Quick Facts and Resources for Texas Residents
Quick Fact: A signed affidavit must be presented by the child's parent or legal guardian, stating that the child's parent or legal guardian declines vaccinations for reasons of conscience, including because of the person's religious beliefs. The affidavit will be valid for a two-year period. The child, who has not received the required immunizations for reasons of conscience, including religious beliefs, may be excluded from school in times of emergency or epidemic declared by the commissioner of public health. Medical exemptions are allowed as are exemptions for active duty members of the United States armed forces.
Texas passed new laws in 2013 that allows certain minors to consent to vaccination (effective 9/1/2013); requires child-care facilities to develop and implement a policy concerning vaccination of employees (effective 9/1/14); and lowers the age requirement for meningococcal vaccination for college students (effective 10/1/2013)
Other Resources: Many vaccination and exemption information links are date specific. If the links below have expired, click on the state's department of health, or immunization program link provided below, as they are likely to provide links to updated information. The General Information link leads to the overview page provided by the state at the time of this webpage's update and may also be helpful. Please email NVIC with broken link information.
The information contained on NVIC's web pages is for educational purposes only and is not intended to be medical or legal advice. Those seeking medical or legal advice should obtain the services of a competent attorney, physician or qualified health care professional. Although NVIC continually updates our website, state laws and rules change frequently and consumers are ultimately responsible for verifying their state's vaccination and exemption laws and requirements.
- State Healthcare Worker and Patient Vaccination Laws
- State of Texas Legislature - see applicable statutes and their hyperlinks below. Visit NVIC’s Advocacy Portal for information on legislation introduced impacting vaccine exemption rights.
- State of Texas Department of Health
- State of Texas Immunization Program
- State of Texas Vaccine Tracking System - You may also wish to contact your state’s vaccine tracking registry to determine if the ability to opt out is available.
- State of Texas Proposed Rule-Making - View your state’s registry to learn about proposed rule-making.
GOVERNMENT CODE
SUBTITLE I. HEALTH AND HUMAN SERVICES
CHAPTER 531. HEALTH AND HUMAN SERVICES COMMISSION
§ 531.0335. Prohibition on Punitive Action for Failure to Immunize
(a) In this section:
(1) "Person responsible for a child's care, custody, or welfare" has the meaning assigned by Section 261.001, Family Code.
(2) "Punitive action" includes the initiation of an investigation of a person responsible for a child's care, custody, or welfare for alleged or suspected abuse or neglect of a child.
(b) The commissioner by rule shall prohibit a health and human services agency from taking a punitive action against a person responsible for a child's care, custody, or welfare for failure of the person to ensure that the child receives the immunization series prescribed by Section 161.004, Health and Safety Code.
(c) This section does not affect a law, including Chapter 31, Human Resources Code, that specifically provides a punitive action for failure to ensure that a child receives the immunization series prescribed by Section 161.004, Health and Safety Code.
EDUCATION CODE
TITLE 2. PUBLIC EDUCATION
CHAPTER 38. HEALTH AND SAFETY
§ 38.001. Immuizations; Requirements; Exceptions.
(a) Each student shall be fully immunized against diphtheria, rubeola, rubella, mumps, tetanus, and poliomyelitis, except as provided by Subsection (c).
Text of subsection as amended by Acts 2007, 80th Leg., R.S., Ch. 43, § 1
(b) Subject to Subsections (b-1) and (c), the executive commissioner of the Health and Human Services Commission may modify or delete any of the immunizations in Subsection (a) or may require immunizations against additional diseases as a requirement for admission to any elementary or secondary school.
Text of subsection as amended by Acts 2007, 80th Leg., R.S., Ch. 94, § 2
(b) Subject to Subsection (c), the Department of State Health Services may modify or delete any of the immunizations in Subsection (a) or may require immunizations against additional diseases as a requirement for admission to any elementary or secondary school.
Text of subsection as added by Acts 2007, 80th Leg., R.S., Ch. 43, § 1
(b-1) Immunization against human papillomavirus is not required for a person's admission to any elementary or secondary school; however, by using existing resources, the Health and Human Services Commission shall provide educational material about the human papillomavirus vaccine that is unbiased, medically and scientifically accurate, and peer reviewed, available to parents or legal guardians at the appropriate time in the immunization schedule by the appropriate school. This subsection preempts any contrary executive order issued by the governor. This subsection expires January 11, 2011.
