Physician's Guide to Medicine - Immunizations

What are the immunization requirements for children enrolled in child care centers, head starts, preschools, or nursery schools?
Are there any exceptions to the child care immunization requirements?
Are there any exceptions to the school immunization requirements?

What are the immunization requirements for children enrolled in child care centers, head starts, preschools, or nursery schools?

To enroll in or attend any public, private or parochial child care center, preschool, head start or nursery school that is licensed to care for ten or more children, a child must be adequately immunized against vaccine-preventable childhood diseases as specified by the Missouri Department of Health in accordance with the recommendations of the Advisory Committee on Immunization Practices. For information concerning these immunization requirements, contact the Missouri Department of Health at (573) 751-6133.

Child Care Immunization Requirements: Age-appropriate immunizations for all infants and children attending a child care center are required. Immunizations needed are: diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, Hib, and hepatitis B.

School Immunization Requirements:

Measles: All students starting Kindergarten, or who were five or six years of age as of the beginning of the 1990-91 school year, shall be required to have two doses of live measles vaccine by injection, separated by at least twenty-eight days on or after their first birthday. One dose of live measles vaccine received by injection on or after the first birthday shall be required for all children who started Kindergarten prior to the 1990-91 school year. Measles vaccines may be given alone or in combination with other vaccines.

Rubella: One dose of live rubella vaccine received by injection on or after their first birthday shall be required of all students. Rubella vaccines may be given alone or in combination with other vaccines.

Mumps: One dose of live mumps vaccine received by injection on or after their first birthday shall be required of all students. Mumps vaccines may be given alone or in combination with other vaccines.

Polio: Three doses of inactivated polio vaccine (IPV), oral polio vaccine (OPV), or any combination of these two vaccines shall be required for all students. The last dose must have been received at four years of age or greater; if not, an additional dose is required unless the student has received four or more doses of polio vaccine.

Diphtheria: Four doses of diphtheria toxoid vaccine are required for all students starting Kindergarten as of the beginning of the 1999-2000 school year. Three does of diphtheria toxoid vaccine are required for all other students. All students starting Kindergarten, or who were five or six years of age as of the beginning of the 1990-91 school year, must have received the last dose at four years of age or greater; if not, an additional dose is required unless the student has already received six or more doses of diphtheria toxoid. The diphtheria toxoid vaccine may be given alone or in combination with other vaccines.

Pertussis: Four doses of pertussis vaccine are required for all students starting Kindergarten as of the beginning of the 1999-2000 school year. Three doses of pertussis vaccine are required for all other students six years of age and younger. The last dose must have been received at four years of age or greater; if not, an additional dose is required unless the student has already received six or more doses of pertussis vaccine. Pertussis vaccine is not required for students seven years of age or older. Pertussis vaccines may be given alone or in combination with other vaccines.

Tetanus: Four doses of tetanus toxoid vaccine are required for all students starting Kindergarten as of the beginning of the 1999-2000 school year. Three doses of tetanus toxoid vaccine are required for all other students. Students starting Kindergarten, or who were five or six years of age as of and after the beginning of the 1990-91 school year, must have received the last dose at four years of age or greater; if not, an additional dose is required unless the student has already received six or more doses of tetanus toxoid. Tetanus toxoid vaccines may be given alone or in combination with other vaccines.

Tetanus and diphtheria toxoid booster: A booster dose of tetanus and diphtheria toxoid is required every ten years.

Hepatitis B: Three doses of hepatitis B vaccine shall be required for all students entering Kindergarten as of and after the beginning of the 1997-98 school year. Three doses of hepatitis B vaccines shall be required for all students entering the seventh grade at the beginning of the 1999-2000 school year.

Are there any exceptions to the child care immunization requirements?

If a child has not completed all of the required immunizations he or she may still enroll in a child care center, head start, preschool or nursery school if:

(1) There is satisfactory evidence produced that the child has begun the process of immunization. An Immunization In Progress Form (Imm.P. 14) must be on file at the facility;

(2) A licensed doctor of medicine or doctor of osteopathy certifies that immunization would endanger either the child's health or life or the child has documentation of laboratory evidence of immunity to the disease. A Medical Immunization Exemption Form (Imm.P. 12) must be on file at the facility; or

(3) The parent or guardian files a written objection to immunization. A Parent/Guardian Immunization Form (Imm.P. 11) must be on file at the facility. The parental exemption form must be renewed annually.

Are there any exceptions to the school immunization requirements?

If a child has not completed all of the required immunizations, he or she may still enroll in a school if:

(1) There is satisfactory evidence produced that the child has begun the process of immunization. An Immunization In Progress Form (Imm.P. 14) must be on file at the school;

(2) A licensed doctor of medicine or doctor of osteopathy certifies that immunization would endanger either the child´s health or life or the child has documentation of laboratory evidence of immunity to the disease. A Medical Immunization Exemption Form (Imm.P. 12) must be on file at the school; or

(3) The parent or guardian files a written objection that immunizations for their child violates his or her religious beliefs. A Parent/Guardian Immunization Form (Imm.P. 11) must be on file at the school.