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Section VII - Questions and Answers

When did the law for measles, mumps and rubella immunization take effect? Does it apply to all students?

On August 1, 1991, all part-time (as defined by regulations, See Appendix A), full-time, graduate and undergraduate students born on or after January 1, 1957, were required to comply with PHL Section 2165 regarding measles, mumps and rubella immunization.

Are there any exceptions to these immunization requirements?

There are six exceptions:

A student may be permanently or temporarily exempted from specific required immunizations for medical reasons.
A student may be exempt from any or all of the required immunizations for religious reasons.
Students who were born prior to January 1, 1957, are exempt from the MMR requirements.
The law does not apply to students enrolled for fewer than six semester hours.
Prison inmates enrolled at degree granting institutions while they are incarcerated are also exempt.
Students registered for online courses only and who do not meet on campus are not required to meet the immunization requirements.

At what age does a student no longer need to provide proof of immunization?

It is the date of birth rather than the age of the student that needs to be considered. For college entry requirements, any student born prior to January 1, 1957, does not need to provide proof of immunity for measles, mumps, and rubella. This date was selected because the majority of people born prior to 1957 developed immunity against measles and mumps from natural infection due to widespread disease. The date also applied to rubella for the practical application of this law. However, in the event of the diagnosis of one of the diseases in your institution, disease control efforts should be directed to all students, staff and faculty. Immunization records will be audited for proof of immunity against the disease identified.

In the event of an outbreak, persons born prior to 1957 who do not recall having had measles, mumps or rubella (depending on the outbreak) should consult with their physician and be immunized. Pregnant females, regardless of age, should confirm immunity or be excluded from the outbreak setting (rubella).

What is the definition of "hours" as referred to in the college immunization legislation and regulation?

"Hours" means semester hours or credit equivalent.

Do these requirements apply to foreign students, summer school students or other students who temporarily attend classes at our institution?

Yes. The immunization requirements apply to all students who are registered to attend post-secondary institutions in New York State, regardless of the duration of their stay or their area of origin.

Do non-matriculated students taking 6 credits or more need to comply with PHL Section 2165?

Yes. Students who are enrolled for at least 6 semester hours must comply with PHL Section 2165.

If a registered student is not physically on campus because of student – teaching, semesters abroad, an on-line student or enrollment in correspondence courses, how do the immunization requirements apply to that student?

All students as defined by NFYCCR 66-2.1(b) must comply with the requirements. (See Section I.) Affected students attending off-campus programs in group settings with other students are required to comply with the immunization regulations. Students enrolled individually in correspondence courses not involving group participation and prisoners enrolled at an institution while they are incarcerated are not required to comply.

Are there any exceptions to the requirements if a student lives off-campus or at home with his/her parents?

No. All students as defined by 10 NYCCR Subpart 66-2.1(b) enrolled must comply with the requirements. If the student lives at home, it is particularly important that all family members are current on their immunizations. Students residing off campus are at higher risk of exposure to community-based outbreaks of disease.

Can disease history statements submitted by foreign students be accepted? Who can help with the interpretation of immunization records in foreign languages?

Requirements for foreign students are the same as for other students. Under PHL Section 2165, students transferring from out of state or country are given an extended grace period of 45 days. When not in English, student health records should be submitted by the student with a translation. This translation should be submitted at enrollment, but no later than the allowed grace period. For information regarding translating immunization records, contact the National Center for Immunization and Respiratory Diseases at 1-800-232-4636.

Is a written or verbal parental statement that the student has had the disease or the required immunization acceptable proofs?

No. Neither PHL Section 2165 nor NYCRR SUBPART 66-2 allow for accepting such statements as satisfactory evidence of immunity.

Is an immunization history signed by the student or parent acceptable as proof of immunization?

