Immunization Guidelines for Schools
The University of the State of New York
The State Education Department
Office of Student Support Services
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THE UNIVERSITY OF THE STATE OF NEW YORK
Regents of The University
LESTER W. YOUNG, JR., Chancellor, B.S., M.S., Ed.D. ...................................... Beechhurst
J
OSEPHINE VICTORIA FINN, Vice Chancellor B.A., J.D. ..................................... Monticello
R
OGER TILLES, B.A., J.D. .................................................................................... Manhasset
CHRISTINE D. CEA, B.A., M.A., Ph.D. ............................................................... Staten Island
W
ADE S. NORWOOD, B.A. .................................................................................. Rochester
K
ATHLEEN M. CASHIN, B.S., M.S., Ed.D. ........................................................ Brooklyn
JAMES E. COTTRELL, B.S., M.D. ......................................................................... New York
J
UDITH CHIN, B.S., M.S. in Ed. .......................................................................... Little Neck
C
ATHERINE COLLINS, R.N., N.P., B.S., M.S. in Ed., Ed.D. .............................. Buffalo
ELIZABETH S. HAKANSON, A.S., B.A., M.A., C.A.S. ........................................ Syracuse
L
UIS O. REYES, B.A., M.A., Ph.D. ...................................................................... New York
S
USAN W. MITTLER, B.S., M.S. .......................................................................... Ithaca
FRANCES G. WILLS, B.A., M.A., M.Ed., C.A.S., Ph.D. ..................................... Ossining
A
RAMINA VEGA FERRER, B.A., M.S. in Ed., Ph.D. .......................................... Bronx
S
HINO TANIKAWA, B.A., M.S. ........................................................................... Manhattan
ROGER P. CATANIA, B.A., M.A., M.S., C.A.S., Ph.D. ...................................... Saranac Lake
ADRIAN I. HALE, A.S., B.A. ............................................................................... Rochester
Commissioner of Education and President of The University
B
ETTY A. ROSA, B.A., M.S. in Ed., M.S. in Ed., M.Ed., Ed.D.
Deputy Commissioner of P12 Instructional Support
A
NGELIQUE JOHNSON-DINGLE
The State Education Department does not discriminate on the basis of race, creed, color, national
origin, religion, age, sex, military, marital status, familial status, domestic violence victim status,
carrier status, disability, genetic predisposition, sexual orientation and criminal record in its
recruitment, educational programs, services, and activities. NYSED has adopted a web
accessibility policy, and publications designed for distribution can be made available in an
accessible format upon request. Inquiries regarding this policy of nondiscrimination should be
directed to the Office of Human Resources Management, Room 528 EB, Education Building,
Albany, New York 12234.
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FOREWORD
This document provides all schools (public, charter, BOCES, and nonpublic) in New York
State with a framework for developing policy and procedures that meet the immunization
requirements for school entrance/attendance as defined in State law and regulation. The
document explains the purpose of immunization policy, procedures in schools and
provides guidelines for developing an effective program including planning,
implementation, and follow-up. This document is intended for use by administrators and
school health personnel. Schools should review these guidelines with their counsel as
necessary to incorporate the guidance into school policy.
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TABLE OF CONTENTS
DEFINITION OF TERMS ............................................................................................................ 1
INTRODUCTION ........................................................................................................................ 4
Statutory Background ......................................................................................................... 4
SCHOOL IMMUNIZATION POLICY ............................................................................................ 4
SCHOOL AND COMMUNITY EDUCATION ................................................................................ 6
Influenza Education ............................................................................................................ 6
IMMUNIZATION REQUIREMENTS FOR SCHOOL ATTENDANCE ........................................... 6
Acceptable Certificates of Immunization and Proof of Immunity ........................................... 7
In Process Students ............................................................................................................ 7
Special Circumstances ....................................................................................................... 8
Homeless Students .............................................................................................................. 8
Students in Foster Care ....................................................................................................... 8
Non- graded Classrooms ..................................................................................................... 9
Refugee Students ................................................................................................................ 9
Homeschooled Students ...................................................................................................... 9
Medical Exemptions ............................................................................................................ 9
Students Not Meeting Immunization Requirements ...........................................................10
DOCUMENTATION/RECORDKEEPING .................................................................................. 12
Susceptible Students .........................................................................................................12
Confidentiality ....................................................................................................................12
Graduating Seniors ............................................................................................................12
Immunization Surveys........................................................................................................13
DISEASE SURVEILLANCE ...................................................................................................... 13
REFERENCES ......................................................................................................................... 14
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DEFINITION OF TERMS
Acceptable Proof (a.k.a., proof of compliance) - Documents indicating the required receipt of
all vaccines [10 NYCRR §66-1.6]:
• An original signed certificate of immunization signed by a health practitioner licensed to
practice in New York State that shows the products administered along with the dates of
administration;
• A New York State Immunization Information System (NYSIIS); or New York Citywide
Immunization Registry (CIR) immunization record;
• Positive Serologic tests for proof of immunity for specific diseases;
• Physician, nurse practitioner, or physician assistant verified history of varicella disease
• Laboratory confirmation of disease for measles, mumps, rubella, and varicella;
• An official immunization registry from another state;
• An electronic health record;
• An official record from a foreign nation; and/or
• Immunization records forwarded from a previous school – which contain all of the
information specified in a certificate of immunization may be accepted by the principal or
person in charge of the school in lieu of a certificate of immunization. [10 NYCRR §66-1.5]
Age appropriate - means that vaccine doses administered within four calendar days of the
recommended minimum age or interval will be considered valid. [10 NYCRR §66-1.1(i)]
Attend or Admit - means enrolled in, or admitted to, a school for the purpose of participating in
or receiving services at such school, including, but not limited to, special education or related
services, participating in intra-scholastic or interscholastic sports, or other school-sponsored
events or activities; or being transported on a school bus or vehicle with other school children;
except where such services, transportation, events, or activities are open to the general public.
