1. (a) For further information see §97.71 of this title (relating to Provisional Enrollment) and §97.77 of this title (relating to Remarks and Special Recommendations).
2. (b) Doses of oral poliovirus vaccine (OPV) and inactivated poliovirus vaccine (IPV) may be used interchangeably and count equally toward meeting the polio vaccine requirements in all of the following age ranges. A child or student age five and older will be in full compliance with the polio vaccine requirement whenever he or she has received at least three OPV doses or at least three IPV doses, or any combination of at least three doses of OPV and IPV, with one dose received since the fourth birthday.

3. (c) The following immunizations are required in the respective age groupings. A child or student must meet all the immunization requirements specific to an age group upon first entering the age group. Implementation of requirements for hepatitis B vaccine for adolescents and varicella vaccine and hepatitis A for all ages is contingent upon the appropriation of funds to the department for these purposes. By July 1 of each odd-numbered year, the department will publish a statement on whether or not these vaccines have been funded and are required as specified.

   1. (1) Children less than five years of age: polio vaccine; diphtheria-tetanus-pertussis (DTP) or diphtheria-tetanus-acellular pertussis (DTaP) vaccine; measles, mumps, and rubella vaccine (MMR); Haemophilus influenzae type b conjugate vaccine (HibCV), hepatitis A, and varicella vaccine.

      1. (A) Children less than two months old: no immunizations are required.
      2. (B) Children two months of age, but not yet four months of age: one dose each of polio vaccine, DTP/DTaP vaccine, and HibCV are required.
      3. (C) Children four months of age, but not yet six months of age: two doses each of polio vaccine, DTP/DTaP vaccine, and HibCV are required.
      4. (D) Children six months of age, but not yet 12 months of age: two doses of polio vaccine and HibCV, and three doses of DTP/DTaP vaccine are required.

      5. (E) Children 12 months of age, but not yet 15 months of age (12 months through 14 months of age):

         1. (i) three doses of polio vaccine are required;
         2. (ii) three doses of DTP/DTaP vaccine are required. Any combination of three doses of DTP/DTaP will meet this requirement;
         3. (iii) one dose of MMR vaccine is required. Only doses received on or after the first birthday will meet this requirement. Serologic confirmation of measles, mumps, or rubella immunity or serologic evidence of infection is acceptable in lieu of vaccination for that disease only. For further information see §97.67 of this title (relating to Verification of Immunity to Measles, Rubella, Mumps, Hepatitis A, Hepatitis B, or Varicella; and
         4. (iv) two doses of HibCV are required.
         5. (v) no later then August 1, 2000, one dose of varicella vaccine is required. This vaccine must have been received on or after the first birthday. A parent- or physician-validated history of varicella illness (chickenpox) or serologic confirmation of varicella immunity is acceptable in lieu of vaccine. For further information, see §97.67 of this title.

      6. (F) Children 15 months of age, but not yet five years of age (15 months through four years of age):

         1. (i) three doses of polio vaccine are required;

         2. (ii) any combination of DTP/DTaP will meet the following requirement:

            1. (I) Children 17 months of age and younger are required to have three doses of DTP/DTaP vaccine; and
            2. (II) Children 18 months of age through four years of age are required to have four doses of DTP/DTaP vaccine. Children with a medical contraindication to pertussis vaccine will need to have had at least four doses of any combination of DTP/DTaP or diphtheria-tetanus (DT) vaccines if their first dose was given before the first birthday or only three doses if the first dose was given on or after the first birthday;
         3. (iii) one dose of MMR vaccine is required. Only doses received on or after the first birthday will meet this requirement. Serologic confirmation of measles, mumps, or rubella immunity or serologic evidence of infection is acceptable in lieu of vaccination for that disease only. For further information see §97.67 of this title; and
         4. (iv) one dose of HibCV on or after 15 months of age is required unless a schedule for a primary series and booster was completed prior to or at 15 months of age. A physician-validated history of invasive Haemophilus influenzae type b disease, on or after the second birthday will substitute for the vaccine requirement for children two years of age through four years of age.
         5. (v) no later then August 1, 2000, one dose of varicella vaccine is required. This vaccine must have been received on or after the first birthday. A parent- or physician-validated history of varicella illness (chickenpox) or serologic confirmation of varicella immunity is acceptable in lieu of vaccine. For further information, see §97.67 of this title; and

