216 R.I. Code R. 216-RICR-30-05-3.5

Current through November 21, 2024

Section 216-RICR-30-05-3.5 - Minimum Standards for Immunization and Communicable Disease Testing for Students Entering Preschools and Schools (K-12)

A. Each student, upon initial entry to any preschool or school in Rhode Island, shall furnish evidence to the administrative head of the preschool or school (pursuant to the requirements of §3.5.3 of this Part) that the student has been immunized, as required in §§3.5.1(A)(1)(a) and 3.5.2(A) ( 1-7) of this Part, unless the student is in an exempt category.

1. For the immunization requirements stipulated in §§3.5.1-(A)(1)(a) and 3.5.2(A) of this Part, a student who is not in compliance with these requirements shall be excluded from attending preschool or school until the requirements are met, unless the student belongs in an exemption category or is in a waiting period between doses as described in §3.5.4 of this Part.

3.5.1Preschool Entry Requirements

A. No student shall enter a preschool without an immunization record as defined in §3.5.3 of this Part documenting that the student has been or is age appropriately immunized in accordance with the current Recommended Childhood Immunization Schedule approved by the Advisory Committee on Immunization Practices (ACIP)/American Academy of Pediatrics(AAP)/American Academy of Family Physicians (AAFP) against diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, Haemophilus influenzae type b, hepatitis B, varicella (chickenpox), and pneumococcal disease.

1. Beginning August 1, 2015, immunization against hepatitis A and rotavirus will be added to the immunizations required pursuant to §3.5.1 of these Regulations.

a. Beginning August 1, 2015, annual influenza vaccination, given between July 1 and December 31 of each year, is required for all preschool children six to fifty-nine ( 6-59) months of age.

3.5.2School Entry Requirements

A. Each student, upon initial entry to any school, shall furnish evidence as required in §3.5.3 of this Part of having received the vaccines described below:

1. Diphtheria, Tetanus, and Pertussis Vaccine

a. Five (5) doses of diphtheria, tetanus and acellular pertussis (DTaP) vaccine. If the fourth (4th) dose was given after the fourth (4th) birthday, a fifth (5th) dose is not necessary (total of four (4) doses). Where pertussis vaccine is medically contraindicated, diphtheria-tetanus (DT) vaccine is to be substituted.

(1) Where the student is seven (7) or more years of age and requires additional doses of vaccine to satisfy §3.5.3(1)(a), Tdap (tetanus-diphtheria-pertussis) or Td (tetanus-diphtheria) shall be given in place of DTaP/DT according to ACIP age appropriate recommendations.

b. One (1) dose of Tdap vaccine is required for students entering seventh (7th) grade (or in the case of an ungraded classroom, for students twelve (12) years of age or older).

2. Poliomyelitis Vaccine

a. Four (4) doses of any combination of either oral poliovirus vaccine (OPV) or inactivated poliovirus vaccine (IPV). The final dose should be given on or after the fourth (4th) birthday. If the third (3rd) dose was given after the fourth (4th) birthday, a fourth (4th) dose is not necessary (total of three (3) doses), if all three (3) doses were either all OPV or all IPV; or a series administered in accordance with ACIP recommendations.

b. For students eighteen (18) years of age and older, poliovirus vaccine is not required.

3. Measles, Mumps, and Rubella Vaccines

a. Two (2) doses of live measles, mumps and rubella vaccine given at least four (4) weeks apart beginning on or after twelve (12) months of age shall be required for students entering kindergarten (K) and grade seven (7) in accordance with ACIP recommendations.

b. Beginning on August 1, 2015, this requirement shall apply to all students entering grades K through 12 and all students in ungraded classrooms. The following dates are in effect for the grades, as specified below:

(1) August 1, 2014 K,1,2,3,4,5,7,8,9,10,11,12

(2) August 1, 2015 K,1,2,3,4,5,6,7,8,9,10,11,12

4. Hepatitis B Vaccine

a. Three (3) doses of hepatitis B vaccine administered in accordance with ACIP recommendations are required for students entering grades kindergarten (K) through grade twelve (12) and all students in ungraded classrooms.

5. Varicella (Chickenpox) Vaccine

a. Two (2) doses of varicella vaccine given at least four (4) weeks apart beginning at or after twelve (12) months shall be required for students entering kindergarten (K) and grade seven (7) (or in the case of an ungraded classrooms, students twelve (12) years of age or older).

(1) August 1, 2014 K,1,2,3,4,5,7,8,9,10,11,12

(2) August 1, 2015 K,1,2,3,4,5,6,7,8,9,10,11,12

6. Meningococcal Vaccine

a. All students entering seventh (7th) grade, shall be required to receive one (1) dose of meningococcal vaccine in accordance with ACIP recommendations.

b. Beginning August 1, 2014, this requirement shall apply to all students entering grades seven (7) through twelve (12) and all students in ungraded classrooms. The following dates are in effect for the grades, as specified below:

(1) August 1, 2014 7,8,9,10,11,12

c. Beginning August 1, 2015, all students entering grade twelve (12), who had their first dose at age fifteen (15) years or younger, are required to have a booster dose given on or after sixteen (16) years of age.