[10 NYCRR §66-1.1(m)]
Certificate of Immunization - A document prepared and signed by the health practitioner
licensed in New York who administers the immunizations to the student, specifying the product(s)
administered and the dates of administration. It may also show physician, nurse practitioner, or
physician assistant-verified history of varicella disease and/or positive serologic tests for measles,
mumps, rubella, varicella, and/or Hepatitis B and/or laboratory confirmation of disease for
measles, mumps, rubella and/or varicella. [10 NYCRR §66-1.6]
Child (a.k.a., student) - means any person between the ages of two (2) months and 18 years.
[10 NYCRR §66-1.1(b)]
Cumulative Health Record (CHR) - A health record maintained by a PreK-12 school which is
considered part of the educational record.
Diagnosed Disease - Verification of history of varicella diagnosed by a physician, nurse
practitioner, or physician assistant. [10 NYCRR §66-1.1(g)(2)]
Entering school, new entrant, and transferring student - Any student who is under age 18
entering or being admitted to a district or school for the first time, irrespective of the age of the
student or the grade level entered.
Exclusion - The process whereby students are not permitted to attend school due to not meeting
the immunization requirements as determined by school principal, teacher, owner, or person in
charge of the school. This includes the exclusion of susceptible students in the event of a vaccine
preventable disease outbreak as ordered by the Commissioner of Health or their designee. The
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list must be updated each time a new student enrolls in the school or a student's immunization
status changes. [10 NYCRR §66-1.10]
Fully Immunized (a.k.a., Up to Date) - means that an adequate dosage and number of doses of
an immunizing agent licensed by the United States Food and Drug Administration (FDA) has been
received commensurate with the child's age, and at appropriate intervals, or the child has been
demonstrated to have immunity. [10 NYCRR §66-1.1(f)]
Health Practitioner - Person authorized by law to administer an immunization to a child under
18. This includes a physician (MD and DO), nurse practitioner (NP), physician assistant (PA),
nurse-midwife caring for a pregnant student, registered professional nurse (RN), and licensed
practical nurse (LPN) under the direction of an RN. [10 NYCRR §66-1.1(e)]
Immunity - Pursuant to 10 NYCRR §66-1.1(g), Immunity means:
(1) for measles, mumps, and rubella, a child has had a positive serologic test, as defined
in subdivision (h) of this section, for those diseases, or laboratory confirmation of disease, as
defined in subdivision (k) of this section;
(2) for varicella, a child has either a positive serologic test, as defined in subdivision (h)
of this section; laboratory confirmation of disease, as defined in subdivision (k) of this section; or
had the disease as verified by a physician, nurse practitioner, or physician's assistant
statement;
(3) for hepatitis B, a child has had a positive serologic test, as defined in subdivision (h) of
this section; or
(4) for poliomyelitis, positive serologic tests, as defined in subdivision (h) of this section,
for all three serotypes of poliomyelitis, performed prior to September 1, 2019. Positive Serologic
tests of poliomyelitis performed on or after September 1, 2019, will not be accepted in place of
poliomyelitis vaccination.
