No. 29547 (Amendment): R396-100. Immunization Rule for Students

DAR File No.: 29547
Filed: 02/26/2007, 10:07
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule change is necessary to align current immunization requirements with national recommendations for the Tetanus/Diphtheria/acellular Pertussis (Tdap) requirement for 7th grade entry and for two doses of Measles/Mumps/Rubella (MMR) vaccine for school entry. Current national recommendations by the national Advisory Committee on Immunization Practices (ACIP) recommend Tdap vaccine for adolescents and two doses of MMR for children and adolescents. Current Utah requirements include only Tetanus/Diphtheria for 7th grade entry and two doses of measles for kindergarten through grade twelve. This rule change would clarify requirements and meet national recommendations for these two vaccinations. The rule change would allow either Tdap or Td to satisfy the requirement and allow previous receipt of two doses of measles to be accepted.

Summary of the rule or change:

The changes require Tdap or Td vaccine for 7th grade entry instead of only Td and require two doses of MMR vaccine for entry into kindergarten through grade twelve instead of 1 MMR and 1 dose of measles. The amendments also update the incorporated materials to current national standards.

State statutory or constitutional authorization for this rule:

Sections 53A-11-303 and 53A-11-306

This rule or change incorporates by reference the following material:

General Recommendations on Immunization: December 1, 2006/Vol.55/No. RR-15; Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines: March 24, 2006/ Vol. 55/No. RR-3; A Comprehensive Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States: December 23, 2005/Vol. 54/No. RR-6; Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP) for the Control and Elimination of Mumps: June 9, 2006/Vol. 55/No. 22; and Prevention of Hepatitis A Through Active or Passive Immunization: May 29, 2006/Vol. 55/No. RR-7

Anticipated cost or savings to:

the state budget:

Tetanus/Diphtheria (Td) or Tetanus/Diphtheria/Acellular Pertussis (Tdap) -Tetanus/Diphtheria booster is already required for 7th grade entry. Td or Tdap would be acceptable, so it is difficult to estimate the amount of students who would receive Tdap instead of Td. Measles, Mumps, Rubella (MMR) - Two doses of measles have been required kindergarten through grade twelve since 1999. Most children already receive two doses of MMR vaccine as single antigen because measles vaccine is not routinely administered without the mumps and rubella antigens. As such, the impact to state budget would be negligible.

local governments:

Publicly funded vaccines are currently provided to local health departments at no cost to the local health departments through the federal Vaccines For Children program to cover children on Medicaid, CHIP, without insurance, who are American Indian/Alaskan Native and those who are underinsured. Local health departments choosing to serve children with private health insurance with vaccines as a covered service would have to purchase vaccine and be reimbursed by contracts with insurance providers. As a public entity, they may purchase at a lower Center for Disease Control contract price.

other persons:

Approximately 52% of children receive immunizations outside of public clinics. Their immunizations are paid for by insurance plans, Medicaid, and CHIP. All children who are not covered by insurance for these vaccines qualify to receive them at no charge under the federal Vaccines For Children program. Td and MMR have been a standard immunization for many years and have been covered by insurance providers in the state. Tdap has been the ACIP/national standard for almost two years and is covered by insurance. The Department of Health knows of no insurance plan that does not cover required childhood immunizations, so this change will not be imposing an additional cost to them.

Compliance costs for affected persons:

Except for the change from the Td vaccine to the Tdap vaccine, the updates to the incorporated materials do not impose additional costs. Inasmuch as children's vaccinations are covered by either insurance or are available under the Vaccine For Children program, there is no cost to any individuals. Insurance payors that cover vaccinations are already following the ACIP guidelines that prescribe Tdap instead of Td, so this rulemaking will impose no additional burden.

Comments by the department head on the fiscal impact the rule may have on businesses:

Protecting Utah children from preventable diseases through this immunization requirement update is consistent with national standards. The small fiscal impact is justified. David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Community and Family Health Services, Immunization
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

Direct questions regarding this rule to:

Linda Abel at the above address, by phone at 801-538-9450, by FAX at 801-538-9440, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

04/16/2007

This rule may become effective on:

04/23/2007

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

R396. Health, Community and Family Health Services, Immunization.

R396-100. Immunization Rule for Students.

R396-100-3. Required Immunizations.

(1) A student born before July 1, 1993 must meet the minimum immunization requirements of the ACIP prior to school entry for the following antigens: Diphtheria, Tetanus, Pertussis, Polio, Measles, Mumps, and Rubella.

(2) A student born after July 1, 1993 must meet the minimum immunization requirements of the ACIP prior to school entry for the following antigens: Diphtheria, Tetanus, Pertussis, Polio, Measles, Mumps, Rubella, and Hepatitis B.