         6. (vi) no later then August 1, 2000, children subject to these requirements as described in §97.61 (relating to Children and Students Included in Requirements) must comply with the following requirement for hepatitis A vaccine if the facility, school or institution attended is located in any of the following counties: Brewster, Brooks, Cameron, Crockett, Culberson, Dimmitt, Duval, Edwards, El Paso, Frio, Hidalgo, Hudspeth, Jeff Davis, Jim Hogg, Kenedy, Kinney, La Salle, Maverick, McMullen, Pecos, Presidio, Real, Reeves, Starr, Sutton, Terrell, Uvalde, Val Verde, Webb, Willacy, Zapata, and Zavala. Serologic confirmation of immunity to hepatitis A or serologic evidence of infection is acceptable in lieu of vaccine. For further information, see §97.67 of this title. Doses of hepatitis A vaccine are required as follows:

            1. (I) children 2 years of age but not yet 3 years of age are required to show proof by 30 days past their second birthday of one dose of hepatitis A vaccine administered on or after their second birthday; and
            2. (II) children 3 years of age but not yet 5 years of age are required to have received two doses of hepatitis A vaccine administered on or after their second birthday.

   2. (2) Children and students five years of age or older.

      1. (A) Polio. At least three doses of polio vaccine are required, provided at least one dose has been received on or after the fourth birthday. Children and students who have received two doses of inactivated poliovirus vaccine (IPV) followed by two doses of oral poliovirus vaccine (OPV) prior to their fourth birthday do not require one dose of polio vaccine on or after their fourth birthday. Polio vaccine is not required for persons 18 years of age or older. For further information see §97.65 of this title (relating to Pregnancy) and §97.77(c) and (d) of this title (relating to Remarks and Special Recommendations).

      2. (B) Tetanus/Diphtheria.

         1. (i) Children and students six years of age and younger: at least four doses of DTP/DTaP, DT, or Td vaccine are required, provided at least one dose has been received on or after the fourth birthday. Pertussis vaccine is not required for children/students who are five years of age and older. Children with a medical contraindication to pertussis vaccine will need to have had only three doses of any combination of DTP/DTaP/DT/Td vaccines if their first dose was given on or after the first birthday and their third dose was given on or after the fourth birthday. For further information see §97.77(c) and (d) of this title.
         2. (ii) Children and students seven years of age and older: at least three doses of DTP or DTaP, DT, or Td vaccine are required, provided at least one dose has been received on or after the fourth birthday. Pertussis vaccine is not required for children/students who are five years of age and older. Any combination of three doses of DTP/DTaP/DT/Td will meet this requirement. One dose of DTP, DTaP, DT, or Td is required within the last ten years. For further information see §97.77(c) and (d) of this title.

      3. (C) Measles.

         1. (i) Beginning September 1, 1990:

            1. (I) all children and students must have received measles vaccine on or after their first birthday, provide serologic confirmation of measles immunity or serologic evidence of infection; and
            2. (II) the requirement for measles vaccine administered on or after the first birthday will apply if a child's/student's immunization record is updated; a child/student enters a child-care facility or school for the first time; or a child/student transfers from another state into a Texas school or child-care facility.
         2. (ii) Beginning January 1, 1991, children and students born on or after September 1, 1978 will be required to show serologic proof of measles immunity, serologic evidence of infection, or receipt of two doses of measles vaccine administered on or after the first birthday. This proof is not required until the child's 12th birthday. The two doses of measles vaccine must have been administered at least 28 days apart. Children and students may have 30 days past their 12th birthday to be in compliance with this clause. For further information see §97.65 of this title and §97.67 of this title.

         3. (iii) Effective August 1, 1997:

            1. (I) children born on or after September 2, 1991, will be required to show proof of either:

               (-a-) two doses of measles vaccine administered on or after the first birthday and at least 28 days apart; or

               (-b-) serologic confirmation of immunity to measles illness or serologic evidence of infection. For further information see §97.65 of this title and §97.67 of this title; and

            2. (II) children born prior to September 2, 1991 will be required to show proof by 30 days past their 12th birthday of either:

               (-a-) two doses of measles vaccine administered on or after the first birthday and at least 28 days apart; or

               (-b-) serologic confirmation of immunity to measles illness or serologic evidence of infection. For further information see §97.65 of this title and §97.67 of this title.

