Attendance Manual, Immunization Requirements for Admission

IMMUNIZATION REQUIREMENTS FOR ADMISSION

Immunization Requirements

for Admission

HSC §3380 and basic specifications

To ensure the health and safety of pupils, teachers, and staff, the state requires specified immunizations prior to attendance in the schools. The Health and Safety Code contains the basic laws regarding immunization and exclusion (§3380 and following); Title 17 of the California Code of Regulations (6000 and following) details the conditions of admission and exclusion.

HSC §3380. In enacting this chapter, it is the intent of the Legislature to provide:

(a) A means for the achievement of total immunization of appropriate age groups against diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, measles, mumps, and rubella.

(b) That the persons required to be immunized be allowed to obtain immunizations from whatever medical source they so desire, subject only to the condition that the immunization be performed in accordance with the regulations of the State Department of Health Services and that a record of the immunization is made in accordance with such regulations.

(d) For the keeping of adequate records of immunization so that health departments, schools, or other institutions, parents or guardians, and the persons immunized will be able to ascertain that a child is fully or only partially immunized, and so that appropriate public agencies will be able to ascertain the immunization needs of groups or children in schools or other institutions.

As elsewhere, the law makes important distinctions among the circumstances under which a child shall be admitted, the conditions under which the child may be admitted, and the circumstances under which an already admitted pupil must be excluded from further attendance. The decision depends on the pupil's immunization or exemption status, as verified in written records.

The following definitions are essential to a correct understanding of the laws governing admissions:

17 CCR 6000. "Admission" means a pupil's first entry into a given public or private elementary or secondary school, child care center, day nursery, nursery school or development center. "Admission" also denotes a pupil's re-entry to one of these institutions after withdrawing from a previous enrollment.

(a) "Unconditional admission" is admission based upon documentation of receipt of all required immunizations or upon documentation of a permanent medical exemption or of a personal beliefs exemption to immunization in accordance with Section 6051.

(b) "Conditional admission" is admission based upon either documentation of having received some but not all required immunizations and of not being due for any vaccine at the time of entry or upon documentation of a temporary medical exemption to immunization in accordance with Section 6050. Continued attendance after conditional admission is contingent upon receipt of the remaining required immunizations in accordance with Sections 6020 and 6035.

Unconditional admission

The basic immunization requirement for admission to school is:

HSC §3381. As used in this chapter, the term "governing authority" means the governing board of each school district or the authority of each other private or public institution responsible for the operation and control of the institution or the principal or administrator of each school or institution.

The governing authority shall not unconditionally admit any person as a pupil of a private or public elementary or secondary school, child care center, day nursery, nursery school, or development center, unless prior to his first admission to that institution he or she has been fully immunized against diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, measles, mumps, and rubella in the manner and with the immunizing agents approved by the state department, except that all students who have reached the age of seven shall not be required to be immunized against pertussis or mumps.

Persons already enrolled in California public or private schools at the kindergarten level or above as of January 1, 1980, shall be exempt from the rubella and mumps immunization requirement for school attendance until they transfer to, enter, or attend a school at the seventh and ninth grade levels. Students entering the ninth grade on or after February 1, 1985, need not be screened for rubella. Students entering the seventh grade on or after February 1, 1987, need not be screened for rubella.

17 CCR 6025. Any pupil aged 18 months or older who has received all the immunizations against poliomyelitis, diphtheria, tetanus, pertussis, measles (rubeola), rubella and mumps required for his or her age, as defined in Table 1, Section 6020, or who has documented a permanent medical exemption or a personal beliefs exemption to immunization in accordance with Section 6051, shall be admitted unconditionally as a pupil to a given public or private elementary or secondary school, child care center, day nursery, nursery school or development center. However, for some pupils admitted unconditionally to a child care center, day nursery, nursery school or development center, an additional dose of DTP and/or polio vaccine will be required for admission to school at kindergarten level or above, as indicated in Table 1, Section 6020.

Hence, there are three ways for a pupil to be admitted unconditionally:

with documented proof of complete immunization;

with a permanent medical exemption;

with a currently valid personal beliefs exemption.

A pupil who has a properly documented full immunization record must be admitted unconditionally:

17 CCR 6065. (a) There shall be a written record given to the person immunized or to his parent or guardian by the physician or agency performing the immunization which shall contain the following information:

(1) Name of the person.

