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School Immunization Model Policy

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Rationale

Vaccination is regarded as one of the top 10 greatest achievements of public health in the last century. The successful vaccination of each US birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease.1 On-time vaccination throughout childhood is essential, because it helps provide immunity before children are exposed to potentially life-threatening diseases.2 

 Safeguarding places where children gather, like schools and daycares, requires a commitment to health from parents, administrators, clinicians and the health department. South Dakota Codified Law (SDCL 13-28-7.1) requires that any child entering school or an early childhood program in this state shall, prior to admission, be required to present to school authorities certification from a licensed physician that the child has received, or is in the process of receiving, adequate immunization against poliomyelitis, diphtheria, pertussis, rubeola (measles), rubella, mumps, tetanus, meningitis, and varicella (chickenpox), according to recommendations provided by the South Dakota Department of Health (SD DOH). This law applies to all children entering a South Dakota school district for the first time. This would include children in early intervention programs, preschool, kindergarten, and students transferring from another state through twelfth grade. Children under 4 years of age need to be age appropriately immunized. As an alternative to the requirement for a physician’s certification, the child may present: 

  1.  Certification from a licensed physician stating the physical condition of the child would be such that immunization would endanger the child’s life or health; or 
  2.  A written statement signed by one parent or guardian stating the child is an adherent to a religious doctrine whose teachings are opposed to such immunization. 

For the 2021–2022 school year, 339 South Dakota schools with kindergarten classes submitted vaccination audit data to the South Dakota Department of Health. South Dakota’s overall coverage rate was 93.7% for the MMR (measles, mumps, rubella) vaccine, 93.2% for the DTaP (diphtheria, tetanus, pertussis) vaccine, and 95.5% for the varicella (chicken pox) vaccine. One concerning trend has been the incremental increase in the overall exemption rate from 1.8% in 2013 to 3.5% in 2021.4 

Policy Guidelines

The adoption of an immunization policy will lead to a reduction in the incidence of vaccine-preventable diseases. This model policy can be used in its entirety or adapted to fit the needs of your school. A school immunization policy can include a few or all of the following guidelines: 

  1. [School] will enforce the following mandatory immunizations for any child entering kindergarten: diphtheria, pertussis and tetanus; poliovirus; measles, mumps and rubella (MMR), and varicella.5, 6, 7 
  2. [School] will enforce the following mandatory immunizations for any child entering 6th grade: tetanus, diphtheria and pertussis (Tdap), meningococcal conjugate (MCV4). See full requirements on the SD Department of Health website.5, 6, 7 
  3. [School] will comply with South Dakota Department of Health requirements in submitting immunization records for all students, including requirements for students entering a South Dakota school for the first time, beginning kindergarten, or entering 6th grade.5, 6, 7 
  4. [School] will provide adequate communication to families with a student entering a South Dakota school for the first time, beginning kindergarten, or 6th grade regarding the requirements of the law. This communication should outline mandatory immunizations needed prior to the start of the school year. 
  5. [School] will provide education to families on the importance of fully vaccinating children against all vaccine-preventable diseases, including those that are recommended but not required by law: Hib, Hepatitis A, Hepatitis B, Human Papillomavirus (HPV), annual influenza, Meningococcal B and Pneumococcal. 
  6. [School] will uphold the State law regarding allowable exemptions. Schools will educate parents on the allowable exemptions as well as inform parents that other exemptions including philosophical exemptions are not allowable by state law.5, 6, 7
  7. [School] will utilize the required South Dakota Department of Health—Certificate of Immunization form to document Medical/Religious exemptions.5, 6, 7
  8. [School] will ensure appropriate certification from a licensed physician stating that immunization would endanger the child’s life or health prior to granting medical exemption.5, 6, 7
  9. [School] will communicate with the student’s health care provider regarding required immunizations as permitted by SDCL 34-22-12.5.7 
  10. [School] will designate at least one staff person responsible for tracking all student immunization records and submitting records to the SD Department of Health. 
  11. [School] will notify parents/guardians of free or reduced community immunization services when available. 
  12. [School] will set up a system to monitor any student who is in the process of receiving adequate immunization and communicate properly with the family to ensure full vaccination as soon as possible per the Department of Health vaccination requirements. 
  13. [School] will maintain immunization records per the recommendations of the State of South Dakota Bureau of Administration Records Management Program.9 

Implement

Following are Instructions for Submitting Immunization Records for kindergarten, 6th Grade, and Transfer Students to the South Dakota Department of Health. 

