1. A. Except as provided in Regulations .04—.06 of this chapter, a preschool or school principal or other person in charge of a preschool or school, public or private, may not knowingly admit a student to or retain a student in a:

   1. (1) Preschool program unless the student's parent or guardian has furnished evidence of age-appropriate immunity against Haemophilus influenzae, type b, and pneumococcal disease;
   2. (2) Preschool program or kindergarten through the second grade of school unless the student's parent or guardian has furnished evidence of age-appropriate immunity against pertussis; and

   3. (3) Preschool program or kindergarten through the 12th grade unless the student's parent or guardian has furnished evidence of age-appropriate immunity against:

      1. (a) Tetanus;
      2. (b) Diphtheria;
      3. (c) Poliomyelitis;
      4. (d) Measles (rubeola);
      5. (e) Mumps;
      6. (f) Rubella;
      7. (g) Hepatitis B;
      8. (h) Varicella;
      9. (i) Meningitis; and
      10. (j) Tetanus-diphtheria-acellular pertussis acquired through a Tetanus-diphtheria-acellular pertussis (Tdap) vaccine.

2. B. Except as provided in Regulations .04—.06 of this chapter, a parent or guardian shall provide evidence of age-appropriate immunity to the preschool or school authority on a form provided by the Secretary or on a printed or computer-generated form that lists the following:

   1. (1) Name of the student;
   2. (2) Date of birth;
   3. (3) Name and address of parent or guardian;
   4. (4) Complete history of vaccines received with month, day, and year of each vaccine dose; and
   5. (5) Signature, title, and date of the physician, health official, school official, or regulated child care program providing the information on the form.
3. C. Except as provided in Regulations .04—.06 of this chapter and §A(3) of this regulation, a student shall obtain immunizations in accordance with the schedule of immunizations recommended by the Medical and Chirurgical Faculty of Maryland and the Secretary, as set forth in §D of this regulation and as required to be implemented in §§E and F of this regulation.

4. D. Schedule of Immunizations.

   1. (1) Student in Preschool. In order for the immunization status of a student enrolled in a preschool to be complete, the student's parent or guardian shall provide proof of the following doses of immunizations:

      Age of Student	Diphtheria, Tetanus, Pertussis	Poliomyelitis	Haemophilus influenzae, type B	Measles, Mumps, Rubella	Hepatitis B	Varicella	Pneumococcal
      Less than 2 months	0	0	0	0	1	0	0
      2—3 months	1	1	1	0	1	0	1
      4—5 months	2	2	2	0	2	0	2
      6—11 months	3	3	2	0	3	0	2
      12—14 months	3	3	At least 1 dose after 12 months old	1	3	1	2
      15—23 months	4	3	At least 1 dose after 12 months old	1	3	1	2
      24—59 months	4	3	At least 1 dose after 12 months old	1	3	1	1
      60—71 months	4	3	0	2	3	1	0

   2. (2) Student in Kindergarten Through 12th Grade.

      1. (a) In order for the immunization status of a student enrolled in kindergarten through 12th grade to be complete, the student's parent or guardian shall provide proof of the immunizations or immunity as outlined in §D(2)(b)—(l) of this regulation.

      2. (b) Diphtheria.

         1. (i) Four doses of diphtheria immunization vaccine are required for a student younger than 7 years old; and
         2. (ii) Three doses of diphtheria immunization vaccine are required for a student 7 years old or older.

      3. (c) Tetanus.

         1. (i) Four doses of tetanus immunization vaccine are required for a student younger than 7 years old; and
         2. (ii) Three doses of tetanus immunization vaccine are required for a student 7 years old or older.
      4. (d) Pertussis. Four doses of pertussis immunization vaccine are required for a student younger than 7 years old.

      5. (e) Poliomyelitis (Oral or Injectable).

         1. (i) Three doses of poliomyelitis immunization vaccine are required for a student younger than 18 years old; or
         2. (ii) Proof of immunity from poliomyelitis by blood test is required for a student younger than 18 years old.

      6. (f) Rubella.

         1. (i) Two doses of live rubella virus vaccine are required when the student is 1 year old or older; or
         2. (ii) Proof of immunity from rubella by blood test is required when the student is 1 year old or older.

      7. (g) Measles (rubeola).

         1. (i) Two doses of live measles (rubeola) virus vaccine are required when the student is 1 year old or older; or
         2. (ii) Proof of immunity from rubeola by blood test is required when the student is 1 year old or older.

      8. (h) Mumps.

         1. (i) Two doses of live mumps virus vaccine are required when the student is 1 year old or older; or
         2. (ii) Proof of immunity from mumps by blood test is required when the student is 1 year old or older.

      9. (i) Hepatitis B.

         1. (i) Three doses of hepatitis B vaccine are required; or
         2. (ii) Proof of immunity from hepatitis B by blood test is required.

      10. (j) Varicella.

          1. (i) All doses of varicella vaccine shall be given when the student is 1 year old or older.
          2. (ii) Per the schedule of implementation in §E(1) of this regulation and except as provided in §D(2)(j)(iii) of this regulation, one dose of live varicella vaccine is required for a student younger than 13 years old, or two doses of live varicella vaccine are required for a student 13 years old or older, if the student does not have proof of vaccination against varicella at an age younger than 13 years old.
          3. (iii) Proof of immunity from varicella by blood test or by medical diagnosis indicated by month and year of diagnosis may be provided instead of meeting the requirements of §D(2)(j)(ii) or (iv) of this regulation.
          4. (iv) Per the schedule of implementation in §E(2) of this regulation and except as provided in §D(2)(j)(iii) of this regulation, two doses of live varicella vaccine are required.
      11. (k) Meningococcal. One dose of meningococcal vaccine is required per the schedule of implementation in §F of this regulation.
      12. (l) Tetanus-diphtheria-acellular pertussis (Tdap). One dose of Tetanus-diphtheria-acellular pertussis (Tdap) immunization vaccine is required per the schedule of implementation in §F of this regulation.
   3. (3) Record Review for Student in Preschool Through 12th Grade. A preschool or school, public or private, may count as valid, vaccine doses administered less than or equal to 4 days before the minimum interval or age.

