Alaska, Indiana, Massachusetts, Michigan, Ohio, and Tennessee have recently expanded their immunization requirements for pre-school, school, and/or college attendance. Details follow. [Note: "school year" is abbreviated as SY throughout this IAC Express article.]


BACKGROUND INFORMATION--ACTIONS TAKEN BY THE SIX STATES' LEGISLATIVE OR EXECUTIVE BRANCHES:

• Alaska: In April 2008, the lieutenant governor filed revisions to the state's regulations governing immunization requirements. Exemptions to the requirements may be granted for medical reasons or if vaccination conflicts with the tenets and practices of the church or religious denomination of which the child is a member.
   
• Indiana: On May 13, 2009, the governor signed a law requiring that school children receive additional immunization against meningitis, pertussis, and varicella. Exemptions to the requirements may be granted for medical reasons or on religious grounds.
   
• Massachusetts: On January 8, 2010, regulations were issued that require certain students to receive additional immunization with measles-mumps-rubella (MMR) vaccine, tetanus-diphtheria toxoid and acellular pertussis (Tdap) vaccine, and varicella vaccine. Medical and religious exemptions to the requirements may be granted.
   
• Michigan: In fall 2009, the state legislature approved new communicable disease rules for schools that expand vaccination requirements. Exemptions for medical reasons, religious convictions, or other objections may be granted.
   
• Ohio: On December 9, 2009, the director of health approved revisions to the state's code governing immunization requirements. Exemptions may be granted for medical reasons or if the parent/guardian declines for reasons of conscience.
   
• Tennessee: On December 9, 2009, amendments to rules governing requirements for immunization became effective for children in day care centers, elementary and secondary schools, and certain higher education settings. Exemptions to these and other requirements continue for medical reasons or if vaccination is contrary to the religious tenets and practices of the child's parent or guardian.

NEW REQUIREMENTS (LISTED IN ALPHABETICAL ORDER BY VACCINE):
HEPATITIS A
Tennessee: Rules amended in December 2009 require 1 dose of hepatitis A vaccine for children ages 18 through 59 months (effective 7/1/10) and 2 doses for students in kindergarten (effective 7/1/11). Laboratory evidence of immunity may be submitted to meet the requirements for hepatitis A vaccination.

IAC has compiled a chart of information about all states that have hepatitis A prevention mandates for day care and school attendance. To access the information, go to: http://www.immunize.org/laws/hepa.asp

The information is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/pdfs/hepa.pdf


HEPATITIS B
Tennessee: Rules amended in December 2009 require age-appropriate vaccination against hepatitis B virus infection for children enrolled in child care centers (effective 7/1/10). The hepatitis B vaccine series is required for health science students who expect to have patient contact, and who are enrolled full time in higher education institutions that have more than 200 students (effective 7/1/11). Laboratory evidence of immunity may be submitted to meet the requirements for hepatitis B vaccination.

IAC has compiled a chart of information about all states that have hepatitis B prevention mandates for day care and school attendance. To access the information, go to: http://www.immunize.org/laws/hepb.asp

The information is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/pdfs/hepb.pdf

IAC has compiled a chart of information about all states that have hepatitis B prevention mandates for college and university attendance. To access the information, go to: http://www.immunize.org/laws/hepbcollege.asp

The information is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/pdfs/hepb_college.pdf


HAEMOPHILUS INFLUENZAE type b (Hib)
Tennessee: Rules amended in December 2009 require the resumption of age-appropriate Hib vaccination for children younger than age 5 years for whom Hib vaccination was suspended in January 2008 because of a shortage of Hib vaccine (effective 12/9/09).

CDC has compiled a chart of information about all states that have Hib prevention mandates for child care attendance. To access the information, go to: http://www.immunize.org/laws/hib_childcare.pdf Note: the information on the chart is current for SY 2007-08.


MENINGOCOCCAL
Indiana: Revisions to Indiana's immunization administrative code, adopted in October 2009, require that all students in grades 6 through 12 have evidence of meningococcal conjugate vaccination (effective for SY 2010-11).

Michigan: Effective 1/1/10, students in grade 6 (as well as students ages 11 through 18 years who are changing school districts) are required to have documentation of 1 dose of meningococcal vaccine.

IAC has compiled a chart of information about all states that have mandates for either meningococcal education or vaccination for school attendance. To access the information, go to: http://www.immunize.org/laws/menin_sec.asp

The information is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/laws/menin_sec.pdf


MEASLES-MUMPS-RUBELLA (MMR)
Massachusetts: Effective in fall 2011, students entering kindergarten and grade 7 are required to have 2 doses of MMR, as are full-time college freshman and health science students (currently these groups are required to have 2 doses of measles vaccine and 1 dose each of mumps and rubella vaccines). Enforcement of requirements for students in elementary and secondary schools will be progressive (i.e., students in the subsequent grade will be added each year).