Two options are available to submit immunization records:

Option 1 (Preferred)

Utilizing the SD Immunization Information System (SDIIS):

  • Utilize SDIIS to verify adequate immunization. 
  • Make a roster, enter child’s name, date of birth and indicate the type of immunization record used. 
    • Note: It is not necessary to print a hard copy long version of the immunization record from SDIIS. 
  • Religious and Medical Exemptions need a CURRENT Certificate of Immunization form completed and signed by a parent (religious exemption) or by a physician (medical exemption). Note: Only a licensed physician may sign a medical exemption. 
  • As an alternative to the requirement for a physician or parent signature on Certificate of Immunization the child may present: 
    • Certification from a licensed physician stating the physical condition of the child would be such that immunization would endanger child’s life or health; 
    • or a written statement signed by one parent or guardian stating the child is adherent to a religious doctrine whose teachings are opposed to such immunization. 
  • Rosters with COMPLETE information should be sent to your assigned Community Health Nurse no later than Nov 1st of the current school year. 

Sample Roster:

Washington ElementaryKindergarten2019–2020Hughes County
Name of StudentDOBSDIISCertificate of Immunization
Anderson, Timothy01/01/2009Yes
Hughes, Hailey02/01/2009NoAttached (religious exemption)
Smith, Sam02/12/2009YesAttached (medical exemption)

Option 2

Utilizing the Certificate of Immunization form (hard copy/triplicate form):

  • Order Certificate of Immunization form from the SD Department of Health. 
  • Must use most up to date version received from the SD Department of Health. 
  • Follow the guidance on the back of form outlining the required immunizations. 
  • Compile a separate roster for kindergarten, 6th-grade, and transfer students. 
  • Complete all demographics on form. 
  • All immunizations should be documented with a complete date corresponding to the correct Vaccine Type: 
    • E.g.: DTaP/DT 01/18/2007, 03/26/2007, 06/19/2007, 10/17/2013 
  • Parents must sign and date their signature on the certificate in the designated box if a child has had the chicken pox. 
  • Records need to be signed by the designated school health authority. 
    • Note: It is permissible for a school secretary or a principal to sign. 
  • Medical exemption is signed by the student’s doctor. If certification of an immunization form is not available, the parent may submit: 
    • Certification from a licensed physician stating the physical condition of the child would be such that an immunization would endanger the child’s life or health ***Signature from a Nurse Practitioner, Physician’s Assistant or Chiropractor WILL NOT be accepted!*** 
  • Religious exemption is signed by the parent. If certification of an immunization form not available, the parent may submit: 
    • A written statement signed by one parent or guardian that the child is adherent to a religious doctrine whose teachings are opposed to such immunization. 
  • Philosophical exemptions/personal exemptions are NOT permissible under South Dakota law. 
  • Arrange rosters and immunization certificates alphabetically; combine if more than one class. 
  • Send rosters and immunization certificates to your assigned Community Health Nurse by Nov 1st of the current school year. 

Transfer Students

  • Transfer students are defined as students entering a South Dakota school for the very first time. 
    • E.g.: A child moving to South Dakota from Michigan or a child previously home-schooled and now entering a South Dakota school. 
  • Transfer students’ immunization records need to be submitted with same guidelines for kindergarten and 6th grade students. 

Pre-Kindergarten Students or Jr Kindergarten Students

  • Currently do not send records for students in these classes to the Department of Health. 
  • Collect immunization records for each student and hold in the student’s file until they enter kindergarten the next fall. 
    • Note: If a child moves from Pre-K directly to first grade, they are considered a transfer student. 

