Sixth Grade Entry Law for Tdap Immunizations - Provider Letter

March 2007

Dear Provider:

The purpose of this letter is to inform you about a recent change in the immunization requirements for school entry related to diphtheria, tetanus, and pertussis vaccine that will take effect September 1, 2007. The key points regarding the requirements of the law and its implementation are:

  • Students who are entering 6th grade or a comparable age-level special education school or program on or after September 1, 2007 and who are 11 years of age or older must receive an immunization containing tetanus toxoids, diphtheria, and acellular pertussis (Tdap).
  • If a student has received a Td, DT, or DTaP vaccination within the last two years, the student's Tdap vaccination should be deferred (with rare exceptions) until a period of two years has elapsed.
  • 10-year-old students who are entering 6th grade will not be required to receive a Tdap vaccine and will not be excluded from school, but they must be flagged, tracked and immunized when they turn 11 years old.

Interval between Td, DT, or DTaP and Tdap:

The Advisory Committee on Immunization Practices (ACIP) encourages a 5-year interval between the last Td, DT, or DTaP and the adolescent Tdap, with exceptions made for certain situations, including during outbreaks or periods of increased pertussis activity in the community. The safety of administering a dose of Tdap at less than 5 years has been evaluated by several Canadian studies. The language from the ACIP states, "Taken together, these three Canadian studies support the safety of using Tdap after Td at intervals less than 5 years. The largest study suggests intervals as short as approximately 2 years are acceptably safe [MMWR, March 24, 2006/55 (RR03); 1-34]."

The New York State Department of Health recommends that students who were born on or after January 1, 1994, and are entering, repeating or transferring into the 6th grade on or after September 1, 2007, and have received a tetanus/diphtheria vaccine within two years prior to this date should not (with rare exceptions) receive the booster immunization until a period of two years has elapsed. It is required that those children who are not eligible on this basis be flagged, tracked, and immunized at the appropriate time.

Widespread outbreaks of pertussis have continued to occur in New York State throughout 2006. Due to the ongoing morbidity and burden of outbreaks, the benefit of protection against pertussis disease outweighs concerns regarding an interval between Td and Tdap of less than 5 years and the risk of local and systemic reactions.

Children who will be 10 years old when entering 6th grade:

There are two Tdap vaccines available, Sanofi Pasteur's Adacel, which is licensed for persons aged 11 to 65 years, and GlaxoSmithKline's Boostrix, which is licensed for persons aged 10 to 18 years. There are two options available regarding 10-year-old children who are entering 6th grade: (1) vaccinate those children using Boostrix, or (2) delay vaccination until those children are 11 years old. Children whose vaccination with Tdap has been delayed will be considered "in process" for receiving the required immunization. These children will not be excluded from school but they will be flagged and tracked. It is expected that they will receive the Tdap immunization once they turn 11 years old.

Medical or religious exemptions from this requirement:

There are two exemptions from this requirement: (1) a medical exemption consisting of a written statement from a physician licensed to practice medicine in the State of New York stating that there is a valid medical contraindication to the student receiving the booster vaccine, or (2) a statement of religious exemption written by the parent(s) or guardian(s) of the student stating that they hold genuine and sincere religious beliefs which prohibit the immunization of their child. A religious exemption must be approved by the superintendent, principal, administrator, or person in charge of the school, and the principal may require additional documents to support the application. Secular principles, including philosophical exemptions, are not allowed. The New York State Education Department (SED) has provided guidance for schools regarding religious exemptions. Information can be found at the SED Web site.

Detailed information on the ACIP recommendations for the use of Tdap can be found at the Centers for Disease Control and Prevention Web site.

In addition, a copy of the letter sent to schools regarding the requirements for Tdap can be found on the New York State Department of Health Web site.

If you have any questions regarding this requirement, please contact the New York State Department of Health Immunization Program at one of the following telephone numbers:

Central Office - Albany (518) 473-4437

Capital District Regional Office (518) 408-5278

Western Regional Office (716) 847-4385

Rochester Field Office (585) 423-8014

Syracuse Regional Office (315) 477-8164

New Rochelle Field Office (914) 654-7194

Central Islip Office (631) 851-3081

Monticello District Office (845) 794-2045

In New York City, please contact the New York City Department of Health and Mental Hygiene's Bureau of Immunization at (212) 676-2259.

Thank you for your assistance in ensuring that all children in New York State are immunized and in helping to control vaccine-preventable disease.

Sincerely,

Debra Blog, M.D., M.P.H.
Medical Director
Immunization Program