Header:
CODE OF RHODE ISLAND RULES
AGENCY 14. DEPARTMENT OF HEALTH
SUB-AGENCY 040. COMMUNICABLE DISEASE
CHAPTER 007. IMMUNIZATION AND TESTING FOR COMMUNICABLE DISEASES FOR STUDENTS ENTERING COLLEGES OR UNIVERSITIES
Date:
08/31/2009
Document:
14 040 007 IMMUNIZATION AND TESTING FOR COMMUNICABLE DISEASES FOR STUDENTS ENTERING COLLEGES OR UNIVERSITIES
INTRODUCTION
These rules and regulations are promulgated under the authority of section 23-1-18(9) of the General Laws of Rhode Island, as amended, and are established in accordance with the most current recommendations of the Centers for Disease Control and Prevention for the purpose of adopting standards pertaining to requirements for immunizations and testing for communicable diseases for students entering colleges or universities in Rhode Island.
Pursuant to the provisions of section 42-35-3(c) of the General Laws of Rhode Island, as amended, consideration was given to: (1) alternative approaches to the regulations; (2) duplication or overlap with other state regulations: and (3) significant economic impact placed on small business as defined in Chapter 42- 35 of the General Laws as a result of the amended regulations. No alternative approach, overlap or duplication nor any significant economic impact was identified, consequently the regulations are adopted in the best interest of the health, safety and welfare of the public.
These regulations shall supersede all previous Rules and Regulations Pertaining to Rubella and Measles Immunization for Persons Entering Colleges or Universities promulgated by the Rhode Island Department of Health and filed with the Secretary of State.
TABLE OF CONTENTS
1.0 Definitions
2.0 General Requirements
3.0 Minimum Standards for Immunization and Communicable Disease Testing for Students Entering Colleges or Universities
4.0 Tuberculosis Testing
5.0 Severability
References
Section 1.0 Definitions
Wherever used in these rules and regulations, the following terms shall be construed as follows:
1.1 "Advisory Committee on Immunization Practices (ACIP) recommendations", as used herein, means official federal recommendations for the use of vaccines in the United States and as published by the Centers for Disease Control and Prevention.
1.2 "College" or "university" means any public or private institution of higher learning in the state of Rhode Island.
1.3 "Department" means the Rhode Island Department of Health.
1.4 "Director" means the Director of the Rhode Island Department of Health.
1.5 "Entering" means formal registration by a student (as defined in section 1.7 herein) for initial attendance at a college or university to pursue a course or courses of study.
1.6 "Physician", as used herein, means an individual licensed under the provisions of Chapter 5-37 of the General Laws of Rhode Island, as amended, or an individual licensed to practice allopathic or osteopathic medicine under the laws of another state or territory of the United States, provided those laws are deemed to be substantially equivalent to Chapter 5-37 of the Rhode Island General Laws, as amended.
1.7 "Student", as used herein, means any person entering any public or private college or university in Rhode Island as a:
. full-time undergraduate or graduate student;
. part-time undergraduate or graduate student in a health science program who may be in contact with patients; and
. full or part-time student entering an institution of higher education in Rhode Island while on a student or other visa, including a student attending or visiting classes or programs as part of a formal academic visitation or exchange program.
1.8 "Waiting period" means the time interval between scheduled doses of vaccine. The length of waiting periods are defined by the ACIP.
Section 2.0 General Requirements
2.1 Colleges and universities shall adopt, at a minimum, the standards of immunization and communicable disease testing contained in section 3.0 of these regulations.
2.2 It shall be the responsibility of the administrative head, or his/her designee, of any college or university to secure compliance with these rules and regulations.
2.3 Persons charged with reporting communicable diseases (e.g., physicians, physician assistants, registered nurse practitioners, midwives, laboratories, certified school nurse teachers, and other entities or persons) shall comply with the most current version of the Rules and Regulations Pertaining to the Reporting of Communicable, Environmental and Occupational Diseases of reference 5 herein and the most current version of the Guidelines for Prevention and Control of Communicable Diseases issued by the Department.
