" when reporting on the School Immunization Law Report (SILR).

Tdap

If a student did not receive the Tdap in seventh grade and is currently in eighth grade, does he or she need to get a dose of Tdap?
Yes. If a student has not received a dose of Tdap and is in seventh or subsequent grades, he or she needs a dose on or before the start of school. This is an example of a single-dose vaccine and is required on the child's first day of attendance for that school year.

If a student received their first dose of Tdap at age 10, is that? It? acceptable?
Yes. The ACIP schedule recommends the Tdap vaccine be given at age 11-12.  This is the ideal and preferred age group for administration of the vaccine.  We understand there are times when a 10-year-old who is up to date with vaccination may receive the Tdap dose.  Therefore, a 10-year-old who is already up-to-date with vaccinations that intentionally receives Tdap due is considered to have received a valid and accepted dose that may be counted as the seventh grade Tdap dose and does not need to have the vaccine repeated at age 11-12.
 

MCV

Will the Serogroup B Vaccine meet the new requirements for the MCV booster?
No, they are two different vaccines. We do not have a requirement for Meningococcal B vaccine.

If MCV was given at age 7, does the child require another dose to attend seventh grade?
Yes, the dose before age 10 is not counted toward the seventh grade dose. It needs to be given by the first day of school.

What if a student fails 12th grade and returns at 19 years of age?
The regulations refer to entry into 12th grade in any school in the commonwealth. There is no reference to age. In addition to the immunizations listed in subsections (b) and (c), one dose of MCV is required for entry into 12th grade at any public, private, parochial or nonpublic school in this commonwealth.

If a senior did not receive MCV, is he/she provisional or excluded?
Senior students should have had one dose in seventh grade; if so, they would need the second dose within five days of 12th grade. If they did not receive one dose of MCV prior to age 16, then they need one dose by the first day of 12th grade.