Posted Date: November 26, 2012
TITLE 37 JUVENILES
CHAPTER 10. MISCELLANEOUS PROVISIONS
PART 4. CHILDHOOD IMMUNIATIONS
Tenn. Code Ann. § 37-10-401
37-10-401. Responsibility of parents to have children immunized - Specific vaccines - Immunization registry
(a) It is the responsibility of each parent or legal guardian to ensure that such person's child or children receive the vaccines as are recommended by guidelines of the Center for Disease Control or the American Academy of Pediatrics to be administered to a child. The parent or legal guardian is encouraged to obtain the recommended immunizations within the first two (2) years of the child's life. Such vaccines include without limitation, the following specific vaccines:
(1) Diphtheria -tetanus-pertussis (DTP)
(2) Polio: oral polio vaccine (OPV) or inactivated polio vaccine (IPV)
(3) Measles-mumps-rubella (MMR)
(4) Haemophilus influenzae type B conjugate vaccines (Hib)
(5) Hepatitis B vaccine (Hep B)
(6) Pneumoccocal vaccine when medically indicated
(7) Influenza vaccine when medically indicated, and
(8) Varicella when available.
(b) Subject to availability of funding for such purpose, the department of health is authorized to provide free vaccine, through the first twenty-four (24) months of life, for Tennessee children born after January 1, 1996. If an administration fee is charged by a health provider receiving this vaccine, such fee may not exceed the administration fee established by the health care financing administration under the Vaccines for Children Program established in the Omnibus Budget Reconciliation Act of 1993. No immunization may be withheld due to the family's inability to pay the fee.
(c) The department shall establish and maintain an immunization registry for children. By January 1, 1996, the department shall incrementally require all local public health departments to report, in a designated format, the record of each immunization given. Other health care providers or any third party payor or health insurance entity regulated by the department of commerce and insurance doing business in Tennessee, or any entity that has elected, organized and qualified as a self-insured entity may likewise report such records. Information from the registry shall be available to parents and legal guardians; health care providers; any third party payor or health insurance entity regulated by the department of commerce and insurance doing business in Tennessee; any entity that has elected, organized and qualified as a self-insured entity; and schools, child care facilities, and other institutions having care or custody of children.
(d) The commissioner of health shall report to the members of the health and human resources committee of the house of representatives, and the senate general welfare, health and human resources committee, by March 1 of each year, on the immunization rates in each county and improvements or changes made during the preceding year.
TITLE 37. JUVENILES
CHAPTER 10. MISCELLANEOUS PROVISIONS
PART 4. CHILDHOOD IMMUNIZATIONS
Tenn Code Ann § 37-10-402
37-10-402. Conflict with religious tenets and practices of parent
In the absence of an epidemic or immediate threat thereof, this section does not not apply to any child whose parent or guardian files with proper authorities a signed written statement that such immunization and other preventative measures conflict with the religious tenets and practices of the parent or guardian affirmed under penalties of perjury.
TITLE 49. EDUCATION
CHAPTER 6. ELEMENTARY AND SECONDARY EDUCATION
PART 50. IMMUNIZATION OF SCHOOL CHILDREN
Tenn. Code Ann. § 49-6-5001
49-6-5001. General provisions. -
(a)The commissioner of health is authorized, subject to the approval of the public health council, to designate diseases against which children must be immunized prior to attendance at any school, nursery school, kindergarten, preschool or child care facility of this state.
(b)
(1) It is the responsibility of the parents or guardian of children to have their children immunized, as required by subsection (a).
(2) In the absence of an epidemic or immediate threat of an epidemic, this section shall not apply to any child whose parent or guardian files with school authorities a signed, written statement that the immunization and other preventive measures conflict with the parent's or guardian's religious tenets and practices, affirmed under the penalties of perjury.
(c)
(1) No children shall be permitted to attend any public school, nursery school, kindergarten, preschool or child care facility until proof of immunization is given the admissions officer of the school, nursery school, kindergarten, preschool or child care facility except as provided in subsection (b).
