| (a) For further information see §97.71 of this title (relating to Provisional Enrollment)
and §97.77 of this title (relating to Remarks and Special Recommendations).
(b) Doses of oral poliovirus vaccine (OPV) and inactivated poliovirus vaccine (IPV) may be
used interchangeably and count equally toward meeting the polio vaccine requirements in all
of the following age ranges. A child or student age five and older will be in full
compliance with the polio vaccine requirement whenever he or she has received at least three
OPV doses or at least three IPV doses, or any combination of at least three doses of OPV and
IPV, with one dose received since the fourth birthday.
(c) The following immunizations are required in the respective age groupings. A child or
student must meet all the immunization requirements specific to an age group upon first
entering the age group. Implementation of requirements for hepatitis B vaccine for
adolescents and varicella vaccine and hepatitis A for all ages is contingent upon the
appropriation of funds to the department for these purposes. By July 1 of each odd-numbered
year, the department will publish a statement on whether or not these vaccines have been
funded and are required as specified.
(1) Children less than five years of age: polio vaccine; diphtheria-tetanus-pertussis (DTP)
or diphtheria-tetanus-acellular pertussis (DTaP) vaccine; measles, mumps, and rubella
vaccine (MMR); Haemophilus influenzae type b conjugate vaccine (HibCV), hepatitis A, and
varicella vaccine.
(A) Children less than two months old: no immunizations are required.
(B) Children two months of age, but not yet four months of age: one dose each of polio
vaccine, DTP/DTaP vaccine, and HibCV are required.
(C) Children four months of age, but not yet six months of age: two doses each of polio
vaccine, DTP/DTaP vaccine, and HibCV are required.
(D) Children six months of age, but not yet 12 months of age: two doses of polio vaccine
and HibCV, and three doses of DTP/DTaP vaccine are required.
(E) Children 12 months of age, but not yet 15 months of age (12 months through 14 months
of age):
(i) three doses of polio vaccine are required;
(ii) three doses of DTP/DTaP vaccine are required. Any combination of three doses of
DTP/DTaP will meet this requirement;
(iii) one dose of MMR vaccine is required. Only doses received on or after the first
birthday, or in accordance with the most recent General Recommendations on Immunizations
adopted by the Centers for Disease Control and Prevention (CDC) issued by the Advisory
Committee on Immunization Practices (ACIP) regarding the validity of vaccine doses
administered less than or equal to 4 days before the minimum interval or age will meet
this requirement. Serologic confirmation of measles, mumps, or rubella immunity or
serologic evidence of infection is acceptable in lieu of vaccination for that disease
only. Copies of General Recommendations on Immunizations may be obtained from Texas
Department of Health, 1100 West 49th Street, Austin, Texas 78756-3180, (512) 458-7284.
For further information see §97.67 of this title (relating to Verification of Immunity
to Measles, Rubella, Mumps, Hepatitis A, Hepatitis B, or Varicella); and
(iv) two doses of HibCV are required.
(v) no later then August 1, 2000, one dose of varicella vaccine is required. This
vaccine must have been received on or after the first birthday, or in accordance with
the most recent General Recommendations on Immunizations adopted by Centers for Disease
Control and Prevention (CDC) issued by the Advisory Committee on Immunization Practices
(ACIP) regarding the validity of vaccine doses administered less than or equal to four
days before the minimum interval or age. A parent- or physician-validated history of
varicella illness (chickenpox) or serologic confirmation of varicella immunity is
acceptable in lieu of vaccine. For further information, see §97.67 of this title.
