Administrative Code

Virginia Administrative Code
5/27/2022

Chapter 110. Regulations for the Immunization of School Children

Part I
Definitions

12VAC5-110-10. Definitions.

The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Adequate immunization" means the immunization requirements prescribed under 12VAC5-110-70.

"Admit" or "admission" means the official enrollment or reenrollment for attendance at any grade level, whether full-time or part-time, of any student by any school.

"Admitting official" means the school principal or his designated representative if a public school; if a nonpublic school or child care center, the principal, headmaster or director of the school or center.

"Board" means the State Board of Health.

"Commissioner" means the State Health Commissioner.

"Compliance" means the completion of the immunization requirements prescribed under 12VAC5-110-70.

"Conditional enrollment" means the enrollment of a student for a period of 90 days contingent upon the student having received at least one dose of each of the required vaccines and the student possessing a plan, from a physician or local health department, for completing his immunization requirements within the ensuing 90 calendar days. If the student requires more than two doses of hepatitis B vaccine, the conditional enrollment period, for hepatitis B vaccine only, shall be 180 calendar days.

"Documentary proof" means an appropriately completed copy of the most current version of Form MCH 213G signed by a physician or his designee, registered nurse, or an official of a local health department. A copy of the immunization record signed or stamped by a physician or his designee, registered nurse, or an official of a local health department indicating the dates of administration including month, day, and year of the required vaccines, shall be acceptable in lieu of recording these dates on Form MCH 213G, as long as the record is attached to Form MCH 213G and the remainder of Form MCH 213G has been appropriately completed. A printout of an immunization record from the provider's electronic health record can be accepted without a signature or stamp. For a new student transferring from an out-of-state school, any immunization record, which contains the exact date (month/day/year) of administration of each of the required doses of vaccines, is signed by a physician or his designee or registered nurse, and complies fully with the requirements prescribed under 12VAC5-110-70 shall be acceptable.

"Immunization" means the administration of a product licensed by the FDA to confer protection against one or more specific pathogens.

"Immunization schedules" means the 2017 Recommended Immunization Schedules for Children and Adolescents Aged 18 Years or Younger developed and published by the Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP).

"Physician" means any person licensed to practice medicine in any of the 50 states or the District of Columbia.

"School" means:

1. Any public school from kindergarten through grade 12 operated under the authority of any locality within this Commonwealth;

2. Any private or religious school that offers instruction at any level or grade from kindergarten through grade 12;

3. Any private or religious nursery school or preschool, or any private or religious child care center required to be licensed by this Commonwealth;

4. Any preschool classes or Head Start classes operated by the school divisions within this Commonwealth; and

5. Any family day home or developmental center.

"Student" means any person who seeks admission to a school, or for whom admission to a school is sought by a parent or guardian, and who will not have attained the age of 20 years by the start of the school term for which admission is sought.

"Twelve months of age" means the 365th day following the date of birth. For the purpose of evaluating records, vaccines administered up to four days prior to the first birthday (361 days following the date of birth) will be considered valid.

Statutory Authority

§§ 22.1-271.2, 32.1-46, and 32.1-47 of the Code of Virginia.

Historical Notes

Derived from VR355-28-300 § 1.1, eff. August 13, 1992; amended, Virginia Register Volume 11, Issue 16, eff. August 1, 1995; Volume 26, Issue 11, eff. March 3, 2010; Volume 32, Issue 7, eff. January 14, 2016; Volume 34, Issue 9, eff. February 10, 2018.

Part II
General Information

12VAC5-110-20. Purpose.

This chapter is designed to ensure that all students attending any school in the Commonwealth, are adequately immunized and protected against diphtheria, pertussis, tetanus, poliomyelitis, rubeola, rubella, mumps, haemophilus influenzae type b, hepatitis B, varicella, pneumococcal, and human papillomavirus disease as appropriate for the age of the student.

Statutory Authority

§§ 22.1-271.2, 32.1-12, and 32.1-46 of the Code of Virginia.

Historical Notes

Derived from VR355-28-300 § 2.1, eff. August 13, 1992; amended, Virginia Register Volume 11, Issue 16, eff. August 1, 1995; Volume 26, Issue 11, eff. March 3, 2010.

12VAC5-110-30. Administration.