(2) No child shall be denied admission to any school or school facility if the child has not been immunized due to medical reasons if the child has a written statement from the child's doctor excusing the child from the immunization.
(3) No child or youth determined to be homeless shall be denied admission to any school or school facility if the child or youth has not yet been immunized or is unable to produce immunization records due to being homeless. The enrolling school shall comply with any and all federal laws pertaining to the educational rights of homeless children and youth, including the McKinney-Vento Homeless Assistance Act, compiled in 42 U.S.C. § 1141 et seq.
(d) Each child attending any school, nursery school, kindergarten, preschool or child care facility without furnishing proof of immunization or exception under subsection (b) or (e), shall not be counted in the average daily attendance of students for the distribution of state school funds.
(e) Any immunization specified under this part shall not be required if a qualified physician certifies that administration of the immunization would be in any manner harmful to the child involved.
(f) The commissioner shall promulgate rules and regulations necessary to carry out this section.
(g) By October 1 of each year, the commissioner shall report the number of children in the state during the preceding school year who were determined to be homeless and who enrolled in public schools without being immunized or being able to produce immunization records and the average length of time required for these children to be immunized or to obtain their immunization records. The report shall be submitted to the education committees of the senate and of the house of representatives.
TENNESSEE RULES AND REGULATIONS
CHAPTER 12O0. HEALTH, ENVIRONMENT AND CONSERVATION
CHAPTER 1200-14. BUREAU OF HEALTH SERVICES ADMINISTRATION,
DIVISION OF COMMUNICABLE AND ENVIRONMENTAL DISEASE SERVICES
CHAPTER 1200-14-1. COMMUNICABLE AND ENVIRONMENTAL DISEASES
TENN. RULES AND REG. § 1200-14-1-.29
1200-14-1-.29 Immunization against certain diseases prior to school attendance in Tennessee.
(1) Every nursery school, day care center, Head Start center, Kindergarten, or other pre-school, day care or grades Kindergarten through twelve of any public, private, or church related school shall obtain proof of adequate immunization against diphtheria, measles (rubeola), pertussis (whooping cough), poliomyelitis, rubella, mumps, hepatitis B and tetanus on the form prescribed by the Commissioner (unless otherwise exempted by law) prior to admitting a child. It shall be the duty of the school to enforce the provisions of this regulation, subject to the exemptions as set out in T.C.A. §49-6-5001(b).
(2) The state and county health departments are authorized to provide proof of immunization to the admissions officer of any school in the state of Tennessee. For the purpose of this subsection, “school” shall include nursery schools, Kindergartens, other pre-schools, day care centers and facilities, after school day care facilities, grades Kindergarten through twelve of any public, private or church-related schools, vocational schools, technical schools, colleges and universities. The state and county health departments are further authorized to provide proof of immunization to physicians who are evaluating a school-aged patient’s immunization status.
(3) The Department shall publish an official Certificate of Immunization, (“Certificate”). A Certificate may be signed by an individual licensed by the Board of Medical Examiners, the Board of Osteopathic Examiners, or an Advanced Practice Nurse licensed by the Board of Nursing (hereinafter “providers”) or by a local health department. The Certificate may include space to record vaccinations which are routinely recommended but not required by law. Certificates shall be available online to authorized users of the Tennessee Web Immunization System (TWIS) or in hard copy to providers from local health departments or from the Department’s central office.
(4) For each disease identified in these rules, the Department adopts the recommended immunization schedule or the “catch-up” immunization schedule (when applicable), published by the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC). An individual shall be presumed to be immunized against a particular disease when the individual has been immunized in a manner consistent with the recommendations of ACIP for that disease. The Department shall make the schedule available on its website and at local health departments, and shall revise the schedule from time to time in accordance with revisions published by ACIP, and shall publish the effective dates of any revisions.
