School Immunization Requirements

School Immunization Requirements

IN State Department of Health

2013-2014 School Year

FAQ’s

RequirementsCompliance

1. Arethereanynewrequiredimmunizationsforthe2013-2014schoolyear?

Yes.All students in grades Kindergarten through 12th grade arerequiredtohavetwo(2)appropriately administered dosesofvaricella vaccine,orevidence of immunity. The first dose must be administered on or after the 1st birthday. Doses of varicella must be spaced at least 28 days apart and given at least 28 days after any other live virus vaccine if not administered on the same day.

2. Arethereanynew recommendedimmunizationsthat are not required for school entry for the

2013- 2014 school year?

Yes. There are several vaccinations included on the schedules that are not required for school entry this year. These recommendations include 2 doses of Hep A vaccine for kindergarten entry and the meningococcal booster dose for students in grades 11 & 12 (if the first dose was received prior to the student’s 16th birthday) for the 2013-2014 school year. These vaccinations are strongly recommended by the IN State Department of Health (ISDH) in anticipation of inclusion with school entry requirements for the 2014-2015 school year.

3. Areimmunizationsrequiredforallchildrenenrolledinschool?

Yes.Studentsinall gradesarerequiredtomeettheminimum immunizationrequirements.Immunization requirementsextendto childrenages3through5 attendingspecialeducationprograms,childcare,orpreschoolwithintheschoolbuilding.

4. Whatinformationmustbeincludedonthephysician’sstatementtodocumentimmunization?

Thestatementmustincludethestudent’snameanddateofbirth,the vaccinegivenanddate

(month/day/year)ofeachimmunization.

5. Whatisconsideredadequatedocumentationofan immunizationhistory?

Adequate documentation is as follows: documentation from a healthcare provider, an immunization record from another school corporation, an immunization record in the Indiana Immunization Registry (CHIRP), or a printed record from another state registry. Thisdocumentationmustincludethemonth,day,andyear for eachdoseofvaccineadministered.

6. Whatis“laboratoryevidenceofimmunity”?

Laboratoryevidenceof immunityisa bloodtestfordisease-specificimmuneglobulinthatmeasures immunity todisease.Thisis oftenusedtoconfirm immunitywhenimmunizationrecordsarenotavailable, oraparent reportsa historyofdisease.

7. Whoshouldinterpretlabresultsforevidenceofimmunity?

Laboratoryresultsforevidenceofdiseaseimmunitymustbe orderedbya physician.Theordering physician is responsibleforinterpretingtheresultsanddeterminingadequateevidenceof immunitybased oncurrent medicalguidelines.

8. Islabevidenceofimmunityacceptablefor ALLschoolrequiredimmunizations?

No.LabevidenceisNOTacceptableforDiphtheria,Pertussis,or Tetanus.

Laboratoryevidenceof immunitymaybeusedinplaceof immunizationrequirementsforthefollowing schoolrequiredimmunizations:

Measles / Mumps / Rubella
Chickenpox / HepatitisA & B / Polio

Serology testing for chickenpox can only be used to document history of disease

9. Whatisthefour-daygraceperiodandwhencanitbeused?

CDCandACIPallowa 4-daygraceperiod.If avaccineis givenupto4 daysbeforetheminimum recommendedageforadministrationofthevaccine,itcanbecountedas valid.However,thisdoesnot applytoeveryvaccineanddoesnot changetherecommendedscheduleforroutinevaccineadministration. The 4-day grace period does not apply to the minimum 28-day interval between 2 live virus vaccines (MMR, LAIV and Varicella).

10. WhatistheminimumageforMMRvaccinetobecountedasa validdose?

FortheMMRtobecountedasa validdose,itmusthavebeengivenonor afterthefirstbirthday.The fourdaygraceperiodisapplicabletoMMRvaccine.

11.Whenare4dosesofPoliovaccinerequired?

