<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.06.04.03" title_num="10" subtitle_num="06" chapter_num="04" heading="Required Immunizations.">
  <paragraph num="A.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>Preschool program unless the student's parent or guardian has furnished evidence of age-appropriate immunity against Haemophilus influenzae, type b, and pneumococcal disease;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Preschool program or kindergarten through the 12th grade unless the student's parent or guardian has furnished evidence of age-appropriate immunity against:</text>
      <paragraph num="(a)">
        <text>Tetanus;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Diphtheria;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Poliomyelitis;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Measles (rubeola);</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Mumps;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Rubella;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Hepatitis B;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Varicella;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Meningitis; and</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Tetanus-diphtheria-acellular pertussis acquired through a Tetanus-diphtheria-acellular pertussis (Tdap) vaccine.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>Name of the student;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Date of birth;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Name and address of parent or guardian;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Complete history of vaccines received with month, day, and year of each vaccine dose; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Signature, title, and date of the physician, health official, school official, or regulated child care program providing the information on the form.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>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.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Schedule of Immunizations.</text>
    <paragraph num="(1)">
      <text>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:</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Student in Kindergarten Through 12th Grade.</text>
      <paragraph num="(a)">
        <text>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.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Diphtheria.</text>
        <paragraph num="(i)">
          <text>Four doses of diphtheria immunization vaccine are required for a student younger than 7 years old; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Three doses of diphtheria immunization vaccine are required for a student 7 years old or older.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Tetanus.</text>
        <paragraph num="(i)">
          <text>Four doses of tetanus immunization vaccine are required for a student younger than 7 years old; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Three doses of tetanus immunization vaccine are required for a student 7 years old or older.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>Pertussis. Four doses of pertussis immunization vaccine are required for a student younger than 7 years old.</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Poliomyelitis (Oral or Injectable).</text>
        <paragraph num="(i)">
          <text>Three doses of poliomyelitis immunization vaccine are required for a student younger than 18 years old; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Proof of immunity from poliomyelitis by blood test is required for a student younger than 18 years old.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(f)">
        <text>Rubella.</text>
        <paragraph num="(i)">
          <text>Two doses of live rubella virus vaccine are required when the student is 1 year old or older; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Proof of immunity from rubella by blood test is required when the student is 1 year old or older.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(g)">
        <text>Measles (rubeola).</text>
        <paragraph num="(i)">
          <text>Two doses of live measles (rubeola) virus vaccine are required when the student is 1 year old or older; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Proof of immunity from rubeola by blood test is required when the student is 1 year old or older.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(h)">
        <text>Mumps.</text>
        <paragraph num="(i)">
          <text>Two doses of live mumps virus vaccine are required when the student is 1 year old or older; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Proof of immunity from mumps by blood test is required when the student is 1 year old or older.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(i)">
        <text>Hepatitis B.</text>
        <paragraph num="(i)">
          <text>Three doses of hepatitis B vaccine are required; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Proof of immunity from hepatitis B by blood test is required.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(j)">
        <text>Varicella.</text>
        <paragraph num="(i)">
          <text>All doses of varicella vaccine shall be given when the student is 1 year old or older.</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>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.</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>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.</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>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.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(k)">
        <text>Meningococcal. One dose of meningococcal vaccine is required per the schedule of implementation in §F of this regulation.</text>
      </paragraph>
      <paragraph num="(l)">
        <text>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.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>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.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Schedule of Implementation: Varicella Effective Immunization Dates for a Student in Kindergarten Through 12th Grade.</text>
    <paragraph num="(1)">
      <text>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:</text>
      <paragraph num="(a)">
        <text>Has received age appropriate vaccination with varicella vaccine; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Is immune to varicella by providing the results of a blood test or a medical diagnosis indicated by month and year of diagnosis.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>One-Dose Requirement Immunization Dates for a Student in Kindergarten Through 12th Grade.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>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:</text>
      <paragraph num="(a)">
        <text>Has received two doses of varicella vaccine; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Is immune to varicella by providing the results of a blood test or a medical diagnosis indicated by month and year of diagnosis.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Two-Dose Requirement Immunization Dates for a Student in Kindergarten Through 12th Grade.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Schedule of Implementation: Meningococcal and Tetanus-diphtheria-acellular pertussis (Tdap) Effective Immunization Dates for a Student in Preschool Through 12th Grade.</text>
    <paragraph num="(1)">
      <text>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:</text>
      <paragraph num="(a)">
        <text>Meningococcal immunization vaccine; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Tetanus-diphtheria-acellular pertussis (Tdap) immunization vaccine.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Immunization Dates for a Student in 7th Through 12th Grade.</text>
    </paragraph>
  </paragraph>
</regulation>