(2) Birth date.

(3) Type of vaccine administered.

(4) Month, day, and year of each immunization.

(5) Name of the physician or agency administering the vaccine.

(b) The written record shall be shown by the parent, guardian, or person immunized to the governing authority of the school, child care center, day nursery, nursery school or development center at the time of the pupil's admission and at subsequent times when required by the governing authority to determine the pupil's immunization status. For the pupil to be admitted, the written record shall show at least the month and year of each required vaccine dose. For doses of measles, rubella and mumps vaccine given during the month of the first birthday the record shall also show the specific date (i.e., month, day and year) of immunization.

(c) When such records are not available, the pupil shall not be admitted and the parent or guardian shall be referred to a physician or nurse for review of his or her immunization history and provision of immunizations as needed.

(d) Pupils who were admitted to a California school at kindergarten level or above before March 5, 1986 on the basis of a parent or guardian's having completed and signed a California School Immunization Record (PM 286) that shows at least the month and year each required vaccine dose was received (and also shows the day of immunization if a measles, rubella and/or mumps vaccine dose was received during the month of the first birthday), rather than on the basis of a parent or guardian's having provided a written record as described in Parts (a) and (b) of this Section, shall be allowed to continue in attendance in California schools.

Subdivision (c) of §6065 disallows admission without proper documentation--"When such records are not available, the pupil shall not be admitted"--except under conditions left to local officials' discretion (see "Conditional Admissions," following).

Circumstances arise in which a child does not need a particular immunization, for example when s/he has already had the disease; proper documentation, however, is always required:

HSC §3386. If the parent or guardian files with the governing authority a written statement by a licensed physician to the effect that the physical condition of the child is such or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances which contraindicate immunization, such person shall be exempt from the requirements of this chapter to the extent indicated by the physician's statement.

17 CCR 6051. A pupil with a permanent medical exemption or a personal beliefs exemption to immunization shall be admitted unconditionally. A permanent medical exemption shall be granted upon the filing with the governing authority of a written statement from a licensed physician to the effect that the physical condition of the pupil or medical circumstances relating to the pupil are such that immunization is permanently not indicated. The fact of the permanent medical exemption shall be recorded on the California School Immunization Record, PM 286. A permanent medical exemption may be provided for one or more vaccines. A physician may provide a written statement that the pupil is medically exempt from the measles (rubeola) requirement as a result of having had measles (rubeola) disease. A physician may provide a written statement that the pupil is medically exempt from the rubella and/or mumps requirement as a result of having had laboratory confirmed illness with the corresponding disease.

A personal beliefs exemption shall be granted upon the filing with the governing authority of a letter or affidavit from the pupil's parent or guardian or adult who has assumed responsibility for his or her care and custody in the case of a minor, or the person seeking admission if an emancipated minor, that such immunization is contrary to his or her beliefs. A pupil with an exemption which is not based on pre-existing immunity to disease may be subject to exclusion pursuant to Section 6060.

The law also allows unconditional admission when immunization is contrary to a family's beliefs, with documentation again required pursuant to 17 CCR 6051, as well as:

HSC §3385. Immunization of a person shall not be required for admission to a school or other institution listed in Section 3381 if the parent or guardian or adult who has assumed responsibility for his or her care and custody in the case of a minor, or the person seeking admission if an emancipated minor, files with the governing authority a letter or affidavit stating that such immunization is contrary to his or her beliefs. However, whenever there is good cause to believe that such person has been exposed to one of the communicable diseases listed in subdivision (a) of Section 3380, that person may be temporarily excluded from the school or institution until the local health officer is satisfied that the person is no longer at risk of developing the disease.

It is important to note that both these sections specifically allow for the subsequent exclusion of a "pupil with an exemption which is not based on pre-existing immunity to disease" (see "Immunization," following). Such precautionary exclusions may not be credited as apportionment-excused absences.

Conditional admission

A district is not required to admit a child who has not been fully immunized; it may admit such a child, but only with certain conditions:

HSC §3382. A person who has not been fully immunized against one or more of the diseases listed in Section 3381 may be admitted by the governing authority on condition that within time periods designated by regulation of the state department he or she presents evidence that he or she has been fully immunized against all of these diseases.

