ADMISSION REQUIREMENTS: Physical Examinations, Immunizations, Tuberculosis Screening 1. Physical Examination Before any child is admitted for the first time to any public elementary school (preschool, grades K4), such child must have a comprehensive physical examination, of a scope as prescribed by the State Department of Health, by a qualified licensed physician or licensed nurse practitioner, or licensed physician assistant acting under the supervision of a licensed physician who will make a report of such examination and summarize any abnormal physical findings at the end of such report, and who will specifically state what, if any, conditions are found that would identify the child as disabled. If a student is enrolled in preschool, the student is still required to present proof of a physical examination received no earlier than 12 months prior to the date of first entering kindergarten. The report will be made on the most current version of the MCH-213, or a form which includes the same components. A. A copy of such report must be presented to the school on the child's behalf. B. Such report must indicate that the child has received such physical examination no earlier than 12 months prior to the date of first entering preschool, kindergarten or elementary school. C. A certificate of recent physical examination by a U. S. licensed physician (School Entrance Physical Examination and Immunization Certification form) is required for all foreign-born students, kindergarten through 4th grade performed no earlier than 12 months prior to date of first entering school. D. Transfer students entering the must provide either one of the following: (1) Records establishing that a physical examination was completed no earlier than 12 months prior to enrolling in another public school. Evidence of such an examination may be: (a) (b) a copy of the report of the medical examination transcript notation or phone verification from the other school with records to follow (2) A report of a physical examination which meets the Virginia physical examination 1
requirements, performed within the last 12 months. A transfer student entering a middle school or high school shall not be required to submit a certificate of a physical examination. However, evidence of immunization and tuberculosis screening, if applicable, is required before the student may attend class. E. A student registering directly for alternative high school placement or adult education who is 18 years of age or older shall not be required to submit a certificate of a physical examination. However, evidence of immunization and tuberculosis screening, if applicable, is required before the student may attend class. F. Such physical examination reports will be placed in the student s record at school and shall be made available for review by local or state health department employees or officials. G. Such physical examination will not be required of any student whose parent or guardian objects on religious grounds and who shows no visual evidence of sickness. The parent or guardian must state in writing that, to the best of his/her knowledge, the student is in good health and free from any communicable or contagious disease. H. If a student is homeless, and for that reason cannot furnish documentation of a physical examination, the student should be immediately enrolled and immediately referred to the appropriate resource. The FCCPS homeless liaison is available to help the student obtain the necessary physical examination. I. The Fairfax County Health Department provides referral information for physical examinations for indigent children, upon request. 2. Immunizations Before entering a public school (preschool, grades K-12), every pupil must furnish a certificate (see paragraph D below, "Evidence of Immunization") certifying that the pupil has been immunized against communicable diseases as required by Section 32.1-46 of the Code of Virginia, or has begun receiving the first series of all such vaccinations. All dates of immunizations or the date of the report of the serological confirmation of immunity must include the month, day, and year. A. Immunizations and Screening Tests Required Under Section 32.1-46 of the Code of Virginia 2
Immunization Symbol Description and Number of Required Doses Doses Diphtheria* Whooping Cough (pertussis) Tetanus DPT Td DT DTaP For students either enrolling in kindergarten or students new to school and who are under seven years of age, a minimum of four combination doses are required at least four weeks apart, with one dose administered after the fourth birthday. If a student has received six doses before the fourth birthday, additional doses are contraindicated and a medical exemption is required. DT is required for students medically exempt from pertussis vaccine Four** with one dose on or after the fourth birthday **see note * Note: A minimum of three doses of adult Td is required for students seven years of age or older provided at least one prior dose was given at 12 months of age or older and the spacing between doses is as follows: at least four weeks between the first to second dose and 6 to 12 months between the second to third dose. It is acceptable for one of the Td doses to be substituted with a single dose of