Immunization Registry - The New York State Immunization Information System (NYSIIS), a
statewide computerized database of immunizations developed and maintained by NYSDOH. In
New York City, it is the Citywide Immunization Registry (CIR) - administered by the NYC
Department of Health and Mental Hygiene. [10 NYCRR §66-1.2]
Immunization Survey Process - The annual collection and compilation by schools of
immunization data for all students entering and/or attending their schools and reporting it to
NYSDOH or the New York City Commissioner of Health. [10 NYCRR §66-1.7]
In Process - Pursuant to 10 NYCRR §66-1.1(j), in process means that:
(1) a child has received at least the first dose in each immunization series required by §2164 of
the Public Health Law (except in the case of live vaccines in which a child should wait 28 days
after one live vaccine administration before receiving another live vaccine, if the vaccines were
not given on the same day) and has age appropriate interval appointments to complete the
immunization series according to the Advisory Committee on Immunization Practices (ACIP)
Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger; or
(2) a child has had blood drawn for a serologic test and is awaiting test results within 14
days after the blood draw; or
(3) a child's serologic test(s) are negative, and therefore the child in question has
appointments to be immunized within 30 days of notification of the parent/guardian to complete,
or begin completion, of the immunization series based on the ACIP Recommended Child and
Adolescent Immunization Schedule for ages 18 years or younger.
(4) Children who are not fully immunized can only continue to attend school if they are in the
process of completing the immunization series based on the ACIP Recommended Child and
Adolescent Immunization Schedule for ages 18 years or younger. If a child does not receive
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subsequent doses of vaccine in an immunization series according to the age appropriate ACIP
catch-up schedule, including at appropriate intervals, the child is no longer in process and must
be excluded from school within 14 days after the minimum interval identified by the ACIP catch-
up schedule, if not otherwise exempt in accordance with §66-1.3 of this Subpart.
May be detrimental - A physician has determined that a child has a medical contraindication or
precaution to a specific immunization consistent with ACIP guidance or other nationally
recognized evidence-based standard of care. [10 NYCRR §66-1.1(l)]
Medical exemption - A signed, completed medical exemption form approved by the NYSDOH
or NYC Department of Education from a physician licensed to practice medicine in NYS certifying
that immunization may be detrimental to the child's health, containing sufficient information to
identify a medical contraindication to a specific immunization and specifying the length of time the
immunization is medically contraindicated. The medical exemption must be reissued annually.
The principal or person in charge of the school may require additional information supporting the
exemption. [10 NYCRR §66-1.3(c)]. If a physician licensed to practice medicine in NYS certifies
that an immunization is detrimental to a child's health, the requirement for that immunization is
waived until such immunization is no longer detrimental to the child's health.
Partially immunized - Any student who has received some, but not all, the currently required
doses of a series, and does not have serological evidence of immunity, or history of healthcare
provider diagnosed varicella.
School - Includes public, private, or nonpublic child caring center, daycare agency providing day
care of children defined in this section, nursery school as defined in this section, kindergarten and
any elementary, intermediate, or secondary class or school building. [10 NYCRR §66-1.1(a)]
Serologic test for immunity- means a blood test for Immunoglobulin G (IgG), or for hepatitis B,
a blood test for hepatitis B surface antibody, as determined by the testing lab's criteria. Serology
results reported as equivocal are not acceptable proof of immunity. A positive serologic test can
be accepted in place of vaccination only for the following diseases: measles, mumps, rubella,
varicella, and hepatitis B, and for poliomyelitis, positive serologic tests, as defined in subdivision
(h) of this section, for all three serotypes of poliomyelitis, performed prior to September 1, 2019.
Serologic tests for poliomyelitis performed on or after September 1, 2019, will not be accepted in
place of poliomyelitis vaccination. [10 NYCRR §66-1.1(h)]
Student - See definition of “Child.”
Susceptible student - A student who is either not immunized or is partially immunized. This
includes students who have medical exemptions and students who are “in process.”
Vaccine - A specially prepared antigen which, upon administration to a person, will result in
immunity.
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INTRODUCTION
In the early 1900s, communicable disease control was the primary reason for the establishment
of school health services. There has been a decline in communicable diseases over the past 50
years due to the widespread use of immunizations (also known as vaccines) against many
diseases. However, this success has also brought both complacency and fear regarding vaccines.
Where students do not have all the required immunizations, New York State is seeing the spread
of vaccine preventable diseases. In 2013 and again in 2019, the state experienced Measles
outbreaks and in July 2022, a case of paralytic poliomyelitis (polio) was reported in Rockland
County, New York. Vaccine-preventable diseases (e.g., diphtheria, pertussis, tetanus,
poliomyelitis, measles, mumps, rubella, Haemophilus influenzae type b, hepatitis B, varicella,
pneumococcal and meningococcal disease and others) still occur among students who are either
under-immunized or lack all immunizations. Schools assist in public health efforts to combat
communicable diseases by ensuring students meet immunization requirements as defined and
required in Public Health Law.
Statutory Background
Public Health Law §2164.docx (ny.gov) and the New York State Department of Health (NYSDOH)
Commissioner’s regulations §66-1 Title: Subpart 66-1 - School Immunization Requirements | New
York Codes, Rules and Regulations (ny.gov) define immunization program requirements for
certain types of daycare settings, nursery schools, and all NYS PreK-12 schools.
