For children immigrating to the United States and attending school while living in the U.S., an essential document for enrollment is the Immunization Record, commonly referred to as the "Yellow Card." However, for new parents and those arriving in Los Angeles from other states or abroad, determining which vaccines are required, when to get them, and how many doses are needed can be a confusing and tedious process. Therefore, today we will provide an overview of the immunization requirements for school enrollment in California.
Immunization Requirements: To enter or transfer to a public or private elementary or secondary school, from kindergarten through secondary school, children under 18 must be vaccinated according to the following requirements:
1. Polio Vaccine:
4 doses at any age, but 3 doses meet the requirement for children aged 4-6 if at least one dose was administered on or after the 4th birthday1; for children aged 7-17, 3 doses meet the requirement if at least one dose was administered on or after the 2nd birthday1.
2. Diphtheria, Tetanus, and Pertussis Vaccine:
① 6 years and under (Pertussis vaccine required): DTP, DTaP, or DT (diphtheria, tetanus vaccine) or any combination of DTP or DTaP: 5 doses at any age, but 3 doses meet the requirement for children aged 4-6 if at least one dose was administered on or after the 4th birthday1.
② 7 years and older (Pertussis vaccine not required): Td, DT, or DTP, DTaP, or any combination of the above: 4 doses at any age, but 3 doses meet the requirement for children aged 8-17 if at least one dose was administered on or after the 2nd birthday1. If the last dose was administered before the 2nd birthday, more than 1 dose of Td vaccine is required.
③ 7th Grade Td Booster: 1 dose, not required but recommended if the last dose of DTP, DTaP, DT, or Td was administered more than 5 years ago.
3. Measles, Mumps, and Rubella (MMR) Vaccine:
① Kindergarten: 2 doses2, both administered on or after the 1st birthday1.
② 7th Grade: 2 doses2, both administered on or after the 1st birthday1.
③ Grades 1-6 and 8-12: 1 dose must be administered on or after the 1st birthday1.
4. Hepatitis B Vaccine:
① Kindergarten: 3 doses at any age.
② 7th Grade: 3 doses3 at any age.
5. Varicella (Chickenpox) Vaccine:
① Kindergarten: 1 dose4.
② New students from other states (Grades 1-12): 1 dose for children under 13; 2 doses required if administered on or after the 13th birthday4.
Notes:
1 Vaccines administered within 4 days (inclusive) before the birthday will satisfy the school enrollment vaccination requirements.
2 Two doses of measles-containing vaccine are required. One dose of mumps and rubella-containing vaccine is required; mumps vaccine is not required for children 7 years or older.
3 Two doses of 2-dose Hepatitis B vaccine, with documentation from the provider stating that both doses were 2-dose Hepatitis B vaccines and both were administered between 11-15 years of age, will satisfy this requirement.
4 A physician-documented history of chickenpox disease or immunity meets the varicella requirement.
Exemptions:
The law allows (1) parents/guardians to choose to exempt immunization requirements based on personal beliefs, and (2) a child's physician to choose a medical exemption.
The law does not allow parents/guardians to choose an exemption simply due to inconvenience (e.g., lost or incomplete records and the trouble of resolving this with a doctor or clinic). The back of the blue "California School Immunization Record" (PM286) contains instructions and an affidavit for parents/guardians to sign for personal belief exemptions. For children with medical exemptions, the physician's written statement should be stamped by the CSIR. Schools should maintain an up-to-date list of exempted students so they can be quickly removed from school in the event of a disease outbreak.
Immunization Record (Yellow Card)
Must include the year and month of each vaccine dose; for measles, rubella, and/or mumps vaccines administered within the first birthday, the exact date (day, month, year) is required. Records with checkmarks but no dates, or those that only state "up to date," "meets all requirements," or "series completed" are incomplete. Furthermore, parents cannot fill out the "California School Immunization Record" based on memory alone; a written immunization record must be presented. Additionally, the record must show that all due vaccines have been administered.
All adolescents under 18 enrolling or transferring. New kindergarten students or those from outside the U.S. must present an individual immunization record. (New kindergarten students may present the "California School Immunization Record" issued by their previous childcare center, but this record often does not include the final polio "booster," DTP or DTaP vaccine doses, or the second measles vaccine). Children transferring from schools in California or other states must present an individual immunization record or a state school immunization record. Since July 1, 1999, students entering 7th grade must present an individual immunization record so that the 7th-grade immunization date requirements can be added to the student's school immunization record.
New kindergarten students, new 7th-grade students, and new students from outside the U.S. must present this record at or before enrollment; if they do not have the record, there is no "grace period" for enrollment. Students transferring from other schools in California or other states, or students entering the next grade level, have a maximum of 30 days to wait for records to arrive from the previous school.
Children missing one or more necessary vaccines that are not currently due may be admitted, provided they receive the remaining vaccines according to the following schedule when they become due. If the maximum interval between two doses has passed, the child cannot be enrolled until they receive the next dose:
1. Polio: 2nd dose: 6-10 weeks after 1st dose; 3rd dose: 6 weeks-12 months after 2nd dose.
2. DTP, DTaP, DT, Td: Under 7 years (DTP, DTaP, DT): 2nd dose: 4-8 weeks after 1st dose; 3rd dose: 4-8 weeks after 2nd dose; 4th dose: 6-12 months after 3rd dose.
3. 7 years and older (Td)*: 2nd dose: 4-8 weeks after 1st dose; 3rd dose: 6-12 months after 2nd dose.
4. MMR: 2nd dose: 1-3 months after 1st dose.
5. Hepatitis B:
① 3-dose vaccine: 2nd dose: 1-2 months after 1st dose; 3rd dose: 2-6 months after 2nd dose, and at least 4 months after the 1st dose.
② 2-dose vaccine (7th-grade entrants, 11-15 years old): 2nd dose: 4-8 months after 1st dose.
6. Varicella (unvaccinated transfer students over 13): 2nd dose: 4 weeks-3 months after 1st dose.
* Note: Previously administered DTP, DTaP, DT vaccines can count toward the 3-dose diphtheria-tetanus requirement for this age group.
Additionally, a special note regarding coming to the U.S. for school from China: Vaccines received in China can be converted into an internationally certified, all-English yellow vaccine card by taking the child's Chinese vaccination card (green card) and 2-inch photos to a local physical examination center for outbound travelers. They will translate the vaccines you received in China into English, fill them in, and stamp the document.