Tdap for children aged 10-18 years. For students 18 years of age and older, evidence of a Td booster within the last ten years is required for alternative high school or adult education. Tetanus Diphtheria Acellular Pertussis Poliomyelitis* Tdap Effective July 1, 2006, a booster dose of Tdap is required for all students entering sixth grade, if at least five years have passed since the last dose of tetanus containing vaccine. One OPV IPV For students entering kindergarten or students new to school: For students under seven years of age, a minimum of four doses is required with at least four weeks spacing between the first to second dose and four weeks spacing between the second to third dose and 6 months spacing between the third to the fourth dose. At least one dose must be administered on or after the fourth birthday. Four** with one dose on or after the fourth birthday **see note For children who received an all OPV or IPV series, a 3
Immunization Symbol Description and Number of Required Doses Doses fourth dose is not necessary if the third dose was administered at age 4 years or older. If uncertain of the combination of the vaccine type or if the three dose primary series consisted of a combination of OPV and IPV a fourth dose is required. **Note: For students seven years and older, a minimum of three doses with at least four weeks between the first and second dose and at least 6 months following the previous dose for the second to third dose. For students 18 years of age and older, OPV or IPV is not required. Measles (rubeola) German measles (rubella) Mumps MMR A minimum of two doses of measles vaccine, two doses of mumps vaccine, and one of rubella vaccine required. The first dose must be administered at age 12 months or older. The second dose of measles vaccine does not have to be administered until age four to six years (at entry into kindergarten) but can be administered at any time 28 days or more after the first dose. Students born before 1957 are exempt from receiving MMR immunization. Dated report of serological confirmation of the measles and rubella is acceptable. A physician s dated statement that mumps disease was diagnosed or serological confirmation is acceptable. 2 doses of measles and mumps and one rubella with the 1st dose on or after the first birthday 4
Immunization Symbol Description and Number of Required Doses Doses Hepatitis B* HBV A complete series of three doses of hepatitis B vaccine is required for all students. There should be at least one month spacing between the first and second doses and four months spacing between the first and third doses. FDA-Approved Exception: A two-dose schedule ONLY for Three Two adolescents 11-15 years of age AND ONLY when Merck brand (RECOMBIVAX HB) adult formulation hepatitis B vaccine is used. The two RECOMBIVAX HB adult doses must be separated by a minimum of four months. Vaccine doses administered equal to or less than four days before the minimum interval or age should be counted as valid. Dated report of serological confirmation of hepatitis B is acceptable. Varicella Zoster (chicken pox) Two * One dose of varicella vaccine administered not earlier than the age of 12 months is required for all children born on or after January 1, 1997. Effective March 3, 2010*, a second does of varicella vaccine is required before entering kindergarten. A dated report of serological confirmation or statement from physician of a reliable report of the disease is acceptable. First dose on or after first birthday Haemophilus Influenzae Type b Pneumococcal 7- valent conjugate Human papillomavirus Hib Minimum of one dose required ONLY for students up to 60 months of age. PVC HPV Two to four doses, dependent on age at first dose, of pneumococcal 7-valent conjugate vaccine (PVC) for students less than two years of age. Effective October 1, 2008, a complete series of three doses of HPV is required for all females. The first dose shall be administered before the child enters sixth grade. The second and third doses should be given at two and six months after the first dose, respectively. However, after reviewing materials approved by the Virginia Department of Health, the parent or guardian, at his or her sole discretion, may elect for the student not to receive the HPV series. One Two to four Three 5
* Vaccine doses administered equal to or less than 4 days before the minimum interval or age should be counted as valid. B. Conditional Enrollment A student may be enrolled for a period of 90 school days contingent upon the student s having received at least one dose of each of the required vaccines and the student s possessing a plan, from a physician or local health department, for completing his or her immunization requirements within the ensuing 90 school days or as otherwise indicated in the plan. C. Exemptions The following constitute authorized exemptions to the immunization requirements. 1. When the parent or guardian has an objection on the grounds that the administration of immunizing agents conflicts with his/her religious tenets or practices and provides the principal with a written statement of such objection on the Commonwealth of Virginia Certificate of Religious Exemption form, unless an emergency or disease epidemic has been declared by the Virginia Department of Health. (If the parent maintains the need to continue the religious exemption during a documented school health emergency, the student shall be excluded from school for the protection of the student until the time that the health emergency has been concluded.) 