HLT-36-13-00007-A School Immunization Requirements

2/19/14 N.Y. St. Reg. HLT-36-13-00007-A

NEW YORK STATE REGISTER

VOLUME XXXVI, ISSUE 7

February 19, 2014

RULE MAKING ACTIVITIES

DEPARTMENT OF HEALTH

NOTICE OF ADOPTION

 

I.D No. HLT-36-13-00007-A

Filing No. 114

Filing Date. Feb. 03, 2014

Effective Date. Jul. 01, 2014

School Immunization Requirements

PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:

Action taken:

Amendment of Subpart 66-1 of Title 10 NYCRR.

Statutory authority:

Public Health Law, sections 2164 and 2168

Subject:

School Immunization Requirements.

Purpose:

To amend and update NYS school entry immunization requirements.

Substance of final rule:

This proposal will amend Subpart 66-1 (School Immunization Requirements) to update regulations so that they comply with current immunization recommendations and medical knowledge. The regulations would be effective July 1, 2014.

Proposed amendments to Section 66-1.1 provide that a child will be considered fully-immunized when (i) the child has received an adequate dosage and number of doses of an immunizing agent commensurate with his or her age or (ii) the child has otherwise demonstrated immunity to measles, mumps, rubella, hepatitis B, poliomyelitis (all three serotypes) and varicella through a positive serologic test or, for varicella only, disease as verified by a physician, nurse practitioner or physician’s assistant. For those immunizations required by Public Health Law (PHL) § 2164 only, the number of doses that a child should have at any given age, and the minimum intervals between these doses, is determined by the Recommended Immunization Schedule for Persons Aged 0 Through 18 Years issued by the Advisory Committee on Immunization Practices (ACIP). If a child is not fully immunized, immunization must take place according to the Catch-Up Schedule of the ACIP.

For all vaccinations except poliomyelitis and varicella, children shall be assessed upon school entry or attendance, and annually thereafter, and be found to be fully immunized commensurate with their age. For poliomyelitis vaccination beginning on or after July 1, 2014, children shall be assessed upon entry or attendance to kindergarten and sixth grade, and/or their equivalent grades, and must be fully immunized commensurate with their age. As the students enrolling in kindergarten and sixth grade move up a grade level each year, the students enrolling in those higher grades, or grade equivalent, must be appropriately immunized against poliomyelitis. For varicella vaccination beginning on and after July 1, 2014, children shall be assessed upon entry or attendance to kindergarten and sixth grade, and/or their equivalent grades, and must have received two adequate doses of vaccine. As the students enrolling in kindergarten and sixth grade move up a grade level each year, the students enrolling in those higher grades, or grade equivalent, must be appropriately immunized against varicella.

The proposed amendments also provide that a child will be considered “in process” of receiving necessary immunizations if he or she has received at least the first dose in each required immunization series and has age appropriate appointments to complete the immunization series or is obtaining serologic tests and has appointments to complete the immunization series within 30 days of notification that serologic tests are negative. Children who are not fully immunized can only continue to attend school if they are in the process of completing the ACIP catch up schedule. If a child does not receive subsequent doses of vaccine in an immunization series according to the age appropriate ACIP catch-up schedule, the child is no longer in process and must be excluded from school, if not otherwise exempt from immunization requirements.

Proposed amendments to Section 66-1.2 update the definitions in the regulation to conform to changes in the New York State Immunization Information System (NYSIIS) statute (PHL § 2168), to account for the implementation of NYSIIS that has occurred since 2008, and to include references to the New York City Immunization Registry (CIR). The proposed amendments also expand upon the definition of authorized users as well as the types of information to be reported to NYSIIS or the CIR to include race, ethnicity, telephone numbers, birth order (if multiple birth), birth state/country, Vaccines for Children Program eligibility and Medicaid number.

Proposed amendments to Section 66-1.3 provide that a school shall not admit a child without receipt of a certificate of immunization from a health care practitioner, or from NYSIIS or the CIR, documenting that the child has been fully immunized, documentation that the child is “in process,” a signed medical exemption, or a completed religious exemption. The proposed changes state that a principal or person in charge of a school shall not refuse to admit a child to school, based on immunization requirements, if that child is in process. The proposed changes also require that a medical exemption must be reissued annually and must contain sufficient information to identify a medical contraindication to a specific immunization and specify the length of time the immunization is medically contraindicated. For both medical and religious exemptions, the principal or person in charge of the school may require additional information supporting the exemption.

Proposed amendments to Section 66-1.4 clarify that the 14 calendar day period for continued school attendance may be extended to not more than 30 calendar days for an individual student who is transferring from out-of-state or from another country and can show a good faith effort to obtain the necessary evidence of immunization.

