1.0
PURPOSE
1.01 The purpose of
these rules is to establish the requirements and procedures for governing
Kindergarten through 12th grade immunization
requirements in Arkansas Public Schools.
1.02 Immunizations against poliomyelitis,
diphtheria, tetanus, pertussis, red (rubeola) measles, mumps, rubella,
varicella (chickenpox), haemophilus imfluenza type b,
hepatitis B, hepatitis A, meningococcal, and pneumococcal, and other
communicable diseases have resulted in a dramatic decrease in the incidence of
these diseases in Arkansas. However, these diseases continue to occur in
childcare facilities, schools, and colleges and universities. A requirement
that children and students furnish proof that they have immunity against
certain communicable diseases will reduce the potential for an outbreak of
these diseases.
2.0
REGULATORY AUTHORITY
2.01 The
following Rules governing Kindergarten through 12th
grade immunization requirements in Arkansas Public Schools are duly adopted and
promulgated by the Arkansas State Board of Education pursuant to the authority
expressly conferred by the laws of the State of Arkansas including, without
limitation, Ark. Code Ann. §
20-7-109,
Ark. Code Ann. §
6-18-702, Ark. Code
Ann. §§
6-60-501 - 504, and Ark.
Code Ann. §
20-78-206.
3.0
REQUIREMENTS
3.01 Except as otherwise provided in these
rules, no child shall be admitted to a public school of this state who has not
been immunized against poliomyelitis, diphtheria, tetanus, pertussis, red
(rubeola) measles, rubella, mumps, hepatitis B, hepatitis A, meningococcal
disease and varicella (chickenpox) (See Table I.), as evidenced by an
immunization record from a licensed physician or a public health department
acknowledging the immunization.
3.02 The requirements for entry into school
are:
3.02.1 Kindergarten: At least four doses
of Diphtheria/Tetanus/Acellular Pertussis (DTaP), Diphtheria/Tetanus/Pertussis
(DTP), or Diphtheria/Tetanus (DT pediatric) vaccine; at least three doses of
Polio vaccine; two doses of MMR (measles, mumps, and rubella) vaccine; three
doses of Hepatitis B vaccine; one dose of Hepatitis A; and two doses of
Varicella (chickenpox) vaccine. A medical professional's [medical doctor (MD),
advanced practice nurse (APN), doctor of osteopathy (DO), or physician
assistant (PA)] history of disease may be accepted in lieu of receiving
Varicella vaccine. No self of parental history of varicella disease will be
accepted (See Table I). Exception: If a student has previously received two
doses of measles, one dose of mumps and one dose of rubella before January 1,
2010, the doses will be accepted as compliant to immunization requirements and
2 MMRs are not required.
3.02.2
1st through 12th grade:
At least three or four doses of Diphtheria/Tetanus/Acellular Pertussis (DTaP),
Diphtheria/Tetanus/Pertussis (DTP), Diphtheria/Tetanus (DT-pediatric),
Tetanus/Diphtheria (Td-adult) or Tetanus/Diphtheria/Acellular Pertussis (Tdap)
and one dose of Tdap for ages 11 years (as of September
1st each year) and older or 3 doses for unvaccinated
persons 7 years of age or older (including persons who cannot document prior
vaccination); at least three doses of Polio vaccine; two doses of MMR (measles,
mumps, and rubella) vaccine, two or three doses of Hepatitis B vaccine; one
dose of Hepatitis A for First Grade; two doses of varicella vaccine; and one or
two doses of Meningococcal vaccine with one dose for
7th grade and a second dose of Meningococcal vaccine
at age 16 years (as of September 1st each year).
However, if the first dose of Meningococcal vaccine is administered at age 16
years or older, no second dose is required; or if not vaccinated prior to age
16 years, one dose is required. A medical professional's [medical doctor (MD),
advanced practice nurse (APN), doctor of osteopathy (DO), or physician
assistant (PA)] history of disease may be accepted in lieu of receiving
Varicella vaccine. No self or parental history of varicella disease will be
accepted. (See Table I). Exception: If a student has previously received two
doses of measles, one dose of mumps and one dose of rubella before January 1,
2010, the doses will be accepted as compliant to immunization requirements and
2 MMRs are not required.
3.02.3
7th grade: In addition to the vaccines requirements
listed under 1st through 12th grade, one dose of
Meningococal vaccine (See Table I.)