No. NYCRR Subpart 66-2.1(b) clearly defines a certificate of immunization as a document prepared by the health practitioner who administers the vaccine and which specifies the products administered and the dates of administration. It may also show physician verified history of disease and/or laboratory evidence of disease. A Certificate of Immunization could also be an immunization record which specifies products administered and dates of administration, and whose source was a certificate of immunization from a health practitioner submitted by an institution or school previously attended by a student. The meningococcal meningitis response form required by PHL Section 2167, which allows for student or parent recall is not a certificate of immunization.

How complete must a "date" be to meet the standards for documenting receipt of vaccine?

The dates for measles, mumps and rubella must be specific enough to determine that the first dose of vaccine was given no more than 4 days before the first birthday and the second dose of measles vaccine was received at least 28 days after the first dose. In some cases, "year" would be enough, in others, "month and year" would be sufficient, in still others, "month, day and year" would have to be known to make this determination. To assure completeness, the use of month-day-year is encouraged.

What constitutes sufficient evidence for an institution to grant a religious exemption?

In order to qualify for a religious exemption, a student under 18 years old must submit a written statement signed by his/her parent(s) or guardian stating that they hold religious beliefs contrary to the practice of immunization. Students 18 years old or older must submit such a statement themselves to qualify for religious exemption. This statement must demonstrate that the student, or his/her parent(s), or guardian holds genuine and sincere religious beliefs which are contrary to the practices of immunization. Each statement requesting a religious exemption must be specific to the college in which the student is currently enrolled. Prior religious exemption statements addressed to other institutions are not considered valid. PHL Section 2165 does not allow for philosophical exemptions. When a religious exemption is claimed, the institution may require supporting documentation.

If a student says "my doctor says I shouldn't have any shots," is that sufficient information for a medical exemption?

No. The student's physician must provide a written statement of exemption, specifying which of the immunization products should not be administered, the reason, and how long the medical contraindication will last. (See Section I.)

What constitutes acceptable proof of immunity through serology?

A notation by a physician or certified medical laboratory that antibodies are positive or demonstrate a level of immunity for measles, mumps or rubella is acceptable. It should be clearly indicated for which disease serological evidence is available.

If a student is not in compliance, or does not present acceptable evidence of compliance, should the institution refuse to allow the student to continue in attendance?

Yes. No institution shall permit any student to attend such institution in excess of 30 days without submitting acceptable evidence of compliance with PHL Sections 2165 and 2167. By law, an institution is required to exclude students who are noncompliant. PHL Section 2165, provides for the grace period of 30 days, to be extended to 45 days when a student is from out of state or out of the country or can show a good faith effort to comply with the requirements. PHL Section 2167 provides that the 30 day grace period may be extended to a total of 60 days if the student can show a good faith effort to comply with the requirement. (See Appendix A.)

In order to know when to exclude a noncompliant student, when does a student begin "attending" an institution? At the time of registration or on the first day of classes?

Attendance is defined in regulation as the physical presence of the student at the institution and shall begin on the first scheduled day of classes for a student each semester.

If the student cannot provide acceptable proof of compliance, must the institution require re-immunization of the student?

Yes. If the student cannot provide acceptable proof of immunity or religious or medical exemption, then re-immunization is required. However, if the student cannot access his/her immunization record and the student can prove that he/she attended school in the United States after 12/31/80, one dose of measles vaccine can be assumed. If this option is used, the second dose must be administered no more than one year prior to attendance at an institution. Also, if a student presents proof of honorable discharge from the armed services within 10 years from the date of application to the institution, the proof of honorable discharge shall qualify as a certificate enabling the student to attend the institution pending actual receipt of immunization records from the armed services.

If a student has had none of the required immunizations, must we refuse attendance until all are completed?

No. The regulations are quite clear that students who are "in the process of receiving immunization" should be permitted to attend class. The institution should require the student to submit proof that he/she meets the requirements specified of being considered in process in the regulations that show he/she is in "process"and provides date(s) of appointments with a specified health practitioner or health facility for completion of the remainder of the immunizations. The institution should then allow the student to attend but should maintain supervision until the immunization process has been completed, or exclude the student if he/she defaults (refer to page 3).