A. The Board of Health has the responsibility for promulgating regulations pertaining to the implementation of the school immunization law and standards of immunization by which a child attending any school may be judged to be adequately immunized.

B. The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session, subject to the rules and regulations of the board.

C. The local health director is responsible for providing assistance in implementing this chapter to the school divisions in his jurisdiction and for providing immunizations to children determined not to be adequately immunized, who present themselves to the local health department for immunization.

D. The school principals of public schools and the principals, headmasters and directors of nonpublic schools shall require each student attending their institutions to provide documentary proof of immunization against the diseases listed in 12VAC5-110-70.

Statutory Authority

§§ 22.1-271.2, 32.1-12, and 32.1-46 of the Code of Virginia.

Historical Notes

Derived from VR355-28-300 § 2.2, eff. August 13, 1992; amended, Virginia Register Volume 11, Issue 16, eff. August 1, 1995; Volume 26, Issue 11, eff. March 3, 2010.

12VAC5-110-40. Application of chapter.

This chapter has general application throughout the Commonwealth.

Statutory Authority

§§ 22.1-271.1, 22.1-271.2, 32.1-12, and 32.1-46 of the Code of Virginia.

Historical Notes

Derived from VR355-28-300 § 2.3, eff. August 13, 1992; amended, Virginia Register Volume 11, Issue 16, eff. August 1, 1995.

12VAC5-110-50. Application of the Administrative Process Act.

The provisions of the Virginia Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia) shall govern the adoption, amendment, modification and revision of this chapter, and the conduct of all proceedings and appeals hereunder.

Statutory Authority

§§ 22.1-271.2, 32.1-12, and 32.1-46 of the Code of Virginia.

Historical Notes

Derived from VR355-28-300 § 2.4, eff. August 13, 1992; amended, Virginia Register Volume 11, Issue 16, eff. August 1, 1995; Volume 26, Issue 11, eff. March 3, 2010.

12VAC5-110-60. Powers and procedures of chapter not exclusive.

The board reserves the right to authorize a procedure for enforcement of this chapter which is not inconsistent with the provisions set forth herein and the provisions of Chapter 2 (§ 32.1-35 et seq.) of Title 32.1 of the Code of Virginia.

Statutory Authority

§§ 22.1-271.1, 22.1-271.2, 32.1-12, and 32.1-46 of the Code of Virginia.

Historical Notes

Derived from VR355-28-300 § 2.7, eff. August 13, 1992; amended, Virginia Register Volume 11, Issue 16, eff. August 1, 1995.

Part III
Immunization Requirements

12VAC5-110-70. Immunization requirements.

Every student enrolling in a school shall provide documentary proof of adequate immunization with the prescribed number of doses of each of the vaccines and toxoids listed in the following subdivisions, as appropriate for the child's age according to the immunization schedules. Spacing, minimum ages, and minimum intervals shall be in accordance with the immunization schedules. A copy of every student's immunization record shall be on file in his school record.

1. Diphtheria Toxoid. A minimum of four properly spaced doses of diphtheria toxoid. One dose shall be administered on or after the fourth birthday and prior to entering kindergarten.

2. Tetanus Toxoid. A minimum of four properly spaced doses of tetanus toxoid. One dose shall be administered on or after the fourth birthday and prior to entering kindergarten.

3. Pertussis Vaccine. A minimum of four properly spaced doses of pertussis vaccine. One dose shall be administered on or after the fourth birthday. A booster dose shall be administered prior to entering the seventh grade.

4. Poliomyelitis Vaccine. A minimum of four doses of poliomyelitis vaccine with one dose administered on or after the fourth birthday and prior to entering kindergarten.

5. Measles (Rubeola) Vaccine. One dose of live measles vaccine administered at age 12 months or older, and a second dose administered prior to entering kindergarten.

6. Rubella Vaccine. A minimum of one dose of rubella virus vaccine administered at age 12 months or older.

7. Mumps Vaccine. One dose of mumps virus vaccine administered at age 12 months or older and a second dose administered prior to entering kindergarten.

