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From:   Susan M. Lett, M.D., M.P.H.

Medical Director, Immunization Program

 

Kathleen Shattuck, M.P.H.

Assessment Coordinator, Immunization Program

 

Date:   August 2010

 

Re:       Revisions to the Regulation Specifying Immunizations Required for Entry to School

 

 

Childhood immunization plays an invaluable role in protecting public health. School immunization requirements are an important safety net to ensure that as many children as possible are immunized.  State law, c. 76, s.15, requires that students receive those vaccines specified by the Department of Public Health before being admitted to school, unless the student meets the test for a medical or religious exemption.   

 

The school immunization regulations, 105 CMR 220.000: Immunization of Students Before Admission to School, were recently amended, in early 2010, to reflect the latest recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) as well as the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP).

 

In this memo:

  • Table 1 summarizes the changes to 105 CMR 220.000 Immunization of Students Before Admission to School, effective in the Fall of 2011. 
  • Detailed information is provided about the new requirements and their phase in.
  • Table 2 outlines changes in the regulations which will take effect in Fall, 2011.

 

Table 1. Summary of Changes to 105 CMR 220.000 Immunizations Required Before Admission to School

Type of Change

Revised Content, effective in the Fall of 2011

Groups Impacted

Definitions

Revisions to “Certificate of Immunization”

–see below

All students

Revision to “Preschool” (indicating new name of regulating agency)

–see below

 

Immunization Requirements

2 doses MMR vaccine required

·    kindergarten

·    7th Grade

·    full-time college freshman

·    college health science students

2 doses varicella vaccine required

·    kindergarten

·    7th Grade

·    full-time college freshman

·    college health science students

1 dose Tdap vaccine required

·    7th Grade

·    full-time college freshman

·    college health science students

Proof of Immunity

Birth in the US before 1957 sufficient proof of immunity to measles, mumps and rubella (does not apply to health science students)

All college students (except health science students)

Birth in the US before 1980 is sufficient proof of immunity to chickenpox (does not apply to health science students)

All college students (except health science students)

 

1.   Definitions

a)      Certificate of Immunization: this definition has been revised to also allow nurse practitioners and physician assistants, in addition to physicians, to sign and date the form or letter.

 

b)      Preschool: To reflect a name change, the Office of Child Care Services has been updated to the Department of Early Education and Care.

 

2.   Kindergarten Through 12th Grade

a)      MMR: Beginning September 1, 2011, 2 doses of live measles, mumps and rubella vaccine will be required for students attending kindergarten and 7th grade (these doses must be given at least four weeks apart beginning at or after 12 months of age).  Beginning on September 1, 2017, this requirement will apply to all students attending grades K through 12.

 

b)      Varicella: Beginning September 1, 2011, 2 doses of live varicella vaccine will be required for students attending kindergarten and 7th grade (these doses must be given at least four weeks apart beginning at or after 12 months of age). Beginning on September 1, 2017, this requirement will apply to all students attending grades K through 12.

 

c)      Tdap/Td: Beginning September 1, 2011, a single dose of Tdap vaccine will also be required for students attending 7th grade if it has been more than five years since the last dose of DTaP, DT or Td.  If it has been less than five years since a student received his/her last dose of DTaP, DT or Td, Tdap will not be required, but may be administered according to the judgment of a physician, nurse practitioner or physician assistant.  Beginning on September 1, 2017, the requirement of a single dose of Tdap will apply to all students attending grades 7 through 12.

 

For students who are seven or more years of age and require additional immunization to satisfy the DTaP/DTP/DT requirement, Td or Tdap (given according to age appropriate-schedules) is required beginning September 1, 2011.

     

3.      College

a)      MMR: Beginning September 1, 2011, 2 doses of live measles, mumps and rubella vaccine will be required for all full-time freshmen, and full- and part-time undergraduate and graduate students in a health science program who may be in contact with patients (these doses must be given at least four weeks apart beginning at or after 12 months of age).  Beginning on September 1, 2015, this requirement will apply to all postsecondary students.

 

b)      Varicella: Beginning on September 1, 2011, 2 doses of live varicella vaccine will be required for full-time freshmen, and all full- and part-time undergraduate and graduate students in a health science program who may be in contact with patients (these 2 doses must be given at least four weeks apart beginning at or after 12 months of age).  Beginning on September 1, 2015, this requirement shall apply to all postsecondary students.

 

c)      Tdap: Beginning on September 1, 2011, a single dose of Tdap will be required for full-time freshmen, and full- and part-time undergraduate and graduate students in a health science program who may be in contact with patients if it has been more than five years since the last dose of Td.  If it has been less than 5 years since the last dose of Td, Tdap will not be required, but may be administered according to the judgment of a physician, nurse practitioner or physician assistant.  Beginning on September 1, 2015, this requirement shall apply to all postsecondary students.

 

d)     Proof of Immunity Satisfies Requirement: New alternative proofs of immunization have been added to clarify that the requirements of 105 CMR 220.600 shall not apply where:

                                            i.      in the case of measles, mumps and rubella, the student presents laboratory evidence of immunity. Those born in the United States before 1957 can be considered immune to measles, mumps and rubella, with the exception of all full- and part-time students in a health science program who may be in contact with patients.

                                          ii.      in the case of varicella, the student presents laboratory evidence of immunity; or a statement signed by a physician, nurse practitioner, physician assistant, or designee that the student has a reliable history of chickenpox disease; a self reported history of disease verified by a physician, nurse practitioner or physician assistant; or is born in the United States before 1980, with the exception of all full- and part-time students in a health science program who may be in contact with patients.

 

The following table compares the new requirements which will be effective in the fall of 2011 to the current immunization requirements for those vaccines.

 

Table 2: Current Requirements and New Requirements Effective Fall 2011

 

Current Requirement

New Requirement Effective Fall 2011

MMR Vaccine

2 doses of measles, 1 dose of mumps, 1 dose of rubella vaccine for entry to kindergarten, 7th grade, full-time college freshmen and health science students

2 doses MMR for entry to kindergarten, 7th grade, full-time college freshmen and health science students

Varicella Vaccine

1 dose for entry to kindergarten and 7th grade; no requirement for college

2 doses varicella for entry to kindergarten, 7th grade, full-time college freshmen and health science students

Tdap Vaccine

1 dose of Td for entry to 7th grade, full-time college freshmen and health science students

1 dose Tdap for entry to 7th grade, full-time college freshmen and health science students

 

If you have any questions, please contact the DPH Immunization Program at 617-983-6800.  Information is also available on the Immunization Program website: www.mass.gov/dph/imm

 

 

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