6 CAR Part 520 — Rules Pertaining to Immunization Requirements

Chapter XVI

Subchapter A

Subpart 1

6 CAR § 520-101 Purpose {#sec-6-car-520-101 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-101}

6 CAR § 520-101. Purpose.

(a) Immunizations against poliomyelitis, diphtheria, tetanus, pertussis, red (rubeola) measles, mumps, rubella, varicella (chickenpox), Haemophilus influenzae type b, hepatitis B, hepatitis A, meningococcal, and pneumococcal, and other communicable diseases have resulted in a dramatic decrease in the incidence of these diseases in Arkansas.

(b) However, these diseases continue to occur in childcare facilities, schools, and colleges and universities.

(c) A requirement that children and students furnish proof that they have immunity against certain communicable diseases will reduce the potential for an outbreak of those diseases.

Subpart 2

6 CAR § 520-201 Childcare and early childhood education facilities {#sec-6-car-520-201 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-201}

6 CAR § 520-201. Childcare and early childhood education facilities.

(a)(1) Except as otherwise provided in this rule, no infant or child shall be admitted to attend a childcare facility in this state who has not been age-appropriately immunized against poliomyelitis, diphtheria, tetanus, pertussis, red (rubeola) measles, rubella, mumps, Haemophilus influenzae type b, hepatitis B, hepatitis A, pneumococcal disease, and varicella (chickenpox) as evidenced by an immunization record from a licensed physician or a public health department acknowledging the immunization (see Table I).

(2)(A) A history of disease from a medical professional such as a medical doctor, advanced practice nurse, doctor of osteopathy, or physician assistant may be accepted in lieu of receiving varicella vaccine.

(B) No self or parental history of varicella disease will be accepted.

(3) Children attending a childcare facility before or after attending school and during school closings shall be required to meet age-appropriate childcare attendance requirements according to Table I.

(b)(1) Every child must have received all of the vaccines, be in process of receiving needed doses listed in Table I for their age, show proof that they have a letter from the Department of Health approving serology as proof of immunity, or have applied for an exemption for those vaccines he or she has not received in order to continue attendance in a childcare facility.

(2) If the child does not meet the immunization requirements for entering the childcare facility, refer the child to a medical authority (private doctor or health department) for immunization or consultation.

(c)(1) A facility may temporarily admit a child provided that the child becomes age-appropriately immunized, is in process of receiving the needed doses of vaccine, or obtains an exemption for those vaccines he or she has not received within fifteen (15) program days after the child's original admission.

(2) "In process" means the child:

(A) Has received at least one (1) dose of the required immunizations; and

(B) Is waiting the minimum time interval to receive the additional doses.

(3) When a child is admitted who is in the process of completing the required minimum immunizations, the childcare facility shall require each child to complete the required doses on schedule.

(4) A written statement from a public health nurse or private physician stating that the child is in process and containing a date when he or she must return for the next immunization shall be in the child's file.

(5) If a child does not produce documentation of additional immunizations per the schedule or show proof that he or she has applied for an exemption from the immunization requirements, he or she must be excluded from the childcare facility until documentation is provided.

(6) The immunization series does not need to be restarted as each dose of vaccine counts toward the minimum requirements.

(d)(1) Childcare facilities are required to evaluate the immunization status of all children in their facilities.

(2) Table I is used to determine if the child meets the immunization requirements to be admitted to and continue attendance in a childcare facility.

(e) The Division of Child Care and Early Childhood Education shall be responsible for enforcing immunization requirements with respect to childcare facilities.

6 CAR § 520-202 Kindergarten through grade twelve {#sec-6-car-520-202 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-202}

6 CAR § 520-202. Kindergarten through grade twelve.

(a) Except as otherwise provided in this rule, no child shall be admitted to a public or private school of this state who has not been immunized against poliomyelitis, diphtheria, tetanus, pertussis, red (rubeola) measles, rubella, mumps, hepatitis B, hepatitis A, meningococcal disease, and varicella (chickenpox) (see Table II), as evidenced by an immunization record from a licensed physician or a public health department acknowledging the immunization.