3.03 Every child must have received all of
the vaccines, be in-process of receiving needed doses listed in Table 1, show
proof that they have a letter from the Arkansas Department of Health approving
serology as proof of immunity, or applied for an exemption for those vaccines
he or she has not received in order to continue attendance in a public school.
If the child does not meet the immunization requirements for entering a public
school, refer the child to a medical authority (private doctor or health
department) for immunization or consultation.
3.04 A facility may temporarily admit a child
provided that the child becomes appropriately immunized, is in-process of
receiving the needed doses of vaccine, or shows proof that they have applied
for an exemption for those vaccines he/she has not received within thirty (30)
calendar days after the child's original admission or by October
1st for Tdap and Meningococcal at age 11 and 16
years respectively. "In process" means the student has received at least one
dose of the required immunizations and is waiting the minimum time interval to
receive the additional doses. When a student is admitted who is in the process
of completing the required minimum immunizations, the facility shall require
each student to complete the required doses on schedule. A written statement
from a public health nurse or private physician stating that the student is in
process and containing a date when he/she must return for the next immunization
shall be in the student's file. If a student does not produce documentation of
additional immunizations per the schedule or show proof that they have applied
for an exemption from the immunization requirements, they must be excluded from
the facility until documentation is provided. The immunization series does not
need to be restarted as each dose of vaccine counts toward the minimum
requirements.
3.05 School officials
should evaluate the immunization status of all children in their facilities.
Table I is used to determine if the child meets the immunization requirements
to enter school.
3.06 School
boards, superintendents, and principals shall be responsible for enforcing
immunization requirements with respect to kindergarten through grade 12 (K-12)
within public schools.
4.0
DOCUMENTATION FOR IMMUNIZATION OR
PROOF OF IMMUNITY
4.01 The following
documentation of immunizations is required:
4.01.1 Immunization records may be stored on
a computer database, such as the Arkansas Public School Computer Network
(APSCN). A copy of the original source document or a copy from the immunization
provider's medical record shall be placed in a permanent file. The immunization
record printed off the statewide immunization registry with the Official Seal
of the State of Arkansas is considered an official immunization record and is
approved for placement in a permanent file as source documentation. It shall be
the responsibility of the entity to maintain a list of individuals not
appropriately immunized and a list of individuals with medical, religious or
philosophical exemptions.
4.01.2
The only proof of immunizations to be accepted shall be an immunization record
provided by a licensed physician, health department, military service, or an
official record from another educational institution in Arkansas, acknowledging
the same, stating the vaccine type and dates of vaccine administration must be
provided and entered on the school record. Terms such as "up-to-date",
"complete", "adequate", etc. are not to be accepted as proof of
immunization.
4.02 The
following documentation for proof of immunity is required:
4.02.1 Serologic testing is only applicable
to Hepatitis B virus, Measles, Mumps, Rubella and Varicella. Any individual who
has immunity to Hepatitis B, Measles, Mumps, Rubella and/or Varicella as
documented by appropriate serological testing shall not be required to have the
vaccine for that disease.
4.02.2 A
copy of the serological test should be submitted to the Arkansas Department of
Health, Immunization Section, along with a letter requesting that the
serological test be accepted as proof of immunity in lieu of receiving vaccine
for the disease indicated on the serological test. After review by the Medical
Director, Immunization Section, a letter indicating approval or denial will be
sent to the individual, parent, or guardian and it will be that person's
responsibility for informing the school. For approvals, annual approval is not
required and a copy of the letter should be placed in the student's permanent
file. For denials, the student must receive the required immunization or
request an exemption.
4.03 An individual who has lost his/her
immunization records or whose serology test results are unavailable shall be
properly immunized for those diseases or will be required to show proof that
they have applied for an exemption for those vaccines he/she has not
received.
5.0
EXEMPTIONS
5.01 General Requirements
5.01.1 Exemptions shall be granted only by
the Department of Health.
5.01.2
Individuals shall complete an annual application for medical, religious, and
philosophical exemptions.