(5) For children aged between 8 weeks and 19 months of age enrolling in child care facilities, a provider shall issue a Certificate showing a child is age-appropriately immunized in accordance with the ACIP schedule at the time of enrollment. For these children, a provider shall issue an updated Certificate at no later than 19 months of age.
(6) A provider may issue a Temporary Certificate for a child who has not received all required vaccines, but is in the process of completing required immunizations. A Temporary Certificate must have an expiration date that is one month after the date the next required immunization is due according to the minimum acceptable (“catch-up”) dose interval published on the Official Immunization Schedule. An expired Certificate is not valid proof of immunization. The school shall obtain a current Certificate no later than the expiration date of a Temporary Certificate.
(7) A provider shall certify adequate immunization against measles, mumps and rubella for admission into any child care facility and grades Kindergarten through twelve. For purposes of this paragraph adequate immunization is defined as:
(a) For children 12 months of age or older admitted to a child care facility, one dose of vaccine against measles, mumps and rubella administered no earlier than 4 days before the first birthday; or
(b) For children admitted to grades Kindergarten through twelve, two doses of vaccine against measles, mumps and rubella, administered a minimum of 28 days apart and no earlier than 4 days before the first birthday; or
(c) For children 12 months of age or older, laboratory evidence of immunity against each disease.
(8) A provider shall certify adequate immunization against Haemophilus influenza type B (“Hib”) for any child under the age of five years entering into any child care facility.
(9) A provider shall certify adequate immunization against varicella, or a history of varicella disease, prior to admission of a child aged 12 months or older in licensed child care facilities. For purposes of this paragraph, adequate immunization is defined as:
(a) One dose of varicella vaccine administered no earlier than 4 days before the child‘s first birthday; or
(b) Laboratory evidence of immunity; or
(c) A history verified by a physician, advanced practice nurse, physician’s assistant or health department of varicella disease.
(10) A provider shall certify adequate immunization against varicella, or a history of the disease, prior to a child’s entry into Kindergarten.
(11) Effective July 1, 2010, a provider shall certify adequate immunization against varicella for any child entering Kindergarten or 7th grade, and for new enrollees into any school. For purposes of this paragraph, adequate immunization is defined as one of the following:
(a) Two doses of varicella vaccine; administered at least 28 days apart and no earlier than 4 days before the child’s first birthday; or
(b) Laboratory evidence of immunity; or
(c) A history verified by a physician, advanced practice nurse, physician’s assistant or health department of varicella disease.
(12) Effective July 1, 2010, a provider shall certify adequate immunization against pneumococcal disease for enrollment of any child under the age of five years into any child care facility.
(13) Effective October 1, 2010, a provider shall certify continued adequate immunization against tetanus, diphtheria and pertussis for any child entering the 7th grade (or, in the case of students in ungraded classrooms, any child age 13). For the purposes of this paragraph, adequate immunization is defined as a complete primary tetanus and diphtheria-containing
vaccine series and a dose of vaccine against tetanus, diphtheria and pertussis administered at or after age 10 years; however, a pertussis booster dose is not required if the child has received a complete primary tetanus- and diphtheria-containing vaccine series and has received a tetanus- and diphtheria-containing containing booster dose within the previous
five years.
(14) Effective July 1, 2010, a provider shall certify adequate immunization against hepatitis A for any child aged 18 months or over, but under five (5) years, enrolling in child care facilities. For purposes of this paragraph, adequate immunization is defined as
(a) one dose of hepatitis A vaccine; or
(b) documented laboratory evidence of immunity.
(15) Effective July 1, 2011, a provider shall certify adequate immunization against hepatitis A for any child enrolling in Kindergarten. For purposes of this paragraph, adequate immunization is defined as
(a) two doses of hepatitis A vaccine; or
(b) documented laboratory evidence of immunity.