8. Haemophilus Influenzae Type b (Hib) Vaccine. A complete series of Hib vaccine (i.e., up to a maximum of four doses of vaccine as appropriate for the age of the child and the age at which the immunization series was initiated). The number of doses administered shall be in accordance with current immunization schedule recommendations. Attestation by the physician or his designee, registered nurse, or an official of a local health department on that portion of Form MCH 213G pertaining to Hib vaccine shall mean that the child has satisfied the requirements of this section. This section shall not apply to children older than 60 months of age or for admission to any grade level, kindergarten through grade 12.

9. Hepatitis B Vaccine. A minimum of three doses of hepatitis B vaccine for all children. The FDA has approved a two-dose schedule only for adolescents 11 through 15 years of age and only when the Merck brand (RECOMBIVAX HB) Adult Formulation Hepatitis B vaccine is used. The two RECOMBIVAX HB adult doses must be separated by a minimum of four months. The two dose schedule using the adult formulation must be clearly documented in the Hepatitis B section on Form MCH 213G.

10. Varicella (Chickenpox) Vaccine. All children born on and after January 1, 1997, shall be required to have one dose of chickenpox vaccine on or after 12 months of age and a second dose administered prior to entering kindergarten.

11. Pneumococcal Conjugate Vaccine (PCV). A complete series of PCV (i.e., up to a maximum of four doses of vaccine as appropriate for the age of the child and the age at which the immunization series was initiated). The number of doses administered shall be in accordance with current immunization schedule recommendations. Attestation by the physician or his designee, registered nurse, or an official of a local health department on that portion of Form MCH 213G pertaining to PCV vaccine shall mean that the child has satisfied the requirements of this section. This section shall not apply to children older than 60 months of age or for admission to any grade level, kindergarten through grade 12.

12. Human Papillomavirus (HPV) Vaccine. Three doses of properly spaced HPV vaccine for females, effective October 1, 2008. The first dose shall be administered before the child enters the sixth grade.

Statutory Authority

§§ 22.1-271.2, 32.1-12, and 32.1-46 of the Code of Virginia.

Historical Notes

Derived from VR355-28-300 § 3.1, eff. August 13, 1992; amended, Virginia Register Volume 11, Issue 16, eff. August 1, 1995; Volume 26, Issue 11, eff. March 3, 2010; Volume 31, Issue 1, eff. October 10, 2014; Volume 32, Issue 7, eff. January 14, 2016; Volume 35, Issue 23, eff. August 9, 2019.

12VAC5-110-80. Exemptions from immunization requirements.

A. Religious and medical exemptions. No certificate of immunization shall be required of any student for admission to school if:

1. The student or his parent or guardian submits a notarized Certificate of Religious Exemption (Form CRE 1), to the admitting official of the school to which the student is seeking admission. Form CRE 1 is an affidavit stating that the administration of immunizing agents conflicts with the student's religious tenets or practices. The form is available on the Division of Immunization website at http://www.vdh.virginia.gov/immunization/requirements; or

2. The school has written certification on either of the documents specified under "documentary proof" in 12VAC5-110-10 from a physician, registered nurse, or a local health department that one or more of the required immunizations may be detrimental to the student's health. Such certification of medical exemption shall specify the nature and probable duration of the medical condition or circumstance that contraindicates immunization.

3. Upon the identification of an outbreak, potential epidemic, or epidemic of a vaccine-preventable disease in a public or private school, the commissioner has the authority to require the exclusion from such school of all children who are not immunized against that disease.

B. Demonstration of existing immunity. The demonstration in a student of antibodies against mumps, measles, rubella, or varicella in sufficient quantity to ensure protection of that student against that disease, shall render that student exempt from the immunization requirements contained in 12VAC5-110-70 for the disease in question. Such protection should be demonstrated by means of a serological testing method appropriate for measuring protective antibodies against mumps, measles, rubella, or varicella respectively. Reliable history of chickenpox disease diagnosed or verified by a health care provider shall render students exempt from varicella requirements.

C. HPV vaccine. Because the human papillomavirus is not communicable in a school setting, a parent or guardian, at the parent's or guardian's sole discretion, may elect for the parent's or guardian's child not to receive the HPV vaccine, after having reviewed materials describing the link between the human papillomavirus and cervical cancer approved for such use by the board.

Statutory Authority

§§ 22.1-271.2, 32.1-12, and 32.1-46 of the Code of Virginia.