(b) The requirements for entry into school are:

(1)(A) Kindergarten:

(i) At least four (4) doses of diphtheria/tetanus/acellular pertussis (DTaP), diphtheria/tetanus/pertussis (DTP), or diphtheria/tetanus (DT-pediatric) vaccine;

(ii) At least three (3) doses of polio vaccine;

(iii) Two (2) doses of MMR (measles, mumps, and rubella) vaccine;

(iv) Three (3) doses of hepatitis B vaccine;

(v) One (1) dose of hepatitis A; and

(vi) Two (2) doses of varicella (chickenpox) vaccine.

(B)(i) A history of disease from a medical professional such as a medical doctor, advanced practice nurse, doctor of osteopathy, or physician assistant may be accepted in lieu of receiving varicella vaccine.

(ii) No self or parental history of varicella disease will be accepted (see Table II).

(C) Exception. If a student has previously received two (2) doses of measles, one (1) dose of mumps, and one (1) dose of rubella before January 1, 2010:

(i) The doses will be accepted as compliant to immunization requirements; and

(ii) Two (2) MMR vaccines are not required; and

(2)(A) First through twelfth grade:

(i) At least three (3) or four (4) doses of:

(a) Diphtheria/tetanus/acellular pertussis (DTaP);

(b) Diphtheria/tetanus/pertussis (DTP);

(c) Diphtheria/tetanus (DT-pediatric);

(d) Tetanus/diphtheria (Td-adult); or

(e) Tetanus/diphtheria/acellular pertussis (Tdap);

(ii) One (1) dose of tetanus/diphtheria/acellular pertussis (Tdap) for ages eleven (11) years as of September 1 each year and older or three (3) doses for unvaccinated persons seven (7) years of age or older, including persons who cannot document prior vaccination;

(iii) At least three (3) doses of polio vaccine;

(iv) Two (2) doses of MMR (measles, mumps, and rubella) vaccine;

(v) Two (2) or three (3) doses of hepatitis B vaccine;

(vi) One (1) dose of hepatitis A for first grade;

(vii) Two (2) doses of varicella vaccine; and

(viii)(a) One (1) or two (2) doses of meningococcal vaccine with one (1) dose for seventh grade and a second dose of meningococcal vaccine at age sixteen (16) years as of September 1 each year.

(b) However, if the first dose of meningococcal vaccine is administered at age sixteen (16) years or older, no second dose is required.

(c) If not vaccinated prior to age sixteen (16) years, one (1) dose is required.

(B)(i) A history of disease from a medical professional such as a medical doctor, advanced practice nurse, doctor of osteopathy, or physician assistant may be accepted in lieu of receiving varicella vaccine.

(ii)(a) No self or parental history of varicella disease will be accepted (see Table II).

(b) Exception. If a student has previously received two (2) doses of measles, one (1) dose of mumps, and one (1) dose of rubella before January 1, 2010:

(iii) The doses will be accepted as compliant to immunization requirements; and

(iv) Two (2) MMR vaccines are not required.

(E) Seventh grade. In addition to the vaccine requirements listed under first through twelfth grade, one (1) dose of meningococcal vaccine is required (see Table II).

(c)(1) Every child must have received all of the vaccines, be in process of receiving needed doses listed in Table II, show proof that they have a letter from the Department of Health approving serology as proof of immunity, or applied for an exemption for those vaccines he or she has not received in order to continue attendance in a public or private school.

(2) If the child does not meet the immunization requirements for entering a public or private school, refer the child to a medical authority (private doctor or health department) for immunization or consultation.

(d)(1) A facility may temporarily admit a child provided that the child becomes appropriately immunized, is in process of receiving the needed doses of vaccine, or shows proof that he or she has applied for an exemption for those vaccines he or she has not received within:

(A) Thirty (30) calendar days after the child’s original admission; or

(B) By October 1 for Tdap and meningococcal vaccine at age eleven (11) and sixteen (16) years, respectively.