(F) Children 15 months of age, but not yet five years of age (15 months through four years
of age):
(i) three doses of polio vaccine are required;
(ii) any combination of DTP/DTaP will meet the following requirement:
(iii) one dose of MMR vaccine is required. Only doses received on or after the first
birthday, or in accordance with the most recent General Recommendations on Immunizations
adopted by Centers for Disease Control and Prevention (CDC) issued by the Advisory
Committee on Immunization Practices (ACIP) regarding the validity of vaccine doses
administered less than or equal to four days before the minimum interval or age will
meet this requirement. Serologic confirmation of measles, mumps, or rubella immunity or
serologic evidence of infection is acceptable in lieu of vaccination for that disease
only. For further information see §97.67 of this title; and
(iv) one dose of HibCV on or after 15 months of age is required unless a schedule for a
primary series and booster was completed prior to or at 15 months of age. A
physician-validated history of invasive Haemophilus influenzae type b disease, on or
after the second birthday will substitute for the vaccine requirement for children two
years of age through four years of age.
(v) no later then August 1, 2000, one dose of varicella vaccine is required. This
vaccine must have been received on or after the first birthday, or in accordance with
the most recent General Recommendations on Immunizations adopted by Centers for Disease
Control and Prevention (CDC) issued by the Advisory Committee on Immunization Practices
(ACIP) regarding the validity of vaccine doses administered less than or equal to four
days before the minimum interval or age. A parent- or physician-validated history of
varicella illness (chickenpox) or serologic confirmation of varicella immunity is
acceptable in lieu of vaccine. For further information, see §97.67 of this title; and
(vi) no later then August 1, 2000, children subject to these requirements as described
in §97.61 (relating to Children and Students Included in Requirements) must comply with
the following requirement for hepatitis A vaccine if the facility, school or institution
attended is located in any of the following counties: Brewster, Brooks, Cameron,
Crockett, Culberson, Dimmitt, Duval, Edwards, El Paso, Frio, Hidalgo, Hudspeth, Jeff
Davis, Jim Hogg, Kenedy, Kinney, La Salle, Maverick, McMullen, Pecos, Presidio, Real,
Reeves, Starr, Sutton, Terrell, Uvalde, Val Verde, Webb, Willacy, Zapata, and Zavala.
Serologic confirmation of immunity to hepatitis A or serologic evidence of infection is
acceptable in lieu of vaccine. In addition to the above hepatitis A vaccine
requirements, the Texas Department of Health (department) pursuant to the requirements
of Health and Safety Code §81.023 shall require hepatitis A vaccine for children
residing in other geographic areas specified by the department when the incidence rate
of hepatitis A during a representative period of time of no less than 180 days has
reached the rate at least twice the national average, as recommended by the Centers for
Disease Control and Prevention's Advisory Committee on Immunization Practices. Serologic
confirmation of immunity to hepatitis A or serologic evidence of infection is acceptable
in lieu of vaccine. For further information, see §97.67 of this title. Doses of
hepatitis A vaccine are required as follows:
(I) children 2 years of age but not yet 3 years of age are required to show proof by
30 days past their second birthday, or in accordance with the most recent General
Recommendations on Immunizations adopted by Centers for Disease Control and Prevention
(CDC) issued by the Advisory Committee on Immunization Practices (ACIP) ) regarding
the validity of vaccine doses administered less than or equal to four days before the
minimum interval or age of one dose of hepatitis A vaccine administered on or after
their second birthday, or in accordance with the most recent General Recommendations
on Immunizations adopted by Centers for Disease Control and Prevention (CDC) issued by
the Advisory Committee on Immunization Practices (ACIP) regarding the validity of
vaccine doses administered less than or equal to four days before the minimum interval
or age; and
(II) children 3 years of age but not yet 5 years of age are required to have received
two doses of hepatitis A vaccine administered on or after their second birthday, or in
accordance with the most recent General Recommendations on Immunizations adopted by
Centers for Disease Control and Prevention (CDC) issued by the Advisory Committee on
Immunization Practices (ACIP) regarding the validity of vaccine doses administered
less than or equal to four days before the minimum interval or age.
(2) Children and students five years of age or older.
(A) Polio. At least three doses of polio vaccine are required, provided at least one dose
has been received on or after the fourth birthday. Children and students who have received
two doses of inactivated poliovirus vaccine (IPV) followed by two doses of oral poliovirus
vaccine (OPV) prior to their fourth birthday do not require one dose of polio vaccine on
or after their fourth birthday. Polio vaccine is not required for persons 18 years of age
or older. For further information see §97.65 of this title (relating to Pregnancy) and §97.77(c)
and (d) of this title (relating to Remarks and Special Recommendations).