5. E. Schedule of Implementation: Varicella Effective Immunization Dates for a Student in Kindergarten Through 12th Grade.

   1. (1) As set forth in §E(2) of this regulation, by the date listed in Column 1, the parent or guardian of a student entering the grade listed in Column 2 shall provide proof to the school that the student:

      1. (a) Has received age appropriate vaccination with varicella vaccine; or
      2. (b) Is immune to varicella by providing the results of a blood test or a medical diagnosis indicated by month and year of diagnosis.

   2. (2) One-Dose Requirement Immunization Dates for a Student in Kindergarten Through 12th Grade.

      Date	Grade
      September 2011, 2012, 2013	K, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12
      September 2014	1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12
      September 2015	2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12
      September 2016	3, 4, 5, 6, 7, 8, 9, 10, 11, 12
      September 2017	4, 5, 6, 7, 8, 9, 10, 11, 12
      September 2018	5, 6, 7, 8, 9, 10, 11, 12
      September 2019	6, 7, 8, 9, 10, 11, 12
      September 2020	7, 8, 9, 10, 11, 12
      September 2021	8, 9, 10, 11, 12
      September 2022	9, 10, 11, 12
      September 2023	10, 11, 12
      September 2024	11, 12
      September 2025	12

   3. (3) As set forth in §E(4) of this regulation, by the date listed in Column 1, the parent or guardian of a student entering the grade listed in Column 2 shall provide proof to the kindergarten or school that the student:

      1. (a) Has received two doses of varicella vaccine; or
      2. (b) Is immune to varicella by providing the results of a blood test or a medical diagnosis indicated by month and year of diagnosis.

   4. (4) Two-Dose Requirement Immunization Dates for a Student in Kindergarten Through 12th Grade.

      Date	Grade
      September 2014	K
      September 2015	K, 1
      September 2016	K, 1, 2
      September 2017	K, 1, 2, 3
      September 2018	K, 1, 2, 3, 4
      September 2019	K, 1, 2, 3, 4, 5
      September 2020	K, 1, 2, 3, 4, 5, 6
      September 2021	K, 1, 2, 3, 4, 5, 6, 7
      September 2022	K, 1, 2, 3, 4, 5, 6, 7, 8
      September 2023	K, 1, 2, 3, 4, 5, 6, 7, 8, 9
      September 2024	K, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10
      September 2025	K, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11
      September 2026	K, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12

6. F. Schedule of Implementation: Meningococcal and Tetanus-diphtheria-acellular pertussis (Tdap) Effective Immunization Dates for a Student in Preschool Through 12th Grade.

   1. (1) As set forth in §F(2) of this regulation, by the date listed in Column 1, the parent or guardian of a student entering the grade listed in Column 2 shall provide proof to the preschool or school that the student has received one dose of:

      1. (a) Meningococcal immunization vaccine; and
      2. (b) Tetanus-diphtheria-acellular pertussis (Tdap) immunization vaccine.

   2. (2) Immunization Dates for a Student in 7th Through 12th Grade.

      Date	Grade
      September 2014	7
      September 2015	7, 8
      September 2016	7, 8, 9
      September 2017	7, 8, 9, 10
      September 2018	7, 8, 9, 10, 11
      September 2019	7, 8, 9, 10, 11, 12

Authority: Education Article, §7-403 and Health-General Article, §18-102(a), Annotated Code of Maryland

Effective date:

Regulation .01 amended as an emergency provision effective May 10, 1977 (4:11 Md. R. 865); emergency status extended at 4:22 Md. R. 1667 and 4:27 Md. R. 2095 (Emergency provisions are temporary and not printed in COMAR)

Regulation .01 amended effective December 16, 1977 (4:26 Md. R. 2024) and May 18, 1979 (6:10 Md. R. 842)

Regulation .01A amended and C adopted effective February 11, 1985 (12:3 Md. R. 245)

Regulation .03 amended effective January 2, 1984 (10:26 Md. R. 2340)

Annotation: COMAR 10.06.04.03 cited in Davis v. State, 294 Md. 370 (1982), in which the court held that “membership in a recognized religious group cannot be required as a condition of exemption from vaccination”. The religious exemption was held to contravene the Establishment Clause of the First Amendment and was therefore invalid. The immunization requirement itself was found to be severable and remains in force.

Chapter revised effective March 30, 1992 (19:6 Md. R. 672)

Regulation .03 amended effective April 22, 1996 (23:8 Md. R. 605); May 19, 1997 (24:10 Md. R. 710)

Regulations .01—.10 repealed and new Regulations .01—.10 adopted effective November 24, 2005 (32:23 Md. R. 1826)

Regulation .03 amended effective November 12, 2012 (39:22 Md. R. 1428)

Regulation .03E amended as an emergency provision effective July 1, 2006 (33:15 Md. R. 1273); amended permanently effective September 25, 2006 (33:19 Md. R. 1560)

Regulation .03F adopted as an emergency provision effective March 20, 2007 (34:8 Md. R. 766); emergency provision expired