(2) "In process" means the student:

(A) Has received at least one (1) dose of the required immunizations; and

(B) Is waiting the minimum time interval to receive the additional doses.

(3) When a student is admitted who is in the process of completing the required minimum immunizations, the facility shall require each student to complete the required doses on schedule.

(4) A written statement from a public health nurse or private physician stating that the student is in process and containing a date when he or she must return for the next immunization shall be in the student's file.

(5) If a student does not produce documentation of additional immunizations per the schedule or show proof that he or she has applied for an exemption from the immunization requirements, he or she must be excluded from the facility until documentation is provided.

(6) The immunization series does not need to be restarted, as each dose of vaccine counts toward the minimum requirements.

(e)(1) School officials should evaluate the immunization status of all children in their facilities.

(2) Table II is used to determine if the child meets the immunization requirements to enter school.

(f) School boards, superintendents, and principals shall be responsible for enforcing immunization requirements with respect to kindergarten through grade twelve within public schools.

(g) The Arkansas Nonpublic School Accrediting Association, Inc. shall assist the department in ensuring compliance with immunization requirements in respect to kindergarten through grade twelve within private schools.

6 CAR § 520-203 Colleges and universities {#sec-6-car-520-203 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-203}

6 CAR § 520-203. Colleges and universities.

(a) To attend a public or private college or university in this state, a part-time student housed in on-campus premises and a full-time student must show proof of immunization, immunity, a medical or non-medical exemption, or birth before 1957 for the following requirements:

(1) For incoming freshmen and foreign-born students, two (2) doses of MMR (measles, mumps, and rubella) vaccine (see Table III);

(2) For all other students, one (1) dose of MMR (measles, mumps, and rubella) vaccine (see Table III); or

(3) Exception. If a student has previously received two (2) doses of measles, one (1) dose of mumps, and one (1) dose of rubella before January 1, 2010:

(A) The doses will be accepted as compliant to immunization requirements; and

(B) Two (2) MMR vaccines are not required.

(b)(1) Proof of immunization, immunity, a medical or non-medical exemption, or birth before 1957 must be provided within such time as set by the college or university but not to exceed thirty (30) calendar days after enrollment.

(2) Acceptable proof of immunization is an official immunization record from:

(A) Another educational institution in Arkansas;

(B) A licensed medical doctor or an authorized public health representative; or

(C) Military service.

(3) In lieu of receiving vaccine, immunity can be shown by providing documented evidence (such as a letter from the department approving serology as proof of immunity) of appropriate serological testing.

(4) Proof that the student has applied for or received a medical or non-medical exemption for those vaccines he or she has not received will be accepted in lieu of receiving vaccine.

(5) Proof that the student was born prior to January 1, 1957, will be accepted in lieu of receiving vaccine.

(c)(1) A college or university may temporarily admit an incoming freshman or a foreign-born student who is in process of receiving the required two (2) doses of MMR vaccine.

(2) "In process" means the student:

(A) Has received at least one (1) dose of the required immunizations; and

(B) Is waiting the minimum time interval to receive the additional dose.

(3) When a student is admitted who is in the process of completing the required minimum immunizations, the facility shall require each student to complete the required doses on schedule.

(4) A written statement from a public health nurse or private physician stating that the student is in process and containing a date when he or she must return for the next immunization shall be in the student's file.

(5) If a student does not produce documentation of the additional immunization per the schedule or show proof that he or she has applied for an exemption from the immunization requirements, he or she must be excluded from the facility until documentation is provided.

(d) A “freshman” is defined as a student who has not earned thirty (30) hours of college credit.

(e) A “foreign-born student” is defined as any student born outside of the United States of America.

(f) Students who receive their education by correspondence and do not attend any classes on campus are not required to receive MMR (measles, mumps, and rubella) vaccine.

(g) Enforcement of these requirements for colleges and universities is the responsibility of the director of admissions or the registrar at each college or university.