(B) Tetanus/Diphtheria.
(i) Children and students six years of age and younger: at least four doses of DTP/DTaP,
DT, or Td vaccine are required, provided at least one dose has been received on or after
the fourth birthday. Pertussis vaccine is not required for children/students who are
five years of age and older. Children with a medical contraindication to pertussis
vaccine will need to have had only three doses of any combination of DTP/DTaP/DT/Td
vaccines if their first dose was given on or after the first birthday and their third
dose was given on or after the fourth birthday. For further information see §97.77(c)
and (d) of this title.
(ii) Children and students seven years of age and older: at least three doses of DTP or
DTaP, DT, or Td vaccine are required, provided at least one dose has been received on or
after the fourth birthday. Pertussis vaccine is not required for children/students who
are five years of age and older. Any combination of three doses of DTP/DTaP/DT/Td will
meet this requirement. One dose of DTP, DTaP, DT, or Td is required within the last ten
years. For further information see §97.77(c) and (d) of this title.
(C) Measles.
(i) Beginning September 1, 1990:
(I) all children and students must have received measles vaccine on or after their
first birthday, or in accordance with the most recent General Recommendations on
Immunizations adopted by Centers for Disease Control and Prevention (CDC) issued by
the Advisory Committee on Immunization Practices (ACIP) regarding the validity of
vaccine doses administered less than or equal to four days before the minimum interval
or age, provide serologic confirmation of measles immunity or serologic evidence of
infection; and
(II) the requirement for measles vaccine administered on or after the first birthday,
or in accordance with the most recent General Recommendations on Immunizations adopted
by Centers for Disease Control and Prevention (CDC) issued by the Advisory Committee
on Immunization Practices (ACIP) regarding the validity of vaccine doses administered
less than or equal to four days before the minimum interval or age will apply if a
child's/student's immunization record is updated; a child/student enters a child-care
facility or school for the first time; or a child/student transfers from another state
into a Texas school or child-care facility.
(ii) Beginning January 1, 1991, children and students born on or after September 1, 1978
will be required to show serologic proof of measles immunity, serologic evidence of
infection, or receipt of two doses of measles vaccine administered on or after the first
birthday, or in accordance with the most recent General Recommendations on Immunizations
adopted by Centers for Disease Control and Prevention (CDC) issued by the Advisory
Committee on Immunization Practices (ACIP) regarding the validity of vaccine doses
administered less than or equal to four days before the minimum interval or age. This
proof is not required until the child's 12th birthday. The two doses of measles vaccine
must have been administered at least 28 days apart. Children and students may have 30
days past their 12th birthday to be in compliance with this clause. For further
information see §97.65 of this title and §97.67 of this title.
(iii) Effective August 1, 1997:
(I) children born on or after September 2, 1991, will be required to show proof of
either:
(-a-) two doses of measles vaccine administered on or after the first birthday, or
in accordance with the most recent General Recommendations on Immunizations adopted
by Centers for Disease Control and Prevention (CDC) issued by the Advisory Committee
on Immunization Practices (ACIP) regarding the validity of vaccine doses
administered less than or equal to four days before the minimum interval or age and
at least 28 days apart; or
(-b-) serologic confirmation of immunity to measles illness or serologic evidence of
infection. For further information see §97.65 of this title and §97.67 of this
title; and
(II) children born prior to September 2, 1991 will be required to show proof by 30
days past their 12th birthday of either:
(-a-) two doses of measles vaccine administered on or after the first birthday, or
in accordance with the most recent General Recommendations on Immunizations adopted
by Centers for Disease Control and Prevention (CDC) issued by the Advisory Committee
on Immunization Practices (ACIP) regarding the validity of vaccine doses
administered less than or equal to four days before the minimum interval or age, and
at least 28 days apart; or
(-b-) serologic confirmation of immunity to measles illness or serologic evidence of
infection. For further information see §97.65 of this title and §97.67 of this
title.
