For SCHOOL-Aged Children

Information concerning:
   Measles
   Rubella
   Poliomyelitis
   Diphtheria, Tetanus, Pertussis (DTP)
   Mumps
   Hemophilus influenzae Type b (Hib)
   Hepatitis B (HBV)
   Varicella
   Religious Exemption
   Immunization Schedule

The following are the most recent regulations covering school-related immunizations. Additions are in CAPS and went into effect in March 2000.

Regulation of the Department of Public Health concerning school-related immunizations subject matter of regulation

Section 1.

Section 10-204a-1 of the Regulations of Connecticut State Agencies is amended to read as follows:

Immunization of School Children Against Measles, Mumps, Rubella, Poliomyelitis, Diphtheria, Tetanus, Pertussis, Hemophilus influenzae Type B (HIB), Hepatitis B, AND VARICELLA

Section 10-204a-1. Definitions

As used in Sections 10-204a-2 through 10-204a-4 of the Regulations of Connecticut State Agencies:

(a) "Commissioner" means the commissioner of public health.

(b) "Department" means the department of public health.

(c) "Local health authority" means and includes the town, city, borough and local district director of health, local superintendent and commissioner of public health and any officer or person having the usual powers and duties of a local director of health.

(d) "Medically contraindicated immunization" means an immunization that is not in the best health interest of an individual as determined by a physician licensed to practice medicine in the United States and in accordance with:

(1) the then current recommendation of the United States Public Health Service Advisory Committee on Immunization Practices, Centers for Disease Control or American Academy of Pediatrics Committee on Infectious Diseases; or

(2) written approval of the commissioner for any case not resolvable by reference to the recommendations specified in subdivision (1) of this subsection.

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Sec. 2.

Section 10-204a-2a of the regulations of Connecticut State Agencies is amended to read as follows:

Sec. 10-204a-2a. Adequate Immunization

(a) Measles. An individual shall be considered adequately protected against measles if that individual:

(1) IS ENROLLED IN PRESCHOOL AND IS LESS THAN FOUR (4) YEARS OF AGE AND WAS IMMUNIZED BY USE OF LIVE ATTENUATED MEASLES VACCINE ON OR AFTER THAT INDIVIDUAL'S FIRST BIRTHDAY; OR

(2) is OR HAS BEEN enrolled in KINDERGARTEN ON OR AFTER AUGUST 2000 and was immunized against measles by use of TWO (2) DOSES OF A live attenuated measles vaccine GIVEN AT LEAST THIRTY (30) DAYS APART, THE FIRST on or after that individual's first birthday; or

(3) is or has been enrolled in seventh grade after September 1992 and had two (2) doses of a live attenuated measles vaccine, the first on or after that individual's first birthday; or

(4) has had protection against measles confirmed in writing by a physician, physician assistant or ADVANCED PRACTICE REGISTERED NURSE based on specific blood testing by a certified laboratory.

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(b) Rubella. An individual shall be considered adequately protected against rubella, if that individual:

(1) was immunized at one (1) year or older with a rubella vaccine; or

(2) has had protection against rubella confirmed in writing by specific blood testing conducted by a certified laboratory.

(c) Poliomyelitis

(1) An individual eighteen (18) months of age or older shall be considered adequately protected against poliomyelitis if that individual has had a minimum of (3) doses of either trivalent oral polio vaccine (TOPV) or inactivated polio vaccine (IPV), two (2) doses of polio vaccine given at least four (4) weeks apart and a third dose given at least TWO (2) months after the previous dose.

(2) For individuals ENROLLED IN GRADES KINDERGARTEN THROUGH TWELVE (12) AND AT LEAST FORTY-EIGHT (48) MONTHS OF AGE, at least one (1) dose of polio vaccine must been given on or after the fourth birthday.

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(d) Diphtheria, Tetanus, Pertussis (DTP)

(1) An individual eighteen to seventy-one (18-71) months of age shall be considered adequately protected against diphtheria, tetanus and pertussis if such individual was immunized with a minimum of four (4) doses of diphtheria, tetanus, and pertussis toxoid, three (3) doses given at a minimum of four (4) week intervals followed by a fourth DTP dose at least six (6) months after the third.

(2) For individuals FORTY EIGHT (48) to seventy-one (48-71) months of age AND ENROLLED IN GRADES KINDERGARTEN AND ABOVE, at least one (1) dose of DTP vaccine must have been given on or after the fourth birthday.

