You probably know that daycares and schools require vaccines for attendance. But do you know which ones your child needs and how to show documentation? If not, it’s completely understandable. While there are required vaccines for schools in every state, the rules, regulations and exemptions vary across the country.
“Vaccine requirements and their enforcement vary by state,” says Dr. Amy Middleman, chief of adolescent medicine at Oklahoma Children’s Hospital. Middleman also notes that, for kids who aren’t caught up, “parents can talk to their [healthcare] providers to safely catch their children up on vaccines that may have been missed.” (More on this in a bit.)
“Vaccine requirements and their enforcement vary by state. Parents can talk to their [healthcare] providers to safely catch their children up on vaccines that may have been missed.”
— Dr. Amy Middleman, chief of adolescent medicine
Whether you’re wondering what’s required in your specific state or what will happen if your child isn’t vaccinated, here’s everything you need to know about mandatory vaccines for school during the 2023-24 year.
Why schools require vaccines
Simply put, vaccines prevent communicable diseases from spreading. While different states have different vaccine requirements, some commonly mandated ones.
The common mandatory vaccines for schools include:
- DTaP (diphtheria, tetanus, pertussis).
- Hepatitis B.
- IPV (Polio).
- MMR (measles, mumps, rubella).
- Varicella (chicken pox).
These diseases killed kids by the thousands in their heyday, and widespread vaccination has lowered and even eliminated cases of them in the U.S., says Johan Bester, assistant professor of family medicine and director of Bioethics for the University of Nevada Las Vegas. Bester explains that mandating vaccines in schools prevents outbreaks in a community by creating “herd immunity,” a phenomenon in which a community is protected from an outbreak because a high percentage of the population has been vaccinated.
The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) recommend the same immunization schedule for children and teens. It’s available on the AAP and CDC websites.
What vaccines are required for school?
School immunization requirements are determined by each state, so some light research is in order.
“A great website to look at what is required in each state is Immunize.org,” Middleman says.
The CDC Vaccination Laws information page and its link to the Public Health Law Program State School Immunization Requirements and Vaccine Exemption Laws (last assessed in 2019), can give you an idea about the vaccines required in each state to enter kindergarten, as well as those required for later grades. For instance, in some states, kids need to get the meningococcal (meningitis) vaccine before entering 7th grade. And Hawaii, Rhode Island, Washington D.C. and Virginia all require the HPV vaccine at around the same time.
You can also find information on what’s considered “acceptable proof of vaccination,” as well as which states allow vaccine exemptions and for what reasons.
For the most up-to-date information, however, check your state health department websites. The CDC has an interactive map, where families can click on their state to find school vaccination requirements and exemption information where they live.
What vaccines are required for daycare?
According to Dr. Danielle Street Stephens, a pediatrician at Holston Medical Group in Kingsport, Tennessee, the majority of daycares follow the same rules as the schools in their state. “A lot of daycares receive state funding, so they want the same schedule and documentation as the schools,” she explains, but adds that “if they’re private, it can vary a bit from center to center.”
“A lot of daycares receive state funding, so they want the same schedule and documentation as the schools.”
— Dr. Danielle Street Stephens, pediatrician
Immunize.org is also a great resource for parents looking for daycare vaccine requirements, as vaccine requirements are broken down into the following groups:
- Child care/pre-K and school.
- School only.
- Child care/pre-K only.
For instance, in Indiana, the hepatitis A vaccine is only mandated for school, but over in Ohio, it’s only required for pre-K and child care centers.
Are vaccines required for in-home child care?
If your child care provider is a nanny or babysitter, there aren’t any state-mandated vaccine requirements. That said, Middleman and Street Stephens, as well as the CDC, advise having your child — and their babysitter or nanny — up to date on their vaccines.
“Currently, vaccines in California are not required for in-home, non-group child care, but all children and parents should have up-to-date vaccines recommended by the CDC,” says Dr. Steven Abelowitz, the regional medical director of Coastal Kids Pediatrics in Orange County, California. “Special attention should be made to ensure that sitters have an updated TDAP, which protects against pertussis [whooping cough].”