(D) Rubella. Beginning September 1, 1991:
(i) all children and students must have received rubella vaccine on or after their first
birthday, or in accordance with the most recent General Recommendations on Immunizations
adopted by Centers for Disease Control and Prevention (CDC) issued by the Advisory
Committee on Immunization Practices (ACIP) regarding the validity of vaccine doses
administered less than or equal to four days before the minimum interval or age, provide
serologic confirmation of rubella immunity, or serologic evidence of infection; and
(ii) the requirement for rubella vaccine administered on or after the first birthday, or
in accordance with the most recent General Recommendations on Immunizations adopted by
Centers for Disease Control and Prevention (CDC) issued by the Advisory Committee on
Immunization Practices (ACIP) regarding the validity of vaccine doses administered less
than or equal to four days before the minimum interval or age will apply if a
child's/student's immunization record is updated; a child/student enters a child-care
facility or school for the first time; or a child/student transfers from another state
into a Texas school or child-care facility. For further information see §97.65 of this
title and §97.67 of this title.
(E) Mumps. Beginning September 1, 1990:
(i) all children or students will be required to have received mumps vaccine
administered on or after their first birthday, or in accordance with the most recent
General Recommendations on Immunizations adopted by Centers for Disease Control and
Prevention (CDC) issued by the Advisory Committee on Immunization Practices (ACIP)
regarding the validity of vaccine doses administered less than or equal to four days
before the minimum interval or age, provide serologic confirmation of mumps immunity, or
serologic evidence of infection; and
(ii) the requirement for mumps vaccine administered on or after the first birthday, or
in accordance with the most recent General Recommendations on Immunizations adopted by
Centers for Disease Control and Prevention (CDC) issued by the Advisory Committee on
Immunization Practices (ACIP) regarding the validity of vaccine doses administered less
than or equal to four days before the minimum interval or age, will apply if a
child's/student's immunization record is updated, a child/student enters a child-care
facility or school for the first time; or a child/student transfers from another state
into a Texas school or child-care facility. For further information see §97.65 of this
title and §97.67 of this title.
(F) Hepatitis B.
(i) Effective August 1, 1998, children born on or after September 2, 1992, will be
required to show proof of either:
(I) three doses of hepatitis B vaccine; or
(II) serologic confirmation of immunity to hepatitis B or serologic evidence of
infection. For further information see §97.67 of this title.
(ii) No later then August 1, 2000, children born on or after September 2, 1988, but
before September 2, 1992 will be required to show proof by 30 days past their 12th
birthday of either:
(I) three doses of hepatitis B vaccine; or
(II) serologic confirmation of immunity to hepatitis B or serologic evidence of
infection. For further information see §97.67 of this title.
(G) Varicella.
(i) No later then August 1, 2000, children born on or after September 2, 1994, will be
required to show proof of either:
(I) one dose of varicella vaccine received on or after the first birthday, or in
accordance with the most recent General Recommendations on Immunizations adopted by
Centers for Disease Control and Prevention (CDC) issued by the Advisory Committee on
Immunization Practices (ACIP) regarding the validity of vaccine doses administered
less than or equal to four days before the minimum interval or age, (two doses are
required if the child is 13 years old or older at the time the first dose of varicella
vaccine is received); or
(II) a parent- or physician-validated history of varicella illness (chickenpox) or
serologic confirmation of varicella immunity. For further information, see §97.67 of
this title.
(ii) No later than August 1, 2000, children born on or after September 2, 1988, but
before September 2, 1994, will be required to show proof by 30 days past their 12th
birthday of either:
(I) one dose of varicella vaccine received on or after the first birthday, or in
accordance with the most recent General Recommendations on Immunizations adopted by
Centers for Disease Control and Prevention (CDC) issued by the Advisory Committee on
Immunization Practices (ACIP) regarding the validity of vaccine doses administered
less than or equal to four days before the minimum interval or age (two doses are
required if the child is 13 years old or older at the time the first dose of varicella
vaccine is received); or
(II) a parent- or physician-validated history of varicella illness (chickenpox) or
serologic confirmation of varicella immunity. For further information, see §97.67 of
this title.
