School Immunization Requirements FAQs

Schools

Are there any new required immunizations for the 2020-2021 school year?

The Hepatitis A vaccine is now required for all grades K-12. All other requirements from 2019-2020 still apply.

Are there any recommended immunizations that are not required for school entry for the 2020-2021 school year?

Yes. There are several immunizations included on the routine immunization schedules that are not required for school entry this year. These include two to three doses of Human Papillomavirus (HPV) vaccine for grades 6-12, and two doses of Meningococcal Serogroup B (MenB) vaccine for grade 12. The flu vaccine is also recommended annually for all students and staff.

Are immunizations required for all children enrolled in school?

Yes. Students in all grades are required to meet the minimum immunization requirements. Immunization requirements extend to children ages 3 through 5 attending special education programs, child care, or preschool within the school building.

What information must be included on the physician’s statement to document immunization?

The statement must include the student’s name and date of birth, the vaccine given, and date (month/day/year) of each immunization.

Who should interpret lab results for evidence of immunity?

Laboratory results for evidence of disease immunity must be ordered by a physician. The ordering physician is responsible for interpreting the results and determining adequate evidence of immunity based on current medical guidelines.

What is “laboratory evidence of immunity”?

Laboratory evidence of immunity is a blood test for disease-specific immune globulin that measures immunity to disease. This is often used to confirm immunity when immunization records are not available, or a parent reports a history of disease (i.e. varicella).

What is considered adequate documentation of an immunization history?

Adequate documentation is as follows: documentation from a healthcare provider, an immunization record from another school corporation, an immunization record in CHIRP, or a printed record from another state registry. This documentation must include the date (month/day/year) for each dose of vaccine administered.

Is lab evidence of immunity acceptable for ALL school required immunizations?

No. Lab evidence is NOT acceptable for Diphtheria, Pertussis, or Tetanus. Laboratory evidence of immunity may be used in place of immunization requirements for the following school required immunizations:

  • Measles
  • Mumps
  • Rubella
  • Chickenpox
  • Hepatitis A & B
  • Polio

What is the four-day grace period and when can it be used?

The CDC and ACIP allow a 4-day grace period. If a vaccine is given up to 4 days before the minimum recommended age or interval for administration of the vaccine, it can be counted as valid. However, this does not apply to every vaccine and does not change the recommended schedule for routine vaccine administration.

The 4-day grace period does not apply to the minimum 28-day interval between 2 live virus vaccines (MMR, LAIV, and Varicella).

What is the minimum age for MMR vaccine to be counted as a valid dose?

For the MMR to be counted as a valid dose, it must have been given on or after the first birthday. The four day grace period is applicable to MMR vaccine.

May a chiropractor give a medical exemption for vaccination?

No. Only a licensed physician (M.D. or D.O.) or advanced practice provider (nurse practitioner or physician assistant under a physician’s supervision) can provide a medical exemption.

What must a medical exemption contain?

A medical exemption is a physician’s certification that a particular immunization may be detrimental to the child’s health. It must state in writing that the child has a medical contraindication to receiving a vaccine. The Indiana State Department of Health has a medical exemption form available on CHIRP that providers should use to document medical exemptions. Many contraindications to vaccination are not permanent so a medical exemption should be obtained for the student each school year. As true medical contraindications to immunization are vaccine-specific, medical exemptions must be written for each vaccine that is contraindicated.

When a valid medical exemption form is received by the school, the school nurse must document this exemption in CHIRP.

The state vaccine medical exemption form can be found here.

What must a religious objection contain?

A religious objection must state that the objection to immunization is based on religious grounds. The objection must be in writing, be signed by the child’s parent, and delivered to the school.

There is no requirement of proof. To ensure the continued religious objection status for a student, schools must require written documentation of the religious objection each school year. When a valid religious exemption is received by the school, the school nurse must document this exemption in CHIRP. Please note: there is no state form for a religious objection.

If a student received a dose of vaccine before the recommended minimum interval or age, can I accept a physician note stating there is no need to repeat the dose as a medical exemption?

No. School immunization requirements in the state of Indiana follow the recommendations made by the ACIP and are adopted by the CDC. Invalid doses will be marked in CHIRP with a red “X”, and the parent/guardian will need to provide evidence of immunity in order to meet school entry requirements. Evidence of immunity includes documentation of a valid dose(s) of vaccine, a positive IgG titer (if acceptable for the vaccine dose in question), or acceptable documentation of history of disease

Is there a philosophical objection allowed in Indiana?

No. Indiana law only allows religious and medical exemptions.

If a child does not present an immunization record or is not up to date with his/her immunizations, may he/she enroll in school?

Yes, but Indiana Code (IC 20-34-4-5) states that a child is not permitted to attend school beyond the first day without furnishing a written record, unless:

  • The school gives a waiver (for a period not to exceed 20 days); or
  • The local health department or a physician determines that the child’s immunizations have been delayed due to extreme circumstances and that the required immunizations will not be completed by the first day of school. The parent must furnish a written statement and a time schedule approved by a physician or health department; or
  • A medical exemption or religious objection is on file.