17 CCR 6000.

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17 CCR 6035. (a) Any pupil seeking admission to a given public or private elementary or secondary school, child care center, day nursery, nursery school or development center who lacks documentation of having received all the required vaccine doses against poliomyelitis, diphtheria, tetanus, pertussis, measles (rubeola), rubella and mumps 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.

(b) The public or private elementary or secondary school, child care center, day nursery, nursery school 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.

Conditional admission is allowable if the child:

is partially immunized and on schedule to date toward completion;

has a temporary medical exemption from one or more immunizations, in accordance with 17 CCR 6050;

is completely immunized but whose records have been delayed in transmission (17 CCR 6070).

It is in the district's and child's best interests to bring his/her immunization status into compliance as soon as possible. The law sets time limits for conditional admission, while providing rules for notifying the parents/guardians of children who face exclusion. When they conditionally admit pupils, school authorities incur responsibility for regular review of records:

17 CCR 6070.

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(e) The governing authority shall see that the immunization record of each pupil admitted conditionally is reviewed every 30 days until that pupil has received all the required immunizations. Any immunizations received subsequent to conditional admission shall be entered in the pupil's immunization record.

If a partially immunized child is currently due for a vaccine dose, s/he may not be admitted. As 17 CCR 6000(b) makes clear, "Continued attendance after conditional admission is contingent upon receipt of the remaining required immunizations..."; furthermore, time constraints attach to such admission:

17 CCR 6040. An already admitted pupil who is subsequently discovered not to have received all the immunizations which were required before admission or who is subsequently discovered not to have complied with the requirements for conditional admission specified in Section 6035 shall continue in attendance only if he or she receives all vaccine doses for which he or she is currently due and provides documentation of having received such doses no later than 10 school days after he or she or the parent or guardian is notified. The school, child care center, day nursery, nursery school or development center shall notify the pupil or the parent or guardian of the time period (no longer than 10 school days) within which the doses must be received.

Section 6040 applies not only to conditionally admitted pupils, but also to any pupils discovered to be in attendance without complete immunization records. Governing authorities must notify the parent/guardian and give the parent/guardian not more than 10 schooldays to provide verification that the child has received the required doses.

Under certain circumstances, it may be medically inadvisable to administer certain immunizations to a child. The resultant exemption may be permanent (pursuant to HSC §3386 and 17 CCR 6051, as described earlier) or temporary (pursuant to HSC §3386 and 17 CCR 6050), but in both cases the statement of a licensed physician is a prerequisite for any admission. Such a statement must always describe "the specific nature and probable duration of the medical condition or circumstances which contraindicate immunization..." (HSC §3386).

Temporary medical exemptions are authorized in:

17 CCR 6050. A pupil who is temporarily exempt from immunization for medical reasons shall be admitted on condition that required immunizations are obtained at the termination of the exemption; the fact of the temporary medical exemption shall be recorded on the California School Immunization Record (PM 286). A pupil with a temporary medical exemption may be subject to exclusion pursuant to Section 6060.

The conditions accompanying such admission must be communicated to the parent/guardian responsible; 17 CCR 6035(a)(3) describes this notification: "the pupil's parent or guardian [must be] notified of the date by which the pupil must complete all the required immunizations when the temporary exemption terminates...." As in other cases, "A pupil with an exemption which is not based on pre-existing immunity to disease may be subject to exclusion pursuant to Section 6060" (17 CCR 6051).

In some circumstances, such as when paperwork on a transferring student is expected but has not arrived, a district may at its discretion admit a pupil who does not hold all required records at the time of admission:

17 CCR 6070.

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(d) For pupils at kindergarten level and above transferring between school campuses within California or from a school in another state to a school in California, if the mandatory permanent pupil record or other immunization record has not been received at the time of entry to the new school, the governing authority of the school may admit the pupil for a period of up to 30 school days. If the mandatory permanent record or other immunization record has not arrived by the end of this period, the governing authority shall require the parent or guardian to present a written immunization record, as described in Section 6065, documenting that all currently due required immunizations have been received. If such a record is not presented, the pupil shall be excluded from further attendance until he or she comes into compliance with the immunization requirements, as outlined in Sections 6020, 6035, 6065.