7. Human Papillomavirus (HPV) Vaccine

a Beginning August 1, 2015, all students entering seventh (7th) grade shall be required to have at least one (1) dose of the HPV vaccine series.

b Beginning August 1, 2016, all students entering eighth (8th) grade shall be required to have at least two (2) doses of the HPV vaccine series.

c Beginning August 1, 2017, all students entering ninth (9th) grade shall be required to have completed the HPV vaccine series (3 doses).

3.5.3Immunization Records

A. Acceptable evidence of completion of immunizations shall include the day, month, year and type/name of each dose of vaccine administered. Such evidence shall consist of a record signed by a physician, registered nurse practitioner, physician's assistant, or his/her designee (the signature of the student's parents is not acceptable). This record may be submitted to the preschool or school by a health care provider, another preschool or school, a parent or a guardian.

1. An official immunization record card, preschool or school immunization record, Medical Passport, World Health Organization immunization record, or other official immunization records acceptable to the Department; or

2. An electronically stored and/or transmitted documentary record (facsimile transmission, computerized record, including, but not limited to, a record obtained from the KIDSNET statewide registry or other statewide registry, record on magnetic media or similar record) as may be utilized by a preschool or school; or

3. Presentation of laboratory evidence of immunity is made in the case of measles, mumps, rubella, hepatitis B and varicella (chickenpox); or,

4. For chickenpox (varicella), a physician, a physician assistant, a certified registered nurse practitioner, or other licensed practitioner acting within his/her scope of practice signs a statement that the student has a history of chickenpox disease (varicella).

5. Telephone confirmation by the preschool or school or college of the existence of immunization records as defined above, provided all of the following conditions are met:

a. An acceptable documentary record is on file with the preschool or school officials at a preschool or school which the student previously attended, or is on file with a health provider, public health agency, other health professional or preschool or school official responsible for maintenance of immunization records; and

b. Telephone confirmation is obtained by a preschool or school official at the preschool or school in which the student enrolls; and

c. Telephone confirmation is sought and obtained within one (1) working day of the student's initial entry; and

d. Written documentation is made in the student's preschool or school health record of the telephone confirmation call, including the date and time of the call, the name, address, and telephone number of the person who confirmed the immunization status; and

e. A written documentary record of immunization is received by the preschool or school in which the student has enrolled within ten (10) working days of initial entry; and

f. The preschool or school shall implement the telephone confirmation as described above, if a student is seeking entry and does not present a copy of immunization records.

3.5.4Provisions for Exclusions, Waiting Periods and Exemptions

A. Exclusions

1. Students who have not received the minimum number of required immunizations, who are not in a prescribed waiting period between doses, as specified in §3.5.4(B) of this Part and who are not exempt pursuant to §3.5.4(C) of this Part, shall be excluded from the preschool or school by the administrative head of the preschool or school, pending the completion of the required dose(s) of vaccine(s).

2. Students upon initial entry to any preschool or school shall be excluded unless evidence is submitted that the student has received initial dose(s) of required vaccine(s) for preschool or school entry as set forth in these Regulations.

a. The presence of a vaccine-preventable disease outbreak is determined in consultation with the Department. If an outbreak of vaccine-preventable disease should occur, an exempt student shall be excluded from school by the administrative head of school for a period of time as determined by the Department based on a case-by-case analysis of public health risk.

b. The preschool or school shall have a written protocol in place for the exclusion of unvaccinated students in the event of an outbreak. An accurate and current listing of unvaccinated students shall be maintained by the preschool or school for this purpose.

B. Waiting Periods

1. If at initial preschool or school entry a student is within a waiting period for the minimum number of doses for a given vaccine, the student shall be registered and/or admitted to preschool or school. It shall be the responsibility of the administrative head of the preschool or school or his/her designee to ensure the completion of at least the minimum number of immunizations, following the prescribed waiting period(s) and consistent with the provisions of these Regulations.

a. The administrative head of the preschool or school or his/her designee shall sign a Temporary Immunization Exemption Certificate, provided by the school, indicating that an appointment with a health care provider for the required immunization(s) has been made. This temporary exemption shall expire on the date of the immunization appointment.

2. At initial preschool or school entry a student who is under the care of the Department of Children, Youth and Families (DCYF) shall be enrolled in school upon presentation of a completed intra-state education identification card in accordance with the requirements of R.I. Gen. Laws § 42-72.4-1 or as stipulated in §3.5.3 of this Part.

C. Exemptions

1. A student may only be exempt from the immunization requirements described in these Regulations for either of the two (2) reasons stated below:

a. A physician, a physician assistant, a certified registered nurse practitioner, or other licensed practitioner acting within his/her scope of practice signs the Rhode Island Department of Health's "Medical Immunization Exemption Certificate" provided by the school attesting that the student is exempt from a specific vaccine because of medical reasons, in accordance with ACIP recommendations; or

b. A parent or guardian completes and signs the Department's "Religious Immunization Exemption Certificate" provided by the school, attesting that immunization conflicts with the tenets of their religious beliefs.

216 R.I. Code R. 216-RICR-30-05-3.5