902 KAR 2:060. Immunization schedules for attending child day care centers, certified family child care homes, other licensed facilities which care for children, preschool programs, and public and private primary and secondary schools.

 

      RELATES TO: KRS 158.035, 211.090, 211.220, 214.032-214.036

      STATUTORY AUTHORITY: KRS 194A.050, 211.090(3), 211.180(1)(a), 214.034

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050 requires the secretary for the Cabinet of Health and Family Services to promulgate administrative regulations necessary to operate the programs and fulfill the responsibilities vested in the cabinet. KRS 211.190(3) requires the secretary to promulgate administrative regulations necessary to regulate and control all matters set forth in KRS 211.180. KRS 214.034(1) requires the cabinet to promulgate administrative regulations to establish immunization schedules. This administrative regulation establishes the mandatory immunization schedule for attendance at child day care centers, certified family child care homes, other licensed facilities which care for children, preschool programs, and public and private primary and secondary schools.

 

      Section 1. Definitions. (1) "ACIP" or Advisory Committee on Immunization Practices" means the United States Department of Health and Human Services (HHS) Committee that makes national immunization recommendations to the Secretary of the HHS, the Assistant Secretary for Health, and the Director of the.

      (2) "Advanced Practice Registered Nurse" or "APRN" (APRN) means a nurse designated to engage in advanced registered nursing practice as defined in KRS 314.011.

      (3) "Dose" means a measured quantity of vaccine, specified in the package insert provided by the manufacturer.

      (4) "DT" means diphtheria and tetanus toxoids combined.

      (5) "DTaP" means diphtheria and tetanus toxoids combined with acellular pertussis vaccine.

      (6) "DTP" means diphtheria and tetanus toxoids combined with pertussis vaccine.

      (7) "Healthcare provider" means a person licensed under KRS 311.530 to 311.620, 311.840 to 311.862, and a nurse designated to engage in advanced practice registered nursing as defined in KRS 314.011 and 314.042.

      (8) "HepB" means hepatitis B vaccine.

      (9) "Hib" means haemophilus influenzae type b conjugate vaccine.

      (10) "IPV" means inactivated polio virus vaccine.

      (11) "MCV" means meningococcal conjugate vaccine.

      (12) "MMR" means measles, mumps, and rubella vaccines combined.

      (13) "MPSV" means meningococcal polysaccharide vaccine.

      (14) "OPV" means trivalent oral poliovirus vaccine (Sabin).

      (15) "PCV" means pneumococcal conjugate vaccine.

      (16) "Pharmacist" means a person licensed under KRS 315.002 to 315.050.

      (17) "Physicians Assistant" means a person licensed under KRS 311.840 to 311.862.

      (18) "Td" means combined tetanus and diphtheria toxoids (adult type).

      (19) "Tdap" means tetanus toxoid and reduced diphtheria toxoid combined with acellular pertussis vaccines.

      (20) "Varicella" means varicella or chickenpox vaccine.

 

      Section 2. Immunization Schedules. (1) A child three (3) months of age or older, without a current immunization certificate, shall not attend:

      (a) A child day care center;

      (b) Certified family child care home;

      (c) Other licensed facility which cares for children;

      (d) Preschool program; or

      (e) Public or private primary or secondary school.

      (2) Except as provided in Section 3 of this administrative regulation, the immunization certificate of a child shall be considered current if the child is:

      (a) At least three (3) and less than five (5) months of age and has received at least:

      1. One (1) dose of DTaP or DTP;

      2. One (1) dose of IPV or OPV;

      3. One (1) dose of Hib;

      4. One (1) dose of HepB; and

      5. One (1) dose of PCV;

      (b) At least five (5) and less than seven (7) months of age and has received at least:

      1. Two (2) doses of DTaP or DTP or combinations of the two (2) vaccines;

      2. Two (2) doses of IPV or OPV or combinations of the two (2) vaccines;

      3. Two (2) doses of Hib;

      4. Two (2) doses of HepB; and

      5. Two (2) doses of PCV;

      (c) At least seven (7) and less than twelve (12) months of age and has received at least:

      1. Three (3) doses of DTaP or DTP or combinations or the two (2) vaccines;

      2. Two (2) doses of IPV or OPV or combinations of the two (2) vaccines;

      3. Two (2) doses of Hib;

      4. Two (2) doses of HepB; and

      5.a. Three (3) doses of PCV; or

      b. Two (2) does of PCV if a child received the first dose of PCV between seven (7) to eleven (11) months of age;