(H) Hepatitis A. Effective August 1, 1999, children subject to these requirements as
described in §97.61 of this title (relating to Children and Students Included in
Requirements) must comply with the following requirement for hepatitis A vaccine if the
facility, school or institution attended is located in any of the following counties:
Brewster, Brooks, Cameron, Crockett, Culberson, Dimmitt, Duval, Edwards, El Paso, Frio,
Hidalgo, Hudspeth, Jeff Davis, Jim Hogg, Kenedy, Kinney, La Salle, Maverick, McMullen,
Pecos, Presidio, Real, Reeves, Starr, Sutton, Terrell, Uvalde, Val Verde, Webb, Willacy,
Zapata, and Zavala. Serologic confirmation of immunity to hepatitis A or serologic
evidence of infection is acceptable in lieu of vaccine. In addition to the above hepatitis
A vaccine requirements, the department pursuant to the requirements of Health and Safety
Code §81.023 shall require hepatitis A vaccine for children residing in other geographic
areas specified by the department when the incidence rate of hepatitis A during a
representative period of time of no less than 180 days has reached the rate at least twice
the national average, as recommended by the Centers for Disease Control and Prevention's
Advisory Committee on Immunization Practices. Serologic confirmation of immunity to
hepatitis A or serologic evidence of infection is acceptable in lieu of vaccine. For
further information, see §97.67 of this title. Children and students born on or after
September 2, 1992, will be required to have received two doses of hepatitis A vaccine
administered on or after their second birthday, or in accordance with the most recent
General Recommendations on Immunizations adopted by Centers for Disease Control and
Prevention (CDC) issued by the Advisory Committee on Immunization Practices (ACIP)
regarding the validity of vaccine doses administered less than or equal to four days
before the minimum interval or age.
(3) Students in institutions of higher education (colleges, universities, and other teaching
facilities above the high school level).
(A) Applicability. This paragraph applies to all students enrolled in health-related
courses which will involve direct patient contact in medical or dental care facilities.
This includes all medical interns; residents; fellows; and others who are being trained in
medical schools, hospitals, and health science centers listed in the Texas Higher
Education Coordinating Board's list of higher education in Texas; and students attending
two-year and four-year colleges whose course work involves direct patient contact
regardless of: number of courses taken; number of hours taken; and classification of
student. Subparagraph (I) of this paragraph also applies to veterinary medical students
whose course work involves direct contact with animals or animal remains regardless of
number of courses taken; number of hours taken; and classification of student. The
department will assist institutions of higher education to educate all students of the
need for immunizations and will assist in the provision of vaccines as resources allow.
(B) Provisional enrollment. Students referenced in this paragraph may be provisionally
enrolled for up to one semester or one quarter. The provisional enrollment will allow
students to attend classes while obtaining the required immunizations and documentation
(immunization records) of required immunizations. Student health care providers cannot be
provisionally enrolled without receipt of at least one dose of MMR vaccine if direct
patient contact will occur during the provisional enrollment period. For further
information see §97.62 of this title (relating to Exclusions from Compliance); §97.65 of
this title; §97.67 of this title; §97.73 of this title (relating to Acceptable Documents
of Immunizations); and §97.77 of this title. Other sections of this chapter regarding
immunizations also affect college/university students and institutions of higher
education.
(C) Polio. Polio vaccine is not required for any student. All students enrolled in
health-related courses are encouraged to ascertain that they are immune to poliomyelitis.
(D) Tetanus/Diphtheria. Beginning January 1, 1992, tetanus/diphtheria toxoid (Td) is
required for all students defined previously in subparagraph (A) of this paragraph.
Students enrolled in health-related courses must have received one dose of Td within the
past ten years. For recordkeeping, only one date (month, day, year) for Td must be
recorded, this dose is the Td dose administered within the past ten years.
