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of the Commonwealth of Pennsylvania

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    School Immunization Frequently Asked Questions

    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

    *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.

    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.

    What immunization schedule does Pennsylvania follow for timing and spacing of vaccines for children and adolescents?                                                                                                  

    We follow the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG) for guidance on timing and spacing of all vaccinations.

    I have a transfer student who provided proof of their immunizations 10 days after their enrollment. They still need their second dose of MMR. Do I give them an extra five days?
    Yes. The parent or guardian presented their child’s immunization records on day 10. When the immunization records are received by the school, the 5-day timeframe starts for those who have one dose and are not up to date with a vaccine. For children who are missing a single-dose vaccine, they are excluded until they are up to date. Appointments do not count; the child must be up to date with vaccines within the 5 days or be excluded.

    Is a titer for immunity acceptable for mumps, tetanus, diphtheria or polio?
    No. Since most of the vaccines are combination vaccines, we only accept titers for varicella.

    How are homeschooled students reported on the School Immunization Law Report (SILR)?
    Homeschooled students, or parent-taught students, are placed in a separate category on the SILR and should be reported by the school that the child would normally attend if the child were in public school attendance.

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

    Is a signed attestation stating a child is up to date with immunizations, provided by homeschool parents, accepted?                                                                          

    No, the official immunization records with a date of birth listed on the record for vaccine timing/spacing must be provided in the homeschool packet and reviewed for up-to-date immunizations before homeschooling.

    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 by 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 due at the time of school entry and the child has started the series with at least one dose, the child has five days to receive the next appropriate dose of vaccine or risk exclusion. If the vaccine is not due to be given the next dose within the first five days of school due to spacing from the previous dose, a medical plan is needed within the first five days of school outlining the dates they will receive the required vaccine(s) at an appropriate and timely interval.

    If a child has not received all the doses for a multiple-dose vaccine series that were due 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 for another month 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 Pennsylvania Department of Health. A nurse visit can be scheduled for vaccinations if a doctor’s appointment is not available.

    If a student transfers into our school district a week after we start, does he/she have five days or 30 days to comply?

    1. Unless the parent or guardian has difficulty in obtaining their immunization records, they have 5 days if they have one dose and are not up to date with the next doses of a multidose vaccine. Once the records are received, the 5 days are given to have the child up to date with the next doses due or the child is excluded from attendance.       
    2. If a child, when moving or transferring into a school in this commonwealth (whether from out-of-state or in-state), has difficulty providing 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. A child who is unable to provide the necessary records may be excluded at the end of the 30-day period and in subsequent school years until the requirements are met. Once the records are received, the 5 days starts to be up to date with multidose vaccines. If a single-dose vaccine is not completed, they should not attend school until the vaccine is given

    A current 11th grade student who transferred from another school outside the district and has not had one dose of MCV will be entering 12th grade.  Does the five-day provisional apply?
    No. Since he/she never received one dose of MCV,  the student is not permitted to attend school on the first day. This is an example of a single-dose vaccine.

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

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

    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 recommended immunizations. 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 are outlined in the Department’s regulations 28 Pa. Code, Chapter 23, Subchapter C.

    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 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 school immunization file.

    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 after 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 AAP (American Academy of Pediatrics), 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 AAP; if four or more doses of polio vaccine are administered before age 4, an additional dose should be administered at age 4 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 but would not be accepted if given before the 4-day grace period.

    I have a student who received 5 doses of OPV given in 2018 and in 2019 with proper spacing, and the last dose was given after age 4 and 6 months after the 4th dose. Would these doses be acceptable for a completed polio vaccination?                                                                                                        No, OPV given after April 2016 is not an accepted vaccine. OPV after April 1, 2016, is either monovalent (mOPV), which contains only one of the three types of polio in the vaccine, or bivalent (bOPV), containing two of the three types of polio in the vaccine. The trivalent (tOPV) is the only acceptable vaccine that contains all three types of polio, but it has not been produced or used worldwide since May 2016 due to the vaccine-derived poliomyelitis that it caused in thousands of people. If a child has all oral polio given after April 1, 2016, the child must be revaccinated with IPV for all three or four doses depending on the age of the child.                                                                                  

    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 attenuated vaccines from our school immunization requirements (MMR, 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 the live vaccines are administered at an interval of less than four weeks, then the vaccine given second should be repeated in four weeks.

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

    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 acceptable?
    Yes. The PA regulations require the Tdap vaccine be given at age 11-12.  This is the ideal and preferred age group for administration of the vaccine.  Tdap given at age 10 or older is accepted as the adolescent dose, but not prior to age 10.

    Does the Meningitis B Vaccine meet the requirements for the MCV vaccine?
    No, they are two different vaccines. MCV4 contains more types of meningitis protection.  Though the Meningitis B vaccine is also a recommended vaccine by physicians, PA does not have a requirement for the Meningococcal B vaccine for school attendance as we do for MCV4.

    If MCV was given at age 7, does the child require another dose to attend seventh grade?
    Yes, any dose of MCV given before age 10 is not counted toward the required seventh-grade dose and must be repeated. This is a single-dose vaccine and is required to be given by the first day of school to be able to attend school.

    If a high school senior student did not receive MCV, is he/she 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 prior to the first day of 12th grade or they will be unable to attend on the first day. One dose of MCV given after the age of 16 years would be counted as up to date.