Proposed amendments to Section 66-1.6 provide that the certificate of immunization shall be prepared by the health practitioner who administers the immunizing agents and shall specify the products administered and the dates of administration. It may also show physician, nurse practitioner, or physician assistant-verified history of varicella disease and/or laboratory evidence of immunity to measles, mumps, rubella, varicella, Hepatitis B and all 3 serotypes of poliomyelitis contained in the polio vaccines.

Proposed amendments to Section 66-1.7 provide that every school shall annually provide the Commissioner of Health, or in the city of New York, the New York City Commissioner of Health, a summary regarding compliance with immunization requirements. For all schools, excluding public schools within New York City, the summary will be provided in the form of the yearly school survey conducted by the Department of Health.

Proposed amendments to Sections 66-1.8 and 66-1.9 clarify the obligation of the school to notify the local health authority, when a child has been excluded because of lack of acceptable evidence of immunization or exemption, and the obligation of the local health authority to arrange for a suitable health practitioner to administer immunizations.

Proposed amendments to Section 66-1.10 provide that, for those diseases listed in PHL § 2164, in the event of an outbreak of disease in a school, the Commissioner, or his or her designee, or in the City of New York, the New York City Commissioner of Health may order the exclusion of children who have been exempted from immunization or are “in process” of receiving required immunizations. Any exclusion shall continue until the Commissioner, or his or her designee, or the New York City Commissioner of Health (as appropriate), determines that the danger of disease transmission has passed. The proposed changes also require schools to maintain a current list of susceptible students who should be excluded from attendance in the event of an outbreak of vaccine-preventable disease.

Final rule as compared with last published rule:

Nonsubstantive changes were made in sections 66-1.2(a)(2), (d)(1)(i), 66-1.6 and 66-1.10.

Text of rule and any required statements and analyses may be obtained from:

Katherine Ceroalo, DOH, Bureau of House Counsel, Reg. Affairs Unit, Room 2438, ESP Tower Building, Albany, NY 12237, [phone], email: [e-mail]

Revised Regulatory Impact Statement, Regulatory Flexibility Analysis, Rural Area Flexibility Analysis and Job Impact Statement

Changes made to the last published rule do not necessitate revision to the previously published RIS, RFA, RAFA and JIS.

Assessment of Public Comment

Comment:

In proposed § 66-1.2(a)(2), the Citywide immunization registry is defined to include “those persons 19 years and older with written consent in accordance with the New York City Health Code.” Because the requirement for written consent was removed pursuant to a recent State legislative change, the word “written” should be deleted.

Response:

Regulatory language has been revised to incorporate this change.

Comment:

Proposed § 66-1.2 (a)(7) defines school as “any agency or entity required by law or regulation to verify immunization status for participants.” Because the applicable existing laws and regulations do not specifically refer to verification, it is recommended that the reference to verification be removed. Proposed § 66-1.2(a)(8)(v) also refers to schools and incorporates this definition.

Response:

The regulations were not revised to include this change. Applicable existing law at Public Health Law (PHL) § 2168(8)(d)(i) does refer to school verification of immunization status for eligibility for admission.

Comment:

The definition of who is an authorized user of the registry should be expanded to encompass the person who administers the vaccine.

Response:

The regulations were not revised to include this change. Authorized users of the registry already include an ordering provider’s “designee.” One type of individual who could be an ordering provider’s designee is the individual administering the vaccine.

Comment:

The reference to “CIR” in § 66-1.2(d)(1)(i) regarding allowance for a time-limited deferral on electronic data submission to the registry should be stricken. NYCDOHMH does not provide deferrals to such electronic submission.

Response:

Regulatory language has been revised to incorporate this change.

Comment:

In § 66-1.3(c), add the word “recognized” before the term “medical contraindication.”

Response:

The regulations were not revised to include this change as the term “medical contraindication” is clear and does not require further modification.

Comment:

In § 66-1.3(c), revise regulations so that the “local health authority” has the authority to require additional information supporting an exemption.

Response:

The regulations were not revised to include this change. Under PHL § 2164(7), the responsibility to exclude a non-compliant student from school lies with the principal, teacher, owner or person in charge of the school. As such, the principal or person in charge of the school has the authority to require additional information relevant to making this decision.

Comment:

In § 66-1.3(c), revise the regulation so that the local health authority has the authority to order a school to exclude a child who has not complied with immunization requirements.

Response:

The regulations were not revised to include this change. Under PHL § 2164(7), the authority to exclude a non-compliant student from school lies with the principal, teacher, owner or person in charge of the school.

Comment:

In § 66-1.6, revise the regulation to clarify that a record issued by the New York State Immunization Information System or Citywide Immunization Registry may be accepted as a certificate of immunization.

Response:

Regulatory language has been revised to incorporate this change.