School and Child Care
Immunization laws and regulations protect everyone; high immunization coverage levels greatly reduce the risk of vaccine-preventable disease outbreaks. Kentucky has regulations requiring immunizations for children in child care and school. These same requirements also provide exemptions from these immunizations for both medical reasons and religious beliefs.
||Immunization Certificates and Schedules
Legislation and Regulation
KRS 158.035 Certificate of Immunization
KRS 214.034 Immunization of Children and Retention of Records
KRS 214.036 Immunization Exemptions
902 KAR 2:060 Immunization Schedules
Immunization Requirements and Immunization Monitoring Guides
Please use the following cheat sheet for help with assessing immunization requirements: Immunization Requirements Cheat Sheet
Please use the following for help in creating a tickler system to remind you of when a child is due for a required immunization:
Tickler Systems for Schools and Childcare Facilities
||Updated Child Day Care and School Immunization Requirements
New requirements for Kentucky children entering child day care, Head Start programs, public and private preschool programs and public and private elementary and secondary schools were approved in February 2011, and can be found online.
The effective date for these regulatory changes is July 1, 2011. Any immunization certificate presented on or after July 1, 2011, for a child entering child day care, preschool, Head Start, kindergarten or sixth grade should comply with the new requirements.
Since the requirements had not been revised since 2002, several updates were made, in order to assure improved vaccine coverage for children in these settings. The following is a summary of the changes.
Newly Required Vaccinations:
- Pneumococcal conjugate vaccine (PCV)
- Age appropriate immunization with PCV is required for children up to five years of age. Children aged five years or older are not required to receive PCV, as it is not licensed for healthy children in that age range.
- Meningococcal conjugate vaccine (MCV)
- One dose of meningococcal vaccine for sixth grade entry, 11 or 12 years or older, is required.
- The use of meningococcal conjugate vaccine is preferred, but meningococcal polysaccharide vaccine (MPSV) may be used if the conjugate vaccine is unavailable.
- Tetanus-diphtheria-acellular pertussis vaccine (Tdap)
- One dose of Tdap regardless of interval since last dose of tetanus-containing vaccine is required for students at sixth grade entry, 11 or 12 years or older, with option for Td for individuals who cannot receive pertussis containing vaccines.
Changes in Varicella Immunization and Documentation Requirements:
- Additional dose of varicella vaccine
- A second dose of varicella vaccine, or proof of disease, is required for children at least 48 months of age and less than 5 years of age and for children entering the 6th grade, 11-12 years of age or older, if these children have not already been vaccinated with two doses of varicella.
- More stringent documentation of varicella or herpes zoster disease
- In lieu of immunization against varicella, the immunization certificate now requires that proof of disease be in the form of verification of a history of varicella or herpes zoster infection by a healthcare provider
Changes that Allow Greater Flexibility in Vaccine Administration:
- Flexibility in use of different brands of Haemophilus influenzae type b (Hib) vaccine
- Children at least 5 months and less than 7 months of age are now required to have two doses of Hib vaccine instead of three. Some brands of Hib vaccine or combination Hib-containing vaccines permit doses at 2 months and 4 months, but do not require a dose at 6 months as described in the 2011 Advisory Committee on Immunization Practices (ACIP) recommended schedule. This amendment gives providers more flexibility in choosing Hib-containing vaccine brands for their practices.
- Flexibility in timing of Hepatitis B vaccination
- The third dose of hepatitis B vaccine is now required for children at least 19 and less than 48 months of age. This amendment allows providers the flexibility to administer the third dose of hepatitis B vaccine as late as 18 months of age while maintaining compliance with requirements for child day care entry. This timing is in compliance with 2011 ACIP recommendations for hepatitis B vaccine administration.
- Polio (IPV) vaccine
- The final dose of IPV vaccine should be administered at age four years or older regardless of the number of previous doses and the minimum interval between this final dose and the previous dose should be at least six months.
- Measles-mumps-rubella (MMR) vaccine
- Since MMR is the only measles-containing vaccine licensed in this country, the language for age appropriate vaccination against measles with a “measles-containing vaccine” was replaced with language requiring a second dose of MMR.
Providers should particularly focus immunization efforts through the fall of 2011 on immunizations for school age children, especially those children entering kindergarten and sixth grade, in order to meet the new school entry requirements. However, immunization records should be reviewed at every patient encounter, and age appropriate immunizations should be administered at any visit unless medically contraindicated.