Text of subsection as added by Acts 2007, 80th Leg., R.S., Ch. 94, § 2
(b-1) Each year, the Department of State Health Services shall prepare a list of the immunizations required under this section for admission to public schools and of any additional immunizations the department recommends for school-age children. The department shall prepare the list in English and Spanish and make the list available in a manner that permits a school district to easily post the list on the district's Internet website as required by Section 38.019.
(c) Immunization is not required for a person's admission to any elementary or secondary school if the person applying for admission: (1) submits to the admitting official:
(A) an affidavit or a certificate signed by a physician who is duly registered and licensed to practice medicine in the United States, in which it is stated that, in the physician's opinion, the immunization required poses a significant risk to the health and well-being of the applicant or any member of the applicant's family or household; or
(B) an affidavit signed by the applicant or, if a minor, by the applicant's parent or guardian stating that the applicant declines immunization for reasons of conscience, including a religious belief; or (2) is a member of the armed forces of the United States and is on active duty.
(c-1) An affidavit submitted under Section (c)(1)(B) must be on a form described by Section 161.0041, Health and Safety Code, and must be submitted to the admitting official not later than the 90th day after the date the affidavit is notarized.
(d) The Department of State Health Services shall provide the required immunization to children in areas where no local provision exists to provide those services.
(e) A person may be provisionally admitted to an elementary or secondary school if the person has begun the required immunizations and if the person continues to receive the necessary immunizations as rapidly as is medically feasible. The Department of State Health Services shall adopt rules relating to the provisional admission of persons to an elementary or secondary school.
(f) A person who has not received the immunizations required by this section for reasons of conscience, including because of the person's religious beliefs, may be excluded from school in times of emergency or epidemic declared by the commissioner of public health.
EDUCATION CODE
TITLE 3. HIGHER EDUCATION
CHAPTER 51. PROVISIONS GENERALLY APPLICABLE TO HIGHER EDUCATION
§ 51.933. Immmunization Requirements; Exceptions
(a) An institution of higher education may require applicants for admission to be immunized against diphtheria, rubeola, rubella, mumps, tetanus, and poliomyelitis, except as provided in Subsection (d).
(b) The Texas Board of Health may require immunizations against the diseases listed in Subsection (a) and additional diseases for students at any institution of higher education who are pursuing a course of study in a human or animal health profession, and the board may require those immunizations for any students in times of an emergency or epidemic in a county where the commissioner of public health has declared such an emergency or epidemic.(b-1) A rule adopted under Subsection (b) that requires a hepatitis B vaccination for students may apply only to students enrolled in a course of study that involves potential exposure to human or animal blood or bodily fluids.
(c) An institution of higher education, in conjunction with the Texas Department of Health, should provide individual notice to each student applying for admission regarding:
(1) the consequences of not being current on immunization for certain diseases;
(2) the age groups most vulnerable to these vaccine preventable diseases; and
(3) local providers of immunization services.
(d) No form of immunization is required for a person's admission to an institution of higher education if the person applying for admission:
(1) submits to the admitting official:
(A) an affidavit or a certificate signed by a physician who is duly registered and licensed to practice medicine within the United States in which it is stated that, in the physician's opinion, the immunization required poses a significant risk to the health and well-being of the applicant or any member of the applicant's family or household; or(B) an affidavit signed by the applicant or, if a minor, by the applicant's parent or guardian stating that the applicant declines immunization for reasons of conscience, including a religious belief; or
(2) is a member of the armed forces of the United States and is on active duty.
(d-1) An affidavit submitted under Section (d)(1)(B) must be on a form described by Section 161.0041, Health and Safety Code, and must be submitted to the admitting official not later than the 90th day after the date the affidavit is notarized.
(e) The exception provided by Subsection (d)(1)(B) does not apply in a time of emergency or epidemic declared by the commissioner of public health.
HEALTH & SAFETY CODE
TITLE 2. HEALTH
CHAPTER 161. PUBLIC HEALTH PROVISIONS
§ 161.004. Statewide Immunization of Children
(a) Every child in the state shall be immunized against vaccine preventable diseases caused by infectious agents in accordance with the immunization schedule adopted by the board. (b) Hospitals shall be responsible for
(1) referring newborns for immunization at the time the newborn screening test is performed;
(2) reviewing the immunization history of every child admitted to the hospital or examined in the hospital's emergency room or outpatient clinic; and
(3) administering needed vaccinations or referring the child for immunization.