(16) Unless exempted by law, any new full-time enrollee of a higher education institution with an enrollment greater than two hundred students who is not enrolled as a full-time distance learning student shall present proof of adequate immunization against the following diseases:
(a) Measles, provided that this requirement shall only apply to those students born on or after January 1, 1957; for purposes of this subparagraph, adequate immunization is defined as:
1. two doses of measles-containing vaccine, administered at least 28 days apart and no earlier than 4 days before the first birthday; or
2. laboratory evidence of immunity.
(b) Mumps, provided that this requirement shall only apply to those students born on or after January 1, 1957; for purposes of this subparagraph, adequate immunization is defined as:
1. two doses of mumps-containing vaccine, administered at least 28 days apart and no earlier than 4 days before the first birthday; or
2. laboratory evidence of immunity.
(c) Rubella, provided that this requirement shall only apply to those students born on or after January 1, 1957; for purposes of this subparagraph, adequate immunization is defined as:
1. two doses of rubella-containing vaccine, administered at least 28 days apart and no earlier than 4 days before the first birthday; or
2. laboratory evidence of immunity.
(d) Varicella, provided that this requirement shall not become effective until July 1, 2011, and shall only apply to those students born on or after January 1, 1980. For purposes of this subparagraph, adequate immunization is defined as follows:
1. two doses of varicella-containing vaccine, administered at least 28 days apart; or
2. laboratory evidence of immunity; or
3. a history verified by a physician, advanced practice nurse, physician’s assistant or health department of varicella disease.
For purposes of this paragraph, “full time” means, for an undergraduate, enrolled in twelve (12) or more educational credit hours, and for a graduate student, enrolled in nine (9) or more educational credit hours, or such lesser number as may be deemed full time by the institution. Such students may be enrolled or registered after a single dose of all required
vaccines provided that the second dose is obtained within 2 months of registration, and at least 28 days after the first dose, and provided, further, that the institution has a procedure for identifying students who have failed to obtain the necessary immunizations and for taking appropriate action to ensure compliance.
(17) Effective July 1, 2011, unless exempted by law, any student enrolled in a higher education institution who is a health science student expected to have patient contact shall present proof of protection against hepatitis B before patient contact begins. For purposes of this paragraph adequate immunization is defined as:
(a) a complete hepatitis B vaccine series; or
(b) laboratory evidence of immunity or infection
(18) An individual may be exempted from the requirements of this section only under the following circumstances:
(a) Where a physician licensed by the Board of Medical Examiners, the Board of Osteopathic Examiners or a Health Department determines that a particular vaccine is contraindicated for one of the following reasons :
1. the individual meets the criteria for contraindication set forth in the manufacturer’s vaccine package insert; or
2. the individual meets the criteria for contraindication published by the U.S. Centers for Disease Control or the ACIP;
3. in the best professional judgment of the physician, based upon the individual’s medical condition and history, the risk of harm from the vaccine outweighs the potential benefit.
(b) An individual who has been exempted from a particular vaccination must comply with immunization requirements for any vaccines from which he/she has not been exempted.
(c) Where a parent or guardian, or in the case of an adult student, the student, provides to the school a written statement, affirmed under penalties of perjury, that vaccination conflicts with the religious tenets and practices of the parent or guardian, or in the case of an adult student, the student.
(19) If the Commissioner determines that insufficient vaccine is available to meet the terms of these rules, the Commissioner shall notify providers, the Commissioners of the Departments of Education and Human Services and the public of any necessary change in immunization requirements, consistent with any changes published by ACIP. The changes will be
published as a temporary addendum to the Official Immunization Schedule and individuals vaccinated in accordance with that temporary schedule will be deemed adequately immunized until the Commissioner determines, in accordance with ACIP recommendations, that sufficient vaccine is again available. When sufficient vaccine is again available, Commissioner shall so notify providers, the Commissioners of Education and Human Services and the public and reinstate the Official Immunization Schedule. The reinstated Official Immunization Schedule shall not become effective until at least 2 months after the determination that sufficient vaccination is again available.