PURPOSE: This rule establishes immunization requirements in accordance with recommendations of the Advisory Committee on Immunization Practices (ACIP) for all children attending public, private, or parochial day care, preschool or nursery schools caring for ten or more children, and describes actions to be taken to ensure compliance with section 210.003, RSMo.

1. (1) As mandated by section 210.003, RSMo, the administrator of each public, private, or parochial day care center, preschool, or nursery school caring for ten (10) or more children shall have a record prepared showing the immunization status of every child enrolled in or attending a facility under the administrator’s jurisdiction. An annual summary report shall be made by January 15 of each year showing the immunization status of each child enrolled using forms provided for this purpose by the Department of Health and Senior Services. All facilities caring for or licensed for ten (10) or more children must submit a summary report. This report shall include immunization information by age up to kindergarten entry, by vaccine antigen, number of children enrolled, number of children fully immunized, number of children in progress, number of children with signed medical exemption, number of children with signed parental exemption, number of children in noncompliance, and number of children with proof of varicella disease.
2. (2) No child shall enroll in or attend a public, private, or parochial day care center, preschool, or nursery school caring for ten
3. (10) or more children unless the child has been adequately immunized according to this rule. Children attending elementary school who receive before or after school care, or both, shall meet the immunization requirements established in the School Immunization Rule, 19 CSR 20-28.010. Age-appropriate vaccine requirements will be according to the attachments listed in section (5).

4. (3) Section 210.003, RSMo, provides that a child who has not completed all appropriate immunizations may enroll if—

   1. (A) Satisfactory evidence is produced that the child has begun the process of immunization. The child may continue to attend as long as they have started an immunization series and provide satisfactory evidence indicating progress is being accomplished. The Department of Health and Senior Services form Imm.P.14, included herein, shall be completed and placed on file with the child’s immunization health record for each child with immunizations in progress. Failure to 19 CSR 20-28

meet the next scheduled appointment constitutes noncompliance with the day care immunization law, and action shall be initiated immediately by the administrator to have the child excluded from the facility.

1. (B) The parent or guardian has signed and placed on file with the day care administrator a statement of exemption which may be either of the following:

   1. 1. A medical exemption, by which a

child shall be exempted from the requirements of this rule upon signed certification by a licensed doctor of medicine (MD), doctor of osteopathy (DO), or his or her designee indicating that either the immunization would seriously endanger the child’s health or life, or the child has documentation of disease or laboratory evidence of immunity to the disease. The Department of Health and Senior Services’ form Imm.P.12, included herein, shall be placed on file with the immunization record of each child with a medical exemption. The medical exemption need not be renewed annually; or

1. 2. A parent or guardian exemption, by

which a child shall be exempted from the requirements of this rule if one (1) parent or guardian files a written objection to immunization with the day care administrator. The Department of Health and Senior Services’ form Imm.P.11, included herein, shall be signed by the parent or guardian and placed on file with the immunization record of each child with a parental exemption. The parental exemption must be renewed annually.

1. (4) The parent or guardian shall furnish the day care administrator satisfactory evidence of completion of the required immunizations, exemption from immunization, or progress toward completing all required immunizations. Satisfactory evidence of immunization means a statement, certificate, or record from a physician or his or her designee, other recognized health facility, or immunization registry stating that the required immunizations have been given to the person and verifying type of vaccine. This statement, certificate, or record shall provide documentation of the specific antigen and the month, day, and year of vaccine administration. However, if a child has had varicella (chickenpox) disease, a licensed healthcare provider (e.g., school or occupational clinic nurse, nurse practitioner, physician assistant, physician) may sign and place on file with the day care administrator a written statement documenting previous varicella (chickenpox) disease. The statement may contain wording such as: “This is to verify that SENIOR SERVICES Public Health

(name of child) had varicella (chickenpox) disease on or about (date) and does not need varicella vaccine.”

1. (5) Immunization requirements for children attending day care facilities shall be:

   1. (A) Missouri Day Care Immunization Requirements Vaccines Received 0–6 Years of Age, included herein; and

   2. (B) Catch-up Immunization Schedule for Persons Aged 4 Months–6 Years Who Start Late or Who Are More Than 1 Month Behind, included herein. SENIOR SERVICES Public Health SENIOR SERVICES Public Health SENIOR SERVICES Public Health

      *Original authority: 376.215, RSMo 1996.

AUTHORITY: sections 192.006 and 210.003, RSMo 2000.* Emergency rule filed Aug. 1, 1995, effective Aug. 11, 1995, expired Dec. 8, 1995. Original rule filed April 17, 1995, effective Nov. 30, 1995. Emergency amendment filed June 14, 2000, effective June 24, 2000, expired Feb. 22, 2001. Amended: Filed June 14, 2000, effective Nov. 30, 2000. Amended: Filed Jan. 3, 2001, effective July 30, 2001. Amended: Filed Oct. 1, 2008, effective March 30, 2009. Amended: Filed Nov. 30, 2011, effective June 30, 2012. *Original authority: 192.006, RSMo 1993, amended 1995; 210.003, RSMo 1988.