Is it a Problem if a Child Received a Vaccination "Early," Before Entering Kindergarten?

Marilyn W. Edmunds, PhD, NP


February 03, 2004


A kindergarten child received his varicella vaccine on January 2, 1999. As his first birthday occurred on January 13, 1999, the school system indicated that the child should be revaccinated before he attends kindergarten. The child's vaccination was close enough to his first birthday (11 days before) to be immunologically effective. What should be the resolution?

Marguerite Edwards, MSN, NP-BC

Response from Marilyn W. Edmunds, PhD, NP

The situation is frustrating for you, the school staff, the parents, and especially the child who is going to end up with another shot! The question is not one of efficacy; rather, it is one of state law. All states mandate immunizations prior to school and/or daycare entry. These requirements vary by state, though all states do require diphtheria-pertussis-tetanus, polio, and measles immunizations.

School vaccination requirements have been credited with leading to current immunization rates that are greater than 90% in 45 states.[1] Requirements for vaccination are rigidly defined in state regulatory code and may not be varied. Schools are prohibited from admitting children who do not meet these requirements, and exemptions for children who receive vaccine early are not allowed.

From a therapeutic point of view, it is frustrating to a provider who recognizes that a vaccine received at 50.5 weeks of age is likely to be as immunogenic as one received at or after 52 weeks. However, from the monitoring point of view, it is essential that clear guidelines be adhered to. States do not want to be in a position of asking that school staff make therapeutic decisions. The question is: At what point do you draw the line? If a vaccine received 7 days early is allowed and considered acceptable, why not 8 days? And so forth...down the slippery slope!

The Immunization Action Coalition, a nonprofit organization devoted to increasing immunization rates, maintains a Web site that provides a wealth of information on vaccine law. A very helpful compilation of state mandates is available for easy referral. In addition, the CDC publishes a free booklet listing vaccine requirements for day care, Head Start and school entry, valid exemptions, penalties, and enforcement procedures.[2] Proof of varicella vaccine or immunity is required in all but 9 states.[3] This relatively new requirement is still in the process of being implemented in some states.

The State Health Department Web sites provide an easy mechanism to review specific regulatory language about immunization requirements and the school exemption process. Finally, each state also has an immunization state coordinator to whom questions and concerns can be directed.


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