5.01.3 A
notarized statement by the individual requesting the exemption must accompany
the application.
5.01.4 All
individuals requesting an exemption must complete an educational component
developed by the Department of Health that includes information on the risks
and benefits of vaccinations.
5.01.5 All individuals must sign an "informed
consent" form provided by the Department of Health that includes:
5.01.5.1 A statement of refusal to
vaccinate;
5.01.5.2 A statement of
understanding that at the di scretion of the Department of Health the
non-immunized child or individual may be removed from the applicable facility
(for 21 days or longer) during an outbreak if the child or individual is not
fully vaccinated; and
5.01.5.3 A
statement of understanding that the child or individual shall not return to the
applicable facility until the outbreak has been resolved and the Department of
Health approves the return.
5.02 Medical Exemptions
5.02.1 Only a letter issued by the Medical
Director, Immunization Section of the Arkansas Department of Health, stating
the vaccine or vaccines for which a child/student is exempt is to be accepted
as a valid medical exemption by the school. Statements from private physicians
are not to be accepted by the school without this letter. In addition to the
general requirements found in section 5.01, the Immunization Section's standard
form for medical exemptions must be submitted to the Immunization Section. This
form is available from the Immunization Section of the Department of Health
upon request.
5.03
Religious Exemptions
5.03.4 In addition to
the general requirements found in section 5.01, the Department of Health,
Immunization Section's standard form for religious exemptions must be submitted
to the Immunization Section. This form is available from the Immunization
Section upon request.
5.04 Philosophical Exemptions
5.04.1 In addition to the general
requirements found in section 5.01, the Department of Health Immunization
Section's standard form for philosophical exemptions must be submitted to the
Immunization Section. This form is available from the Immunization Section upon
request.
6.0
EXCLUSION FROM FACILITIES
6.01
Public Schools
6.01.1 Each facility must
maintain an accurate and current list of all exempt and deficient individuals.
Individuals who are exempt or deficient (except those who have had the disease
as verified by appropriate serological testing) will be excluded from the
facility if the Department of Health determines that a possibility of disease
transmission exists. The exempt or deficient child or individual shall not
return to the facility (for 21 days or longer) until the possibility of disease
transmission has been controlled and the Department of Health approves the
return.
6.01.2 If a child is
excluded from afacility pursuant to Section 6.01.1 of these rules, he or she
shall not be dismissed or dropped from the attendance records of the school,
school district, or open-enrollment charter school in accordance with Ark. Code
Ann. §
6-18-213(f).
6.01.2.1 Absences accrued due to exclusion
from a facility pursuant to Section 6.01.1 of these rules shall be counted as
excused or unexcused in accordance with the attendance policy of the school,
school district, or open-enrollment charter school.
7.0
REPORTING
REQUIREMENTS
7.01 In order to identify
areas where additional emphasis is needed and to measure levels of immunization
compliance, the Arkansas Department of Health will conduct annual assessments
in schools. The entity's cooperation in completing these surveys and audits is
required.
TABLE I
KINDERGARTEN THROUGH GRADE TWELVE IMMUNIZATION
REQUIREMENTS*
|
Vaccine
*
Grade
*
|
Diphtheria,
Tetanus,
Pertussis
(DTP/DT/Td/DTa
P/Tdap)
|
Polio
(OPV - Oral or
IPV-Inactivated)
|
MMR***** (Measles, Mumps,
and Rubella)
|
HepB
|
Meningococca l(MCV4)
|
Varicella
|
Hepatitis A
|
|
Kinderga rten
|
4 doses
(with 1 dose on or after 4th
birthday)
|
3 doses
(with 1 dose on or after 4th
birthday)
with a minimum
interval of 6
months between the
2nd and
3rd
dose
OR
4 doses with 1 dose on or after 4th
birthday and a minimum interval of 6
months between the
3rd and
4th
dose.
|
2 doses
(with dose
1 on or after 1st
birthday and dose 2
at least 28
days after dose 1)
|
3 doses
|
None
|
2 doses (with dose 1 on or after 1st
birthday and dose 2 at least 28 days after dose 1)
******A
medical professional history of disease will be accepted in
lieu of vaccine.