Are COVID vaccines required for school and daycare?
Currently, the only district requiring the COVID vaccine for school enrollment and attendance is Washington D.C.
The Office of the State Superintendent of Education website reads:
“Beginning in the 2023-24 school year, the COVID-19 vaccine is required for school enrollment and attendance in the District of Columbia for all students who are of an age for which there is a COVID-19 vaccination fully approved by the US Food and Drug Administration (FDA).”
What vaccine exemptions may be considered?
Schools may consider exempting a child from a vaccine for the following reasons:
History of adverse reaction
“Prior history of a severe reaction to a prior vaccine, as well as an allergy towards any of the components of the vaccines, would most likely be reasons for vaccine exemption,” says Abelowitz. However, Street Stephens notes, this is “very rare.”
Certain immunocompromised conditions
In most cases, it’s even more important for children with immunocompromisation to be vaccinated. While there are some specific contraindications to the use of various vaccines, patients who are at higher risk of acquiring a disease due to a medical condition are often the exact people who should be vaccinated,” explains Middleman. “The disease would be far worse for them than possible side effects from a vaccine.”
That being said, “in rare cases, certain vaccines don’t mix with existing conditions,” Street Stephens notes. “For instance, a child with leukemia shouldn’t receive varicella or MMR vaccines while they’re receiving treatment,” she says. “But all the other child vaccines are inactive.” These very specific situations should be discussed with your child’s healthcare team.
Religious or philosophical beliefs
Some states will grant exemption when a vaccine clashes with religious beliefs, though, as Street Stephens notes, “most religions don’t have issues with vaccines; it’s more used as a scapegoat.”
Both Immunize.org and the CDC show which states allow for religious or philosophical exemptions. Unlike medical exemptions, not all states allow students to opt out of vaccines due to religious or philosophical beliefs — and the ones that do generally have an exclusion policy for such students during an outbreak.
Additionally, certain states have sub-rules within these rules. For instance, Washington allows for “medical, religious and philosophical exemptions, but it does not allow philosophical exemptions for the MMR vaccine.”
To find out the specifics on how to file for a vaccine exemption and what documentation is necessary, check with your county and/or state health office.
What happens if you don’t comply?
If you can’t get an exemption and your child isn’t vaccinated, they may not be able to attend public school, daycare or even private or parochial school at all. Getting a nanny and/or home-schooling may be your only option, depending on your state.
“In California, children in school or daycares are required to have up-to-date vaccines in order to enroll,” Abelowitz says. And if a student’s records aren’t checked beforehand, they’re usually checked on the first day of school.
“The state will come into daycares to look for papers showing proof of vaccination,” explains Street Stephens. “They want to see that everyone is up to date, and if they’re not, the kids who aren’t vaccinated will be sent home and the center can be penalized [by] the health department.”
How to catch up if your child isn’t vaccinated
The good news is that if your child doesn’t have all their vaccines, they can still catch up — and many schools will even allow a child to stay in school or daycare if they’re in the process of getting on schedule, according to Street Stephens.
“There’s a spot on the paperwork that indicates a child is in the process of catching up,” she says. “So long as it’s filled out and dated, the child won’t be sent home.”
“There’s a spot on the paperwork that indicates a child is in the process of catching up. So long as it’s filled out and dated, the child won’t be sent home.”
— Dr. Danielle Street Stephens, pediatrician
The CDC has a vaccine catch-up schedule for kids, but ultimately, it’s highly personalized. “It’s case-by-case when it comes to vaccine catchup,” Street Stephens continues. “It depends on what a child is due for, how many of each vaccine they need, how much time needs to go between and whether or not they’ve aged out of any,” she says. “For instance, a child over 5 isn’t going to get the rotavirus vaccine.”
If your child is not insured or is underinsured, they may be able to get vaccines through the Vaccines for Children (VFC) program, which offers vaccines at no cost to eligible children through healthcare providers enrolled in the program. To find out more, contact the VFC coordinator in your area.