Immunization and exclusions

In the context of immunizations, "exclusion" occurs when a child is refused admission to school, or when an already admitted pupil is prohibited from further attendance. Two conditions constitute grounds for exclusion: the child has not fully complied with immunization regulations within the time period specified by law, or the pupil's further attendance would constitute a risk to the health of other pupils, teachers, or staff. Although in many cases a governing authority must provide notice before excluding a pupil, there are situations in which governing authorities or health officials can use their discretion to act immediately in protecting the general health.

A clear and complete paper trail must verify the immunization status of each pupil and prospective pupil:

17 CCR 6070. (a) The governing authority of each school, child care center, day nursery, nursery school or development center shall record each pupil's immunization on the California School Immunization Record, PM 286, which, at kindergarten level and above, shall be part of the mandatory pupil record as defined in Section 430 of Title 5, California Code of Regulations.

(b) Each pupil's immunization record shall contain:

(1) Name of pupil.

(2) Birth date (month, day, and year).

(3) Date of unconditional or conditional admission

(4) Type of vaccine and date (month, day, and year) each dose was administered.

(5) Date and type of exemption, if any.

The specific connections between immunization records and exclusions are found in:

HSC §3389. (a) The governing authority of each school or institution included in Section 3381 shall require documentary proof of each entrant's immunization status. The governing authority shall record the immunizations of each new entrant in the entrant's permanent enrollment and scholarship record on a form provided by the state department. The immunization record of each new entrant admitted conditionally shall be reviewed periodically by the governing authority to ensure that within the time periods designated by regulation of the state department he or she has been fully immunized against all of the diseases listed in Section 3381, and such immunizations received subsequent to entry shall be added to the pupil's immunization records.

(b) The governing authority of each school or institution included in Section 3381 shall prohibit from further attendance any pupil admitted conditionally who failed to obtain the required immunizations within the time limits allowed under the regulations of the state department, unless the pupil is exempted under Section 3385 or 3386, until that pupil has been fully immunized against all of the diseases listed in Section 3381.

(c) The governing authority shall file a written report on the immunization status of new entrants to the school or institution under their jurisdiction with the state department and the local health department at times and on forms prescribed by the state department. As provided in paragraph (4) of subdivision (a) of Section 49076 of the Education Code, the local health department shall have access to the complete health information as it relates to immunization of each student in the schools or other institutions listed in Section 3381 in order to determine immunization deficiencies.

(d) The governing authority shall cooperate with the county health officer in carrying out programs for the immunization of persons applying for admission to any school or institution under its jurisdiction. The governing board of any school district may use funds, property, and personnel of the district for that purpose. The governing authority of the school or other institution may permit any licensed physician or any qualified registered nurse as provided in Section 2727.3 of the Business and Professions Code to administer immunizing agents to any person seeking admission to any school or institution under its jurisdiction.

The conditions of admission specify the time period within which further immunizations are required, or following which temporary medical exemptions expire. A pupil not meeting these conditions within the specified time is subject to exclusion:

17 CCR 6055. The governing authority of the school, child care center, day nursery, nursery school or development center shall exclude from further attendance any pupil who fails to obtain the required immunizations within no more than 10 days following receipt of the notice provided pursuant to Section 6040, unless the pupil is exempt for medical reasons or personal beliefs, until the pupil provides written evidence that he or she has received another dose of each required vaccine due at that time. Any pupil so excluded shall be reported to the attendance supervisor or to the building administrator.

As the wording ("shall prohibit from further attendance," "shall exclude from further attendance") makes clear, there are no grounds on which an incompletely immunized pupil may continue to attend more than 10 days after receiving notice.

The last sentence of 17 CCR 6051 allows the exclusion of pupils even when they have been "unconditionally" admitted: "A pupil with an exemption which is not based on pre-existing immunity to disease may be subject to exclusion pursuant to Section 6060."

The operative priority is always the health and safety of the general school population:

17 CCR 6060. Whenever the governing authority has good cause to believe that a pupil who is not completely immunized against a particular communicable disease may have been exposed to that disease, that information shall be reported by the governing authority immediately by telephone to the local health officer. The local health officer shall determine whether the pupil is at risk of developing the disease and, if so, may require the exclusion of the pupil from that school, child care center, day nursery, nursery school or development center until the completion of the incubation period and the period of communicability of the disease.

