Administrative Procedure 5161 - Immunizations

I. Purpose

To provide procedures to ensure compliance with Maryland Department of Health and Mental Hygiene regulations requiring children entering and currently enrolled in school to be protected against vaccine-preventable diseases.

II. Definitions

Compliant Student: An enrolled student who meets the age appropriate vaccine requirements per the Department of Health and Mental Hygiene immunization regulations

Exclusion: A student who is unable to attend school due to non-compliance with immunization regulations

Immunization: The process of inducing immunity, usually through inoculation or vaccination

Missing Immunization Record: Lack of documentation of immunizations in the health room, even if the immunization documentation is in the student’s cumulative folder.

Non-compliant Student: An enrolled student who does not meet the age appropriate vaccine requirements per the Department of Health and Mental Hygiene immunization regulations

School Health Electronic Record (S.H.E.R.e.): Computerized database that documents and maintains student medical information

Vaccine: a preparation of killed microorganisms that is administered to produce or artificially increase immunity to a particular disease

III. Procedures

Forms (Click here to view forms)
1. Prince George's County Public Schools (PGCPS) will maintain a Maryland Immunization Certification Form, DHMH 896 (See Attachment A), and a computerized school health electronic record that shall include an immunization record on each student. All immunization information is confidential by law. The immunization records will be maintained in the student's health record as a hard copy in the cumulative folder and scanned copy in the PGCPS School Health Electronic Health Record (S.H.E.R.e.)
2. The immunization record must include:
  1. month, day and year of each vaccine;
  2. the month and year of history of varicella disease, if any;
  3. the month and the year of each blood test (titer) results; and
  4. a signature and printed name with official stamp of a health care provider (i.e. Medical Doctor (MD), Nurse Practitioner (NP), Physician Assistant (PA), Registered Nurse (RN) or Licensed Practical Nurse (LPN)).
3. Proof of immunizations must include student’s name, gender and date of birth and will be accepted in the following formats:
  1. DHMH 896 (hard copy or scanned); or
  2. Computerized immunization record from Immunet or the S.H.E.R.e. system which must include the student's gender, date of birth, county, school name, and parent/guardian(s) name. (Note: this information must be added to the documents provided if not included.)
4. Form DHMH 896 must also be used to document medical contraindications, religious objection, and lost or destroyed records.
5. Any discrepancies related to immunization administration dates or demographic information (e.g. name and date of birth doesn’t match) must be reconciled with the child’s health care provider, PGCPS Records Management Office and SchoolMax®, and remain consistent throughout the child’s school years.
6. Annual Report of School Immunization Status Form DHMH 1013 (See Attachment 2) will be used to complete the annual immunization survey.
Guidelines for All Students in the PGCPS System
1. In accordance with state law, the school principal may not knowingly admit a student to or retain a student in a preschool program or kindergarten through twelfth grade unless the student’s parent or guardian has furnished evidence of age-appropriate immunity against diphtheria, tetanus, pertussis, polio, hepatitis B, varicella, measles, rubella, mumps, meningitis, and Tetanus-diphtheria-acellular pertussis (Tdap) acquired through Tdap vaccine. (See COMAR 10.06.04.03.)
2. PGCPS requires that:
  1. a child will not be permitted to enter school unless he/she has received at least one dose of each required vaccine as listed in the most current Maryland immunization implementation schedule. (Click here to school immunization requirements.)
  2. all students up to age 59 months (or 4 years, 11 months old) must receive Hib and Prevnar vaccines; and
  3. all student(s) must complete the required immunization requirement for their age/grade according to the Maryland immunization implementation schedule.
3. All students entering pre-school/kindergarten through twelfth grade must show proof of meeting the Maryland immunization schedule.
4. A student who has received one or more doses of the required vaccines for their age and grade according to the most current Maryland Immunization schedule, but who has not completed the series, must continue to receive subsequent doses on schedule in order to remain in compliance and remain in school.
5. Proof of immunity by blood test results (titer) is acceptable in lieu of vaccine history for hepatitis B, polio, measles, mumps, rubella and varicella only.
6. Students must be revaccinated for diphtheria, pertussis, tetanus, Hib and Prevnar if records have been lost or destroyed.
Temporary Admission or Retention
1. Subject to the provisions of Maryland law, a preschool or public school shall temporarily admit a student or retain a student in a preschool or school if:
  1. The student is homeless, pending a restart of their immunization schedule as soon as is feasible in collaboration with vaccine providers; or