For a student who has no proof of immunization for measles, mumps or rubella, what is a reasonable length of time for completion of the required vaccines?

Measles, mumps and rubella can be administered simultaneously through a dose of MMR vaccine which combines the three antigens. For those students who just received their first dose, a minimum interval of 28 days is required between the first and second doses of measles vaccine. For a student to be in the process of competing the requirements, 10 NYCRR 66-2(c) states that a maximum interval of 90 days between doses is acceptable. (MMR or MMRV vaccine is recommended for all measles vaccine to provide increased protection against all three vaccine-preventable diseases and varicella if the student has no history of disease or immunity.)

Should a student be allowed to continue to attend school if only one measles immunization has been given?

Yes, if a student can show acceptable proof that he/she is "in the process of receiving" the required immunizations. (See answer to question 19 above.)

Is there any problem in immunizing someone who may already be immune to measles, mumps or rubella?

No. There is no increased risk of adverse events when immunizing someone who may already be immune to any or all of these diseases.

What contraindications exist for the administration of either measles, mumps or rubella vaccine?

The manufacturer's product insert provides the most complete information and should always be consulted prior to administration of any vaccine. For more information regarding vaccine contraindications, refer to the Guide to Vaccine Contraindications and Precautions published by the Centers for Disease Control and Prevention. (See also Section III, Recommendations of Adult Immunization, and Appendix G.)

What immunizations would be required of a student who received MMR vaccine before 12 months of age or prior to 1968, or who received IG or ISG simultaneously with the live virus?

An immunization given before 1968 is acceptable only if the immunization record specifies that the vaccine was live virus vaccine and that the vaccine was received no more than 4 days prior to their first birthday. Also, if the immunization record indicates that immune globulin (IG or ISG) was administered simultaneously with the live virus vaccine, the immunization should be considered invalid. Students immunized for measles, mumps and/or rubella received more than 4 days prior to their first birthday should be re-immunized with MMR vaccine. A third dose of measles or MMR vaccine (the second acceptable dose for attendance at post-secondary institutions) should be administered at least 28 days after the second dose (the first legally acceptable dose).

If the student refuses to be immunized or provide proof of compliance, what should the institution do?

The institution should inform the student that he or she will not be permitted to attend the institution after the maximum grace period permitted by law. Exclusion means removal of the student from campus as well as from classes.

What if the student is from out-of-state or from out of the country and refuses to be immunized or provide proof of compliance, what should the institution do?

If the student's physician refuses to re-immunize his/her patient because the physician does not believe in it, how should the institution proceed?

The institution should inform the student that, in order to continue attendance, he/she will be required to provide proof of immunity or documentation of medical or religious exemption as described in Section I of this handbook. The student should also be informed that any health care practitioner, including the local public health unit, may administer vaccines.

If the student's physician refuses to issue a certificate of immunization because the family has outstanding bills, how should the institution proceed?

Under PHL Section 18, titled Access To Patient Records, patients may obtain copies of their medical records. Physicians or health care facilities should not withhold medical records due to non-payment of bills. The student should contact the NYSDOH Office of Professional Medical Conduct.

If necessary, refer the student to student health services or the local public health department to obtain immunization. The institution may contact the Immunization Program representative for the region, giving him/her the name, address and telephone number of the physician, and the name, address and birth date of the student.

If a prior school refuses to provide a student or the institution with immunization records, how should the institution proceed?

The institution may contact the Immunization Program representative for the region, giving him/her the name, address and telephone number of the school, and the name, address and birth date of the student.

Does the institution have to keep a paper copy of the student's immunization record or can the file be kept electronically?

Electronic files are allowable as long as the actual immunization records were reviewed and deemed legitimate by appropriate institution staff, a quality assurance review was conducted to verify the electronic record and back-up copies of the electronic record have been made. Refer to Appendix K for record retention.