(3) An individual seventy-two (72) months of age or older shall be considered adequately protected if such individual was immunized with a minimum of two (2) doses of tetanus, diphtheria toxoid (td) at a minimum of four (4) week intervals, followed by a third dose of tetanus, diphtheria toxoid at least six (6) months after the second dose and on or after the fourth birthday.

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(e) Mumps. An individual shall be considered adequately protected against mumps if such individual:

(1) was immunized at one (1) year of age or older with live mumps vaccine, or

(2) has protection against mumps confirmed in writing by a physician based on specific blood testing by a certified laboratory.

(f) Hemophilus influenzae Type b (Hib). An individual shall be considered adequately protected against Hib invasive disease if such individual:

(1) was immunized before age five (5) years with a single dose of Hib vaccine given at age TWELVE (12) months or older, or

(2) is currently age five (5) years or older, or

(3) had a natural laboratory confirmed infection with hemophilus influenzae type b at age twenty-four (24) months or older confirmed in writing by a physician.

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(g) Hepatitis B (HBV)

(1)   An individual born January 1, 1994, or later shall be considered adequately protected against Hepatitis B if that individual:

(A) was immunized with three (3) doses of Hepatitis B vaccine, as follows two (2) doses given at least four (4) weeks apart followed by a third dose at least four (4) months after the second; or

(B) has had protection against Hepatitis B confirmed in writing by a physician based on specific blood testing conducted by a certified laboratory.

(2)   An individual born before January 1, 1994, AND ENROLLED IN SEVENTH (7th) GRADE IN AUGUST 2000 OR LATER, SHALL HAVE BEGUN VACCINATION AGAINST HEPATITIS B TO ENTER SEVENTH (7th) GRADE. SUCH INDIVIDUAL SHALL BE CONSIDERED TO HAVE BEGUN VACCINATION AGAINST HEPATITIS B IF THAT INDIVIDUAL:

    (A) WAS IMMUNIZED WITH AT LEAST ONE (1) DOSE OF HEPATITIS B VACCINE AT THE TIME OF SEVENTH (7th) GRADE ENTRY; OR

    (B) HAS HAD PROTECTION AGAINST HEPATITIS B CONFIRMED IN WRITING BY SPECIFIC BLOOD TESTING CONDUCTED BY A CERTIFIED LABORATORY.

(3) AN INDIVIDUAL BORN BEFORE JANUARY 1, 1994 AND ENROLLED IN EIGHTH (8th) GRADE IN AUGUST 2001 OR LATER, SHALL BE ADEQUATELY PROTECTED AGAINST HEPATITIS B TO ENTER EIGHTH (8th) GRADE. SUCH INDIVIDUAL SHALL BE CONSIDERED ADEQUATELY PROTECTED AGAINST HEPATITIS B IF THAT INDIVIDUAL:

    (A) WAS IMMUNIZED WITH AT LEAST THREE (3) DOSES OF HEPATITIS B VACCINE, TWO (2) DOSES GIVEN AT LEAST FOUR WEEKS APART FOLLOWED BY A THIRD DOSE AT LEAST FOUR (4) MONTHS AFTER THE SECOND; OR

    (B) HAS HAD PROTECTION AGAINST HEPATITIS B CONFIRMED IN WRITING BY SPECIFIC BLOOD TESTING CONDUCTED BY A CERTIFIED LABORATORY.

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(h) VARICELLA. AN INDIVIDUAL SHALL BE CONSIDERED ADEQUATELY PROTECTED AGAINST VARICELLA IF THAT INDIVIDUAL:

(1) WAS BORN JANUARY 1, 1997 OR LATER AND WAS IMMUNIZED WITH ONE (1) DOSE OF VARICELLA VACCINE ON OR AFTER THAT INDIVIDUAL'S FIRST BIRTHDAY AND BEFORE THAT INDIVIDUAL'S THIRTEENTH BIRTHDAY OR TWO (2) DOSES OF VARICELLA VACCINE GIVEN AT LEAST FOUR WEEKS APART IF THE FIRST DOSE WAS GIVEN ON OR AFTER THE INDIVIDUAL'S THIRTEENTH BIRTHDAY; OR