  2. The student's parent or guardian (in a preschool program) is unable to provide proof of immunization pursuant to the requirements of the Maryland immunization schedule.
2. In order for a student to be temporarily admitted or retained in a preschool or school, the student's parent or guardian shall present evidence of the student's appointment with a health care provider or local health department as documented on the PGCPS Verification of Appointment Form (see attached in Appendix A). The purpose of the appointment must be to:
  1. Receive a required immunization or immunizations;
  2. Reconstruct a lost immunization record; or
  3. Acquire evidence of age-appropriate immunity.
3. The date of the appointment may not be later than 20 calendar days following the date the student was temporarily admitted or retained as documented on the PGCPS Verification of Appointment Form.
4. A preschool or public school shall exclude a student who has been temporarily admitted or retained on the next school day following the appointment date if the student's parent or guardian fails to provide evidence of required immunizations.
Exclusion from School
1. Any student who is not in compliance with the immunization requirements, and who has not satisfied the conditions for temporary admission or retention under Section C, will be excluded from school using SchoolMax Code 17.
2. The student’s parent(s) or guardian(s) must be notified of this exclusion through an exclusion letter, generated by the S.H.E.Re system, and signed by the Principal/Designee and the School Nurse.
3. The exclusion letter shall include the following:
  1. Exclusion date that is 20 calendar days from the date non-compliance was identified by the S.H.E.Re system;
  2. A statement that the 20 calendar day exclusion period will not be extended; and
  3. A statement that exclusion from school will be enforced by Principal/Designee if vaccine verification is not presented by the date of exclusion.
Alert Letters
1. Alert letters will be sent to students who are in danger of being non-compliant due to:
  1. an alert by the S.H.E.Re system; or
  2. new regulations that are issued by DHMH.
2. Alert letters shall be sent by April 30 of each school year to all students identified by the S.H.E.Re system that they will be non-compliant at the beginning of the next school year.
Medical Contraindications
1. A child with a medical contraindication to one or more vaccine(s) may be exempted from immunization.
2. A health care provider must complete and sign the medical contraindication section of Form DHMH 896, or provide other appropriate documentation on physician letterhead, prior to the child's admission to school indicating whether the condition is permanent or temporary.
3. If the condition is temporary, the student must be monitored and the vaccine(s) received within 20 calendar days of the exemption expiration date.
4. Medical contraindication statement(s) documented on the DHMH 896, or other appropriate documentation on physician letterhead, will be maintained in the student health record in the school health room and scanned into S.H.E.Re at the student's school.
5. During an infectious disease outbreak, students with immunization exemptions will be excluded from school by a letter written by the County Health Officer to the parent/guardian of the student.
6. During an infectious disease outbreak, a report of all students enrolled who have a medical exemption to immunizations on medical grounds shall be generated for the Principal, CEO and the County Health Officer by the Office of School Health Policy, Services and Innovation.
Religious Objection
1. A parent or guardian may object to one or all immunizations on religious grounds.
2. A student's parent or guardian claiming exemption for religious reasons must sign the religious objection section on the DHMH 896, which will then be retained in the student's health record and the S.H.E.Re system.
3. When a parent or guardian exercises this right, the immunizations which the student has received must be recorded on the immunization record section of the DHMH 896.
4. During an infectious disease outbreak, students with immunization exemptions on religious grounds will be excluded from school for medical reasons by a letter written by the County Health Officer to the parent/guardian of the student.
5. During an infectious disease outbreak, a report of all students enrolled who have an exemption to immunizations on religious grounds shall be generated for the Principal and for the County Health Officer.
Exceptions

Transfer Students
1. All students who do not have a completed immunization record must be given the Immunization Exclusion Letter with the exception of students transferring within PGCPS or another Maryland school who have a Maryland Student Transfer Record (SR-7) indicating that the student is in compliance with immunizations or a DHMH-896/immunization record indicating one dose of all required vaccines.
2. It is the responsibility of the parent or guardian to obtain the most current immunization record for their child and share it with the School Nurse, who will record receipt of such record by a date stamp and signature of the parent/guardian in a log book.
  