2.4 In accordance with ACIP recommendations, for all vaccines discussed herein, vaccine doses administered less than or equal to four (4) days before the minimum interval or age shall be counted as valid. Doses administered five (5) or more days earlier than the minimum interval or age shall not be counted as valid doses and shall be repeated as age-appropriate. The repeat dose should be spaced after the invalid dose by the recommended minimum interval as provided in ACIP recommendations. (For more information, please see reference 1 herein).
Section 3.0 Minimum Standards for Immunization and Communicable Disease Testing for Students Entering Colleges or Universities
3.1 Each student, upon entering any college or university in this state, shall furnish evidence to the administrative head of the college or university (pursuant to the requirements of section 3.4 of these rules and regulations) that the student has been immunized, as required in section 3.3, unless the student is in an exempt category (e.g., documented evidence of immunity).
3.2 For the immunization requirements stipulated in section 3.3 below, a student who is not in compliance with these requirements shall be excluded from attending college or university classes until the requirements are met, unless the student belongs in an exemption category or is in a waiting period between doses as described in sections 3.9 or 3.10 herein.
College or University Entry: Immunization Requirements
3.3 Each student, upon entering any college or university, shall furnish evidence as required in section 3.4 herein of having received the vaccines described below:
3.3.1 Tetanus, Diphtheria
Evidence of a booster dose of Td within the last ten (10) years shall be required.
3.3.2 Measles, Mumps, and Rubella Vaccines
All students who enter a college or university are required to have received two (2) doses of a measles-containing vaccine (preferably MMR vaccine), one (1) dose of a mumps vaccine, and one (1) dose of a rubella vaccine. The first dose of these three vaccines must be given on or after the first birthday. The second dose of a measles-containing vaccine (preferably MMR vaccine) must be given at least one (1) month after the first dose.
Students born on or before December 31, 1956 are required to have one dose of a measles containing vaccine, one dose of mumps, and one dose of rubella and thus are exempt from the two dose requirement of a measles containing vaccine.
Students vaccinated prior to 1968 shall be revaccinated, unless documentation is provided that indicates that a live virus vaccine was used in vaccinating the student.
3.3.3 Hepatitis B Vaccine
A completed series of hepatitis B vaccine is currently recommended, but shall be required for all students entering on or after August 1, 2006. Three (3) doses of hepatitis B vaccine shall be required for all health science students upon entering a college or university.
3.3.4 Varicella (Chickenpox) Vaccine
All health science students, upon entering a college or university, are required to have received one (1) dose of varicella (chickenpox) vaccine on or after his/her first birthday or, if the first dose is given on or after the student's thirteenth (13th) birthday, two (2) doses of varicella (chickenpox) vaccine, in accordance with the ACIP guidelines.
It is currently recommended that all other students (i.e., those not enrolled in a health science curriculum) meet the requirement for varicella vaccine stated above.
On or after August 1, 2006, all students, upon entering a college or university, are required to have received one (1) dose of varicella (chickenpox) vaccine on or after his/her first birthday or, if the first dose is given on or after the student's thirteenth (13th) birthday, two (2) doses of varicella (chickenpox) vaccine, or in accordance with the most current recommendations of the ACIP guidelines.
3.3.5 Meningococcal Vaccine
It is required that college health services provide information to students entering colleges or universities, and their parents, about meningococcal disease and meningococcal vaccine.
It is recommended that freshmen students entering colleges or universities living in dormitories be vaccinated against meningococcal disease with at least a single dose of quadrivalent meningococcal polysaccharide vaccine if they have not already been vaccinated, and/or in keeping with the most current ACIP recommendations.
