Assess and document immunization status when a student enters school, transfers to another school, or advances to a next level of schooling (e.g., elementary to middle or middle to high school).

It is in the best interest of individual students, the entire student body, and the population as a whole to have all students up to date with recommended immunizations. Record keeping can prevent unnecessary exclusion from school on the basis of state law and can assure that appropriate and selective exclusion from school is recommended for students when there is an outbreak of a vaccine-preventable disease.

Each state has immunization requirements for enrollment in school. All require immunization against tetanus, diphtheria, pertussis, polio, rubella, and measles. Many also require immunization against mumps, varicella, and hepatitis B. School health personnel should strongly encourage important immunizations that are not required by state law, including influenza vaccine for those at highest health risk from this viral infection. Allow an exception if a student has a specific medical condition that would make an immunization dangerous. Most states exempt students from immunizations if they are from families with strong faith-based convictions that oppose immunization. State laws require that all other children who are not in compliance within a certain period of time after enrollment be denied access to school.

Each school should have a mechanism to obtain documentation of immunizations from families, to store immunization records, to notify families of children not in compliance, and to recommend how students can obtain immunizations. Schools should consider participating in regional immunization databases to provide and receive the most up-to-date records. Students who have no access to required immunizations may need the assistance of school staff to help them arrange for immunizations.

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American Academy of Pediatrics, Council on School Health. Role of the school nurse in providing school health services. Pediatrics. 2008;121(5):1052–1056.

Boyer-Chuanroong L. Roll Up Both Sleeves: A Comprehensive Immunization Guide for Nurses and Nurse Planners. Kent OH: American School Health Association; 1999.

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