6 CAR § 520-204 Documentation for immunization or proof of immunity {#sec-6-car-520-204 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-204}

6 CAR § 520-204. Documentation for immunization or proof of immunity.

(a) The following documentation of immunizations is required:

(1)(A) Immunization records may be stored on a computer database, such as the Arkansas Public School Computer Network.

(B) A copy of the original source document or a copy from the immunization provider’s medical record shall be placed in a permanent file.

(C) The immunization record printed off the statewide immunization registry with the Official Seal of the State of Arkansas is:

(i) Considered an official immunization record; and

(ii) Approved for placement in a permanent file as source documentation.

(D) It shall be the responsibility of the entity to maintain a list of individuals:

(i) Not appropriately immunized; and

(ii) With medical, religious, or philosophical exemptions; and

(2)(A) The only proof of immunizations to be accepted shall be an immunization record provided by a licensed physician, health department, or military service, or an official record from another educational institution in Arkansas acknowledging the same and stating the vaccine type and dates of vaccine administration.

(B) These items must be provided and entered on the school record.

(C) Terms such as “up-to-date”, “complete”, “adequate”, etc. are not to be accepted as proof of immunization.

(b) The following documentation for proof of immunity is required:

(1)(A) Serological testing is only applicable to:

(i) Hepatitis B virus;

(ii) Measles;

(iii) Mumps;

(iv) Rubella; and

(v) Varicella.

(B) Any individual who has immunity to hepatitis B virus, measles, mumps, rubella, and/or varicella as documented by appropriate serological testing shall not be required to have the vaccine for that disease; and

(2)(A) A copy of the serological test should be submitted to the Immunization Section of the Department of Health along with a letter requesting that the serological test be accepted as proof of immunity in lieu of receiving vaccine for the disease indicated on the serological test.

(B) After review by the Medical Director of the Immunization Section:

(i) A letter indicating approval or denial will be sent to the individual, parent, or guardian; and

(ii) It will be the individual’s, parent’s, or guardian’s responsibility for informing the childcare facility, school, or college/university.

(C) For approvals:

(i) Annual approval is not required; and

(ii) A copy of the letter should be placed in the student’s permanent file.

(D) For denials, the student must:

(i) Receive the required immunization; or

(ii) Request an exemption.

(c) An individual who has lost his or her immunization records or whose serological test results are unavailable:

(1) Shall be properly immunized for those diseases; or

(2) Will be required to show proof that he or she has applied for an exemption for those vaccines he or she has not received.

Subpart 3

6 CAR § 520-301 General requirements {#sec-6-car-520-301 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-301}

6 CAR § 520-301. General requirements.

(a) With the exception of medical exemptions for college and university students, exemptions shall be granted only by the Department of Health.

(b) Individuals shall complete an annual application for medical, religious, and philosophical exemptions.

(c) A notarized statement by the individual requesting the exemption must accompany the application.

(d) All individuals requesting an exemption must complete an educational component developed by the department that includes information on the risks and benefits of vaccinations.

(e) All individuals must sign an “informed consent” form provided by the department that includes:

(1) A statement of refusal to vaccinate;

(2) A statement of understanding that at the discretion of the department the non-immunized child or individual may be removed from the applicable facility, for twenty-one (21) days or longer, during an outbreak if the child or individual is not fully vaccinated; and

(3) A statement of understanding that the child or individual shall not return to the applicable facility until the outbreak has been resolved and the department approves the return.

6 CAR § 520-302 Medical exemptions {#sec-6-car-520-302 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-302}

6 CAR § 520-302. Medical exemptions.

(a)(1) Only a letter issued by the Medical Director of the Immunization Section stating the vaccine or vaccines for which a child/student is exempt is to be accepted as a valid medical exemption by the school or childcare facility.

(2) Statements from private physicians are not to be accepted by the school or childcare facility without this letter.

(3)(A) In addition to the general requirements found in 6 CAR § 520-301, the Immunization Section of the Department of Health’s standard form for medical exemptions must be submitted to the section.

(B) This form is available from the section upon request.