      (d) At least twelve (12) and less than sixteen (16) months of age and has received at least:

      1. Three (3) doses of DTaP or DTP or combinations of the two (2) vaccines;

      2. Two (2) doses of IPV or OPV or combinations of the two (2) vaccines;

      3.a. Three (3) doses of Hib; or

      b. Two (2) doses of Hib between twelve (12) and fifteen (15) months of age;

      4. Two (2) doses of HepB; and

      5. a. Four (4) doses of PCV with one (1) dose on or after twelve (12) months of age;

      b. Three (3) doses of PCV if a child received the first dose of PCV between seven (7) to eleven (11) months of age, with at least one (1) dose on or after twelve (12) months of age; or

      c. Two (2) doses of PCV if a child received the first dose of PCV between twelve (12) to fifteen (15) months of age;

      (e) At least sixteen (16) and less than nineteen (19) months of age and has received at least:

      1. Four (4) doses of DTaP or DTP or combinations of the two (2) vaccines;

      2. Two (2) doses of IPV or OPV or combinations of the two (2) vaccines;

      3. Four (4) doses of Hib;

      4. Two (2) doses of HepB;

      5.a. Four (4) doses of PCV with one (1) dose on or after twelve (12) months of age;

      b. Three (3) doses of PCV if a child received the first dose of PCV between seven (7) to eleven (11) months of age, with at least one dose on or after twelve (12) months of age; or

      c. Two (2) doses of PCV if a child received the first dose of PCV between twelve (12) to fifteen (15) months of age;

      6. One (1) dose of MMR; and

      7. One (1) dose of varicella, unless a healthcare provider states that the child has had a diagnosis of typical varicella disease or verification of a history of varicella disease by a healthcare provider or a diagnosis of herpes zoster disease or verification of a history of herpes zoster disease by a healthcare provider;

      (f) At least nineteen (19) and less than forty-eight (48) months of age and has received at least:

      1. Four (4) doses of DTaP or DTP or combinations of the two (2) vaccines;

      2. Three (3) doses of IPV or OPV or combinations of the two (2) vaccines:

      3. Four (4) doses of Hib;

      4. Three (3) doses of HepB; and

      5.a. Four (4) doses of PCV with one (1) dose on or after twelve (12) months of age;

      b. Three (3) doses of PCV if a child received the first dose of PCV between seven (7) to eleven (11) months of age, with at least one (1) dose on or after twelve (12) months of age;

      c. Two (2) doses of PCV if a child received the first dose of PCV between twelve (12) to fifteen (15) months of age; or

      d. One (1) dose of PCV if a child received the first dose of PCV at twenty-four (24) months of age or older;

      6. One (1) dose of MMR; and

      7. One (1) dose of varicella, unless a healthcare provider states that the child has had a diagnosis of typical varicella disease or verification of a history of varicella disease by a healthcare provider or a diagnosis of herpes zoster disease or verification of a history of herpes zoster disease by a healthcare provider;

      (g) At least forty-eight (48) months and less than five (5) years of age and has received at least:

      1. Four (4) doses of DTaP or DTP or combinations of the two (2) vaccines;

      2. Three (3) doses of IPV or OPV or combinations of the two (2) vaccines;

      3. Four (4) doses of Hib;

      4. Three (3) doses of HepB;

      5.a. Four (4) doses of PCV with one (1) dose on or after twelve (12) months of age;

      b. Three (3) doses of PCV if a child received the first dose of PCV between seven (7) to eleven (11) months of age, with at least one (1) dose on or after twelve (12) months of age;

      c. Two (2) doses of PCV if a child received the first dose of PCV between twelve (12) to twenty-three (23) months of age; or

      d. One (1) dose of PCV if a child received the first dose of PCV at age twenty-four (24) months or older;

      6. Two (2) doses of MMR; and

      7. Two (2) doses of varicella, unless a healthcare provider states that the child has had a diagnosis of typical varicella disease or verification of a history of varicella disease by a healthcare provider or a diagnosis of herpes zoster disease or verification of a history of herpes zoster disease by a healthcare provider;

      (h) At least five (5) and less than seven (7) years of age and has received at least:

      1. Five (5) doses of DTaP or DTP or combinations of the two (2) vaccines;

      2. Four (4) doses of IPV or OPV or combinations of the two (2) vaccines;

      3. Three (3) doses of HepB;

      4. Two (2) doses of MMR; and

      5. Two (2) doses of varicella, unless a healthcare provider states that the child has had a diagnosis of typical varicella disease or verification of a history of varicella disease by a healthcare provider or a diagnosis of herpes zoster disease or verification of a history of herpes zoster disease by a healthcare provider;

      (i) At least seven (7) years of age and less than eleven (11) years of age and has received:

      1.a. Five (5) doses of DTaP or DTP or combinations of the two (2) vaccines; or

      b. A dose of Td that was preceded by two (2) doses of DTP, DTaP, DT, or Td or combinations of the four (4) vaccines;

      2. Four (4) doses of IPV or OPV or combinations of the two (2) vaccines;

      3. Three (3) doses of HepB;

      4. Two (2) doses of MMR; and

      5. Two (2) doses of varicella, unless a healthcare provider states that the child has had a diagnosis of typical varicella disease or verification of a history of varicella disease by a healthcare provider or a diagnosis of herpes zoster disease or verification of a history of herpes zoster disease by a healthcare provider;

      (3) For sixth grade entry, age eleven (11) or twelve (12) years or older, a child shall have received:

      (a) One (1) dose of Tdap;

      (b) Four (4) doses of IPV or OPV or combinations of the two (2) vaccines;

      (c)1. Three (3) doses of HepB; or

      2. Two (2) doses of adult HepB approved by the FDA to be used for an alternative schedule for adolescents eleven (11) through fifteen (15) years of age;

      (d) Two (2) doses of MMR;

      (e) Two (2) doses of varicella, unless a healthcare provider states that the child has had a diagnosis of typical varicella disease or verification of a history of varicella disease by a healthcare provider or a diagnosis of herpes zoster disease or verification of a history of herpes zoster disease by a healthcare provider; and

      (f) One (1) dose of MCV or MPSV.

      (4) Immunizations shall be administered at least at the minimum ages and intervals recommended by the ACIP. Partial, split, half, or fractionated doses or quantities shall not be administered and shall not be counted as a valid dose.

 

      Section 3. Exceptions and Exemptions to the Immunization Schedules. (1) If the first two (2) doses of Hib vaccine required in Section 2(2) of this administrative regulation were meningococcal group B outer membrane protein (PRP-OMP) vaccines, the third dose may be omitted.

      (2) If one (1) dose of Hib vaccine has been administered to a child who is at least fifteen (15) and less than sixty (60) months of age, the child shall:

      (a) Not be required to receive further doses of Hib; and

      (b) Be considered to have received the Hib doses required by this administrative regulation.

      (3) A child with a contraindication to pertussis vaccine may be given DT in lieu of DTaP or Td in lieu of Tdap required in Section 2 of this administrative regulation.

      (4) If the fourth dose of DT, DTP, or DTaP was administered on or after the fourth birthday, the fifth dose shall not be required.

      (5) If the third dose of IPV or OPV was administered on or after the fourth birthday and at least six (6) months following the previous dose, the fourth dose shall not be required.

      (6) If one (1) dose of PCV has been administered to a child who is at least age twenty-four (24) months and less than sixty (60) months of age, the child shall:

      (a) Not be required to receive further doses of PCV; and

      (b) Be considered to have received the PCV doses required by this administrative regulation.

      (7) A child with a medical contraindication to receiving a vaccine may obtain, from the child's healthcare provider, a "Certificate of Medical Exemption" from the requirements of Section 2 of this administrative regulation, in compliance with KRS 214.036.

      (8)(a) A healthcare provider, pharmacist, local health department, or other licensed healthcare facility administering immunizations, shall, upon receipt of a written sworn statement from the parent or guardian of a child, issue a "Certificate of Religious Exemption" from the requirements of Section 2 of this administrative regulation, in compliance with KRS 214.036.

      (b) A "Certificate of Religious Exemption" shall only be valid for all requirements of Section 2 of this administrative regulation.

      (9)(a) A provisional immunization certificate shall be issued for an otherwise-qualified child, who is behind in required immunizations, and:

      1. Who has not yet reached the required minimum age; or

      2. For whom the time interval between doses has not elapsed.

      (b) A provisional immunization certificate shall:

      1. Permit a child to attend a child day care center, certified family child care home, other licensed facility which cares for children, preschool program, primary or secondary school until the child reaches the appropriate age, or upon passage of the time interval between required doses;

      2. Expire fourteen (14) days from the date the next dose is required to be given; and

      3. Not be valid for more than one (1) year.

 

      Section 4. Immunization Certificates. (1) An immunization certificate may be issued by:

      (a) A physician;

      (b) An advanced practice registered nurse;

      (c) A physician's assistant;

      (d) A pharmacist;

      (e) Local health department; or

      (f)Other licensed healthcare facility administering immunizations.

