Commonly Asked Questions About the
New School Immunization Requirements Revised 3/99

Commonly Asked Questions About the
New School Immunization Requirements Revised 3/99

The California school law and regulations (CAC, Title 17, § 6020, 6025, 6035, 6075, H&SC § 120325,120335) were amended effective 8/1/97. Further changes, effective 7/1/99, will include newrequirements for seventh grade entrants. These Q&A pages have been developed to answer themost commonly asked questions about these changes. If you have additional questions that are notanswered here, please contact your local health department's Immunization Coordinator.

#1. What immunizations are kindergarten entrants required to have?

A. Kindergarten entrants now are required to have 4 doses of polio vaccine (3 doses meet requirement if at least one dose was given on or after the fourth* birthday), 5 doses of DTP or DTaP (4 doses meet requirement if at least one dose was given on or after the fourth* birthday), 2 doses of MMR (one dose may be a measles-only vaccine, both doses given on or after the first birthday), and 3 doses of hepatitis B vaccine.

*Changed from the second birthday as of 7/1/99 to fourth birthday.

#2. What immunizations will seventh grade entrants be required to have, and when will the requirements go into effect?

A. Recent changes to the regulations require three doses of hepatitis B vaccine and a second dose of measles-containing vaccine (usually given as MMR), and also include a recommendation for a tetanus-diphtheria (Td) booster effective July 1, 1999 at or before seventh grade entry. These are in addition to the present requirements of 4 polio, 3 DTP (or Td), and the first dose of MMR.

#3. What is the "fourth birthday" change and what should we be telling parents at kindergarten round-up and registration?

A. Most medical providers and laws in other states use the fourth birthday cutoff and DTP because this matches the nationally recommended immunization schedule for school boosters at age 4-6 years. The previous second birthday cutoff confused health care providers because it did not match the standard immunization schedule. Also, requiring the last dose of DTP after the fourth birthday leads to longer protection against pertussis. Surveys indicate that most children presently get their school boosters after the fourth birthday, so the change should mean that only a small number of children need an additional DTP or polio vaccine dose. So we have changed the requirement to "the fourth birthday" instead of "the second birthday". This applies only to kindergarten entrants.

#4. If a child has had 4 doses of polio or 5 doses of DTP before 4 years of age, does he or she need additional doses?

A. If a child has 4 doses of polio or 5 doses of DTP, he or she has met the requirement, regardless of he age at which they were given, even if they were given prior to the fourth birthday.

#5 . Why do the kindergarten and proposed seventh grade requirements specify "measles-containing vaccine" instead of MMR?

A. Because measles-only vaccine is rarely used in the United States, most children will receive a second dose of MMR. With two doses of measles vaccine, 99% of children are protected. A measles-only vaccine is frequently used in other countries, and a child who already has a measles-only immunization on or after the first birthday, plus an MMR on or after the first birthday, meets the requirement. An advantage of two doses of MMR is almost certain immunity of all children to mumps and rubella as well as measles.

#6. Are children who skip kindergarten and enter the first grade subject to the new hepatitis B and second MMR requirements?

A. Yes, a first grader who skipped kindergarten and entered first grade after August 1, 1997 IS subject to these requirements.

#7. How should children affected by these new requirements be treated as they progress to higher grades?

A. The new hepatitis B and second dose measles requirements are not progressive. They apply only to students entering or in kindergarten, first grade (if kindergarten was skipped), and seventh grade (as of 7/1/99). If a conditionally admitted kindergarten or seventh grade student did not complete the full series of required immunizations, then it will be necessary to complete follow-up during the next academic year. However, this is the only situation when any child not in kindergarten, first grade (if kindergarten is skipped) or seventh grade will be subject to the new requirements of 3 hepatitis B doses and second MMR dose. All other students (e.g., unconditionally admitted) are not subject to these new requirements after they leave kindergarten, first grade (if kindergarten is skipped) or seventh grade. So when dealing with the new requirements of the School Immunization Law, it is extremely important to correctly identify conditional and unconditional entrants.

#8. After the seventh grade requirements go into effect, if a student entering seventh grade had 3 hepatitis B shots in the past, e.g. before entering kindergarten, does he or she need more shots now?

A. No, three shots of the hepatitis B vaccine confer long-term immunity, so no further shots are needed to protect against the disease. Three shots received at any age before entering seventh grade entry fulfill the requirement.

#9. Are children who repeat kindergarten or seventh grade subject to the new hepatitis B and second MMR requirements?

A. Yes, all children entering kindergarten or seventh grade (after 7/1/99), including first time entrants and repeaters, are subject to these requirements.

#10. Are children who transfer from another school subject to the new hepatitis B and second MMR requirements?

A. A child who transfers from another school into kindergarten, first grade (if kindergarten is skipped), or seventh grade (after 7/1/99) IS subject to the hepatitis B and second dose measles requirements, but a child who transfers into other grades IS NOT subject to the hepatitis B and second dose measles requirements.