PUBLIC HEALTH ADVISORY CONCERNING FENTANYL AND FENTANYL-LACED SUBSTANCES

Required Immunizations

The Tennessee Department of Health is responsible for immunization requirements for those who attend child care, pre-school, school and college.  The current immunization requirements are in the Tennessee Department of Health Rules.

The Official Immunization Certificate is available in local health departments through the Tennessee Immunization Information System (TennIIS).

Detailed guidance for healthcare providers on the rules and certificate is available at the TennIIS website.  Tennessee healthcare providers who give vaccines can register as authorized users and download the form through TennIIS.

The state’s immunization schedule follows the current schedule published by the Centers for Disease Control and Prevention (CDC) and endorsed by the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP).

A brief summary of the required immunizations for child care facilities and schools is listed below.

Children enrolling in child care facilities, pre-school, pre-Kindergarten
Infants entering child care facilities must be up to date at the time of enrollment and are required to provide an updated certificate after completing all of the required vaccines due no later than 18 months of age.

    • Poliomyelitis (IPV or OPV)
    • Haemophilus influenzae type B (Hib) - age younger than 5 years only
    • Pneumococcal conjugate vaccine (PCV) - age younger than 5 years only
    • Measles, Mumps, Rubella - 1 dose of each, normally given together as MMR
    • Varicella - 1 dose or credible history of disease
  • Hepatitis B (HBV)
  • Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
  • Hepatitis A - 1 dose, required by 18 months of age or older​​

Children enrolling in KindergartenRequired Immunizations

  • Hepatitis B (HBV)
  • Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
  • Poliomyelitis (IPV or OPV) - final dose on or after the 4th birthday
  • Measles, Mumps, Rubella - 2 doses of each, usually given together as MMR
  • Varicella - 2 doses or credible history of disease
  • Hepatitis A - total of 2 doses, spaced at least 6 - 18 months apart

All children entering 7th grade (including currently enrolled students)

  • Tetanus-diphtheria-pertussis booster (Tdap) - evidence of one Tdap dose given any time before 7th grade entry is required regardless of Td history
  • Varicella - 2 doses or credible history of disease

Children who are new enrollees in a TN school in grades other than Kindergarten

  • Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
  • Measles, Mumps, Rubella (2 doses of each, normally given together as MMR)
  • Poliomyelitis (IPV or OPV) – final dose on or after the 4th birthday now required
  • Varicella (2 doses or credible history of disease) – previously only one dose was required
  • Hepatitis B (HBV) – previously only for Kindergarten, 7th grade entry
  • New students entering grades other than 7th grade are not required to have Tdap

Full-time Tennessee college students

  • Measles, Mumps, Rubella (2 doses of each, normally given together as MMR): if born on or after January 1, 1957 only. 
  • Varicella (2 doses or credible history of disease): if born on or after January 1, 1980 only. 
  • Hepatitis B (HBV) – only for health science students expected to have patient contact (before patient contact begins). 
  • Meningococcal - At a minimum of 1 dose given at 16 years of age or greater if enrolling in public institution for the first time and under 22 years of age and living in on-campus housing; private institutions set their own requirements for this vaccine. 

Children with medical or religious exemption to requirements

Medical – Physician (MD, DO) or department Public Health Nurse authorized to indicate specific vaccines medically exempted (because of risk of harm) on the new form.  Other vaccines remain required.  The medical reason for the exemption does not need to be provided.

Religious – This exemption requires a signed statement by the parent/guardian that vaccination conflicts with their religious tenets or practices.  If the child needs documentation of a health examination for the school, it must be noted by the healthcare provider on the immunization certificate.  In that case, the provider should check the box that the parent has sought a religious exemption to explain why immunization information is absent or incomplete.

Minimum ages or dose intervals – Tennessee follows published CDC guidelines.  For vaccines with critical minimum age requirements (e.g., MMR, varicella) or minimum dose intervals, doses are considered valid if given up to 4 days before the minimum age or dose interval.  Doses administered more than 4 days early are considered invalid and should be repeated as recommended.

Injectable or nasally administered live vaccines not administered on the same day should be administered at least 4 weeks apart. The 4-day "grace period" should not be applied to the 28-day interval between injectable or nasally administered live vaccines not administered at the same visit. If injectable or nasally administered live vaccines are separated by less than 4 weeks, the second vaccine administered should not be counted as a valid dose and should be repeated. The repeat dose should be administered at least 4 weeks after the last invalid dose.

Alternative proof of immunity for certain diseases – A positive serology (year of test documented) is acceptable as an alternative to immunization for measles, mumps, rubella, hepatitis A, hepatitis B or varicella.  For varicella, documentation of provider diagnosed varicella (year) or provider-verified credible history of disease given by a parent or guardian (year) also is acceptable.  By documenting a history of disease, the provider is asserting that he or she is convinced that the child has had chickenpox.