Education Law §914 – mandates:
1. Each school must require of every child entering or attending such school, proof of
immunization in accordance with Public Health Law §2164.
2. Each school district must assist and cooperate with the local department of health in the
development of a plan required by Public Health Law §613
Laws of New York
(state.ny.us). This includes a program of immunization, surveillance, and testing, to raise
to the highest reasonable level the immunity of the children of the state; to administer a
program of influenza education to the families of children ages six months to eighteen
years of age who attend pre-kindergarten, kindergarten, and public schools or nonpublic
schools. Such program shall include educational materials on influenza and the benefits
of influenza immunizations. Schools will be notified by the NYSDOH of the availability of
such materials and such information must be posted by all schools in plain view.
Each school district must participate in the surveys directed by the state Commissioner of Health
pursuant to §613 of the Public Health Law of the immunization level of the children entering and
attending school within such district, and which shall be subject to audit by the state Commissioner
of Health. Each school and school district shall provide the state Commissioner of Health with any
records and reports required for the purpose of such audit. In no event shall the state
Commissioner of Health disclose a student's identity.
SCHOOL IMMUNIZATION POLICY
Each district’s board of education or the school’s governing body, and administration is
responsible for their school immunization program, and that it meets applicable state laws and
regulations. The goal of a school immunization program is for all students to meet the
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immunization requirements for school attendance unless they have an accepted medical
exemption.
Development of school policy should be a collaboration between the board of education or
governing body, school administrators, school health services personnel and school legal
counsel. The policy should include, but is not limited to:
• Identification of key staff members’ roles and responsibilities;
• Identification of professional development needs of staff; and
• Development of written immunization policy and procedures to guide staff and families,
consistent with State and federal laws. Procedures should include sufficient detail to
ensure consistency within all schools in the district. Such procedures should include:
o Obtaining and reviewing immunization records of all entrants and completing and
submitting the annual immunization survey to NYSDOH. For all schools,
excluding public schools within New York City, the summary will be provided in
the form of the yearly school survey conducted by NYSDOH. [10 NYCRR §66-
1.7]
o Identification and maintenance of a list of susceptible students and a plan to notify
parents/guardians of susceptible students during an outbreak of vaccine
preventable disease. [10 NYCRR §66-1.10(c)]
o Procedures for reviewing request for medical exemption to immunizations.
o Identification of students who lack required immunizations and do not qualify as
in process.
o Notification to parents/guardians of students not meeting immunization
requirements along with exclusion procedures.
o Refer parents/guardians of students lacking required immunizations and excluded
from school to their healthcare provider or the local health department to obtain
the required immunization(s). [10 NYCRR §66-1.8(a)].
o Notification to the local health department of the name and address of the
excluded student and the immunizations they lack. [10 NYCRR §66-1.8(b)]
o Provide for a time and place at which the required immunization(s) may be
administered with the help of the local health department. [10 NYCRR §66-1.8(c)]
• Policy and procedures should be evaluated, reviewed, and revised periodically at a rate
necessary to keep them up-to-date.
The following pages provide detailed information to assist schools in developing and
implementing immunization policies.
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SCHOOL AND COMMUNITY EDUCATION
It is important that schools communicate and educate parents/guardians, school personnel, and
local health care providers regarding the immunization requirements for students to attend school.
Attendance at school includes receiving educational services at a school – including, but not
limited to, special education or related services, participating in intra-scholastic or interscholastic
sports, or other school-sponsored events or activities; or being transported on a school bus or
vehicle with other school children. The exception to the immunization requirements for students
is where such services, transportation, events, or activities are open to the general public. [10
NYCRR §66-1.1(m)]
Communication and education can be done via newsletters, emails, websites, and other
accessible means of communication. Whenever possible, communication to parents/guardians
should be in their primary language.
Key school personnel such as building administrators, school health personnel, and school
registrars will need to be trained on state immunization requirements, school policy and
procedures for communicating with parent/guardians, assisting parents/guardians by providing
resources and locating county immunization clinics, how requests for medical exemption to
immunizations will be handled, and procedures for student exclusions.
Influenza Education
Each year, NYSDOH annually produces influenza (flu) education materials to be posted in early
fall in plain view in all schools in the state each year which provide information to families on the
flu and the benefits of the flu vaccine . These education materials are updated annually and are
also available for schools on the NYSDOH website at
Flu (Influenza) Information for Child-Care
Providers and Schools (ny.gov).
