August 19, 2003



August 19, 2003

Dear School Administrator:

Re: New vaccine requirements and health information

This is to inform you of important health and vaccine requirements impacting schools this year. The Texas Department of Health (TDH) can assist with implementing the new vaccine requirements and provide information, technical assistance, and training resources on the issues outlined in this letter.

Exemption from Vaccine Requirements

On June 10, 2003, Governor Perry signed HB 2292 that included language allowing an exemption to vaccine requirements for school admission for reasons of conscience, including religious beliefs. This vaccine exemption is effective on September 1, 2003. With many Texas schools beginning classes in August, however, many school administrators are unsure of how to interpret and implement this new conscientious exemption language.

Students enrolling prior to September 1, 2003 for the 2003-2004 school year are under current law that does not allow for a vaccine exemption for reasons of conscience. Students enrolling before September 1, 2003 can get a vaccine exemption for religious reasons. TEA policy requires school districts to provisionally enroll students for no more than thirty days, pending receipt of their immunization records. Schools provisionally enrolling students are required to have systems in place to readily identify these students after 30 days. At the end of the 30-day provisional enrollment period, students must have an official TDH affidavit form and/or an immunization record on file with the school in order to stay enrolled. Students who cannot produce either of these two documents should be excluded from attendance.

The official TDH affidavit form that parents must use to claim exemption from vaccine requirements is being developed by TDH but is not yet available. By law, this affidavit form has to be secure and not easily reproduced. Only the official TDH affidavit form is legally valid for the conscientious exemption for immunizations. School administrators should be aware that bogus affidavits have been distributed and these should be disregarded. School administrators who receive any bogus affidavits should fax a copy to the TDH Bureau of Immunization and Pharmacy Support at 512/458-7544. Parents or guardians need to request affidavit forms in writing and include the child’s name and date of birth. Written requests must be submitted through the U.S. Postal Service, commercial carrier or by hand-delivery to: TDH Bureau of Immunization and Pharmacy Support, 1100 W. 49th Street, Austin, Texas 78756. Attached is a list of Frequently Asked Questions to help you respond to inquiries about this new vaccine exemption.

Five Doses of DTaP Required for Certain Students

By the Governor’s executive order, the Texas Board of health approved, on August 7, 2003, emergency rules requiring an additional dose of diphtheria-tetanus-acellular pertussis (DTaP) vaccine for children 3 years and 4 years of age. Children 18 months through 3 years of age require 4 DTP/DT/DTaP doses, and children 4 years of age are required to have 5 doses. If the fourth DTaP dose was given on or after the 4th birthday, then a fifth dose is not necessary. Effective immediately, the DTaP requirement may apply to some pre-kindergarten and kindergarten students this school year. All public and private schools are expected to enforce this rule in addition to all other age-appropriate vaccine requirements. For more information about DTaP requirements or the conscientious exemption go to: or contact Monica Gamez at (888) 963-7111 ext. 6470, monica.gamez@tdh.state.tx.us.

Local District Health Advisory Councils

SB 1357 revised Texas Education Code §28.004 and §38.013, which changed the name and broadened responsibilities of the local district health advisory council to include school health services; counseling and guidance services; a safe and healthy school environment; and school employee wellness. The school health advisory council (SHAC) could assist your district with implementation of new school health requirements and guidelines. This is especially important considering the legislative mandate with SB 19, 77th Legislature, which requires all elementary schools in Texas to implement a TEA-approved health program by September 2007. The purpose of the coordinated school health requirement is to provide school-based interventions aimed at reducing the risk factors associated with obesity and Type 2 diabetes. The required coordinated health program will focus on improving dietary and physical activity patterns of adolescents. For assistance, contact Anita Wheeler, R.N. at (888) 963-7111, ext. 2909, anita.wheeler@tdh.state.tx.us.

Students with Diabetes

The U.S. Department of Health and Human Services is mailing all school districts, Helping the Student with Diabetes Succeed: A Guide for School Personnel. TDH, along with the Texas Diabetes Council, is identifying methods to help schools review policies and develop personnel training via regional Education Service Centers and other resources. A link to the Guide and the American Diabetes Association’s training package, Diabetes Care Tasks at School: What Key Personnel Need to Know, is at . For further assistance, contact Kathleen King-Tryce, R.N. at (888) 963-7111, ext. 2610, Kathleen.king-tryce@tdh.state.tx.us or Michele McComb, R.N. at (888) 963-7111, ext. 3307, michelle.mccomb@tdh.state.tx.us.

Managing Wound Infections

TDH has school instructions on preventing and maintaining wound infections. It is important that schools understand this valuable information as the number of Methicillin-resistant Staphylococcus aureus (MRSA) cases in school settings has increased. MRSA is not currently a reportable condition; however, TDH’s Infectious Disease Epidemiology and Surveillance Division provides consultation. For information on Staphylococcal Infections go to: tdh.state.tx.us/ideas/antibiotic_resistance/mrsa/school_athletic_departments.asp or contact Marilyn Felkner at (888) 963-7111, ext. 6393, marilyn.felkner@tdh.state.tx.us.

Our best wishes for a productive school year. Both TDH and TEA are available to assist you with information to create a safe, healthy educational environment for Texas schoolchildren.