(c) Physicians shall be responsible for reviewing the immunization history of every child examined and administering any needed vaccinations or referring the child for immunization.
(d) A child is exempt from an immunization required by this section if:
(1) a parent, managing conservator, or guardian states that the immunization is being declined for reasons of conscience, including a religious belief; or
(2) the immunization is medically contraindicated based on the opinion of a physician licensed by any state in the United States who has examined the child.
(e) For purposes of this section, "child" means a person under 18 years of age.
(f) The board shall adopt rules that are necessary to administer this section.
(g) A parent, managing conservator, or guardian may choose the health care provider who administers the vaccine or immunizing agent under this chapter.
§ 161.0041. Immunization Exception Addidavit Form
(a) A person claiming an exemption from a required immunization based on reasons of conscience, including a religious belief, under Section 161.004 of this code, Section 38.001 or 51.933, Education Code, or Section 42.043, Human Resources Code, must complete an affidavit on a form provided by the department stating the reason for the exemption.
(b) The affidavit must be signed by the person claiming the exemption or, if the person is a minor, the person's parent, managing conservator, or guardian, and the affidavit must be notarized.
(c) A person claiming an exemption from a required immunization under this section may only obtain the affidavit form by submitting a written request for the affidavit form to the department.
(d) The department shall develop a blank affidavit form that contains a seal or other security device to prevent reproduction of the form. The affidavit form shall contain a statement indicating that the person or, if a minor, the person's parent, managing conservator, or guardian understands the benefits and risks of immunizations and the benefits and risks of not being immunized.
(e) The department shall maintain a record of the total number of affidavit forms sent out each year and shall report that information to the legislature each year. The department may not maintain a record of the names of individuals who request an affidavit under this section.
HUMAN RESOURCES CODE
TITLE 2. DEPARTMENT OF HUMAN SERVICES AND
DEPARTMENT OF PROTECTIVE AND
REGULATORY SERVICES
CHAPTER 42. REGULATION OF CERTAIN FACILITIES, HOMES, AND AGENCIES THAT PROVIDE CHILD-CARE SERVICES
§ 42.043. Rules for Immunizations
(a) The executive commissioner shall adopt rules for the immunization of children in facilities regulated under this chapter.
(b) The department shall require that each child at an appropriate age have a test for tuberculosis and be immunized against diphtheria, tetanus, poliomyelitis, mumps, rubella, rubeola, invasive pneumococcal disease, and hepatitis A and against any other communicable disease as recommended by the Department of State Health Services. The immunization must be effective on the date of first entry into the facility. However, a child may be provisionally admitted if the required immunizations have begun and are completed as rapidly as medically feasible.
(c) The executive commissioner shall adopt rules for the provisional admission of children to facilities regulated under this chapter and may modify or delete any of the immunizations listed in Subsection (b) or require additional immunizations as a requirement for admission to a facility.
(d) No immunization may be required for admission to a facility regulated under this chapter if a person applying for a child's admission submits one of the following affidavits:
(1) an affidavit signed by a licensed physician stating that the immunization poses a significant risk to the health and well-being of the child or a member of the child's family or household; or
(2) an affidavit signed by the child's parent or guardian stating that the applicant declines immunization for reasons of conscience, including a religious belief.
(d-1) An affidavit submitted under Section (d)(2) must be on a form described by Section 161.0041, Health and Safety Code, and must be submitted not later than the 90th day after the date the affidavit is notarized.
(e) Each regulated facility shall keep an individual immunization record for each child admitted, and the records shall be open for inspection by the department at all reasonable times.
(f) The Department of State Health Services shall provide the immunizations required by this section to children in areas where there is no local provision of these services.
TEXAS ADMINISTRATIVE CODE
TITLE 25. HEALTH SERVICES
PART 1. DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 97. COMMUNICABLE DISEASES
SUBCHAPTER B. IMMUNIZATION REQUIREMENTS
IN TEXAS ELEMENTARY AND SECONDARY SCHOOLS
AND INSTITUTIONS OF HIGHER EDUCATION
RULE §97.61 Children and Students Included in Requirements
(a) The vaccine requirements apply to all children and students entering, attending, enrolling in, and/or transferring to child-care facilities or public or private primary or secondary schools or institutions of higher education.