IMMUNIZATION REQUIREMENTS FOR SCHOOL ATTENDANCE
A student is considered fully immunized if they have the correct doses for their age and the
minimum interval between doses was in accordance with the Advisory Committee on
Immunization Practices (ACIP) Recommended Child and Adolescent Immunization Schedule for
ages 18 or younger, which are posted on the Centers for Disease Control and Prevention (CDC)
website (Immunization Schedules | CDC). Any child who completed an immunization series
following minimum intervals prescribed in an ACIP Recommended Immunization Schedule pre-
dating February 2019 shall continue to be deemed in compliance as long as the number of vaccine
doses the child received conforms to the current ACIP Recommended Immunization Schedule.
[10 NYCRR §66-1.1(f)]
NYSDOH provides a chart of the New York State Immunization Requirements for School
Entrance/Attendance (ny.gov) for students in all PreK-12 schools which is available in multiple
languages.
The immunization certificates and/or other proof of immunity of all new entrants must be reviewed,
including students transferring into the district. NYSDOH encourages schools to obtain original
documents whenever possible. Original documents should be copied, the copy should be
returned to the parent/guardian, and the original should be retained in the student’s cumulative
health record (CHR). If the student transfers to a new school, the original documentation should
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be forwarded to the new school and the old school should retain copies. Best practice requires
the original document should be at the same location as the student.
Acceptable Certificates of Immunization and Proof of Immunity
NYDOH Commissioner’s regulations §66-1.6 defines what is required in a certificate of
immunization along with which ones require a signature from a health practitioner.
Documents that Require a Health Practitioner’s Signature
:
• A certificate of immunization specifying the vaccines administered and the dates of
administration, signed by a healthcare practitioner licensed to practice in NYS. [10
NYCRR §66-1.6]
• A copy of immunization records (paper or electronic) sent from a previous school to
the new school (not brought in by a parent/guardian), which include who administered
the immunization agents, the products administered (products administered can mean
either the vaccine or its brand name), and dates of administration. The records should
be signed by the school health professional who entered the information into the
student’s Cumulative Health Record (CHR) and include any original documentation
from the administering health practitioner, if available. [10 NYCRR §66-1.5}
• A statement verifying history of varicella diagnosed by a physician, nurse practitioner,
or physician assistant. Original laboratory report of positive serological test
1
for
measles, mumps, rubella, varicella, hepatitis B, and all three serological subtypes of
poliomyelitis
2
[polio virus type 1 (PV1), type 2 (PV2), and type 3 (PV3)] contained in
the polio vaccines performed before September 1, 2019. [10 NYCRR §66-1.1(g)]
Documents that Do Not Require a Health Practitioner’s Signature:
• An electronic health record from a healthcare provider.
• An immunization record issued by NYSIIS or CIR.
• A copy of an electronic immunization record from another state registry.
• An official record from a foreign nation.
In Process Students
Students who do not have all of the required immunizations for their age but qualify as a student
in process must be allowed to attend school [10 NYCRR 66-1.3(b)].
Pursuant to 10 NYCRR §66-1.1(j) a student is in process when:
• The student has received at least the first dose in each immunization series required by
Public Health Law §2164 (except in the case of live vaccines in which a student should
wait 28 days after one live vaccine administration before receiving another live vaccine,
1
Serologic test means a blood test for Immunoglobulin G (IgG), or for hepatitis B, a blood test for hepatitis B surface
antibody, as determined by the testing lab's criteria. Serology results reported as equivocal are not acceptable proof of
immunity[Health Commissioner’s Regulations §66-1.1(h)].
2
Polio serologic tests conducted after 9/1/19 are not accepted. Previous serologic testing conducted before 9/1/19 can
still be accepted if the test documents a separate positive result for each of the three serotypes. Polio antibody tests
which only report a combined antibody titer but do not provide results for each individual serotype will not satisfy the
regulatory requirements. See the memo from the NYSDOH: Use of Serology Testing to Document Polio Immunity
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if the vaccines were not given on the same day) and have age-appropriate appointments
that are met within 14 days of when the subsequent dose is due, confirmed with
healthcare provider written documentation to complete the immunization series,
according to the catch up schedule of the Advisory Committee on Immunization Practices
(ACIP) Catch-up Immunization Schedule | CDC
.
• A student has had blood drawn for a serologic test and is awaiting test results, due
within 14 days after the blood draw; or a student’s serologic test(s) are negative and the
student has appointments to be immunized within 30 days of notification of the
parent/guardian to complete or begin completion of the immunization series.
• Students who are not fully immunized can only continue to attend school if they are in the
process of completing the immunization series. If a student does not receive subsequent
doses of vaccine in an immunization series according to the age appropriate ACIP catch-
up schedule, including at appropriate intervals, the student is no longer in process and
must be excluded from school within 14 days after the minimum interval identified by the
ACIP catch-up schedule.