|
1 dose on or after 1st
birthday
|
|
Grades 1 -12
|
4 doses
(with 1 dose on or after 4th
birthday)
AND
1 dose of Tdap for ages 11 years (as of September
1st each year) and older
OR
|
3 doses (with 1 dose on or after 4th
birthday with a minimum interval of 6
months between the
2nd and
3rd
dose )
OR
4 doses with 1 dose on or
|
2 doses
(with dose
1 on or after 1st
birthday and dose 2
at least 28
days after dose 1)
|
2** or 3*** doses
(11-15
year olds
could be on a
2-dose schedul
e)
|
Second dose at age 16
years (as of
September 1st
each year)
with a minimum
interval of 8
weeks since
1st dose
OR
1 dose if not vaccinated
|
2 doses (with dose 1 on or after 1st
birthday and dose 2 at least 28 days after dose 1)
OR
******A
medical professional history of
|
Grade 1 only:
1 dose on or after 1st
birthday
|
|
3 doses
******* for
persons 7 years of age or older who are not fully
vaccinated
(including persons who cannot
document prior vaccination)
|
after 4th birthday and a minimum
interval of 6
months between the
3rd and
4th
dose.
|
prior to age
16 years (If first dose is administered
at age 16
years or older, no second dose is required.)
|
disease may be accepted in lieu of receiving
vaccine.
|
|
Grade 7
|
4 doses
(with 1 dose on or after 4th
birthday)
and
1 dose of Tdap****
OR
3 doses******
for persons 7
years of age or older who are not fully immunized
(including persons who cannot
document prior vaccination)
|
3 doses (with 1 dose on or after 4th
birthday with a minimum interval of 6
months between the
2nd and
3rd
dose)
OR
4 doses with 1 dose on or after 4th
birthday and a minimum interval of 6
months between the
3rd and
4th
dose.
|
2 doses
(with dose
1 on or after 1st
birthday and dose 2
at least 28
days after dose 1)
|
2** or 3*** doses
(11-15
year olds
could be on a
2-dose schedul
e)
|
1 dose
|
2 doses (with dose 1 on or after 1st
birthday and dose 2 at least 28 days after dose 1)
OR
******A
medical professional history of disease may be accepted in lieu
of receiving
vaccine.
|
NONE
|
*Doses of vaccine required for school entry may be less than the number
of doses required for age-appropriate immunization.
**An alternative two-dose hepatitis B schedule for 11-15 year-old
children may be substituted for the three-dose schedule. Only a FDA-approved
alternative regimen vaccine for the two-dose series may be used to meet this
requirement. If you are unsure if a particular child's two-dose schedule is
acceptable, please contact the Immunization Section for assistance at
501-661-2169.
*** 3rd dose of hepatitis B should be given
at least 8 weeks after the 2nd dose, at least 16
weeks after the 1st dose, and it should not be
administered before the child is 24 weeks (168 days) of age. (All
3rd doses of hepatitis B vaccine given earlier than
6 months of age before 6/21/96 are valid doses and should be counted as valid
until 6/21/2014.)
**** Tdap vaccine can be administered regardless of the interval since
the last tetanus and diphtheria toxoid-containing vaccine.
***** Exception: If a student has previously received two doses of
measles, one dose of mumps and one dose of rubella before January 1, 2010, the
doses will be accepted as compliant to immunization requirements and 2 MMRs are
not required.
****** A medical professional is a medical doctor (MD), advanced
practice nurse (APN), doctor of osteopathy (DO), or physician assistant (PA).
No self or parental history of disease will be accepted.
******* For unvaccinated persons 7 years of age and older (including
persons who cannot document prior vaccination), the primary series is 3 doses.
The first two doses should be separated by at least 4 weeks, and the third dose
at least 6 months after the second. One of these doses (preferably the first)
should be administered as Tdap and the remaining two doses administered as
Td.
Vaccine doses administered up to 4 days before the minimum interval for
age can be counted as valid for doses already administered. Exception: the
minimum interval between doses of live vaccines (such as MMR and Varicella)
must be 28 days.
If the child does not meet the immunization requirements for entering
school, the school shall refer the child to a medical authority (private doctor
or health department) for immunization or consultation for when the
immunization is due.