Whose word does the institution accept in the cases of conflict? For example, the health practitioner indicates that the student will not keep appointments; the student alleges he/she cannot keep appointments citing a lack of transportation, illness, inconvenient clinic hours or other apparently good reasons.

It is the student's responsibility to provide documentation of compliance.

May the institution require additional immunizations of their students?

Yes, that is the prerogative of the institution. Many colleges require additional immunizations or testing for medical and nursing students, those in health-related curricula or students studying veterinary medicine. For additional recommended immunizations, refer to the New York State Department of Health Immunization Guidelines or your local public health unit.

If the institution wishes to offer an immunization clinic, what authority does it have? Who must give the vaccine?

Health care practitioners (physicians, nurses, certified nurse practitioners and physician assistants), as permitted by their licenses, may administer vaccine. For specific information in planning a clinic and related matters, contact the local public health unit and visit the Immunization Action Coalition (IAC). For information regarding LPNs using non-patient specific standing orders see Practice Alerts & Guidelines

If a student is unable to pay for vaccine, how can he or she obtain immunizations needed to comply with the law?

As stated in PHL Section 2F165 (See Appendix A), students unable to pay for the services of a private health practitioner may receive an immunization at the county health department in which they reside, or in which the institution is located.

What are the institution's liabilities if these laws are not enforced?

Under PHL Section 206 (4)(c) (See Appendix A), an institution may be fined up to $2,000 per violation. In addition, the Commissioner of Health has the power to cancel events, quarantine and/or exclude susceptible students in the case of an outbreak.

Can a student entering college who has not received his or her military immunization record at the time they enter, continue to attend the college?

Yes. PHL Section 2165 (8-a) states that proof of honorable discharge from the armed services within 10 years from the date of application to an institution will qualify as a certificate enabling a student to attend the institution pending actual receipt of the immunization records from the armed services.

How many doses of meningococcal vaccine are recommended to prevent bacterial meningitis infections?

Currently, a single dose of conjugate vaccine (Menactra or Menveo) is recommended which protects against four of the most common strains of the disease. These strains account for approximately 70% of the cases among college students. If a student received the meningococcal polysaccharide vaccine (Menomune), a second dose may be recommended.

What are the consequences of the student not receiving the meningococcal vaccine within 30 days?

Unless the college requires meningococcal vaccination for admission, there is no penalty for not receiving the vaccine. However, if the response form is not returned within the extended grace period of 60 days from the first day of classes, then the student must be excluded from classes until the form is completed. (See Exclusion Section of this handbook.)

Why do some colleges and universities require meningococcal vaccination for admission?

PHL Section 2167(b) allows institutions to adopt more stringent policies regarding immunization against meningococcal meningitis.

Are graduate and commuter students required to comply with PHL Section 2167?

Yes, all students are included if they meet the part-time or full-time enrollment criteria. (See Section I of this handbook.)

Is an electronic reply or electronic signature sufficient?

Yes, an electronic/Email response from a password protected identifiable student account is acceptable response to the receipt of meningococcal meningitis information and the acceptance or refusal of immunization. Electronic response, however, does not constitute a certification of immunization.

If a college has three separate summer sessions, are they each considered separate semesters?

Yes, each summer session can be considered a separate semester and students registered for 6 or more credit hours in an approved degree or certificate program must comply with immunization requirements.

Can a college require proof of immunity as a condition for enrollment at the institution for summer or regular courses?

Yes. PHL Section 2165 allows a college to require proof of immunity against measles, mumps and rubella as a condition for enrollment, provided that such person meets the definition of a student, as defined in the law.

PHL 2167 does not require immunity against meningococcal disease but does require completion of the meningococcal meningitis response form.

Who should the institution call if there are further questions?

Questions regarding immunization requirements may be directed to your local health department or to the NYSDOH Bureau of Immunization Regional Office.
(See Appendix M.)

Department of Health