Parents/guardians must present proof of future appointments such as an appointment card,
receipt, or other statement from the provider’s office that includes the date(s) of next appointment
with a healthcare provider or facility for completion of the next dose(s) of required immunizations in
accordance with the Catch-up Immunization Schedule | CDC
. The school should follow and track
in-process students’ immunization status and confirm follow through on appointments and
scheduling of subsequent appointments as needed.
Schools should inform parents/guardians of students in process of the school’s policy and
procedures for exclusion of students not fully immunized as ordered by the Commissioner of
Health, or their designee, during the outbreak of a vaccine preventable disease for the vaccine(s)
the student does not have. [10 NYCRR §66-1.10(a)]
Special Circumstances
Homeless Students
Homeless students are not required to present proof of immunity or immunization in order to be
admitted to school. Under the federal McKinney-Vento Act, homeless children and youth are
entitled to have equal access to a free, appropriate, public education. Such students are entitled
to enrollment in school even if they lack the documents normally needed, including proof of
immunization. Every school district, BOCES, and charter school is required to have a liaison for
homeless students whose duties include making eligibility determinations on a case-by-case
basis, and helping the student obtain the immunization records or immunizations. More
information is available at McKinney-Vento Homeless Education | New York State Education
Department (nysed.gov) .
Students in Foster Care
Students in foster care are to be enrolled even if they are unable to provide records normally
required for enrollment, including immunization records. The enrolling school is to make a written
request for a copy of such records to the school where the student’s records are located, which
the sending school must forward to the enrolling school within five days of receipt of the request.
[Education Law §3244 (1) and (2)]. More information is available at Foster Care | New York State
Education Department (nysed.gov).
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Non- graded Classrooms
Students who attend non-graded classrooms should be assessed for meeting the immunization
requirements based on their age and the grade for which they are age equivalent. Students with
IEPs can be excluded for lack of immunizations, though the services outlined in their IEP should
be provided.
Refugee Students
Refugees come from diverse regions of the world and bring with them varying histories of
immunizations received in their countries of origin. Refugees, unlike most other immigrant
populations, are not required to have any vaccinations before arrival in the United States. In
addition, many vaccines have limited or no availability in some developing countries or in specific
refugee settings.
To allow time for immunization assessment and possible immunization administration,
vaccination requirements do not apply to refugees at the time of their initial arrival to the U.S. At
the medical screening visit during the federal intake process for new arrivals, a healthcare
provider should review any written vaccination records presented by the refugee, assess reported
vaccinations for adherence to acceptable U.S. recommendations, and subsequently, initiate
necessary immunizations. The fourteen-day period may be extended to not more than thirty days
to work with these students and their custodial guardian(s), on a case-by-case basis, to achieve
complete vaccination. Public Health Law §2164 is meant to ensure children’s health and safety
and is not meant to be used to keep refugee children from attending school. See the following for
more information
Educational Services for Recently Arrived Evacuees, Refugees, Immigrants
Field Memo (nysed.gov).
Homeschooled Students
The provisions of Public Health Law §2164 that require parents to submit proof of immunization
prior to admission of their child(ren) to a school do not apply to students being educated at home.
Parents of children being homeschooled who seek to participate in testing or other school-
sponsored events or activities not open to the general public on the premises of a public or
nonpublic school must produce proof of immunization, without which the child(ren) must be denied
access to the school building.
Medical Exemptions
Public Health Law §2164 only permits exemptions to immunization requirements for medical
reasons. A student may continue to attend school without the required immunizations if they have
a valid medical exemption accepted by the school.
A request for medical exemption to immunization must be completed annually on the
NYSDOH
Medical Exemption Statement, (Request for Medical Exemption_SY22-23 (nyc.gov) for New York
City (NYC) schools) and signed by a physician licensed to practice medicine in NYS certifying
that the immunization “may be detrimental” to the child’s health. “May be detrimental to a child’s
health” means that the physician has determined the child has a medical contraindication or
precaution to a specific immunization consistent with ACIP guidance (
ACIP Contraindications
Guidelines for Immunization | CDC) ,or other nationally recognized evidence- based standard of
care. [10 NYCRR §66-1.1(l)]
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The request for medical exemption form, completed and signed by the physician, must contain
sufficient information to identify a medical contraindication(s) for a specific immunization and
specify the length of time the immunization is medically contraindicated pursuant to 10 NYCRR s
§66-1.3(c). The principal or person in charge of a school may require additional information
supporting the exemption request.
3
Schools are encouraged to consult with their medical director
to review requests for medical exemptions and to determine if additional documentation is
required.
For additional information on medical exemptions, refer to the NYSDOH schools web site
https://www.health.ny.gov/prevention/immunization/schools/
.