Fourdosesofpolioareconsideredacompleteseries. The fourth dose must be administered on or after the 4th birthday, and be administered at least 6 months after the previous dose for students in grades kindergarten through 3rd grade for the2013-2014schoolyear.Threedoses are acceptable for all grade levels if thethirddosewasgivenon orafterthe4thbirthday and at least 6 months after the previous dose withonlyone typeof vaccineused (allOPVorallIPV).

12.WhataretheminimumintervalsforHepatitisBvaccine?

Theminimumintervalsbetweenvaccinedosesare:

Dose1 and2is4 weeks(28days)

Dose2 and3is8 weeks(56 days)

Dose1 and3is16weeks (112 days)

Note:Theminimumageforthe3rddoseofHepatitisB vaccineis24weeks(164days).

13.IfthereisanextendedintervalbetweendosesofHepatitisB,doesthestudentneedto

starttheseries over?

No.ThehepatitisB seriesshouldneverberestartedoradditionaldosesgivenduetoanextended intervalbetweendoses.Thestudentshouldjustcompletetheserieswiththeremainingdose(s)due.

14.Mayachiropractorgivea medicalexemptionforvaccination?

No.Onlya licensedphysician(M.D.orD.O.) canprovideamedicalexemption.Anursepractitioneror a physicianassistantunderaphysician’ssupervisioncanalsogiveamedicalexemption.

15.Whatmustamedicalexemptioncontain?

Amedicalexemptionis aphysician’scertificationthata particularimmunizationmay bedetrimentaltothe child’s health.Itmuststateinwritingthatthechildhasamedicalcontraindicationtoreceivingavaccine. Many contraindications to vaccination are not permanent; therefore, a medical exemption should be obtained for the student each school year.Astruemedicalcontraindicationstoimmunizationare vaccine- specific,medicalexemptionsmustbewrittenforeachvaccinethatis contraindicated. There is a state form providers can use to submit a medical exemption for students.

16.Whatmustareligiousobjectioncontain?

Areligiousobjectionmuststatethattheobjectionto immunizationisbasedon religiousgrounds.Each objectedimmunizationmustbespecified.Theobjectionmust beinwriting,signedbythechild’sparent, anddeliveredtotheschool.Thereis norequirementofproof.To ensure the continued religious objection status for a student, schools must require written documentation of the religious objection each school year.

17.IsthereaphilosophicalobjectionallowedinIndiana?

No.Indianalawonlyallowsreligiousandmedicalexemptions.

18.Ifachilddoesnotpresentanimmunizationrecordorisnotuptodatewithhis/herimmunizations,may he/sheenrollin school?

Yes.IndianaCode(IC20-34-4-5)statesthatachildisnotpermittedtoattendschoolbeyondthefirstdaywithoutfurnishinga writtenrecord,unless:

Theschoolgivesa waiver(foraperiodnottoexceed20days);or

Thelocalhealthdepartmentoraphysiciandeterminesthatthechild’simmunizationshavebeen delayedduetoextremecircumstancesandthattherequiredimmunizationswillnotbecompleted by thefirstdayofschool.Theparentmustfurnisha writtenstatementanda timeschedule approvedby a physicianorhealthdepartment;or

Amedicalorreligiousexemptionis onfile.

19.If a student received a meningococcal vaccine noted from an electronic medical record, how do I know if they meet school requirements, and how do I document this in CHIRP?

Most likely, the student received a dose of the quadrivalent meningococcal conjugate vaccine (MCV4). There are 2 conjugate vaccines: Menactra (MCV4P) and Menveo (MCV4O). If the lot # is included on the record, you can determine which vaccine the student received. Menactra is a Sanofi Pasteur product and lot #’s typically begin with a “U”. Menveo is a product from Novartis and lot #’s begin with the letter “M”. If the lot # is not available, you may document the dose using either MCV4P or MCV4O; use MCV4P if the vaccine was administered prior to March 2010. Only doses of meningococcal vaccine administered on or after the 10th birthday meet the school requirements.Any dose of meningococcal vaccine administered prior to 2006 is the meningococcal polysaccharide vaccine (MPSV4). If a child received the meningococcal vaccine overseas, and the record does not specify MCV4, please contact the ISDH Immunization Division for further guidance.

