New School Immunization Requirements for 5th Through 10th Grade:

Information and Guidelines for Physicians

On September 1, 2007 students in 10th grade and below will require documentation of Hepatitis B and Varicella immunization or immunity according to the COMAR 10.06.04.03 schedule of implementation. Parents or guardians must provide proof of their child’s immunization to their preschool or school in-order for the student to attend school. The Prince George’s County Health Department needs your assistance to ensure that your patients in Pre K through 10th Grade will have their immunization requirements met and records updated prior to September 2007.

Though the Health Department does honor physician referrals for immunizations, it does not perform titers. Therefore in an effort to prevent a child from missing any days from school, we are encouraging all providers to begin the review and updating of immunization records for their patients in the 10th Grade or below this Spring. Please review the COMAR information in this letter and encourage parents, guardians, and students to complete their immunization updates as early as possible.

As set forth in COMAR 10.06.04.03, the parent or guardian of a student in 10th Grade or lower shall provide proof to the preschool or school that the student:

1. Has received three (3) doses of hepatitis B vaccine and age-appropriate vaccination with varicella vaccine; or
2. Is immune to hepatitis B and varicella by providing the results of a blood test or other test.

In June 2006, the Advisory Committee on Immunization Practices (ACIP) approved the 2007-2008 School Immunization Requirements. DHMH has adopted the new school immunization requirements under COMAR 10.06.04 School Health Services and Required Immunizations Before Entry into School effective November 24, 2005.

The COMAR 10.06.04 contains the following revisions:

1. Pneumococcal Vaccine (PCV7) or Prevnar will be required for children enrolled in preschool programs.
2. Varicella and Hepatitis B vaccination are required for all students in preschool through ninth grade. This requirement is progressive and will be phased-in to include tenth grade in September 2007, eleventh grade in September 2008, and twelfth grade in 2009. The revised definition for evidence of immunity to Varicella has also changed to include:History of Varicella disease based on healthcare provider diagnosis or parental report of typical varicella symptoms is acceptable evidence of immunity to Varicella.
3. The acceptable required proof of immunity to Varicella disease for school enrollment per COMAR 10.06.04.03 include any of the following:
   • Age appropriate vaccination with Varicella vaccine;
   • Proof of immunity from Varicella by blood test; or
   • Documented history of Varicella disease by a healthcare provider indicated with "recorded month and year of diagnosis."
4. The Parental acceptable history of symptoms of previous Varicella disease must be specific and must include:
   • Generalized pruritic, vesicular rash typically consisting of up to 250-500 lesions
   • Mild fever and other systemic symptoms may be present.
   • Rash usually appears on scalp, followed by the trunk, then progresses to the extremities. The highest concentration of lesions occurs on the trunk.
   • Lesions are 1- 4 mm in diameter.
   • The fluid filled bumps (vesicles) rupture or become purulent, then turn into crusts or scabs, which last about 14 days.
5. For persons reporting a history of atypical mild disease, healthcare providers should seek either:
   • An epidemiologic link to a typical Varicella case; or
   • Evidence of Latex Agglutination laboratory confirmation.
6. When such documentation is lacking, such person/s should not be considered as having a valid history of disease because other diseases may mimic mild atypical Varicella. These persons should be encouraged to receive age appropriate vaccination.

For answers to questions about school immunization requirements, please

1. Call 301-883-7834 to speak with Donald Shell, M.D., M.A., Deputy Health Officer, or
2. Call 301-883-7230/301-583-3387 to speak with the Prince George’s County Health Department immunization clinic staff.
3. You may also call the State of Maryland Center for Immunization at 410-767-6679 for further information or clarification. The reference on ACIP can be found in the “pink book”: 2006 Epidemiology and Prevention of Vaccine Preventable Diseases. CDC. Pages 172 and 182 or at www.cdc.gov/nip/publications/pink/

For Information for parents and guardians about Health Department immunization clinics, go to:  http://www.princegeorgescountymd.gov/Government/AgencyIndex/Health/immunizations.asp

• Letter to Physicians from the Deputy Health Officer (PDF)
• Vaccination Requirements for School Year 2010-2011 (PDF)

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