Immunizations

101220.1

(a) Prior to admission to a child care center, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, commencing with Section 6000.

(1) Centers that meet the criteria of Health and Safety Code Section 1596.794 are not required to verify or document children's immunizations.

Health and Safety Code Section 1596.794 states:

Notwithstanding Section 1597.05, or any other provision of law, any day care center that exclusively offers a program of services at which there is no contract or agreement between any parent and the center for the regular care of any child, and for which there is no prearranged schedule of care for any child, shall not be required to verify children's immunizations or tuberculosis testing or maintain files regarding children's immunizations or tuberculosis testing. Upon admission of the child, the parent shall sign an acknowledgment that he or she understands that verification of immunizations and tuberculosis testing is not required for any child accepted for care in this type of program.

(b) The California Code of Regulations, Title 17, Section 6020, requires that children receive appropriate vaccines as follows:

(1) The required immunizations for admission to and attendance at a public or private elementary or secondary school, child care center, day nursery, nursery school, or family day care home, or developmental center shall be those set forth, according to age, in Table 1.

(2) In Table 1 of Section 6020 and in Table 2 of Section 6035, DTP (or DPT) means diphtheria and tetanus toxoids and pertussis vaccine, including DTaP vaccine. DT (or Td) and Td (or Dt) means diphtheria and tetanus toxoids.

(3) For pupils who have reached their seventh birthday, a history of any preparations containing both diphtheria and tetanus toxoids (DTP, DT, Td, etc.) shall be acceptable as meeting the requirement for tetanus and diphtheria toxoids that is set forth in Table 1.

(4) Pupils who have reached their seventh birthday shall be exempt from the pertussis and mumps immunization requirements.

(5) Combination vaccines that include measles, mumps and rubella components shall be acceptable as meeting the requirements for these vaccines that are set forth in Table 1.

(c) The California Code of Regulations, Title 17, Section 6035(a), requires that:

Any pupil seeking admission to a given public or private elementary or secondary school, child care center, day nursery, nursery school, family day care home, or development center who lacks documentation of having received all the required vaccine doses against poliomyelitis, diphtheria, tetanus, pertussis, measles, rubella, Haemophilus influenzae type B, mumps and hepatitis B as specified in Table 1, Section 6020, and has not obtained a permanent medical exemption or a personal beliefs exemption to immunization in accordance with Section 6051, may be admitted conditionally if:

(1) he or she has not received all the immunizations required for his or her age group but has commenced receiving doses of all the vaccines in accordance with Table 2, is not currently due for any doses at the time of admission (if he or she is due for any doses at this time they must be obtained before admission), and the pupil's parent or guardian is notified of the date by which the pupil must complete all the required immunizations in accordance with Table 2; or

(2) he or she is under age 18 months and has received all the immunizations required for his or her age group but will require additional vaccine doses at an older age, and the pupil's parent or guardian is notified of the date by which the pupil must complete all the remaining doses when they become due in accordance with Table 1, Section 6020; or

(3) he or she has obtained a temporary medical exemption from immunization in accordance with Section 6050, and the pupil's parent or guardian is notified of the date by which the pupil must complete all the required immunizations when the temporary exemption terminates; or

(4) he or she is a pupil entering a child care center governed by Education Code Section 8263(c), where a different deadline for obtaining all required immunizations may apply.

(d) The California Code of Regulations, Title 17, Section 6035(b), requires that children receive appropriate vaccines as follows:

The public or private elementary or secondary school, child care center, day nursery, nursery school, family day care home, or development center shall not allow the admission of any pupil seeking entry who does not meet the requirements for admission under Section 6025 or 6035. The principal or administrator shall advise the pupil, or the parent or guardian, to contact a physician or agency that provides immunizations.

Table 1. Immunization Requirements

Institution	Age	Vaccine	Total Doses Received
Child Care Center, day nursery, nursery school, family day care home, development center	Less than 2 months	None
Same as above	2-3 months	Polio* DTP Hib Hepatitis B**	1 dose 1 dose 1 dose 1 dose
Same as above	4-5 months	Polio* DTP, or combination of DTP and diphtheriatetanus toxoids. Hib Hepatitis B**	2 doses 2 doses 2 doses 2 doses
Same as above	6-14 months	Polio* DTP, or combination of DTP and diphtheriatetanus toxoids. Hib Hepatitis B*	2 doses 3 doses 2 doses 2 doses
Same as above	15-17 months	Polio* DTP, or combination of DTP and diphtheriatetanus toxoids. Measles, rubella, and mumps. Hib Hepatitis B**	2 doses 3 doses 1 dose of each separately or combined on or after the 1st birthday. 1 dose on or after the 1st birthday. 2 doses
Same as above	18 moths - 5 years	Polio* DTP, or combination of DTP and diphtheriatetanus toxoids. Measles, rubella, and mumps. Hib* Hepatitis B**	3 doses 4 doses 1 dose of each separately or combined on or after the 1st birthday 1 dose on or after the 1st birthday. 3 doses
Elementary school at kindergarten level and above	4-6 years	Polio* DTP, or combination of DTP and diphtheriatetanus toxoids. Measles, rubella, and mumps. Hepatitis B**	4 doses, except that a total of 3 doses is acceptable if at least one dose was given on or after the 2nd birthday. At least 4 doses. One more dose required if the last dose was given before the 2nd birthday. 1 dose of each, separately or combined on or after the 1st birthday. Pupils entering a kindergarten (or first grade if kindergarten skipped) on or after August 1, 1997, are required to have 2 doses of measles-containing vaccine, both given on or after the first birthday. 3 doses
Elementary school, secondary school	7-17 years	Polio* Diphtheria and tetanus toxoids, given as DTP, DT, or Td (pertussis not required). Measles and rubella (mumps not required).	4 doses, except that a total of 3 doses is acceptable if at least one dose was given on or after the 2nd birthday. At least 3 doses. One more Td dose is required if the last dose was given before the 2nd birthday. 1 dose of each, separately or combined, on or after the 1st birthday.

