Adherence to immunization requirements ensures students can begin the school year in accordance with regulations and public health and safety standards. Please review the following requirements carefully. The updates and reminders are related to:
At this time all school requirements as listed in COMAR 10.06.04 will be in effect at the start of the 2023-2024 school year. Students who do not have the required vaccinations within 20 days of starting school must demonstrate proof of vaccination, positive titer results, or proof of a vaccination appointment. In order to reduce the number of students that may be out of compliance at the start of the 2023-24 school year, school health officials should begin now to complete assessments of school immunization records and inform the parents of children who may be out of compliance. This will allow maximum time for the parents to get their children up to date and in compliance with school requirements.
We request your assistance in implementing activities to ensure students in your jurisdiction are in compliance with the school requirements. Suggested activities include:
In order to assist school health personnel to assess student vaccination records, school health personnel are permitted to have read-only access to ImmuNet, Maryland’s Immunization Information System. ImmuNet is an online, secure database that captures vaccination records for Maryland residents. With access to ImmuNet, school health personnel will be able to view a student’s immunization records and determine if the student has all of the required vaccines. If your staff needs access to ImmuNet, please complete an enrollment form at https://bit.ly/ImmuNetAcct to set up an account. If you have many accounts to set up, please email the ImmuNet team at email@example.com for assistance.
Maryland residents can gain access to their own immunization records in ImmuNet and print out the Maryland 896 form without having to go to their healthcare provider or local health department. Maryland MyIR (My Immunization Record) is a free website service (https://myirmobile.com) that allows consumers to view and print copies of their official vaccination records directly from ImmuNet. This information can then be presented to schools at the parent or guardian's discretion.
According to COMAR 10.06.04.06, a student who does not meet the immunization requirements may be temporarily admitted to or retained in school if the parent or guardian provides evidence of the student's appointment with a health care provider or local health department to: 1) receive the required immunization; 2) reconstruct a lost record; or 3) acquire evidence of age appropriate immunity on the MD 896 form. The actual appointment should be no later than 20 calendar days following the date the student was temporarily admitted/retained.
Students out of compliance with the immunization requirements may not be admitted to or retained in school without the evidence of an appointment. The parent must present evidence of an appointment on DAY ONE of admittance/retention.
Evidence of an appointment may include the following:
If the student is on a catch-up schedule and is required to receive two or more doses of a particular vaccine in order to meet the immunization requirement, the temporary admittance/retention process should again be applied once the previous dose is administered. The student would then need to provide evidence of the appointment to receive the next dose in the series, which per regulations would need to occur within 20 calendar days: Since most vaccine series require an interval of greater than 20 days between doses, a temporary medical contraindication statement signed by the physician may be provided in order for the student to be temporarily retained in school. The date of the end of the temporary medical contraindication statement should correspond to when the next dose is due (e.g., when the appointment is for the next dose) and is the date when the 20-day temporary admission or retention is reapplied. If neither an appointment date nor a medical contraindication is provided after the first dose in the series, the student must be excluded.
For example, if a student does not have any documented doses of hepatitis B vaccine, they are required to have three doses in order to meet the school requirement. On the first day of school, the student presents evidence of an appointment for receiving the first dose within the 20 calendar days, allowing that student to be temporarily admitted/retained. Once the first dose is received and proof of the vaccination is provided to the school, the student then must provide evidence of the next appointment within the next 20 days or provide documentation of a temporary medical contraindication signed by the physician in order to remain in school. Since there must be 4 weeks between dose 1 and dose 2 of the hepatitis B series, it is more likely that the student would need to provide a signed temporary medical contraindication. If neither is provided, then the student must be excluded. The same process would apply for the temporary admittance/retention between dose 2 and dose 3.
If the scheduled appointment is not completed but is rescheduled within the same 20-day period, the student may continue to be retained and not excluded. For example, if a student has an appointment on day 5 and misses but reschedules to day 10, they may be retained and should not be excluded on day 6. But if a student misses an appointment on day 5 and cannot be rescheduled until day 25, they would need to provide documentation of a temporary medical contraindication or be excluded on day 20 (until they are vaccinated on day 25).
13A.05.09.05 may not be denied enrollment due to failure to comply with immunization requirements. COMAR states: "The school shall immediately enroll the homeless child or youth, even if the child or youth is unable to produce records normally required for enrollment, such as previous academic records, medical records, proof of residency or other documentation. If the child or youth needs to obtain immunizations, or immunization or medical records, immediately refer the parent or guardian of the child or youth to the local school system coordinator, who shall assist in obtaining necessary immunizations, or medical records. The school may not bar enrollment of the homeless student until it has made a diligent effort to assist the parent with obtaining necessary immunizations or records of prior immunization."
According to COMAR 10.06.04.03, students in preschool aged 60-71 months are required to have two doses of MMR vaccine to meet school requirements. For students that turn five years of age (60 months) during the school year, the second MMR dose is required within 20 calendar days of when they turn five years of age or the student must be excluded. If the student is able to provide documentation of an appointment to receive the second dose within 20 calendar days from the fifth birthday, that student may be temporarily admitted or retained. Without the documentation of the appointment, the student must be excluded.