Immunization Records
3.4 Acceptable evidence of completion of immunizations shall include the day, month, year and type/name of each dose of vaccine administered. The record of such evidence shall be signed by a physician or his/her designee (the signature of the student's parents is not acceptable). This record may be submitted to the college or university by a health care provider, another college or university, the student, or a parent/guardian.
3.4.1 For students who initially entered primary school on or before December 31, 1989, existing immunization records shall be deemed acceptable, provided the record contains a valid exemption form or contains documentation that the student has completed the required immunizations.
3.4.2 Acceptable evidence of completion of immunization consists of:
(a) an official immunization record card, school immunization record, Medical Passport, World Health Organization immunization record, or other official immunization records acceptable to the Department; or
(b) an electronically stored and/or transmitted documentary record (facsimile transmission, computerized record, including, but not limited to, a record on magnetic media or similar record) as may be utilized by a school; or
(c) presentation of laboratory evidence of immunity is made in the case of measles, mumps, rubella, hepatitis B, and varicella (chickenpox); or
(d) a physician, physician assistant, certified registered nurse practitioner, or other licensed practitioner acting within his/her scope of practice signs a statement that the student has a history of chickenpox disease (varicella).
Provisions for Exclusions, Waiting Periods, and Exemptions
Exclusions
3.5 Students who have not received the minimum number of required immunizations, who are not in a prescribed waiting period between doses, as specified in section 3.9 herein and who are not exempt pursuant to section 3.10 herein, shall be excluded from the college or university by the administrative head of the college or university, pending the completion of the required dose(s) of vaccine(s).
3.6 Students upon entering any college or university shall be excluded unless evidence is submitted that the student has received initial dose(s) of required vaccine(s) for college or university entry as set forth in these rules and regulations herein.
3.7 If an outbreak of vaccine-preventable disease should occur, an exempt student shall be excluded from school by the administrative head of school for a period of time as determined by the Health Department based on a case-by-case analysis of public health risk.
3.8 The college or university shall have a written protocol in place for the exclusion of unvaccinated students in the event of an outbreak. An accurate and current listing of all unvaccinated students shall be maintained by the college or university for this purpose.
Waiting Periods
3.9 If, at college or university entry, a student is within a waiting period for the minimum number of doses for a given vaccine, the student shall be enrolled and/or admitted to the college or university. It shall be the responsibility of the administrative head of the college or university or his/her designee to ensure the completion of at least the minimum number of immunizations, following the prescribed waiting period(s) and consistent with the provisions of these rules and regulations.
Exemptions
3.10 A student may be exempt from the immunization requirements described herein provided that:
3.10.1 a physician, physician assistant, certified registered nurse practitioner, or other licensed practitioner acting within his/her scope of practice signs the Department's "Medical Immunization Exemption Certificate" provided by the college/university attesting that the student is exempt from a specific vaccine because of medical reasons, in accordance with ACIP guidelines, American Academy of Pediatrics (AAP) guidelines, or package insert instructions;
or
3.10.2 a parent or guardian or student if 18 years of age or older completes and signs the Department's "Religious Immunization Exemption Certificate" provided by the college/university, attesting that immunization conflicts with the tenets of their religious beliefs;
or
3.10.3 the administrative head of the college or university or his/her designee signs a Temporary Immunization Exemption Certificate, provided by the college/university, indicating that an appointment with a health care provider for the required immunization(s) has been made. This temporary exemption shall expire on the date of the immunization appointment.
Section 4.0 Tuberculosis Testing
4.1 Targeted tuberculosis (TB) testing is required for entering students who are from highly endemic countries of the world and have been resident in the United States for less than five (5) years. Testing should be conducted according to the most current version of the Guidelines for Communicable Disease Prevention and Control of the Department of Health.
Section 5.0 Severability
5.1 If any provision of these rules and regulations or the application thereof to any person or circumstances shall be held invalid, such invalidity shall not affect the provisions or application of the rules and regulations which can be given effect, and to this end the provisions of the rules and regulations are declared to be severable.
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