Oral polio vaccine (OPV) or inactivated polio vaccine (IPV) or any combination of these vaccines is

acceptable.

** Applies only to children entering at kindergarten level (or at first grade level if kindergarten skipped)

or below on or after August 1, 1997.

* Required only for children who have not reached the age of 4 years 6 months.

Table 2. Conditional Admission Immunization Schedule

Vaccine	Dose	Time Intervals
Polio*	1st dose 2nd dose 3rd dose 4th dose (Required only for entry to kindergarten level or above)	Before admission. As early as 6 weeks but no later than 10 weeks after the 1st dose. Before admission if 10 or more weeks have elapsed since the 1st dose at the time of admission. As early as 6 weeks but no later than 12 months after the 2nd dose. Before admission if 12 or more months have elapsed since the 2nd dose at the time of admission. If the 3rd dose was given before the 2nd birthday one more dose is required before admission.
Diphtheria, Tetanus, and Pertusis FOR PUPILS UNDER 7 YEARS: Diphtheria-tetanus-pertussis (DTP) or combination of DTP and diphtheria-tetanus toxoids.	1st dose 2nd dose 3rd dose 4th dose 5th dose or more (Required only for pupils ages 4-6 years for entry to kindergarten level and above)	Before admission. As early as 4 weeks but no later than 8 weeks after the 1st dose. Before admission if 8 or more weeks have elapsed since the 1st dose at the time of admission. As early as 4 weeks but no later than 8 weeks after the 2nd dose. Before admission if 8 or more weeks have elapsed since the 2nd dose at the time of admission. As early as 6 months but no later than 12 months after the 3rd dose. Before admission if 12 or more months have elapsed since the 3rd dose at the time of admission. If the last dose was given before the 2nd birthday, one more dose is required before admission.
FOR PUPILS AGE 7 YEARS AND OLDER
Diphtheria-tetanus (Pertussis not required)	1st dose 2nd dose 3rd dose 4th dose or more	Before admission. As early as 4 weeks but no later than 8 weeks after the 1st dose. Before admission if 8 or more weeks have elapsed since the 1st dose at the time of admission. As early as 6 months but no later than 12 months after the 2nd dose. Before admission if 12 or more months have elapsed since the 2nd dose at the time of admission. If the last dose was given before the 2nd birthday, one more dose is required before admission.
Measles Note: For children entering kindergarten (or first grade if kindergarten is skipped) on or after August 1, 1997, two doses are required	One dose only 1st dose 2nd dose	Before admission. If the pupil is under age 15 months, this dose is required when age 15 months is reached. Before admission. As early as 1 month but no later than 3 months after the 1st dose.
Rubella	One dose only	Before admission. If the pupil is under age 15 months, this dose is required when age 15 months is reached.
Mumps (Not required for pupils age 7 years and older)	One dose only	Before admission. If the pupil is under age 15 months, this dose is required when age 15 months is reached.
Hib Children 2-14 months old Children 15 months - 4 1/2 years old	Two doses One dose	1st dose before admission. 2nd dose as early as 2 months but no later than 3 months after the 1st dose. Before admission.
Hepatitis B - For children entering at kindergarten level (or first grade if kindergarten skipped) or below on or after August 1, 1997.	1st dose 2nd dose 3rd dose	Before admission As early as 1 month but no later than 2 months after the first dose. Infants and children under age 18 months: As early as 2 months but no later than 12 months after the 2nd dose. Children age 18 months and older: As early as 2 months but no later than 6 months after the 2nd dose.

Oral polio vaccine (OPV) or inactivated polio vaccine (IPV) or any combination of these vaccines is

acceptable.

(e) The licensee shall be permitted to exempt a child from immunization requirements provided that one of the following criteria is met and the related documentation is kept in the child's file:

(1) A physician provides a written statement that an immunization(s) should not be given to the child and specifies how long this exemption is expected to be needed.

(2) The child's authorized representative provides a written statement that immunizations are contrary to his/her personal or religious beliefs.

(f) As required by the California Code of Regulations, Title 17, Section 6035(b), a child who does not meet any of the requirements in Sections 101220.1(c), (d) or (e) above shall not be admitted to a child care center.

(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.

(1) This requirement includes updating each child's immunization record when the child is due to receive required immunizations after enrollment in the child care center.

(h) The California Code of Regulations, Title 17, Section 6075, specifies in pertinent part that each child care center shall report to state and local health departments as follows:

(1) The ... child care center ... shall file a report with the state and local health departments on the immunization status of new entrants annually or when needed to determine immunization status such as during an epidemic or potential epidemic.... The Department of Health Services or the local health department will provide the appropriate reporting form.

(i) The licensee is not required to document immunizations of children also enrolled in a public or private elementary school.

NOTE: Authority cited Section 1596.81, Health and Safety Code. Reference: Sections 1596.72, 1596.73, 1596.81, 1597.05 and 1596.794, Health and Safety Code.