      4. (D) Rubella. Beginning September 1, 1991:

         1. (i) all children and students must have received rubella vaccine on or after their first birthday, provide serologic confirmation of rubella immunity, or serologic evidence of infection; and
         2. (ii) the requirement for rubella vaccine administered on or after the first birthday will apply if a child's/student's immunization record is updated; a child/student enters a child-care facility or school for the first time; or a child/student transfers from another state into a Texas school or child-care facility. For further information see §97.65 of this title and §97.67 of this title.

      5. (E) Mumps. Beginning September 1, 1990:

         1. (i) all children or students will be required to have received mumps vaccine administered on or after their first birthday, provide serologic confirmation of mumps immunity, or serologic evidence of infection; and
         2. (ii) the requirement for mumps vaccine administered on or after the first birthday will apply if a child's/student's immunization record is updated, a child/student enters a child-care facility or school for the first time; or a child/student transfers from another state into a Texas school or child-care facility. For further information see §97.65 of this title and §97.67 of this title.

      6. (F) Hepatitis B

         1. (i) Effective August 1, 1998, children born on or after September 2, 1992, will be required to show proof of either:

            1. (I) three doses of hepatitis B vaccine; or
            2. (II) serologic confirmation of immunity to hepatitis B or serologic evidence of infection. For further information see §97.67 of this title.

         2. (ii) No later then August 1, 2000, children born on or after September 2, 1988, but before September 2, 1992 will be required to show proof by 30 days past their 12th birthday of either:

            1. (I) three doses of hepatitis B vaccine; or
            2. (II) serologic confirmation of immunity to hepatitis B or serologic evidence of infection. For further information see §97.67 of this title.

      7. (G) Varicella.

         1. (i) No later then August 1, 2000, children born on or after September 2, 1994, will be required to show proof of either:

            1. (I) one dose of varicella vaccine received on or after the first birthday (two doses are required if the child is 13 years old or older at the time the first dose of varicella vaccine is received); or
            2. (II) a parent- or physician-validated history of varicella illness (chickenpox) or serologic confirmation of varicella immunity. For further information, see §97.67 of this title.

         2. (ii) No later than August 1, 2000, children born on or after September 2, 1988, but before September 2, 1994, will be required to show proof by 30 days past their 12th birthday of either:

            1. (I) one dose of varicella vaccine received on or after the first birthday (two doses are required if the child is 13 years old or older at the time the first dose of varicella vaccine is received); or
            2. (II) a parent- or physician-validated history of varicella illness (chickenpox) or serologic confirmation of varicella immunity. For further information, see §97.67 of this title.
      8. (H) Hepatitis A. Effective August 1, 1999, children subject to these requirements as described in §97.61 of this title (relating to Children and Students Included in Requirements) must comply with the following requirement for hepatitis A vaccine if the facility, school or institution attended is located in any of the following counties: Brewster, Brooks, Cameron, Crockett, Culberson, Dimmitt, Duval, Edwards, El Paso, Frio, Hidalgo, Hudspeth, Jeff Davis, Jim Hogg, Kenedy, Kinney, La Salle, Maverick, McMullen, Pecos, Presidio, Real, Reeves, Starr, Sutton, Terrell, Uvalde, Val Verde, Webb, Willacy, Zapata, and Zavala. Serologic confirmation of immunity to hepatitis A or serologic evidence of infection is acceptable in lieu of vaccine. For further information, see §97.67 of this title. Children and students born on or after September 2, 1992, will be required to have received two doses of hepatitis A vaccine administered on or after their second birthday.

   3. (3) Students in institutions of higher education (colleges, universities, and other teaching facilities above the high school level).