Sincerely,

Eduardo J. Sanchez, M.D., M.P.H. Robert Scott

Commissioner of Health Chief Deputy Commissioner of Education

Attachment

Frequently Asked Questions

Vaccine Exemption for Reasons of Conscience

Q. How do I obtain a vaccine exemption for reasons of conscience for my child?

A. Parents or guardians need to request a vaccine exemption affidavit form in writing. Each child’s name and date of birth must be included in the request. The requests must be submitted through the U.S. Postal Service, commercial carrier or hand delivered to:

Texas Department of Health

Bureau of Immunization and Pharmacy Support

1100 W. 49th Street

Austin, Texas 78756

Q. What if I have already submitted a request for a vaccine exemption affidavit form by e-mail or fax?

A. Any request submitted by e-mail or fax will need to be resubmitted in writing and sent through the U.S. Postal Service, commercial carrier or hand delivered to the above address.

Q. How many vaccine exemption affidavit forms can a parent or guardian request at one time?

A. Parents or guardians can request up to five vaccine exemption affidavit forms per child.

Q. What information will be listed on the vaccine exemption affidavit form I receive?

A. Information on the form will include the child’s name; date of birth; a list of vaccines for which exemptions may be requested; a statement for the requesting parent or guardian to indicate their relationship to the child; and an acknowledgement that the parent or guardian has read attached information entitled The Benefits and Risks of Vaccinations. Parents or guardians will then have to sign the form in front of a notary public.

Q. What will happen to the information collected on each child?

A. Requests submitted to TDH will be destroyed once vaccine exemption affidavit forms are mailed to parents or guardians. TDH will track and report on the number of affidavit requests but no personal information will be maintained.

Q. What should parents or guardians do with the vaccine exemption affidavit form?

A After the original vaccine exemption affidavit form is signed and notarized, it must be submitted to the child’s school.

Q. For how long is each child’s individual exemption affidavit valid?

A. Each individual vaccine exemption affidavit is good for five years from the date notarized.

Q. What happens if the parent or school loses the original vaccine exemption affidavit?

A. Photocopies of the vaccine exemption affidavit form are not valid. If parents or schools lose the exemption affidavit, the parent or guardian needs to request another vaccine exemption affidavit in writing following the same procedures used to obtain the first form.

Q. What if my child changes schools?

A. The vaccine exemption affidavit is part of the child’s school records and should be sent to the new school with other school records.

Q. Does a child have a 90-day provisional enrollment in school while awaiting the vaccine exemption form?

A. No. TEA policy requires school districts to provisionally enroll for no more than 30 days, those students whose parents or guardians wish to claim exemption from vaccine requirements for reasons of conscience.

Q. What happens at the end of the 30-day provisional enrollment period?

A. Once the 30-day provisional enrollment period ends, parents or guardians must present an official notarized TDH affidavit form, an up-to-date immunization record or a physician’s affidavit of medical contraindication to school officials to attend school. If parents or guardians cannot produce one of these three documents, their child will be excluded from attendance.

Q. What is required for school enrollment if I want my child exempt from some vaccines but not all of them?

A. Two different immunization documents will be needed: 1) an official notarized TDH vaccine exemption affidavit for those vaccines the parent or guardian has chosen for reasons of conscience to have their child exempt from; and 2) a valid immunization record indicating the month, date and year each vaccine for which the child is not exempt was administered, with appropriate validation by a physician or public health clinic.

Q. If a child currently has a religious exemption for vaccinations on file with the school, do they need to obtain a new vaccine exemption for reasons of conscience affidavit?

A. No. Students who are currently exempt from vaccination for religious beliefs and already have an affidavit on file at the school they attend do not need a new vaccine exemption affidavit form. The religious exemption on file remains valid.

What if there is a vaccine-preventable disease—such as measles—outbreak at a school?

Each parent or guardian who signs a vaccine exemption affidavit form also is acknowledging they understand that their child may be excluded from school attendance in times of emergency or epidemic declared by the Texas Commissioner of Health.

Q. Does this new vaccine exemption option mean that my vaccinated child may be attending school with other children who are not fully vaccinated?

A. Yes.

Q. Can an expectant parent request a vaccination exemption affidavit form for an unborn child?

A. No. Because the child’s name and date of birth is required when the vaccine exemption affidavit form is requested, expectant parents must wait until after the child is born to request the vaccine exemption affidavit form.

Q. Can schools accept any other documents, other than a TDH vaccine exemption affidavit for reasons of conscience, to exempt a child from vaccination requirements for enrollment?

Yes. In addition to the vaccine exemption for reasons of conscience or religion, parents or guardians also may present for their child an affidavit or certificate signed by a licensed physician, which states that, in the physician's opinion, the immunization required would be injurious to the child’s health and well-being or any of the child’s family or household member. Unless a lifelong condition is specified, this affidavit or certificate is valid for only one year from the date signed by the physician and must be renewed every year for the exclusion to remain in effect.

 

Q. Are there other reasons a child may be exempted from vaccination requirements?

 

A. A child may be exempt from one or more vaccinations for medical reasons. The parent or guardian must provide the school with a certificate signed by a physician, registered and licensed to practice medicine in Texas, which states that, in the physician’s opinion, the immunization required would be injurious to the child’s health and well-being or to any of the child’s family or household members. Unless a lifelong condition is specified, that certificate is valid for one year from the date signed by the physician and must be renewed every year for the exclusion to remain in effect.

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