2. When the parent or guardian presents a statement on a School Entrance Physical Examination and Immunization Certificate form from a physician which states that the physical condition of the student is such that the administration of one or more of the required immunizing agents would be detrimental to the health of the student. 3. When a student is homeless and does not have documentary proof of necessary immunizations or has incomplete immunizations and is not exempted from immunization, either medically or religiously. In such cases, the student should be immediately referred to the appropriate resource. The FCCPS homeless liaison is available to help the student obtain the necessary proof or completion of immunizations. D. Evidence of Immunization Evidence that is acceptable for proof of required immunizations must include the month, day, and year each dosage was administered. All students for whom dates cannot be provided (month, day, 6
year) must be referred to the Fairfax County Health Department or their private physicians to update their records before entering school. 1. For new students (students who have never enrolled in school), one of the following is required: a. A School Entrance Physical Examination and Immunization Certification form required as documentation, or b. Comparable documentation, including the month, day, and year each dosage was administered. 2. For transfer students (students previously enrolled in a United States, foreign, or military school) one of the following is required: a. A School Entrance Physical Examination and Immunization Certification form, including the month, day, and year each dosage was administered. b. A copy of a certificate of immunization from a health department or health organization, military card, health card, or overseas travel card, including the month, day, and year each dosage was administered. c. An official school record indicating the month, day, and year each dosage was administered (phone verification of immunizations, including specific dates from another school with records to follow may be used provisionally). d. A signed statement from a physician or health department including the month, day, and year each dosage was administered (e.g., a School Entrance Physical Examination and Immunization Certification form or a comparable form used in another state). 3. Tuberculosis Screening Requirements For all students who have resided in a foreign country (with the exception of Canada, Western Europe, Australia, and New Zealand) during the last five years for a consecutive period of five or more months, one of the following is required: a. Evidence of a negative tuberculin skin test (TST) Interferon gamma Releasing Assay (IGRA),Quantiferon TB Gold blood or T-spot blood test and a negative symptom screen completed within 90 calendar days prior to registration certified by a licensed physician, or department of health. If TST or IGRA is documented to be positive, evidence of a 7
normal (negative chest x-ray) taken within 90 calendar days prior to registration is required. b. Evidence of a normal (negative) chest X-ray taken within 90 calendar days prior to registration c. Documentation of a negative symptom screen or risk assessment from the health department or private physician for students who present written documentation of having completed prophylaxis treatment for tuberculosis. d. A student may be conditionally enrolled in FCCPS if he or she presents a temporary medical waiver of a YSY. 1. A waiver must include the reason for the waiver, that the student is asymptomatic, and the expiration date of the waiver (not to exceed 30 days). 2. A waiver shall only be granted for the following reasons: a. Student received a live virus vaccine immunization less than 30 days before TST was requested. b. TST is not readable (meaning that one of the lateral borders is not palpable and needs repeating.) The repeat TST can be done immediately, unless a live virus vaccine was administered less than 30 days before. If the live virus vaccine was administered, the TST must be given at least 4 weeks after the date the vaccine was administered. 3. A student who is conditionally enrolled with a temporary waiver must complete the designated test within the period specified or he or she shall be excluded from school until the requirement is met. e. Persons returning from temporary (less than five months) trips outside the United States are not required to be screened for the purpose of re-enrollment in FCCPS. f. Homeless students in need of tuberculosis screening should be immediately referred to the FCCPS homeless liaison, who will help the student obtain the necessary documentation. Legal Reference: Code of VA: Sections 22.1-270, Sections 22.1-271.2, and 32.1-46 8