When accepting a medical exemption, a letter of the acceptance from the principal or person in
charge of a school should be provided to the parent/guardian. A copy of the letter should be kept
in the student's cumulative health record (CHR). The letter must inform the parents/guardians of
exempted students about the school’s policy and procedures for exclusion of students with
medical exemptions as ordered by the Commissioner of Health, or their designee, during the
outbreak of a vaccine preventable disease for the vaccine(s) the student does not have. [10
NYCRR s §66-1.10(a)]
Schools that deny a request for medical exemption to immunizations must inform the
parent/guardian of their decision in writing with the specific reason(s) for denial and inform the
parent/guardian of their right to an appeal to the Commissioner of Education within 30 days of
receipt of the school’s decision, pursuant to Education Law §310. See
NYSED Appeals to the
Commissioner for more information.
Students Not Meeting Immunization Requirements
Students who do not have acceptable evidence of immunization or immunity and are not
considered in process or who do not have an acceptable medical exemption must not be permitted
to attend school. Schools should be aware of civil penalties that can be imposed on a school by
NYSDOH if the school allows a student to attend school without the required immunizations. See
NYSDOH Letter to Schools Regarding Required Compliance with Public Health Law §2164
.
Parents/guardians of students who do not meet the immunization requirements and cannot be
admitted to school or permitted continued attendance (a.k.a., excluded) should be provided with:
• A verbal explanation and a written copy of the district or school policy.
• Written documentation specifying the immunization(s) their child is missing.
• A written letter informing the parent/guardian of the exclusion date if the missing
immunizations are not received, written in the parent’s/guardian’s primary language.
Whenever a student is refused admittance or continued attendance due to the lack of acceptable
evidence of immunizations, pursuant to 10 NYCRR s §66-1.8, the school must:
• Notify the parent/guardian of their responsibility to have the child immunized and of the
public resources available for doing so;
• Notify the local department of health of the name and address of the excluded student
and of the immunization(s) which the student is missing; and
3
10 NYCRR §66-1.3(c).
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Immunization Guidelines for Schools
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• Provide, with the cooperation of the local department of health, for a time and place at
which the required immunization or immunizations may be administered.
Pursuant to 10 NYCRR s §66-1.9, local departments of health must:
• Cooperate with the school authorities to provide a time and place, within two weeks of the
exclusion, at which the appropriate immunization or immunizations may be administered,
by a health practitioner as defined in §66-1.1(e); or
• Notify the NYSDOH Commissioner that the required immunizations will not be
administered either by local health authority or school, and that the cost of doing so by the
agents of the commissioner may be recovered from the amount of State aid to which the
local health authority would otherwise be entitled.
Local departments of health and schools should consider the following when determining the
place and time for administering missing immunizations:
• Public school Directors of School Health Services (a.k.a., medical director) who oversee
school health services programs should be consulted prior to immunizations being
administered in the school;
• Only RNs can follow a nonpatient specific order to administer immunizations. The RN must
follow the requirements in NYSED Commissioner’s regulations §64.7(a) [
NYS
Nursing:Laws, Rules & Regulations:Part 64 (nysed.gov)], which includes the requirements
that Health practitioners administering immunizations must be currently certified in
cardiopulmonary resuscitation (CPR) and ensure that an anaphylactic agent is available;
• Schools are not mandated to employ a school nurse. The title “school nurse” is for an RN
pursuant to NYSED Commissioner’s regulations § 136.1(c). If a school chooses to employ
an LPN, such LPN must be under the direction of an RN;
• Administering Schools have read-only access to NYSIIS and CIR. It is required that the
ordering provider enters the immunization data into NYSIIS or CIR;
• Schools must obtain written parent/guardian consent prior to the administration of any
immunizations in a school;
• A copy of a student's immunization administration at school will need to be kept in the
student’s CHR.
Schools should develop procedures for documenting all communication with parents/guardians,
including efforts undertaken by school personnel to assist parents/guardians in meeting the
immunization requirements for their child(ren). Schools should have policies in place regarding
notifying Child Protective Services (CPS) if the student is of compulsory school age
4
and has
been excluded more than 14 days, if the parent refuses to allow the local department of health or
another appropriate health practitioner to immunize their child, and no actions steps are reported
by the parent/guardian for pursuing other education options, such as homeschooling.
4
In New York State, § 3205 of the education law requires a child's attendance in full-time day instruction from the age
of six to the end of the school year in which the child turns sixteen, or seventeen for school districts that select this age.
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Immunization Guidelines for Schools
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DOCUMENTATION/RECORDKEEPING
Schools must maintain an immunization record for each student, ideally as part of their cumulative
health record (CHR). The CHR should be readily accessible to school personnel, especially for
health emergencies.
Susceptible Students
Schools must also maintain a complete and current list of susceptible students who are at risk
in the event of an outbreak of a vaccine preventable disease listed in Public Health Law §2164.