Historical Notes

Derived from VR355-28-300 § 3.2, eff. August 13, 1992; amended, Virginia Register Volume 26, Issue 11, eff. March 3, 2010; Volume 32, Issue 7, eff. January 14, 2016; Volume 37, Issue 23, eff. July 5, 2021.

Part IV
Procedures and Responsibilities

12VAC5-110-90. Responsibilities of admitting officials.

A. Procedures for determining the immunization status of students. Each admitting official or his designee shall review, before the first day of each school year, the school medical record of every new student seeking admission to his school, and that of every student enrolling in grade six for compliance with the requirements prescribed in 12VAC5-110-70. Such review shall determine into which one of the following categories each student falls:

1. Students whose immunizations are adequately documented and complete in conformance with 12VAC5-110-70. Students with documentation of existing immunity to mumps, measles, rubella, or varicella as defined in 12VAC5-110-80 B shall be considered to be adequately immunized for such disease.

2. Students who are exempt from the immunization requirements of 12VAC5-110-70 because of medical contraindications or religious beliefs provided for by 12VAC5-110-80.

3. Students whose immunizations are inadequate according to the requirements of 12VAC5-110-70.

4. Students without any documentation of having been adequately immunized.

B. Notification of deficiencies. Upon identification of the students described in subdivisions A 3 and 4 of this section, the admitting official shall notify the parent or guardian of the student:

1. That there is no, or insufficient, documentary proof of adequate immunization in the student's school records.

2. That the student cannot be admitted to school unless he has documentary proof that he is exempted from immunization requirements pursuant to 12VAC5-110-70.

3. That the student may be immunized and receive certification by a licensed physician, registered nurse, or an official of a local health department.

4. How to contact the local health department to receive the necessary immunizations.

C. Conditional enrollment. Any student whose immunizations are incomplete may be admitted conditionally if that student provides documentary proof at the time of enrollment of having received at least one dose of the required immunizations accompanied by a schedule for completion of the required doses within 90 calendar days, during which time that student shall complete the immunizations required under 12VAC5-110-70. If the student requires more than two doses of hepatitis B vaccine, the conditional enrollment period, for hepatitis B vaccine only, shall be 180 calendar days. If a student is a homeless child or youth and does not have documentary proof of necessary immunizations or has incomplete immunizations and is not exempted from immunization as described in 12VAC5-110-80, the school administrator shall immediately admit such student and shall immediately refer the student to the local school division liaison, who shall assist in obtaining the documentary proof of, or completing, immunizations. The admitting official should examine the records of any conditionally enrolled student at regular intervals to ensure that such a student remains on schedule with his plan of completion.

D. Exclusion. The admitting official shall, at the end of the conditional enrollment period, exclude any student who is not in compliance with the immunization requirements under 12VAC5-110-70 and who has not been granted an exemption under 12VAC5-110-80 until that student provides documentary proof that his immunization schedule has been completed, unless documentary proof that a medical contraindication developed during the conditional enrollment period is submitted.

E. Transfer of records. The admitting official of every school shall be responsible for sending a student's immunization records or a copy thereof, along with his permanent academic or scholastic records, to the admitting official of the school to which a student is transferring within 10 days of his transfer to the new school.

F. Report of student immunization status. Each admitting official shall, within 30 days of the beginning of each school year or entrance of a student, or by October 15 of each school year, file with the State Health Department through the health department for his locality, a report summarizing the immunization status of the students in his school as of the first day of school. This report shall be filed using the web-enabled reporting system or on the most current version of Form SIS, the Student Immunization Status Report, and shall contain the number of students admitted to that school with documentary proof of immunization, the number of students who have been admitted with a medical or religious exemption and the number of students who have been conditionally admitted.

G. Immunization records shall be open to inspection by health department officials.

H. Each admitting official shall ensure that the parent or guardian of a female to be enrolled in the sixth grade receives educational materials describing the link between the human papillomavirus and cervical cancer. Materials shall be approved by the board and provided to the parent or guardian prior to the child's enrollment in the sixth grade.

Statutory Authority

§§ 22.1-271.2, 32.1-46, and 32.1-47 of the Code of Virginia.

Historical Notes

Derived from VR355-28-300 § 4.1, eff. August 13, 1992; amended, Virginia Register Volume 11, Issue 16, eff. August 1, 1995; Volume 26, Issue 11, eff. March 3, 2010; Volume 32, Issue 7, eff. January 14, 2016; Volume 34, Issue 9, eff. February 10, 2018.

