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Communicable and Environmental Disease Services

Required Immunizations

The Tennessee Department of Health has new rules for immunization requirements for those who attend child care, pre-school, school and college, which 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. The new Official Immunization Certificate will be available in local health departments.

Detailed guidance for healthcare providers on the new rules and certificate is available at the Tennessee Web Immunization System (TWIS) website. Tennessee healthcare providers who give vaccine can register as authorized users and download the form through TWIS beginning April 1, 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).

Information for parents

Information for Healthcare Providers

Information about Higher Education (College) Immunization Requirements

A brief summary of the required immunizations for child care facilities, schools and colleges is listed below. The new requirements are in bold print and the effective dates are italicized in parentheses.

Children enrolling in child care facilities, pre-school, pre-Kindergarten
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 no later than 18 months of age.

  • Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
  • Poliomyelitis (IPV or OPV)
  • Measles, Mumps, Rubella (1 dose of each, normally given together as MMR)
  • Varicella (1 dose or credible 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"): evidence of one Tdap dose given any time before 7th grade entry is required regardless of Td history (2013 update)
  • Verification of immunity to varicella – 2 doses or credible history of disease (July 1, 2010)

Children who are new enrollees in a TN school in grades other than Kindergarten

  • Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
  • Measles, Mumps, Rubella (2 doses of each, normally given together as MMR)
  • Poliomyelitis (IPV or OPV) – final dose on or after the 4th birthday now required
  • Varicella (2 doses or credible history of disease) – previously only one dose was required
  • Hepatitis B (HBV) – previously only for Kindergarten, 7th grade entry
  • New students entering grades other than 7th grade are not required to have Tdap

Children with medical or religious exemption to requirements

  • Medical – Physician (MD, DO) or departmentPublic Health Nurse authorized to indicate specific vaccines medically exempted (because of risk of harm) on the new form. Other vaccines remain required. The medical reason for the exemption does not need to be provided.
  • Religious – This exemption requires a signed statement by the parent/guardian that vaccination conflicts with their religious tenets or practices. If the child needs documentation of a health examination for 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 to explain why immunization information is absent or incomplete.

Full-time Tennessee college students

  • Measles, Mumps, Rubella (2 doses of each, normally given together as MMR): if born on or after January 1, 1957 only.
  • Varicella (2 doses or credible 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 – 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 credible 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.