School and camp requirements
- The Immunization Requirements for School Entry resource outlines the required vaccines by child care/preschool, grades K-6, grades 7-12, and college. While MDPH outlines the required vaccines, local school districts are responsible for ensuring compliance to the stated requirements.
- The 2020-21 school year will see the addition of new immunization requirements for meningococcal vaccine for school entry. The flyer, New Meningococcal Conjugate Vaccine (MenACWY) Requirement for School Entry (DOC), answers frequently asked questions about the new requirement.
- Camp directors and parents sending their children to camp may refer to the memo, Required Immunizations for Children Attending Camp, for immunization requirements and recommendations for children attending camp.
- Parents can use the Back to School Pup as an easy to read resource outlining immunization requirements by grade in both English and Spanish.
- The regulation pertaining to school immunization is 105 CMR 220.00: Immunization of students before admission to school
Herd immunity and importance of vaccines
Vaccines are one of the great public health advances of the 20th century, and prevent hundreds of thousands of illnesses in the U.S. every year. Vaccines protect both the person vaccinated and those around them from serious diseases, a concept known as herd immunity. Herd immunity protects other members of the community, such as babies too young to be vaccinated or those who cannot receive immunizations because of a medical condition.
- The FRED Measles Epidemic Simulator shows the impact on how low immunization rates for measles can result in large measles epidemics.
- Parents and caregivers should visit the CDC page, Vaccine Information for Parents, to learn more about childhood vaccines and the recommended immunization schedule.
- Students should be vaccinated according to the recommended immunization schedule. The CDC Immunization Schedules in Easy to Read Format show when children should get recommended vaccines.
School immunization data
Students in kindergarten through 12th grade are required to be immunized with DTaP/Tdap, polio, MMR, Hepatitis B, and Varicella vaccines.
School immunization rates provide insight into the vaccine coverage in communities across the state. Since immunization rates are not uniform across the state, school immunization data highlight areas that may be more susceptible to vaccine-preventable diseases. These data also show the importance of maintaining high immunization rates.
Massachusetts students must provide documentation of immunization, according to school requirements, or show a medical or religious exemption. Medical exemptions come from the student’s doctor and document a contraindication — the reason why an individual cannot medically receive the vaccine. Religious exemptions come from the parent/guardian, and state in writing that a vaccine conflicts with his/her sincerely held religious belief.
Rates of students with an exemption to one or more vaccines are captured in the annual immunization survey of kindergartens (and seventh grades/childcare/college). Exemptions presented here are medical and religious exemptions combined. However, most exemptions claimed in Massachusetts are religious exemptions. There are pockets of higher exemption rates in the western and southeast parts of the state, particularly the Cape and Islands. Areas with higher exemption rates may be more susceptible to disease outbreaks because these students are not fully protected.
Unimmunized rates by county
Many students have an exemption to only one or two vaccines, and are otherwise immunized. Beginning in 2015, our survey collected numbers of students with an exemption that have no documented vaccines on file. This shows the number of students that have an exemption to all vaccines and are likely unimmunized. This number is much lower than the total with an exemption or two. The regional clustering of students with no documented vaccines is similar to that of students with an exemption to one or more vaccines. Students that are completely unimmunized pose a greater risk to the community because they are unprotected from multiple infectious diseases.
Students not meeting school requirements by county
Policies on exclusion from school are developed and enforced at the local level. Many school districts allow students on a catch-up schedule to attend classes. Other school districts allow students to attend classes while awaiting updated immunization documentation. Beginning in 2016, the Immunization Division calculated the number of students that do not meet school requirements (i.e., not having all vaccines required for school with no exemption on file), and this number is often referred to as the “gap.” Students counted in the gap might be appropriately immunized, but the school lacks proper documentation of all received immunizations. However, in the event of a case of vaccine-preventable disease in the school setting, these students would also be subject to exclusion from school due to lack of documentation of immunity. The greater the percentage of the gap, the more significant the potential burden on schools and the community, should those students face exclusion during a breakout.
Immunization requirements are enforced by the grade the student is entering — parents can do their part to make sure their children are appropriately immunized for their grade level, and that updated immunization records are on file with the school nurse.
- Kindergarten Immunization Data by School 2018 – 2019
- Kindergarten Immunization and Exemption Rates by County 2018 – 2019
- Kindergarten Statewide Immunization Rates 1975-Current
- Kindergarten Statewide Exemption Rates 1984-Current
- Kindergarten Three-year Combined Data by School 2016-2018 (Excel)
This spreadsheet combines the last three years of school immunization survey information for each school. Schools that reported fewer than 30 students per year (and whose single-year data may not be available), may have a sufficient number of students over three years for the data to be reported here.
Grade 7 data
Information for schools and childcare programs
- For school nurses and others looking to review and interpret a child’s immunization schedule, the CDC provides guidance on the Recommended and Minimum Ages and Intervals Between Doses. Minimum ages and intervals apply for school requirements of the MMR, polio, and varicella vaccines. Nurses can also use our Combination Vaccines Flyer (DOC) and the list of ACIP Vaccine Abbreviations to help interpret immunization records.
- In the event of a case of vaccine-preventable disease in a school or childcare setting, students that do not meet school requirements may be subject to exclusion. The Vaccine Preventable Disease Exclusion Guidelines in School Settings (DOC) outlines exclusion criteria for specific vaccine-preventable diseases.
- School nurses are reminded that immunization requirements apply to all students, including exchange or visiting students from other countries. MDPH circulated a letter, Immunization Requirements and Visiting Students (DOC), reinforcing this requirement.
- Immunization records must be maintained for all students in the state. The Immunization Requirements for School Entry outline requirements for children 2 years of age and older, while the Preschool/Childcare Requirements Summary (DOC) outlines immunization requirements for children younger than age 2. Programs licensed by the Department of Early Education and Care (EEC) must comply with EEC regulations regarding child and staff immunizations. A summary of these requirements is found in this document: Preschool/Childcare Regulation Summary.
- Schools that have different levels of preschool or pre-kindergarten occasionally have questions about what requirements their students should meet. The MDPH has written a letter with a Clarification of Immunization Requirements for K0, K1 and K2 that can be used to determine the immunization requirements for each grade.
- Meningococcal vaccine is required in certain settings, including students attending college or a residential secondary school. More information on meningococcal disease and vaccination can be found at: Meningococcal Disease Vaccination and Information Requirements for Schools and Academic Institutions.
- Schools and early education providers are required to distribute to parents information regarding the benefits of annual influenza vaccination for children 6 months to 18 years of age. The Flu Awareness Cover Letter (DOC) outlines the legislation around this requirement and provides resources for schools. Circulation of the MDPH document The Flu: A Guide for Parents (DOC) meets this distribution requirement. The flu guide is also available in Spanish (La gripe: Guía para padres (Spanish version) (DOC) and Portuguese (Gripe: um guia para os pais (Portuguese version) (DOC).