(3) [Commencing July 1, 2006, a ]A student born after July 1, 1993, must also meet the minimum immunization requirements of the ACIP prior to entry into the seventh grade for the following antigens: [Adult ]Tetanus, [/]Diphtheria, Pertussis and Varicella.

(4) A student born after July 1, 1996 must meet the minimum immunization requirements of the ACIP prior to school entry for the following antigens: Diphtheria, Tetanus, Pertussis, Polio, Measles, Mumps, Rubella, Hepatitis B, Hepatitis A, and Varicella.

(5) To attend a Utah early childhood program, a student must meet the minimum immunization requirements of the ACIP for the following antigens: Diphtheria, Tetanus, Pertussis, Polio, Measles, Mumps, Rubella, and Haemophilus Influenza Type b prior to school entry.

(6) The vaccinations must be administered according to the recommendations of the United States Public Health Service's Advisory Committee on Immunization Practices (ACIP) as listed below which are incorporated by reference into this rule:

(a) General Recommendations on Immunization: [February 8, 2002/Vol.51/No. RR-2]December 1, 2006/Vol. 55/No. RR-15;

(b) Immunization of Adolescents: November 22, 1996/Vol. 45/No. RR-13;

(c) Combination Vaccines for Childhood Immunization: May 14, 1999/Vol. 48/No.RR-5;

(d) Diphtheria, Tetanus, and Pertussis: Recommendations for Vaccine Use and Other Preventive Measures: August 8, 1991/Vol. 40/No. RR-10;

(e) Pertussis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Children: March 28, 1997/Vol. 46/No. RR-7;

(f) Use of Diphtheria Toxoid-Tetanus Toxoid-Acellular Pertussis Vaccine as a Five-Dose Series: Supplemental Recommendations of the Advisory Committee on Immunization Practices: November 17, 2000/Vol. 49/No. RR-13;

(g) [Protection Against Viral Hepatitis: February 9, 1990/Vol. 39/No. RR-2;]Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines: March 24, 2006/Vol. 55/No. RR-3;

(h) [Hepatitis B: ]A Comprehensive Strategy [for ]to Eliminate[Eliminating] Transmission of Hepatitis B Virus Infection in the United States [Through Universal Childhood Vaccination: November 22, 1991/Vol. 40/No. RR-13]December 23, 2005/Vol. 54/No. RR-6;

(i) Haemophilus b Conjugate Vaccines for Prevention of Haemophilus influenzae Type b Disease Among Infants and Children Two Months of Age and Older: January 11, 1991/Vol. 40/No. RR-1;

(j) Recommendations for Use of Haemophilus b Conjugate Vaccines and a Combined Diphtheria, Tetanus, and Pertussis, and Haemophilus b Vaccine: September 17, 1993/Vol. 42/No. RR-13;

(k) Measles, Mumps, and Rubella-Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps: May 22, 1998/Vol. 47/No. RR-8;

(l) Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP for the Control and Elimination of Mumps: June 9, 2006/Vol. 55/No. 22;

(m) Poliomyelitis Prevention in the United States: May 19, 2000/Vol. 49/No. RR-5;

[(m)](n) Prevention of Varicella: July 12, 1996/Vol. 45/No. RR-11;

[(n)](o) Prevention of Varicella: Updated Recommendations of the Advisory Committee on Immunization Practices: May 28, 1999/Vol. 48/No. RR-6; and

[(o)](p) Prevention of Hepatitis A Through Active or Passive Immunization: [October 1, 1999/Vol. 48/No. RR-12]May 29, 2006/Vol. 55/No. RR-7.

 

R396-100-6. Reporting Requirements.

(1) Each school and early childhood program shall report the following to the Department in the form or format prescribed by the Department:

(a) by November 30 of each year, a statistical report of the immunization status of students enrolled in a licensed day care center, Head Start program, and kindergartens;

(b) by November 30 of each year, a statistical report of the two-dose measles, mumps, and rubella immunization status of all kindergarten through twelfth grade students;

(c) by November 30 of each year, a statistical report of tetanus, diphtheria,[ tetanus,] pertussis, hepatitis B, varicella, and the two-dose measles, mumps, and rubella immunization status of all seventh grade students; and

(d) by June 15 of each year, a statistical follow-up report of those students not appropriately immunized from the November 30 report in all public schools, kindergarten through twelfth grade.

(2) The information that the Department requires in the reports shall be in accordance with the Centers for Disease Control and Prevention guidelines.

 

KEY: immunization, rules and procedures

Date of Enactment or Last Substantive Amendment: [July 21, 2005]2007

Notice of Continuation: April 24, 2003

Authorizing, and Implemented or Interpreted Law: 53A-11-303; 53A-11-306