A parent or guardian who for religious or other reasons refuses to consent to the physical examination of a child must verify such refusal on an annual basis:

§49451. A parent or guardian having control or charge of any child enrolled in the public schools may file annually with the principal of the school in which he is enrolled a statement in writing, signed by the parent or guardian, stating that he will not consent to a physical examination of his child. Thereupon the child shall be exempt from physical examination, but whenever there is good reason to believe that the child is suffering from a recognized contagious or infectious disease, he shall be sent home and shall not be permitted to return until the school authorities are satisfied that any contagious or infectious disease does not exist.

The last paragraph of §48213 (following) also specifically provides for immediate exclusion without prior notice, as may be necessary for a child whose parent withholds consent to physical examination.

Three other Education Code sections set out the grounds for exclusion and the process of notification:

§48211. The governing body of a school district may exclude children of filthy or vicious habits, or children suffering from contagious or infectious diseases.

§48212. The governing board of the school may exclude from attendance on regular school classes any child whose physical or mental disability is such as to cause his attendance to be inimical to the welfare of other pupils.

§48213. Prior to excluding a child from attendance pursuant to Section 48211 or 48212, the governing board shall send a notice to the parent or guardian of the child. The notice shall contain each of the following:

(1) A statement of the facts leading to a decision to propose exclusion of the child.

(2) A statement that the parent or guardian of the child has a right to meet with the governing board to discuss the proposed exclusion.

(3) A statement that at any meeting with the governing board held to discuss such proposed exclusion, the parent or guardian shall have an opportunity to inspect all documents which the governing board relied on in its decision to propose exclusion of the child; to challenge any evidence and to confront and question any witness presented by the governing board; and to present oral and documentary evidence on the child's behalf, including witnesses. The statement shall also include notice that the parent or guardian may designate one or more representatives to be present with the parent or guardian at the meeting.

(4) A statement that the decision to exclude the child is subject to periodic review and a statement of the procedures set by the governing board for such periodic review.

If a child is excluded from attendance pursuant to Section 3118 of the Health and Safety Code or Section 49451 of this code or when a principal or his or her designee determines that the continued presence of the child would constitute a clear and present danger to the life, safety, or health of pupils or school personnel, the governing board shall not be required to send prior notice of the exclusion to the parent or guardian as required in this section. The governing board shall send a notice as required by this section as soon as is reasonably possible after the exclusion.

Specifically addressing the rights of pupils, the CCR provides that:

5 CCR 202. A pupil while infected with any contagious or infectious disease may not remain in any public school.

Under certain conditions, a district may be able to claim up to five days' apportionment attendance credit for a pupil excluded on the basis of inadequate immunization:

§46010.5. The governing board of the district of attendance shall exclude any pupil of the district who has not been immunized properly pursuant to Chapter 7 (commencing with Section 3380) of Division 4 of the Health and Safety Code, for up to five days in order to obtain such immunization, and such exclusion shall not be deemed an absence in computing average daily attendance if the following conditions are complied with:

(a) The governing board of the district notifies the parent or guardian of the pupil that they have two weeks to supply evidence either that the pupil has been properly immunized, or that the pupil is exempted from the immunization requirement pursuant to Section 3385 or Section 3386 of the Health and Safety Code.

(b) The governing board of the district, in such notice, refers the parent or guardian of the pupil to the pupil's usual source of medical care to obtain such immunization, or if no usual source exists, either refers the parent or guardian to the county health department, or notifies the parent that the immunizations will be administered at a school of the district.

If a pupil requires several doses over more than five schooldays before being eligible for legal admission, the rest of the exclusion absence is not apportionable.

It is also important to note that a pupil excluded on a precautionary basis (for example, as provided in HSC §3385 or 17 CCR 6060) does not qualify for the five days' apportionment credit outlined in §46010.5. Similarly, an erroneously admitted pupil who then contracts one of the diseases listed in HSC §3380 is also not eligible for excused absence credit.

Finally, it should be noted that a parent's/guardian's obligation to send a child to public school necessarily includes the obligation to document proper immunization status or to file a personal beliefs exemption.