What immunization education materials must be provided to the parents of enrolled students?

Meningococcal disease – All students (IC 20-30-5-18)

Human Papillomavirus (HPV) Infection— All 6th grade students (IC 20-34-4-3). The HPV letter may be sent to parents or posted on the school’s website.

All educational materials & letter templates can be found in the CHIRP Document Center under the School Nurse link: Letters

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

No. School exclusion is determined by the school corporation according to IC 20-34-4-5. ISDH strongly recommends adherence to this code.

Healthcare Providers

How do I know if a dose of vaccine is valid?

The best resource to use when evaluating immunization records is the minimum ages and intervals table. This table can be found online in Appendix A of the Centers for Disease Control and Prevention (CDC)’s Pink Book or at this link.

This document is also posted to the CHIRP Document Center.

All invalid doses of vaccine will be marked with a big red “X” in CHIRP.

What is the four-day grace period and when can it be used?

If a vaccine is given up to 4 days before the minimum recommended age or interval for administration of the vaccine, it can be counted as valid. This does not change the recommended schedule for routine vaccine administration and should not be used when scheduling future appointments.

The 4-day grace period does not apply to the minimum 28-day interval between 2 live virus vaccines (MMR, LAIV, and Varicella).

Can I convert a vaccine interval to days or weeks?

If the dosing interval is 4 months or more, it is recommended to use only calendar months (e.g., 6 calendar months from October 15 is April 15). If the interval is less than 4 months, it is OK to convert months into days or weeks (1 month = 4 weeks = 28 days).

We follow these conversion guidelines for the school immunization requirements, as it is recommended by the Advisory Committee on Immunization Practices (ACIP) and published by the Centers for Disease Control & Prevention (CDC).

Do invalid doses of vaccine need to be repeated?

A dose of vaccine that is required for school entry and is administered 5 or more days before the recommended minimum age or interval must be repeated as age-appropriate. This also applies to live virus vaccines administered at intervals shorter than 28 days.

In general, the repeat dose must be spaced after the invalid dose by at least the minimum interval. CHIRP will forecast if the vaccine needs to be repeated and the earliest acceptable date for repeat vaccination. Children do not meet school immunization requirements if they have one or more invalid doses of vaccine that need to be repeated.

If a student received a dose of vaccine before the recommended minimum interval or age, can I send a physician note stating there is no need to repeat the dose as a medical exemption?

No. School immunization requirements in the state of Indiana follow the recommendations made by the Advisory Committee on Immunization Practices (ACIP) and are adopted by the CDC. Invalid doses will be marked in CHIRP with a red “X”, and the parent/guardian will need to provide evidence of immunity in order to meet school entry requirements. Evidence of immunity includes documentation of a valid dose(s) of vaccine, a positive IgG titer (if acceptable for the vaccine dose in question), or acceptable documentation of history of disease.

If there is an extended interval between doses of a vaccine series, does the student need to start the series over?

None of the vaccine series required for school should be restarted or contain additional doses due to an extended interval between doses. The student should just complete the series with the remaining dose(s) due.

Are immunizations required for all children enrolled in school?

Yes. Students in all grades are required to meet the minimum immunization requirements. Immunization requirements extend to children ages 3 through 5 attending special education programs, child care, or preschool within the school building.

I have a patient who will be only 10 when he enters 6th grade. Should he receive the MCV4 and Tdap before 6th grade like the other students, or wait until he is 11?

The student should receive the Tdap and MCV4 prior to entering 6th grade. Indiana’s school immunization requirements are grade-based, not age-based. A dose of Tdap and MCV4 will count towards the adolescent requirements if given at age 10 or older. All of the Tdap and MCV4 vaccines are licensed for use in persons 10 years of age. ACIP recommendations are not laws, and Indiana Code for immunization requirements for school trumps the ACIP recommendation.

I have several students who are behind on vaccines. Where can I find the catch-up schedule for vaccination?

The immunization schedules are updated annually by the CDC usually in late January or early February of the current year. These updates include the catch-up schedule.

  • To find the most recent version of the immunization schedules, please click here.
  • The link to the catch-up schedule can be found here.

For children on the catch-up schedule, we recommend using the CHIRP forecast tool to plan future immunization appointments. CHIRP automatically defaults to the catch-up schedule when a child is behind on immunizations and will forecast the earliest date the next dose can be given. Forecast is located below View/Add under the Vaccinations tab on CHIRP.

I have patients from other countries and I am having trouble translating their immunization records.

Appendix B of the CDC Pink Book contains a guide to translating foreign immunization records, as well as a list of vaccines given in other countries. The guide can be found here.

You may contact the ISDH Immunization Division if you need further assistance.

For additional questions, please contact the IN State Dept of Health Immunization Program at 1-800-701-0704.