      (2) An immunization certificate may be signed by:

      (a) A physician;

      (b) An advanced practice registered nurse;

      (c) A physician's assistant;

      (d) A pharmacist;

      (e) Local health department administrator; or

      (f) A registered nurse designee of a physician, local health department administrator, or other licensed healthcare facility.

      (3) A local health department, healthcare provider, pharmacist, or other licensed healthcare facility administering immunizations may obtain the following immunization certificates from the Cabinet for Health and Family Services:

      (a) Commonwealth of Kentucky Immunization Certificate;

      (b) Commonwealth of Kentucky Provisional Immunization Certificate;

      (c) Commonwealth of Kentucky Certificate of Medical Exemption; or

      (d) Commonwealth of Kentucky Certificate of Religious Exemption.

      (4) If an immunization certificate that was not provided by the Cabinet for Health and Family Services is issued to a child, it shall:

      (a) Be a hard copy or an electronically-produced copy;

      (b) Be in the same size and format as a certificate provided by the Cabinet for Health and Family Services; and

      (c) Contain at least the following information:

      1. The name of the child;

      2. The birthdate of the child;

      3. The name of the parent or guardian of the child;

      4. The address of the child, including street, city, state, zip code;

      5. The type(s) of vaccine(s) administered to the child;

      6. The date that each dose of each vaccine was administered;

      7. Certification that the child is current for immunizations until a specified date, including a statement that the certificate shall not be valid after the specified date;

      8. The signature and the date of the signature of:

      a. A physician;

      b. An advanced practice registered nurse;

      c. A physician’s assistant;

      d. A pharmacist;

      e. Local health department administrator; or

      f. A registered nurse designee of a physician, local health department administrator, or other licensed healthcare facility; and

      9. The name of the healthcare provider practice, pharmacy, local health department, or licensed health care facility.

      10. Immunizations included on the certificate shall only be those immunizations required for attending child day care centers, certified family child care homes, other licensed facilities which care for children, preschool programs, and public and private elementary or secondary schools as outlined in Section 2 of this administrative regulation. The certificate issued may have a separately titled additional page for all immunizations administered but not otherwise required for attending child day care centers, certified family child care homes, other licensed facilities which care for children, preschool programs, public and private elementary, and secondary schools.

      (5) A completed immunization certificate shall:

      (a) Be on file for a child:

      1. Enrolled in a public or private primary or secondary school or preschool program; or

      2. Cared for in:

      a. A child day care center;

      b. A certified family child care home; or

      c. Other licensed facility that cares for children; and

      (b) Be available for inspection and review by a representative of the Cabinet for Health and Family Services or a representative of a local health department.

 

      Section 5. Effective Date. This regulation shall become effective for the school year beginning on or after July 1, 2011 for all child day cares, certified family child care homes, other licensed facilities which care for children, preschool programs, public and private primary, and secondary schools.

 

      Section 6. Incorporation by Reference. (1) The following material is incorporated by reference:

      (a) "Commonwealth of Kentucky Immunization Certificate (EPID 230)", revised 08/2010;

      (b) "Commonwealth of Kentucky Provisional Immunization Certificate (EPID 230A)", revised 08/2010;

      (c) "Commonwealth of Kentucky Certificate of Medical Exemption (EPID 230B)", revised 08/2010"; and

      (d) "Commonwealth of Kentucky Certificate of Religious Exemption (EPID 230C)", revised 08/2010.

      (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Department for Public Health, 275 East Main Street, Frankfort Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m. (CDS-6; 1 Ky.R. 188; Am. 460; eff. 3-12-75; 3 Ky.R. 162; eff. 9-1-76; 785; 4 Ky.R. 114; eff. 8-3-77; 5 Ky.R. 933; eff. 7-17-79; 16 Ky.R. 666; 1187; eff. 11-29-89; 23 Ky.R. 2628; 2997; eff. 1-15-97; 27 Ky.R. 1351; 2160; eff. 2-1-2001; 29 Ky.R. 1097; 1613; eff. 12-18-02; 37 Ky.R. 1101; Am. 1442; eff. 12-15-2010.)