(b) The vaccines required in this section are also required for all children in the State of Texas, including children admitted, detained, or committed in Texas Department of Criminal Justice, Department of State Health Services, and the Texas Juvenile Justice Department (TJJD) facilities.
(c) The vaccine requirements are adopted as a statewide control measure for communicable disease as defined in Health and Safety Code, §81.081 and §81.082.
RULE §97.62 Exclusions from Compliance
Exclusions from compliance are allowable on an individual basis for medical contraindications, reasons of conscience, including a religious belief, and active duty with the armed forces of the United States. Children and students in these categories must submit evidence for exclusion from compliance as specified in the Health and Safety Code, §161.004(d), Health and Safety Code, §161.0041, Education Code, Chapter 38, Education Code, Chapter 51, and the Human Resources Code, Chapter 42.
(1) To claim an exclusion for medical reasons, the child or student must present an exemption statement to the school or child-care facility, dated and signed by a physician (M.D. or D.O.), properly licensed and in good standing in any state in the United States who has examined the child or student. The statement must state that, in the physician's opinion, the vaccine required is medically contraindicated or poses a significant risk to the health and well-being of the child or student or any member of the child's or student's household. Unless it is written in the statement that a lifelong condition exists, the exemption statement is valid for only one year from the date signed by the physician.
(2) To claim an exclusion for reasons of conscience, including a religious belief, the child's parent, legal guardian, or a student 18 years of age or older must present to the school or child-care facility a completed, signed and notarized affidavit on a form provided by the department stating that the child's parent, legal guardian, or the student declines vaccinations for reasons of conscience, including because of the person's religious beliefs. The affidavit will be valid for a two-year period from the date of notarization. A child or student, who has not received the required immunizations for reasons of conscience, including religious beliefs, may be excluded from school in times of emergency or epidemic declared by the commissioner of the department.
(A) A person claiming exclusion for reasons of conscience, including a religious belief, from a required immunization may only obtain the affidavit form by submitting a request (via online, fax, mail, or hand-delivery) to the department. The request must include the following information:
(i) full name of child or student;
(ii) child's or student's date of birth (month/day/year);
(iii) complete mailing address, including telephone number; and
(iv) number of requested affidavit forms (not to exceed 5).
(B) Requests for affidavit forms must be submitted to the department through one of the following methods:
(i) written request through the United States Postal Service (or other commercial carrier) to the department at: DSHS Immunization Branch, Mail code 1946, P.O. Box 149347, Austin, Texas 78714-9347;
(ii) by facsimile to (512) 776-7544;
(iii) by hand-delivery to the department's physical address at 1100 West 49th Street, Austin, Texas 78756; or
(iv) via the department's Immunization program website (at www.ImmunizeTexas.com).
(C) The department will mail the requested affidavit form(s) (not to exceed five forms per child or student) to the specified mailing address.
(D) The department shall not maintain a record of the names of individuals who request an affidavit and shall return the original documents (when applicable) with the requested affidavit forms.
(3) To claim an exclusion for armed forces, persons who can prove that they are serving on active duty with the armed forces of the United States are exempted from the requirements in these sections.
Rule §97.63 Immunization Requirements in Child-care Facilities, Pre-Kindergarten, Early Childhood Programs, and Texas Elementary and Secondary Schools
Every child in the state shall be vaccinated against vaccine-preventable diseases caused by infectious agents, in accordance with the following immunization schedule. While the department recommends that providers immunize children according to the recommendations found on the department's website at www.ImmunizeTexas.com, this section sets out minimum immunization requirements for school entry for the child. The child must have the indicated vaccinations by the grade level indicated. The vaccination schedule also indicates the grade before which the child should not obtain the specific vaccination. A copy of the current recommended schedule is available at www.ImmunizeTexas.com, or by mail by writing the Department of State Health Services, Mail Code 1946, P.O. Box 149347, Austin, Texas 78714-9347.
(1) For those vaccines where it is stated in this section that a certain dose must be received on or after a certain birthday, a vaccine administered up to four days prior to the birthday is considered compliant.
