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Communicable and Environmental Disease Services

Required Immunizations

The Tennessee Department of Health has new rules for immunization requirements in child care, pre-school, school and college that became official on December 9, 2009. The changes are listed in the Tennessee Department of Health rules.

Most of the new requirements will take effect on July 1, 2010. A new Official Immunization Certificate will be available in local health departments. The certificates will be provided to Tennessee healthcare providers by the state Immunization Program upon request and will be available to authorized users for downloading through the Tennessee Web Immunization System (TWIS) by April 5, 2010.

This site will be updated with additional information, including guidance for the use of the new certificate, prior to April 5, 2010. The state’s immunization schedule follows the current schedule published by the Centers for Disease Control and Prevention (CDC) and endorsed by the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP).

A brief summary of the required immunizations for child care facilities, schools and colleges are listed below.

Children in Child Care Facilities (new requirements italicized):

  • Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
  • Hepatitis B (HBV), effective July 1, 2010
  • Poliomyelitis (IPV or OPV): final dose on or after the 4th birthday now required
  • Haemophilus influenzae type B (Hib): age younger than 5 years only, effective immediately, resumes requirement suspended in 2008 because of a national vaccine shortage that has ended
  • Pneumococcal conjugate vaccine (PCV): age younger than 5 years only, effective July 1, 2010
  • Measles (1 dose)
  • Mumps (1 dose)
  • Rubella (1 dose)
  • Varicella (1 dose)
  • Hepatitis A (1 dose by 18 months of age), effective July 1, 2010

Children entering Kindergarten (new requirements underlined):

  • Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
  • Hepatitis B (HBV)
  • Poliomyelitis (IPV or OPV): final dose on or after the 4th birthday now required
  • Measles (2 doses)
  • Mumps (2 doses)
  • Rubella (2 doses)
  • Varicella (2 doses or history of disease): previously only one dose was required
  • Hepatitis A (2 doses): effective July 2011

Children entering 7th grade (new requirements underlined):

  • Tetanus-diphtheria-pertussis booster (“Tdap”), effective October 1, 2010
  • Verification of immunity to varicella (2 doses of vaccine or history of disease), effective July 1, 2010

Children who are new enrollees in a TN school in grades other than K or 7th:

  • Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
  • Hepatitis B (HBV)
  • Poliomyelitis (IPV or OPV): final dose on or after the 4th birthday now required
  • Measles (2 doses)
  • Mumps (2 doses)
  • Rubella (2 doses)
  • Varicella (2 doses or history of disease), effective July 1, 2010

Persons entering a Tennessee college as a full-time student (no changes until 2011):

  • Measles (2 doses)
  • Mumps (2 doses)
  • Rubella (2 doses)
  • 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

The schedule of vaccines listed below remains in effect until July 1, 2010:

Required immunizations are defined as those specified by law. However, most health departments and physicians would recommend more than the required doses.

Child Care Attendance
Children attending child care must be immunized age-appropriately. Vaccinations given earlier than the routine ages are valid for state immunization requirements if they meet the acceptable minimum age and dose intervals published by the Centers for Disease Control and Prevention (CDC) as the Catch-Up Schedule. Click here to link to current CDC immunization schedules. The schedule below shows the required doses for immunization at the ages shown:

Age of Child Number of Doses
2-3 months 1 DTP/DtaP/DT, 1 Polio, 1 Hib
4-5 months 2 DTP/DtaP/DT, 2 Polio, 2 Hib
6-11 months 3 DTP/DtaP/DT, 2 Polio, 3 Hib
12-15 months 4 Hib*, and 1 MMR given on or after the first birthday
12-18 months 4 DTP/DtaP/DT, 3 Polio, and 1 Varicella
4-6 years 4 or more DTP/DtaP/DT, 4 Polio, 4 Hib*, 1 Varicella, and 2 MMR given on or after the first birthday

*If child starts Hib at 15 months through 4 years of age, give just one dose of Hib vaccine.

School Attendance (K-12)
DTP/DtaP/DT
4 or more doses, one of which must be given on or after the fourth birthday. If starting series at age seven or older, only three doses are required.

Polio (OPV/IPV)
4 doses of OPV or IPV. If the 3rd dose was given on or after the fourth birthday, the 4th dose is not required. However, if a combination of IPV/OPV (2IPV/2OPV) is used, all 4 doses are needed regardless of age.

MMR
2 doses, given on or after the first birthday required, for entrance into grades K, 4, 8 and 12. The second dose should be administered at least 30 days following the first dose. Beginning with the start of the 2001 school year, all students K-12 must have two doses of MMR.

Hepatitis B
3 doses of Hepatitis B vaccine are required for entry into Kindergarten and 2 or 3 doses (depending on the type of vaccine given) for entry into 7th grade.

Varicella
1 dose given on or after the first birthday for entrance into kindergarten; a parent or physician diagnosed history of disease is acceptable in lieu of vaccine for purposes of the requirement.

College
Two doses are MMR are required for full-time students attending college in Tennessee if they were born after 1957. Parents and students should also consider the need for the meningococcal vaccine, particularly if the student will be living in a dormitory.