12VAC5-110-100. Responsibilities of physicians and local health departments.

A. Documentary proof for students immunized in Virginia. Every physician, registered nurse, and local health department providing immunizations to a child shall provide documentary proof, as defined in 12VAC5-110-10, to the child or his parent or guardian of all immunizations administered.

B. Documentary proof for out-of-state students. For a student transferring from an out-of-state school to a Virginia school, the admitting official may accept as documentary proof any immunization record for that student that is signed by a physician or registered nurse and that contains the exact date (month/day/year) of administration of each of the required doses of vaccines when indicated and that complies fully with the requirements prescribed under 12VAC5-110-70. Any immunization record that does not contain the signature of a physician or a nurse and does not contain the month/day/year of administration of each of the required vaccine doses shall not be accepted by the admitting official as documentary proof of adequate immunization. Such a student's record shall be evaluated by an official of the local health department who shall determine if that student is adequately immunized in accordance with the provisions of 12VAC5-110-70. Should the local health department determine that such a student is not adequately immunized, that student shall be referred to his private physician or local health department for any required immunizations.

Statutory Authority

§§ 22.1-271.2, 32.1-12, and 32.1-46 of the Code of Virginia.

Historical Notes

Derived from VR355-28-300 § 4.2, eff. August 13, 1992; amended, Virginia Register Volume 26, Issue 11, eff. March 3, 2010.

Part V
Penalties

12VAC5-110-110. Exclusion of students.

Any student who fails to provide documentary proof of immunization in the manner prescribed, within the time periods provided for in these regulations and §§ 22.1-271.1 and 22.1- 271.2 of the Code of Virginia, shall be excluded from school attendance by the school's admitting official.

Statutory Authority

§§ 22.1-271.1, 22.1-271.2, 32.1-12, and 32.1-46 of the Code of Virginia.

Historical Notes

Derived from VR355-28-300 § 5.1, eff. August 13, 1992.

12VAC5-110-120. Exclusion of students unprotected against vaccine-preventable diseases.

In accordance with § 32.1-47 of the Code of Virginia, any student exempted from immunization requirements pursuant to 12VAC5-110-80 A, shall be excluded from school attendance for his own protection until the danger has passed, if the commissioner so orders such exclusion upon the identification of an outbreak, potential epidemic or epidemic of a vaccine-preventable disease in that student's school.

Statutory Authority

§§ 22.1-271.1, 22.1-271.2, 32.1-12, and 32.1-46 of the Code of Virginia.

Historical Notes

Derived from VR355-28-300 § 5.2, eff. August 13, 1992.

12VAC5-110-130. Responsibility of parent to have a child immunized.

In accordance with § 32.1-46 of the Code of Virginia, the parent, guardian or person standing in loco parentis of each child within this Commonwealth shall ensure such child is immunized in accordance with the immunization schedule.

The parent or guardian of a child who is home instructed shall ensure such child is immunized in accordance with § 22.1-271.4 of the Code of Virginia.

Penalties for noncompliance shall be in accordance with § 32.1-27 of the Code of Virginia.

Statutory Authority

§§ 22.1-271.2, 32.1-12 and 32.1-46 of the Code of Virginia.

Historical Notes

Derived from VR355-28-300 § 5.3, eff. August 13, 1992; amended, Virginia Register Volume 11, Issue 16, eff. August 1, 1995; Volume 26, Issue 11, eff. March 3, 2010.

12VAC5-110-140. (Repealed.)

Historical Notes

Derived from VR355-28-300 § 5.4, eff. August 13, 1992; amended, Virginia Register Volume 11, Issue 16, eff. August 1, 1995; repealed, Volume 26, Issue 11, eff. March 3, 2010.

FORMS (12VAC5-110).

Certificate of Religious Exemption, CRE-1 (rev. 00/1992)

School Entrance Health Form, Health Information Form/Comprehensive Physical Examination Report/Certification of Immunization, MCH 213G (rev. 3/2014)

Student Immunization Status Report, Form SIS 3 (School) (rev. 5/2009)

Forms (12VAC5-110-9999)

Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States 2017, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, effective January 1, 2017

Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.

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