20.IfachildreceivesonedoseofVaricellavaccineandthensubsequentlyhaschickenpox,isa

seconddose ofVaricellavaccineneeded?

No. Theparent or physician will needtodocumentthehistoryofthedisease.

21. Isadoctor’sstatementrequiredasproofofchickenpoxdisease?

• Forchildrenenteringpreschoolthrough5th grade,a signedstatementbyahealthcare provider, documenting a diagnosis of varicella or verifying the history of disease,includingdate(MM/YY)is required. A child does not need to see their healthcare provider at the time of illness in order to request a verification of disease history. A parent can speak with their child’s healthcare provider to ascertain whether the child had chickenpox based upon the disease presentation and transmission. More information on assessing disease history is available at:

• For children entering grades 6-12,documentationfrom aparent is sufficient. Awritten statement shouldinclude date ofdisease, a parent’ssignature, and date of signature. (Example: If aparentcannotrecall exact dates, something assimple as stating that diseaseoccurred in the spring of2000isacceptable)

Schools do not need to verify the history of disease for students with current documentation in CHIRP.

Reporting

1. How do I submit my report using CHIRP?

IC 20-34-4-6 specifies that schools are to submit a written report of vaccination data levels. Schools are now reporting their vaccination data levels using CHIRP; there is no need tosubmit a written report to ISDH with the use of the registry. Only students who are added to a school roster will be included in the annual reporting completed by ISDH. Parents must provideconsent under FERPA prior to a student’s record being added to the school roster.

2. DoschoolsprovidesummaryreportstoISDHontheimmunizationstatusofstudentsinall

grades?

Whileallstudentsenrolledinschoolarerequiredtobeup-to-dateonallrequiredimmunizations,schools onlyprovidesummarydatatoISDHonstudentsenrolledin kindergarten,first,andsixthgradesatthis time.

3.Ifachildhasan exemptiononfile,mayhe/shebe countedascomplete?

No.Ifachildhasanexemptiononfileforanyimmunization,he/shemusthave the exemption

reported in CHIRP.

4.Doschoolsneedtoreportimmunizationdataforall6thgradeimmunizations?

Yes. IncludingvaricellaandHepatitisB, MCV4,andTdap.

5. What is the deadline for reporting school immunization data?

Student records must be checked upon enrollment for compliance with the school immunization requirements. Per IC 20-34-4-5, students should not be in attendance unless the appropriate immunization records have been presented to the school. For reporting purposes, data entered into CHIRP through February 1st will be included on the annual report for schools.

6. Does ISDH determine if a child is excluded from school for incomplete immunizations?

No.Schoolexclusionisdeterminedbytheschoolcorporation accordingtoIC 20-34-4-5. ISDH strongly recommends adherence to this code.

7.Whatimmunizationeducationmaterialsmustbeprovidedtotheparentsofenrolledstudents?

• Meningococcaldisease–All students (IC 20-30-5-18)
• HumanPapillomavirus(HPV)Infection—6thgrade femalestudents (IC 20-34-4-3). It is stronglyrecommendedthatthis same information be provided to parentsof enrolled 6thgrade males.

8. AreschoolsrequiredtocollecttheresponseformincludedwiththeHumanPapillomavirus

(HPV) infectioneducationalmaterials?

Yes.SchoolsarerequiredtocollectHPVresponseformsfromparentsofsixthgradefemale students under IC 20-34-4-6. However,formsshouldnotincludethestudents’nameand shouldnotbereturnedtoISDH.Schoolswillcompletea summaryreportof responsesreceivedfrom HPVformsandsubmitthereporttoISDH. The survey can be completed online or on paper.

9.AreschoolsrequiredtosendparentsinformationaboutPertussisandtheTdapvaccine?

No.ISDHonly recommendsthatschoolssendthisinformationhometoparents.

For additional questions, please contact the IN State Dept of Health Immunization Program

1-800-701-0704