Immunizations

The Tennessee Department of Health has new rules for immunization requirements in child care, pre-school, school and college. Visit the Tennessee Department of Health for more information. http://health.state.tn.us/CEDS/required.htm. A brief summary of the required immunizations for child care facilities, schools and colleges is listed below.

Infants entering child care facilities must be up to date at the time of enrollment and are required to provide an updated certificate after completing all of the required vaccines due by 18 months of age.

Children Enrolling in Child Care Facilities, Pre-School/Pre-Kindergarten
  • Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
  • Poliomyelitis (IPV or OPV)
  • Measles, Mumps, Rubella (1 dose of each, usually given together as MMR)
  • Varicella (1 dose or history of disease)
  • Haemophilus influenzae type B (Hib) – age younger than 5 years only (This requirement is resumed immediately, following suspension during a national Hib vaccine shortage 2008-2009)
  • Hepatitis B (HBV) (July 1, 2010)
  • Pneumococcal conjugate vaccine (PCV) – age younger than 5 years only (July 1, 2010)
  • Hepatitis A – 1 dose, required by 18 months of age or older (July 1, 2010)

Children Enrolling in Kindergarten

  • Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
  • Hepatitis B (HBV)
  • Measles, Mumps, Rubella (2 doses of each, usually given together as MMR)
  • Poliomyelitis (IPV or OPV) – final dose on or after the 4th birthday now required
  • Varicella (2 doses or history of disease): previously only one dose was required (July 1, 2010)
  • Hepatitis A –total of 2 doses, spaced at least 6 months apart (July 1, 2011)

All Children Entering 7th Grade (Including Currently Enrolled Students)
  • Tetanus-diphtheria-pertussis booster (“Tdap”) – not required if a Td booster dose given less than 5 years before 7th grade entry is recorded on the DTaP/Td line (no later than October 1, 2010)
  • Verification of immunity to varicella – 2 doses or history of disease (July 1, 2010)

All Children Newly Enrolled in a Tennessee School in Grades Other Than Kindergarten or 7th
  • Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
  • Measles, Mumps, Rubella (2 doses of each, usually given together as MMR)
  • Poliomyelitis (IPV or OPV) – final dose on or after the 4th birthday now required
  • Varicella (2 doses or history of disease) – previously only one dose was required
  • Hepatitis B (HBV) – previously only for Kindergarten, 7th grade entry

Children with Medical or Religious Exemption to Requirements
Medical – Physician or health department authorized to indicate specific vaccines medically exempted (because of risk of harm) on the new form. Other vaccines remain required.
Religious – Requires a signed statement by the parent/guardian that vaccination conflicts with their religious tenets or practices. If documentation of a health examination is required by the school, it must be noted by the healthcare provider on the immunization certificate. In that case, the provider should check the box that the parent has sought a religious exemption.


Full-Time Tennessee College Students
  • Measles, Mumps, Rubella (2 doses of each, usually given together as MMR): if born on or after January 1, 1957 only.
  • Varicella (2 doses or history of disease): if born on or after January 1, 1980 only, Effective (July 1, 2011)
  • Hepatitis B (HBV) – only for health science students expected to have patient contact (before patient contact begins) Effective (July 1, 2011)Students should also consider the need for the Meningococcal vaccine, particularly if the student will be living in a dormitory.

Minimum Ages or Dose Intervals
Minimum ages or dose intervals – Tennessee follows published CDC guidelines. For vaccines with critical minimum age requirements (e.g., MMR, varicella) or minimum dose intervals, doses are considered valid if given up to 4 days before the minimum age or dose interval. Doses administered more than 4 days early are considered invalid and should be repeated as recommended.


Alternative Proof of Immunity for Certain Diseases
A positive serology (year of test documented) is acceptable as an alternative to immunization for measles, mumps, rubella, hepatitis A, hepatitis B or Varicella. For Varicella, documentation of provider diagnosed Varicella (year) or provider-verified history of disease given by a parent or guardian (year) also is acceptable. By documenting a history of disease, the provider is asserting that he or she is convinced that the child has had chickenpox.