Public Health System Calendar Attachment A DATE September 5 or 1 st day of school September 29 or last day of September IMMUNIZATION ACTIVITIES Registrar enters into school administrative student information (SASI) application the immunization compliance code for students upon school registration and enters immunization dates for students who do not meet compliance. Registrar completes entry of all kindergarten students immunization information in SASI for the annual Virginia Student Immunization Report as required by Section 22.1-271.2.E of the Code of Virginia. Registrar ensures immunization information for all sixth grade students is entered into SASI for the annual Virginia Student Immunization Report as required by Section 22.1-271.2.E of the Code of Virginia. October 2 June 1 Registrar runs immunization query on the first of each month throughout the school year and gives deficiency report to the clinic. Clinic staff member reviews immunization tab in the health atom and marks the students on the report that should have a deficiency letter sent and returns the report to the registrar. Registrar runs immunization deficiency mail merge letters and mailing labels. Registrar sends letters to parents or guardians and gives copies to the clinic. After two deficiency letters are sent with no response, a clinic staff member will follow up to determine barriers to receiving service and notify principal if unresolved. 9
Date August 1 June 1 Vision and Hearing Screening Activities Vision and hearing screenings must be completed within 60 administrative working days from start of school year or student s enrollment in school. For students with deficiencies, students who were absent, and students who are exempt, the clinic room aide enters all vision and hearing screening data (four fields) directly into SASI within one week of screening for students in grades K, 3, 7, 10 and for all new students. Within one week of vision screening, the clinic room aide runs vision mail merge deficiency letters and mailing labels. Letters are sent to parents or guardians. Within four to six weeks of hearing screening failure, screening is repeated. Within one week of second hearing screening failure, the clinic room aide runs hearing mail merge deficiency letters and mailing labels. Letters are sent to parents or guardians. Clinic room aide enters all information regarding corrected deficiencies into SASI on an ongoing basis as soon as information is received. If a student withdraws or transfers, clinic room aide enters all screening information for that student, regardless of screening results. March 1 For any student in grades K, 3, 7, and 10 who does not have a deficiency, an absent, an exempt, or a screening record entered into SASI, the Department of Information Technology will update the student s screening record with four passes and a screening date equal to 59 days after the student s school-year entry. Clinic room aide enters all vision and hearing screening data directly into SASI within one week of screening for students enrolling on or after March 1. Legal Reference: Code of Virginia, Section 22.1-271.2.E 10
Attachment B Virginia Immunization Requirement for Tetanus, Diphtheria, Acellular Pertussis (Tdap) IMPORTANT NOTICE Dear Parent or Guardian of a Current Fifth Grader: Effective July 1, 2006, all students in Virginia must receive a booster dose of Tdap vaccine prior to entering sixth grade if at least five years have passed since the last dose of tetanus toxoid-containing vaccine (DTP, DTaP, DT, or Td). Please check your child s immunization records carefully. If your child is required to have a Tdap booster, we ask that your child receive it and that you provide documentation to the school prior to June 18, 2007. This documentation can be a copy of your child s immunization record, or a note from your physician listing the date of their most recent Tdap booster shot. The Tdop booster can be obtained from your child s physician. Immunizations required for school are also available at the Fairfax County Health Department at no charge. Clinic locations and walk-in hours are listed on the back of this letter and are available online at http://www.fairfaxcounty.gov/hd/hdclinicsite.htm. Students receiving immunizations at the Health Department must be accompanied by an adult, and students should bring their immunization records to the Health Department clinic with them. It is most important that you attend to this matter soon. Sixth graders cannot begin school in the fall without documentation of having had the Tdap booster or having had a tetanus-containing vaccine within the past five years. Please contact the school public health nurse at 703-237-6014 if you have any questions. Thank you for your cooperation. Sincerely, School Principal
FAIRFAX COUNTY HEALTH DEPARTMENT CLINIC SITES Falls Church District Office 6245 Leesburg Pike, Suite 500 Falls Church, VA 22044 703-534-8343 Herndon-Reston District Office 1850 Cameron Glen Drive, Suite 100 Reston, VA 20190-3310 703-481-4242 Mount Vernon District Office 8350 Richmond Highway, Suite 233 Alexandria, VA 22309-2344 703-704-5203 Springfield District Office Cary Building, First Floor, Suite A100 8136 Old Keene Mill Rd. Springfield, VA 22152 703-569-1031 Joseph Willard Health Center 3750 Old Lee Highway Fairfax City, VA 22030-6903 703-246-7100 Attachment B Walk-in hours at all locations: Monday and Wednesday 8:00 a.m. 3:30 p.m. Tuesday 10:00 a.m. 6:00 p.m. Friday 7:30 a.m. 12:00 p.m.