(b)(1) If a medical doctor licensed to practice in Arkansas determines that an individual is deemed to have a potential contraindication to one (1) or more of the required vaccinations, the individual may initiate an exemption request with the Department of Health.

(2) If granted, it may be accepted by a college or university in lieu of proof of vaccination.

6 CAR § 520-303 Religious exemptions {#sec-6-car-520-303 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-303}

6 CAR § 520-303. Religious exemptions.

(a) In addition to the general requirements found in 6 CAR § 520-301, the Immunization Section of the Department of Health’s standard form for religious exemptions must be submitted to the section.

(b) This form is available from the section upon request.

6 CAR § 520-304 Philosophical exemptions {#sec-6-car-520-304 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-304}

6 CAR § 520-304. Philosophical exemptions.

(a) In addition to the general requirements found in 6 CAR § 520-301, the Immunization Section of the Department of Health’s standard form for philosophical exemptions must be submitted to the section.

(b) This form is available from the section upon request.

Subpart 4

6 CAR § 520-401 Colleges and universities {#sec-6-car-520-401 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-401}

6 CAR § 520-401. Colleges and universities.

(a) No part-time student housed in on-campus premises and no full-time student may attend a public or private college or university in this state unless he or she has furnished proof, within such time as set by the college or university, but not to exceed thirty (30) calendar days after enrollment, by way of an official immunization record from another educational institution in Arkansas, a certificate from a licensed medical doctor, an authorized public health department representative, or military service, that he or she:

(1) Has immunity against:

(A) Measles;

(B) Mumps; and

(C) Rubella; or

(2) Has applied for a medical, religious, or philosophical exemption from the immunization requirements.

(b) If the student does not provide proof of immunizations received, immunity as documented by appropriate serological testing, an application for exemption from the required immunizations, or birth before 1957, he or she must be excluded from the college/university until documentation is provided.

6 CAR § 520-402 Childcare facilities/public and private schools/colleges and universities {#sec-6-car-520-402 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-402}

6 CAR § 520-402. Childcare facilities/public and private schools/colleges and universities.

(a) Each facility must maintain an accurate and current list of all exempt and deficient individuals.

(b) Individuals who are exempt or deficient (except those who have had the disease as verified by appropriate serological testing) will be excluded from the facility if the Department of Health determines that a possibility of disease transmission exists.

(c) The exempt or deficient child or individual shall not return to the facility, for twenty-one (21) days or longer, until the:

(1) Possibility of disease transmission has been controlled; and

(2) Department approves the return.

Subpart 5

6 CAR § 520-501 Generally {#sec-6-car-520-501 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-501}

6 CAR § 520-501. Generally.

(a)(1) In order to identify areas where additional emphasis is needed and to measure levels of immunization compliance, the Department of Health will conduct annual assessments in:

(A) Schools;

(B) Childcare facilities; and

(C) Colleges and universities.

(2) The entity’s cooperation in completing these assessments is required.

(b) The department shall report every six (6) months to the House Committee on Public Health, Welfare, and Labor and Senate Committee on Public Health, Welfare, and Labor regarding:

(1) The geographical patterns of exemptions and vaccination rates of the state; and

(2) Disease incidence of vaccine-preventable disease collected by the department.

(c)(1) The department shall conduct an annual study of the:

(A) Religious, philosophical, and medical exemption patterns; and

(B) Incidence of disease in the state.

(2) The study shall include:

(A) An evaluation of the state's immunization policies;

(B) The incidence of disease in Arkansas and other states; and

(C) A risk evaluation of specific populations in Arkansas.

Subpart 6

6 CAR § 520-601 Table I—Immunization requirements for child care and early childhood education facilities {#sec-6-car-520-601 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-601}

6 CAR § 520-601. Table I—Immunization requirements for child care and early childhood education facilities.

Instructions for utilizing Table I: Table I is not a recommendation of vaccines to get, but of doses required to already have at that age. To determine what vaccines are required for a child to attend a licensed child care facility, refer to Column 1 on the left to see what age range is correct for the child. Then all the vaccines on the same row as the child’s age are required for attendance in a licensed child care facility. Vaccines are required based on the current age of the child. Column 1 is not an age range for when a child can be vaccinated.

