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School Immunizations

Frequently Asked Questions (FAQs)

 

1. Where can I find the new school regulations?

The school regulations were posted online in the PA Bulletin, March 4, 2017, at: http://www.pabulletin.com/secure/data/vol47/47-9/377.html.

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2. When do the new school regulations become effective?

At the start of the 2017/18 school year.

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3. What are the main changes?

  • Reduced eight-month provisional period to five days
  • Required acknowledgement of the pertussis component of DTaP
  • Clarified four doses of polio
  • Added a dose of MCV for 12th grade entry
  • Created a medical plan/certificate
  • Identified reporting period Dec. 1-31
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4. What are the all grade school immunization requirements?

  • 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 ***
  • Three doses of hepatitis B
  • Two doses of varicella (chickenpox) or evidence of immunity

            *Usually given as DTP or DTaP or DT or Td

            **A fourth dose not necessary if the third dose was administered at age 4 years or older and at least six months after the previous dose

            ***Usually given as MMR

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5. What are the seventh grade school immunization requirements?

  • 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.

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6. What are the 12th grade school immunization requirements?

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.

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7. 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 many not be admitted to school.

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8. 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).

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9. What is a medical certificate?

It is also called the red and white form 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.

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10. 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.

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11. 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.

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12. 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.

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13. 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.

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14. 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. Failure to do so is a violation of the law. The immunizations required for school attendance by the Department are ACIP-recommended vaccinations. Both the health care practitioner and the parents should be aware of the insurance coverage and plan to receive the required vaccinations in accordance with the Department's requirements and their insurance coverage. Delay in obtaining the vaccinations could create problems.

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15. 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.

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16. 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.

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17. 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.

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18. I have an 11th grade student (DOB: 11/22/99) whose immunization record indicates fourth polio on 11/20/03. This is two days prior to the fourth birthday. Is this acceptable?

This would count due to the four-day grace period.

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19. Can we accept a written statement from parents that their child had chickenpox or is verification needed from a doctor?

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

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20. A child had one dose of varicella at age 1 and then had chicken pox 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).

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21. 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.

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22. 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 5 days?

No, they do not get an extra 5 days. They had 30 days to show proof of their immunizations and abide by the immunization requirements or provide paperwork for an exemption.

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23. Is serologic evidence of immunity acceptable for mumps, tetanus, diphtheria or polio?

No.

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24. 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.

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25. 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, eighth, ninth, 10th, 11th or 12th grade, 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.

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26. 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.

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27. 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 in 2017-2018. 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.

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28. I work at a private school that has students up to the age of 21. Typically, our 18 year-olds are in 12th grade and I call them 12+. Do the students that are 19, 20 and 21 years old need to follow the regulations for the 12th graders?

The students need to follow age appropriate immunization requirements for ungraded classes per ACIP and CDC recommendations.

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29. 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.

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30. 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.

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31. 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.

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32. 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?

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.

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