  Homeless Students
3. A homeless student without immunization records can be temporarily enrolled in school under the following conditions:
  1. The school nurse will work with the Pupil Personnel Workers (PPWs), Community Resource Coordinators (CRCs) and Community Outreach Assistant (COAs) to provide a referral and calls to providers for the homeless student to obtain pro bono or free health services including required immunizations; and
  2. The Principal/Designee is still required to provide a 30 calendar day exclusion letter to the homeless student who will be excluded on the next school day following the appointment date for failure to provide evidence of required immunizations.
    
    Military Families
4. Students of military families new to the area can be temporarily enrolled in school without current immunization records under the following conditions:
  1. The Principal/Designee is required to provide a 30 calendar day exclusion letter to the parent(s)/guardian(s); and
  2. The student of a military family will be excluded on the next school day following the appointment date if the parent/guardian fails to provide evidence of required immunizations.
Immunization Non-Compliance Tracking
1. The PGCPS Immunization Compliance Planning (ICP) Team
  1. The PGCPS Immunization Compliance Planning (ICP) Team will be led by the Office of School Health Policy, Services and Innovation leadership and include representatives from Academics, Student Services, Office of Diversity, Office of Communications and the Prince George’s County Health Department.
  2. The PGCPS ICP team will convene weekly in May/ June and August/September to review S.H.E.Re immunization compliance data by specific schools, discuss school specific trends and develop strategies to bring students into compliance.
2. School Based Immunization Compliance Planning (ICP) Team
  1. The School Based Immunization Compliance Planning (ICP) Team, which consists of the School Registrar, Lead Secretary, School Nurse, Pupil Personnel Worker, Community Resource Coordinator, and Community Outreach Assistant, will work together to reduce the number of non-compliant students.
  2. The School based ICP will meet once weekly or bi-weekly between May-June and August-September to review school specific non- compliance data and present weekly data reports with the Principal.
  3. The school based ICP will work collaboratively to:
    1. Locate any missing records (cumulative folder) to verify if immunization records can be retrieved from them and provided to the school nurse for review.
    2. Call and make home visits to parents/guardians of students who are currently non-compliant or whose immunization records cannot be located.
3. The school nurse shall work collaboratively with the Principal to:
  1. Provide exclusion letters to all students on bright yellow paper who are out of compliance with the required immunizations schedule prior to the last day of school via letters in the student backpacks and by regular mail addressed to the student’s parent/guardian at the student’s last known home address;
  2. Provide immunization compliance alert notices /to all current grades for new vaccine requirements for the following school year prior to May 1st of each year; and,
  3. Ensure a photographic image of each child is obtained, with written parental/guardian permission, from the school portrait vendor or the child’s parent/guardian to be placed in the S.H.E.Re system for proper identification of children and to reduce errors (e.g., of students with the same names).
School Based Immunization Clinics
1. If more than 5-10% of the student population at a school is non-compliant with immunization requirements, school nurses may be requested by the PGCPS Chief School Health Officer or School Nurse Supervisor to immunize students at that school, as authorized by law, under the clinical supervision of the Health Department.
2. The Office of School Health Policy, Services and Innovation shall ensure that school nurses who are requested to immunize students in a school based setting are appropriately trained by the Prince George’s County Health Department to immunize students and follow federal, state and county policies and procedures related to vaccine storage and administration.
3. The Office of School Health Policy, Services and Innovation shall ensure that all school nurses receive the most current job description during school nurse orientation and on-boarding of new nurses, and shall maintain a signature log of school nurses who are willing to perform the immunization functions described.
4. The Board of Education shall maintain liability insurance to cover all school nurses performing immunization duties while in school only.
5. The Office of School Health Policy, Services and Innovation shall maintain a current MOU with the Prince George’s County Health Department outlining roles and responsibilities for implementing school based immunization duties.

IV. Related Procedures and Regulations

Maryland Department of Health Services and Mental Hygiene Regulations (COMAR 10.06.04.03).

V. Maintenance and Update of These Procedures

The Office of School Health Policy, Services, and Innovation, in consultation with the Prince George's County Health Department, will maintain and update these procedures as necessary.

VI. Cancellations and Supersedures

This Administrative Procedure cancels and supersedes Administrative Procedure 5161, dated July 2, 2011.