*5th DTaP/DTP/DT (Pre-school dose) must be given on/after the child's 4th birthday. Interval between 4th DTaP/DTP/DT and 5th DTaP/DTP/DT should be at least 6 months. If a child is currently ≥49 months of age and does not meet the above criteria or is in process within 15 days, they are not up-to-date and should be scheduled for immunization.

** For Hib and Pneumococcal, children receiving the first dose of vaccine at age 7 months or older require fewer doses to complete the series.

*** 3^rd dose of hepatitis B should be given at least 8 weeks after the 2^nd dose, at least 16 weeks after the 1^st dose, and it should not be administered before the child is 24 weeks of age.

**** Vaccine doses administered up to 4 days before the minimum interval or minimum age can be counted as valid for doses already administered. Exception: The minimum interval between doses of live vaccines (such as MMR and Varicella) must be 28 days.

*****A medical professional is a medical doctor (MD), advanced practice nurse (APN), doctor of osteopathy (DO), or physician assistant (PA). No self or parental history of disease will be accepted.

6 CAR § 520-602 Table II—Kindergarten through grade twelve immunization requirements* {#sec-6-car-520-602 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-602}

6 CAR § 520-602. Table II—Kindergarten through grade twelve immunization requirements*.

*Doses of vaccine required for school entry may be less than the number of doses required for age-appropriate immunization.

**An alternative two-dose hepatitis B schedule for 11-15 year-old children may be substituted for the three-dose schedule. Only a FDA-approved alternative regimen vaccine for the two-dose series may be used to meet this requirement. If you are unsure if a particular child’s two-dose schedule is acceptable, please contact the Immunization Section for assistance at 501-661-2169.

*** 3^rd dose of hepatitis B should be given at least 8 weeks after the 2^nd dose, at least 16 weeks after the 1^st dose, and it should not be administered before the child is 24 weeks (168 days) of age. (All 3^rd doses of hepatitis B vaccine given earlier than 6 months of age before 6/21/96 are valid doses and should be counted as valid until 6/21/2014.)

**** Tdap vaccine can be administered regardless of the interval since the last tetanus and diphtheria toxoid-containing vaccine.

***** Exception: If a student has previously received two doses of measles, one dose of mumps and one dose of rubella before January 1, 2010, the doses will be accepted as compliant to immunization requirements and 2 MMRs are not required.

******A medical professional is a medical doctor (MD), advanced practice nurse (APN), doctor of osteopathy (DO), or physician assistant (PA). No self or parental history of disease will be accepted.

******* For unvaccinated persons 7 years of age and older (including persons who cannot document prior vaccination), the primary series is 3 doses. The first two doses should be separated by at least 4 weeks, and the third dose at least 6 months after the second. One of these doses (preferably the first) should be administered as Tdap and the remaining two doses administered as Td..

Vaccine doses administered up to 4 days before the minimum interval or minimum age can be counted as valid for doses already administered. Exception: The minimum interval between doses of live vaccines (such as MMR and Varicella) must be 28 days.

If the child does not meet the immunization requirements for entering school, the school shall refer the child to a medical authority (private doctor or health department) for immunization or consultation for when the immunization is due.

6 CAR § 520-603 Table III —College/university immunization requirements {#sec-6-car-520-603 omnilex-key=us-ar-regs-official--title-6-part-520--6 CAR § 520-603}

6 CAR § 520-603. Table III —College/university immunization requirements.

• Exception: If a student has previously received two doses of measles, one dose of mumps and one dose of rubella before January 1, 2010, the doses will be accepted as compliant to immunization requirements and 2 MMRs are not required.

Vaccine doses administered up to 4 days before the minimum interval or minimum age can be counted as valid for doses already administered. Exception: The minimum interval between doses of live vaccines (such as between the first and second dose of MMR) must be 28 days.