CDC has compiled a chart of information about all states that require 2 doses of MMR for attendance in kindergarten and another chart for attendance in middle school.

To access the information for kindergarten, go to: http://www.immunize.org/laws/mmr_kinder_2nddose.pdf Note: the information in the chart is current for SY 2007-08.

To access the information for middle school, go to http://www.immunize.org/laws/mmr_middle_2nddose.pdf Note: the information in the chart is current for SY 2007-08.


PNEUMOCOCCAL
Tennessee: Rules amended in December 2009 require age-appropriate vaccination against pneumococcal disease in children younger than age 5 years enrolled in child care centers (effective 7/1/10).

IAC has compiled a chart of information about all states that have pneumococcal prevention mandates for day care attendance. To access the information, go to: http://www.immunize.org/laws/pneuconj.asp

The information is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/pdfs/pcv7.pdf


TETANUS-DIPHTHERIA (Td) AND/OR TETANUS-DIPHTHERIA AND ACELLULAR PERTUSSIS (Tdap)
Indiana: Revisions to Indiana's immunization administrative code, adopted in October 2009, require that all students in grades 6 through 12 have evidence of 1 booster dose of Tdap vaccine (effective for SY 2010-11).

Massachusetts: Effective in fall 2011, students entering grade 7 are required to have 1 dose of Tdap vaccine, as are full-time college freshman and health science students (currently these groups are required to have 1 dose of Td toxoids). Enforcement of requirements for students in elementary and secondary schools will be progressive (i.e., students in the subsequent grade will be added each year).

Michigan: Effective 1/1/10, students in grade 6 (as well as students ages 11 through 18 years who are changing school districts) are required to have documentation of 1 dose of Tdap vaccine.

Ohio: Effective for SY 2010-11, students entering grade 7 are required to have evidence of either 1 booster dose of Td toxoids or Tdap vaccine. The requirement will be enforced progressively (i.e., the requirement will extend to the subsequent grade at the beginning of each new school year).

Tennessee: Rules amended in December 2009 require a 1-time dose of Tdap vaccine for all students enrolled in grade 7 (effective 10/1/10).

IAC has compiled a chart of information about all states that have Tdap vaccination mandates for middle school and high school attendance. To access the information, go to: http://www.immunize.org/laws/tdap.asp

The information is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/pdfs/tdap.pdf


VARICELLA
Alaska: Effective 7/1/09, all children enrolled in kindergarten through grade 6 are required to have evidence of 2 doses of varicella vaccine.

Indiana: Revisions to Indiana's immunization administrative code, adopted in October 2009, require that all students enrolling in kindergarten have evidence of 2 doses of varicella vaccine (effective for SY 2010-11).

Massachusetts: Effective in fall 2011, students entering kindergarten and grade 7 are required to have 2 doses of varicella vaccine, as are full-time college freshman and health science students (currently, varicella vaccination is not mandated for college students). Enforcement of requirements for students in elementary and secondary schools will be progressive (i.e., students in the subsequent grade will be added each year).

Michigan: Effective 1/1/10, all students entering kindergarten and grade 6 are required to have documentation of 2 doses of varicella vaccine or history of chickenpox disease.

Ohio: Effective for SY 2010-11, students enrolling in kindergarten must have evidence of 2 doses of varicella vaccine. The requirement will be enforced progressively (i.e., the requirement will extend to the subsequent grade at the beginning of each new school year).

Tennessee: Rules amended in December 2009 require 2 doses of varicella vaccine for students in kindergarten, grade 7, and new enrollees (effective 7/1/10), as well as for students born on or after January 1, 1980, who are enrolled full time in higher education institutions that have more than 200 students (effective 7/1/11). Laboratory evidence of immunity may be submitted to meet the requirements for varicella vaccination, as may disease history as verified by a healthcare professional.

IAC has compiled a chart of information about all states that require 2 doses of varicella vaccine for school attendance. To access the information, go to: http://www.immunize.org/laws/varicel_sec.asp

The information is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/laws/varicella.pdf


WANT MORE INFORMATION ON STATE IMMUNIZATION MANDATES?
To access more information about state mandates, visit our State Mandates on Immunization and Vaccine-Preventable Diseases web section at http://www.immunize.org/laws

IAC Express depends on readers to help us stay informed and ensure our website contains the most current and accurate information available. Please let us know when any changes occur in your state by emailing us at admin@immunize.org

The CDC website has a section of resources on immunization requirements for school attendance, healthcare workers, patients in various healthcare settings, and residents of various institutional settings. Among the resources is a searchable database on state immunization laws. To access this section of resources, go to: http://www.cdc.gov/vaccines/vac-gen/laws

Updated in June 2010, IAC's popular "Screening Questionnaire for Child and Teen Immunization" is now available in Spanish. The questionnaire makes it easy for healthcare professionals to screen for vaccine contraindications.