      1. (A) Applicability. This paragraph applies to all students enrolled in health-related courses which will involve direct patient contact in medical or dental care facilities. This includes all medical interns; residents; fellows; and others who are being trained in medical schools, hospitals, and health science centers listed in the Texas Higher Education Coordinating Board's list of higher education in Texas; and students attending two-year and four-year colleges whose course work involves direct patient contact regardless of: number of courses taken; number of hours taken; and classification of student. Subparagraph (I) of this paragraph also applies to veterinary medical students whose course work involves direct contact with animals or animal remains regardless of number of courses taken; number of hours taken; and classification of student. The department will assist institutions of higher education to educate all students of the need for immunizations and will assist in the provision of vaccines as resources allow.
      2. (B) Provisional enrollment. Students referenced in this paragraph may be provisionally enrolled for up to one semester or one quarter. The provisional enrollment will allow students to attend classes while obtaining the required immunizations and documentation (immunization records) of required immunizations. Student health care providers cannot be provisionally enrolled without receipt of at least one dose of MMR vaccine if direct patient contact will occur during the provisional enrollment period. For further information see §97.62 of this title (relating to Exclusions from Compliance); §97.65 of this title; §97.67 of this title; §97.73 of this title (relating to Acceptable Documents of Immunizations); and §97.77 of this title. Other sections of this chapter regarding immunizations also affect college/university students and institutions of higher education.
      3. (C) Polio. Polio vaccine is not required for any student. All students enrolled in health-related courses are encouraged to ascertain that they are immune to poliomyelitis.
      4. (D) Tetanus/Diphtheria. Beginning January 1, 1992, tetanus/diphtheria toxoid (Td) is required for all students defined previously in subparagraph (A) of this paragraph. Students enrolled in health-related courses must have received one dose of Td within the past ten years. For recordkeeping, only one date (month, day, year) for Td must be recorded, this dose is the Td dose administered within the past ten years.

      5. (E) Measles. Beginning January 1, 1992:

         1. (i) all students defined previously in subparagraph (A) of this paragraph who were born on or after January 1, 1957, must show proof of either:

            1. (I) two doses of measles vaccine administered since January 1, 1968, and on or after their first birthday and at least 28 days apart; or
            2. (II) at least one dose of measles vaccine administered on or after their first birthday, which must be received by students enrolled in health-related courses prior to direct patient contact and completion of the measles requirement must be accomplished as rapidly as is medically feasible; or
            3. (III) serologic confirmation of measles immunity or serologic evidence of infection; and
         2. (ii) for further information see §97.65 of this title and also §97.67 of this title.

      6. (F) Rubella. Beginning January 1, 1992:

         1. (i) all students defined previously in subparagraph (A) of this paragraph must show, prior to patient contact, proof of either:

            1. (I) one dose of rubella vaccine administered on or after their first birthday; or
            2. (II) serologic confirmation of rubella immunity, or serologic evidence of infection; and
         2. (ii) for further information see §97.65 of this title and also §97.67 of this title.

      7. (G) Mumps, Beginning January 1, 1992:

         1. (i) all students defined previously in subparagraph (A) of this paragraph who were born on or after January 1, 1957, must show, prior to patient contact, proof of either:

            1. (I) one dose of mumps vaccine administered on or after their first birthday; or
            2. (II) serologic confirmation of mumps immunity or serologic evidence of infection; and
         2. (ii) for further information see §97.65 of this title and also §97.67 of this title.
      8. (H) Hepatitis B. Beginning January 1, 1992, all students defined previously in subparagraph (A) of this paragraph shall receive a complete series of hepatitis B vaccine prior to the start of direct patient care or show serologic confirmation of immunity to hepatitis B virus. For further information see §97.67 of this title.

      9. (I) Rabies. Beginning January 1, 1992:

         1. (i) all students enrolled in schools of veterinary medicine shall receive a complete primary series of rabies vaccine prior to the start of contact with animals or their remains; and
         2. (ii) a booster dose of rabies vaccine is to be obtained by the student every two years unless protective serum antibody levels are documented.
      10. (J) Varicella. Beginning August 1, 1999, varicella vaccine is required of all students defined previously in subparagraph (A) of this paragraph. One dose of vaccine is required for students who received this vaccine prior to 13 years of age; two doses are required for students who were not vaccinated before their thirteenth birthday. All doses of this vaccine must have been received on or after the first birthday. A history of varicella illness (chickenpox) validated by the student, the student's parent or the student's physician or serologic confirmation of varicella immunity is acceptable in lieu of vaccine. For further information, see §97.67 of this title.

Source Note:The provisions of this §97.63 adopted to be effective August 12, 1991, 16 TexReg 4163; amended to be effective June 27, 1995, 20 TexReg 4344; amended to be effective April 28, 1997, 22 TexReg 3521; amended to be effective February 5, 1998, 23 TexReg 755; amended to be effective May 16, 1999, 24 TexReg 3499; amended to be effective October 1, 2000, 25 TexReg 9472.