(2) For diseases listed below, a child or student shall show acceptable evidence of vaccination prior to entry, attendance, or transfer to a child-care facility or public or private elementary or
(A) Children enrolled in child-care facilities, pre-kindergarten, or early childhood programs shall be immunized against: diphtheria, pertussis, tetanus, poliomyelitis, Haemophilus influenzae type b (Hib), measles, mumps, rubella, hepatitis B, hepatitis A, invasive pneumococcal, and varicella diseases. In recognition of the fact that immunization needs vary depending on the age of the child, the minimum number of doses required for each vaccine is indicated in the schedule below:
(B) Students in kindergarten through twelfth grade shall have the following vaccines, according to the schedule listed.
(i) Poliomyelitis.
(I) Kindergarten through twelfth grade. Students are required to have four doses of polio vaccine--one of which must have been received on or after the fourth birthday. Or, if the third dose was administered on or after the fourth birthday, only three doses are required. Four doses of oral polio vaccine (OPV) or inactivated poliovirus vaccine (IPV) in any combination by age four to six years old is considered a complete series, regardless of age at the time of the third dose.
(II) Polio vaccine is not required for persons eighteen years of age or older.
(ii) Diphtheria/Tetanus/Pertussis.
(I) Kindergarten through sixth grade. Students are required to have five doses of a diphtheria/tetanus/pertussis-containing vaccine -- one of which must have been received on or after the fourth birthday. Or, if the fourth dose was administered on or after the fourth birthday, only four doses are required.
(II) Students seven years of age or older. Students seven years of age or older are required to have at least three doses of a tetanus/diphtheria-containing vaccine, provided at least one dose was administered on or after the fourth birthday. Any combination of three doses of a tetanus/diphtheria-containing vaccine will meet this requirement.
(III) Tdap.
(-a-) Seventh grade. Students are required to have one booster dose of a tetanus/diphtheria/pertussis-containing vaccine for entry into the 7th grade, if at least five years have passed since the last dose of a tetanus-containing vaccine. If five years have not elapsed since the last dose of a tetanus-containing vaccine at entry into the 7th grade, then this dose will become due as soon as the five-year interval has passed. Td vaccine is an acceptable substitute, if Tdap vaccine is medically contraindicated.
(-b-) Grades 8 - 12. Students who have not already received Tdap vaccine are required to receive one booster dose of Tdap when ten years have passed since the last dose of a tetanus-diphtheria-containing vaccine.
(IV) Children who were enrolled in school, grades K - 12, prior to August 1, 2004, and who received a booster dose of DTaP or polio vaccine in the calendar month of (or prior to) their fourth birthday, shall be considered in compliance with clause (i)(I) (polio) and clause (ii)(I) (DTaP) of this subparagraph.
(iii) MMR. Beginning SY 2016 - 2017, students enrolling in kindergarten through 12th grade are required to have two doses of MMR vaccine with the first dose received on or after the first birthday. Students vaccinated prior to 2009 with two doses of measles and one dose each of rubella and mumps satisfy this requirement.
(iv) Hepatitis B.
(I) Students enrolling in kindergarten through 12th grade are required to have three doses of hepatitis B vaccine.
(II) In some circumstances, the United States Food and Drug Administration may officially approve in writing the use of an alternative dosage schedule for this vaccine. Such an alternative regimen may be used to meet the requirements under this section only when alternative regimens are fully documented. Such documentation must include vaccine manufacturer and dosage received for each dose of that vaccine.
(v) Varicella. Beginning SY 2016 - 2017, students enrolling in kindergarten through 12th grade are required to have two doses of varicella vaccine received on or after the first birthday.
(vi) Hepatitis A. For SY 2016 - 2017, students are required to have two doses of hepatitis A vaccine with the first dose received on or after the first birthday for the following grades and school years:
(I) SY 2016 - 2017: K - 7;
(II) SY 2017 - 2018: K - 8;
(III) SY 2018 - 2019: K - 9;
(IV) SY 2019 - 2020: K - 10;
(V) SY 2020 - 2021: K - 11; and
(VI) SY 2021 - 2022: K - 12.
(VII) Effective SY 2022-2023, students enrolling in kindergarten through 12th grade are required to have two doses of hepatitis A vaccine with the first dose received on or after the first birthday.
(vii) Meningococcal. Effective SY 2016 - 2017, students enrolling in 7th - 12th grades are required to have one dose of quadrivalent meningococcal conjugate vaccine (MCV4) on or after the student's 11th birthday.