The list of susceptible students must include all students who have a current medical exemption
to immunization(s) as well as students who are in process or who are awaiting the results of
serologic testing. The list must be updated each time a new student enrolls in the school or a
student’s immunization status changes. [10 NYCRR s §66-1.10(c)]
Confidentiality
Information contained in education records, including the CHR maintained by a public school, is
governed by the federal Family Educational Rights and Privacy Act (FERPA). Any information
released from education records to an outside entity where parent/guardian consent would
normally be required, such as the local department of health in response to a public health threat,
must be documented in the student’s education record as required by FERPA. Nonpublic schools
may be governed by FERPA and should consult with their school attorney regarding the release
of information. Information on FERPA is available at
US Department of Education Family
Educational Rights and Privacy Act.
Graduating Seniors
The NYS Education Department encourages high schools to forward a copy of students’
immunization certificates at the same time final transcripts are sent to the colleges or universities.
Additionally, high schools are encouraged to provide a copy of immunization certificates to all
graduates to assist them in gaining employment or pursuing higher education at a later date. For
more information, see Memo on Immunization Certificates for High School Graduates
.
The Retention and Disposition Schedule for New York Local Government Records (LGS-
1) indicates the minimum length of time that all New York State local governments including cities,
towns, villages, fire districts, counties, school districts, Boards of Cooperative Educational
Services (BOCES), teacher resource and computer training centers, county vocational education
and extension boards, and miscellaneous local governments, must retain their records before
they may be disposed of legally. See the Health Section of the following for more information
Retention and Disposition Schedule for New York Local Government Records (LGS-01) 2020
(schoolhealthny.com).
Students’ individual immunization records must be kept for a minimum of six years, or three years
after the student is 18 years of age, whichever is longer. These records may be requested beyond
their minimum legal retention period by persons needing proof of certain immunizations for college
admission or other purposes. The State Archives recommends that school districts and BOCES
evaluate the need to retain immunization records longer than the stated minimum retention period
for these purposes.
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Immunization Surveys
Pursuant to Education Law §914, in compliance with PHL §2164 and §613, all schools in the
State must annually submit an immunization survey to the NYS Commissioner of Health utilizing
the Health Commerce System on the NYSDOH website, or for schools located in New York City,
as directed by the New York City Department of Health and Mental Hygiene. The Health
Commerce System is a secure online communications system operated by the NYSDOH. The
NYSDOH conducts annual surveys of school immunization records to determine the immunization
level of students in school. It is mandatory for all schools to complete the immunization survey
online annually and report the immunization status of all students in grades PreK-12.
The NYSDOH also may conduct special audits of school immunization records at any time to
ensure that students are adequately protected against vaccine-preventable diseases. Each
school must provide the NYS Commissioner of Health or their designee with any redacted
immunization records and/or reports required for the purpose of such audit in compliance with
applicable State and federal confidentiality laws. Further information and instructions are available
on the New York State Center for School Health website: Immunization Survey Information
.
DISEASE SURVEILLANCE
In the event of the outbreak of a vaccine-preventable disease listed in Public Health Law §2164,
the NYS Commissioner of Health or their designee (such as the local department of health), may
order schools to exclude from attendance all susceptible students (described in more detail
under the Documentation/Record Keeping section.) Susceptible students who are fully
immunized against the disease that is posing the immediate threat and are considered susceptible
because they are not fully immunized against another disease, do not need to be excluded. The
exclusion will continue until the Commissioner of Health, or their designee determines it is
permissible for such susceptible students to return to school. [DOH Commissioner’s regulations
§66-1.10]
During any communicable disease outbreak, it is recommended schools inform any staff member
and the parent/guardian of any student who has a health condition that may put them at increased
risk from exposure to a communicable disease (e.g., persons with immunosuppressed conditions,
pregnancy, etc.) in coordination with the local department of health. Such persons should be
instructed to contact their healthcare provider for direction related to possible exposure to the
communicable disease. During such an outbreak it is best practice for schools, in collaboration
with the local department of health, to also provide information and education to the entire school
community about the disease, along with school policy and procedures related to communicable
diseases including return to school requirements.
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REFERENCES
Vaccines and Preventable Diseases | CDC
Retrieved June 13, 2024
Immunization Action Coalition, Vaccination Information for Healthcare Professionals
Retrieved June 13, 2024
New York State Association of County Health Officials
Retrieved June 13, 2024
New York State Department of Health - Vaccine Safety
Retrieved June 13, 2024
New York State Department of Health Immunizations: Child Care Programs, Schools, and
Post-Secondary Institutions
Retrieved June 13, 2024
Locating Old Immunization Records (ny.gov)
Retrieved July 6, 2023
New York State Education Department - School Health Services.
Retrieved June 13, 2024
New York State Center for School Health
Retrieved June 13, 2024