To access the Spanish version of "Screening Questionnaire for Child and Teen Immunization," go to: http://www.immunize.org/catg.d/p4060-01.pdf

For English: http://www.immunize.org/catg.d/p4060.pdf

IAC's Handouts for Patients and Staff web section offers healthcare professionals and the public approximately 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely. To access all of IAC's free handouts, go to: http://www.immunize.org/handouts

IAC's Video of the Week uses music and dance to send the message that kids in middle school and high school need a Tdap booster. Created by the Indiana chapter of AAP, the video has a run time of five minutes.

The video will be available on the home page of IAC's website through July 18. To access it, go to: http://www.immunize.org and click on the image under the words Video of the Week. After July 18, you can access the video directly (along with other Tdap information) at http://www.tdapvac.com

Remember to bookmark IAC's home page to view a new video every Monday. To view an IAC Video of the Week from the past, go to the video archive at http://www.immunize.org/votw

CDC published " Notes from the Field: Pertussis--California, January-June 2010" in the July 9 issue of MMWR. The notes are reprinted below in their entirety, excluding references.

To access the complete notes in web-text (HTML) format, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5926a5.htm

On July 2, Medscape posted a 4-minute video titled "CDC Commentary: With Pertussis on the Rise, Who Needs a Tdap Vaccination?" In it, Stacy W. Martin, an epidemiologist with CDC's National Center for Immunization and Respiratory Diseases, discusses the recommendations and rationale for giving tetanus-diphtheria-acellular pertussis (Tdap) vaccine.

To view the video, go to: http://www.medscape.com/viewarticle/724242

Note: to access the video, you must register with Medscape. There is no charge for this service.

The video is a collaboration between CDC and Medscape; it is one of a series of commentaries designed to deliver CDC's authoritative guidance directly to healthcare professionals. To view the available commentary choices, go to: http://www.medscape.com/partners/cdc/public/cdc-commentary

Medscape, a free resource for clinicians and other healthcare professionals, provides timely and relevant clinical information.

The third edition of "The Vaccine Handbook: A Practical Guide for Clinicians"--widely known as the Purple Book--is now available for purchase.

Since the first edition was published in 2004, the Purple Book has become a vital source of practical, up-to-date information for vaccine providers and educators. The driving principle behind the book is simple: to draw together the latest vaccine science and guidance into a concise, user-friendly, practical resource that can be used in the private office, public health clinic, and hospital.

The Purple Book is replete with scientific background and references, but unlike some academic textbooks, the language is plain, simple, and accessible. It is complete in terms of authoritative recommendations, but it expands upon the official publications of professional societies and governmental agencies by including, in one place, information on such things as how vaccines are developed, tested, and licensed; how vaccine policy is made; what constitutes the vaccine safety net; the legal obligations binding on vaccine providers; billing; and office logistics. The Purple Book is ideal for pediatricians, family physicians, internists, obstetrician/gynecologists, nurses, nurse practitioners, physician's assistants, clinic staff, students, and residents. Some parents and patients might also find it useful.

The Purple Book's author, Gary Marshall, MD, is professor of pediatrics; chief, Division of Pediatric Infectious Diseases; and director, Pediatric Clinical Trials Unit at the University of Louisville School of Medicine. In addition to being a busy clinician, he is nationally known for his work in the areas of vaccine research, advocacy, and education.

You can order the Purple Book directly from the publisher, Professional Communications Inc., at http://www.pcibooks.com/books/view/49 or you can buy it from your favorite local bookstore.

CDC published "Announcement: MMWR on Facebook and Twitter" in the July 9 issue of MMWR. The announcement is reprinted below in its entirety.

To access the announcement in web-text (HTML) format, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5926a7.htm

CDC published "Progress Toward Poliomyelitis Eradication--Nigeria, January 2009-June 2010" in the July 9 issue of MMWR. A synopsis prepared for the media is reprinted below in its entirety.

To access the entire article in web-text (HTML) format, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5926a2.htm

Louisiana's Shots for Tots immunization conference is scheduled for October 28-29 in New Orleans. To access the conference brochure, which includes information about the conference program, accommodations, and a mail-in registration form, go to: http://www.shotsfortots.com/18thBrochure2.pdf