Please contact the SD Department of Health Immunization Program 605-773-3737 with any questions. 

Students “In Process” or “Non-Compliant”

The school should set up a system to monitor any student who is in the process of receiving adequate immunization and communicate properly with the family to ensure full vaccination as soon as possible per the South Dakota Department of Health vaccination requirements. If a student is missing a required immunization the parent should be notified immediately by the person in charge of processing immunizations (i.e. clerical, school nurse). They should discuss with the parent the reasons for student not being up-to-date. Barriers may include but are not limited to lack of education, transportation, health care, or funding. The school should work with families to connect them to the proper resources. Schools must continue to work with families to ensure students are up-to-date on their immunizations. 

Enforcement

Schools have the authority to enforce the law (SDCL 13-28-7.1). The South Dakota Department of Education does audit student files to ensure immunization records are present. 

Student Exclusion from School

If a student is not up-to-date on their immunizations, schools should work with families to determine what barriers the student has to obtaining immunizations. Barriers may include but are not limited to lack of education, transportation, health care, or funding. The school should work with families to connect them to the proper resources. When schools have exhausted all efforts to assist families and/or parents refuse to have their child vaccinated, the school may exclude a student. If pursuing exclusion, the school should inform the family of the effective exclusion date and provide them with information regarding the immunizations needed for re-admittance. Homeless students CANNOT be excluded per federal law (McKinney Vento Act). The school should work with families to connect them to the proper resources. Schools must continue to work with families to ensure students are up-to-date on their immunizations. 

Quality Measures

The goal for childhood immunizations is to reach 100%, which includes students who are up-to-date with immunizations and those exempted with documentation on file. 

Final Statement

By implementing this model policy in its entirety or choosing to tailor this policy to your school’s needs, you are taking an important step to improve childhood immunization rates. 

Definition of Terms

Immunization—Immunization is a way to make you immune to a disease, specifically by taking a vaccine. 

Transfer student—Any child entering a South Dakota school district for the first time, including kindergarten. 

School—Any Department of Education accredited public or private school in South Dakota. 

Summary

Contact (program representative) with questions or concerns about the policy. 

Policy Monitoring and Review
(Program Name) will evaluate and revise this policy on an annual basis.

References

Reference to county immunization rates

  1. “Ten Great Public Health Achievements—United States, 1990-1999.” Morbidity and Mortality Weekly Report, vol. 48, no. 12, 1999, pp. 241–243., https://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm. 
  2. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/parents/why-vaccinate/vaccine-decision.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fparents%2Fvaccine-decision%2Findex.html.
  3. Seither R, Calhoun K, Street EJ, et al. Vaccination coverage for selected vaccines, exemption rates, and provisional enrollment among children in kindergarten—United States, 2016-2017 school year. Morbid Mortal Wkly Rep. 2017;66(40):1073-1080. https://www.cdc.gov/mmwr/volumes/66/wr/mm6640a3.htm. 
  4. South Dakota Vaccination Rates —2021-2022 School Year. SD Public Health Bulletin June 2022. https://mailchi.mp/bf9ed00f0119/south-dakota-public-health-bulletinapril-16116169?e=7223ce62f0
  5. State of South Dakota. South Dakota Local School Records Retention and Destruction Schedule. 2017:54-56. https://boa.sd.gov/central-services/docs/Local_Schools_2017_Revised.pdf. 
  6. South Dakota Legislative Research Council. https://sdlegislature.gov/statutes/Codified_laws/DisplayStatute.aspx?Statute=13-28-7.1&Type=Statute. Retrieved 8/7/19. 
  7. South Dakota Department of Health. https://doh.sd.gov/family/childhood/immunization/school.aspx. Retrieved 8/7/19. 
  8. South Dakota Legislative Research Council. https://sdlegislature.gov/statutes/Codified_laws/DisplayStatute.aspx?Statute=34-22-12.5&Type=Statute. Retrieved 8/7/19. 
  9. South Dakota Legislative ResearchCouncil. https://sdlegislature.gov/Rules/DisplayRule.aspx?Rule=44:81. Retrieved 8/7/19.