(2) WAS BORN BEFORE JANUARY 1, 1997 AND IS ENROLLED IN SEVENTH (7th) GRADE IN AUGUST 2000 OR LATER AND WAS IMMUNIZED WITH ONE (1) DOSE OF VARICELLA VACCINE ON OR AFTER THAT INDIVIDUAL'S FIRST BIRTHDAY AND BEFORE THAT INDIVIDUAL'S THIRTEENTH BIRTHDAY OR TWO (2) DOSES OF VARICELLA VACCINE GIVEN AT LEAST FOUR WEEKS APART IF THE FIRST DOSE WAS GIVEN ON OR AFTER THE INDIVIDUAL'S THIRTEENTH BIRTHDAY; OR

(3) HAS A WRITTEN STATEMENT SIGNED AND DATED BY A PHYSICIAN, PHYSICIAN ASSISTANT OR ADVANCED PRACTICE REGISTERED NURSE INDICATING THAT THE INDIVIDUAL HAS ALREADY HAD VARICELLA BASED ON FAMILY AND/OR MEDICAL HISTORY; OR

(4) HAS HAD PROTECTION AGAINST VARICELLA CONFIRMED IN WRITING BY SPECIFIC BLOOD TESTING CONDUCTED BY A CERTIFIED LABORATORY.

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(i) RELIGIOUS EXEMPTION. ANY INDIVIDUAL WHOSE PARENTS OR GUARDIAN PRESENTS A STATEMENT THAT SUCH IMMUNIZATION IS CONTRARY TO THE RELIGIOUS BELIEFS OF SUCH CHILD IS EXEMPTED FROM IMMUNIZATION REQUIREMENTS.

Sec. 3.

Subsection (a) of section 10-204a-3a of the regulations of Connecticut State Agencies is amended to read as follows:

Sec. 10-204a-3a. Immunization in progress

(a) In those instances at school entry where a school-aged child is not adequately immunized school attendance shall be permitted only if that child:

(1) has received a dose of each required vaccine for which that child is behind in the month prior to first attendance; and

(2) continues on the following schedule until adequately immunized.

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Primary Immunizations for individuals not immunized in early infancy.

Individuals ENROLLED IN PRESCHOOL

First visit to physician or local health authority: Dtap  or  (DTP)
TOPV or IPV
Hib
MMR
HBV*
One (1) month after first visit: Dtap  or  (DTP)
HBV*
VAR
Two (2) months after first visit: Dtap  or (DTP)
TOPV or IPV
Eight (8) months after first visit: Dtap  or  (DTP)
TOPV or IPV
HBV*


Individuals ENROLLED IN KINDERGARTEN OR ELEMENTARY SCHOOL UP TO Seventy-one (71) Months of Age

First visit to physician or local health authority: Dtap  or  (DTP)
TOPV or IPV
MMR
HBV*
One (1) month after first visit: Dtap  or  (DTP)
HBV*
VAR
Two (2) months after first visit:Dtap  or (DTP)
TOPV or IPV
MMR
Eight (8) months after first visit: Dtap  or  (DTP)
TOPV or IPV
HBV*


Individuals Six (6) Years UP TO THIRTEEN (13) YEARS OF AGE

First visit to physician or local health authority: Td
TOPV or IPV
MMR
HBV*
Two (2) months after first visit: Td
TOPV or IPV
HBV*
MMR
VAR
Eight (8) months after first visit: Td
TOPV or IPV
HBV*

INDIVIDUALS THIRTEEN (13) YEARS OF AGE OR OLDER
First visit to physician or local health authority: Td
TOPV or IPV
MMR
HBV*
VAR
Two (2) months after first visit: Td
TOPV or IPV
HBV*
MMR
VAR
Eight (8) months after first visit: Td
TOPV or IPV
HBV*
 
*   THE FULL THREE  (3) DOSE SCHEDULE FOR HBV IS required only for children born January 1, 1994 or later, OR FOR CHILDREN ENTERING 8TH GRADE AUGUST 2001 OR LATER.

In those instances at entry to seventh grade, OR AT ENTRY TO KINDERGARTEN AUGUST 2000 OR LATER, where an individual has not received a second dose of measles containing vaccine, a second dose shall be given. If an individual has received no measles containing vaccines, the second dose shall be given no less than thirty (30) days after the first.

Statement of Purpose: To update the school immunization requirements to be consistent with recently revised national recommendations and CGS Section 19a-7f by adding several new requirements (varicella vaccine for school and 7th grade entry, hepatitis B vaccine for 7th and 8th grade entry; a second dose of measles-containing vaccine prior to school entry); by modifying recommendations for timing of administration of DTaP, polio and Hib vaccines; and by revising the schedule for catch-up immunization.

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Infectious Diseases      |      Immunizations