(E) Measles. Beginning January 1, 1992:
(i) all students defined previously in subparagraph (A) of this paragraph who were born
on or after January 1, 1957, must show proof of either:
(I) two doses of measles vaccine administered since January 1, 1968, and on or after
their first birthday, or in accordance with the most recent General Recommendations on
Immunizations adopted by Centers for Disease Control and Prevention (CDC) issued by
the Advisory Committee on Immunization Practices (ACIP) regarding the validity of
vaccine doses administered less than or equal to four days before the minimum interval
or age and at least 28 days apart; or
(II) at least one dose of measles vaccine administered on or after their first
birthday, or in accordance with the most recent General Recommendations on
Immunizations adopted by Centers for Disease Control and Prevention (CDC) issued by
the Advisory Committee on Immunization Practices (ACIP) regarding the validity of
vaccine doses administered less than or equal to four days before the minimum interval
or age, which must be received by students enrolled in health-related courses prior to
direct patient contact and completion of the measles requirement must be accomplished
as rapidly as is medically feasible; or
(III) serologic confirmation of measles immunity or serologic evidence of infection;
and
(ii) for further information see §97.65 of this title and also §97.67 of this title.
(F) Rubella. Beginning January 1, 1992:
(i) all students defined previously in subparagraph (A) of this paragraph must show,
prior to patient contact, proof of either:
(I) one dose of rubella vaccine administered on or after their first birthday, or in
accordance with the most recent General Recommendations on Immunizations adopted by
Centers for Disease Control and Prevention (CDC) issued by the Advisory Committee on
Immunization Practices (ACIP) ) regarding the validity of vaccine doses administered
less than or equal to four days before the minimum interval or age; or
(II) serologic confirmation of rubella immunity, or serologic evidence of infection;
and
(ii) for further information see §97.65 of this title and also §97.67 of this title.
(G) Mumps, Beginning January 1, 1992:
(i) all students defined previously in subparagraph (A) of this paragraph who were born
on or after January 1, 1957, must show, prior to patient contact, proof of either:
(I) one dose of mumps vaccine administered on or after their first birthday, or in
accordance with the most recent General Recommendations on Immunizations adopted by
Centers for Disease Control and Prevention (CDC) issued by the Advisory Committee on
Immunization Practices (ACIP) ) regarding the validity of vaccine doses administered
less than or equal to four days before the minimum interval or age; or
(II) serologic confirmation of mumps immunity or serologic evidence of infection; and
(ii) for further information see §97.65 of this title and also §97.67 of this title.
(H) Hepatitis B. Beginning January 1, 1992, all students defined previously in
subparagraph (A) of this paragraph shall receive a complete series of hepatitis B vaccine
prior to the start of direct patient care or show serologic confirmation of immunity to
hepatitis B virus. For further information see §97.67 of this title.
(I) Rabies. Beginning January 1, 1992:
(i) all students enrolled in schools of veterinary medicine shall receive a complete
primary series of rabies vaccine prior to the start of contact with animals or their
remains; and
(ii) a booster dose of rabies vaccine is to be obtained by the student every two years
unless protective serum antibody levels are documented.
(J) Varicella. Beginning August 1, 1999, varicella vaccine is required of all students
defined previously in subparagraph (A) of this paragraph. One dose of vaccine is required
for students who received this vaccine prior to 13 years of age; two doses are required
for students who were not vaccinated before their thirteenth birthday. All doses of this
vaccine must have been received on or after the first birthday, or in accordance with the
most recent General Recommendations on Immunizations adopted by Centers for Disease
Control and Prevention (CDC) issued by the Advisory Committee on Immunization Practices
(ACIP) regarding the validity of vaccine doses administered less than or equal to four
days before the minimum interval or age. A history of varicella illness (chickenpox)
validated by the student, the student's parent or the student's physician or serologic
confirmation of varicella immunity is acceptable in lieu of vaccine. For further
information, see §97.67 of this title.
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