Advertisement

List of Vaccinations Mandatory for Kids Before School in USA

The recent COVID-19 pandemic that spread throughout the world and took so many lives has firmly put the debate about whether or not school-going children should be vaccinated on the table. The COVID vaccine has brought into focus this discussion about other vaccines as well and whether it should be mandatory for children going to school should be vaccinated.

Many countries around the world have rules about certain vaccines being compulsory for children before they can attend school. Countries like the United States had this rule in place much before the COVID-19 pandemic took over the world. While there are many strong concerns among parents about vaccinating their children, here are some of the vaccines that are mandatory for kids before attending school in the USA.

Advertisement
Advertisement

Vaccination Requirements in the USA

If you look at the history of vaccine mandates in the US, it is not something new that has just started with the COVID-19 pandemic. The first vaccine that was made compulsory in US schools was in the 1850s in the state of Massachusetts for the prevention of smallpox. And by the 1900s, more than half of all the states had also made the same requirement compulsory. The idea behind putting in place such laws was to prevent the spread of diseases and avoid an epidemic-like situation. In the years that followed, more vaccines were added as the coverage for diseases kept on increasing.(1, 2, 3)

According to the Centers for Disease Control and Prevention (CDC), by the end of 1963, nearly 20 states, as well as Puerto Rico and the District of Columbia, had put in place mandatory requirements for numerous vaccines that children had to get in order to enter schools. However, the enforcement of these mandates continued to remain uneven.(4) It was in the late 1960s that the government again made an effort to enforce these vaccination mandates amongst school-going children owing to the widespread outbreak of measles across the US.

Advertisement
Advertisement

Since the transmission in schools amongst children was a huge problem, more states started strictly enforcing the need for certain vaccines as requirements to attend school. Following this, the US government set up the Childhood Immunization Initiative in 1977, which focused on increasing the rate of vaccination in children against seven main diseases for which vaccinations were routinely administered in childhood itself.(5) These include:

After this, all 50 states adopted compulsory vaccinations for school-going children. Today, all US states, territories, and the District of Columbia all have vaccination mandates in place for children to attend daycare facilities and schools.

However, it is important to know that every state makes its own decisions about which vaccines are a must for your child’s enrollment at a school or even at a childcare facility. At the same time, the vaccination requirements and any exemptions that may be allowed also vary by state and on a yearly basis. These vaccination laws don’t only apply to those children who are attending public schools but also to those who go to private schools and daycare facilities. Most schools follow the vaccine schedule for children set by the CDC. Here is a list of vaccinations that the CDC mandates for all school children.(6)

List of Vaccinations Mandatory for Kids Before School in USA

  1. Mandatory vaccines for childcare or preschool(7)

    Between 2 to 3 Months

    • One dose of polio vaccine
    • One dose of DTaP (diphtheria, tetanus, and pertussis) vaccine
    • One dose of Hib (Haemophilus influenza type b) vaccine
    • One dose of hepatitis B vaccine

    Between 4 to 5 Months

    • Two doses of polio vaccine
    • Two doses of DTaP vaccine
    • Two doses of Hib vaccine
    • Two doses of hepatitis B vaccine

    Between 6 to 14 Months

    • Two doses of polio vaccine
    • Three doses of DTaP vaccine
    • Two doses of Hib vaccine
    • Two doses of hepatitis B

    Between 15 to 17 Months

    • Three doses of polio vaccine
    • Three doses of DTaP vaccine
    • Two doses of hepatitis B vaccine
    • One dose of measles, mumps, and rubella (MMR) vaccine on or after the child’s first birthday
    • One dose of Hib vaccine on or after the child’s first birthday

    Between 18 Months to 5 Years

    • Three doses of polio vaccine
    • Four doses of DTaP vaccine
    • Three doses of hepatitis B vaccine
    • One dose of MMR vaccine on or after the child’s first birthday
    • One dose of Hib vaccine on or after the child’s first birthday
    • One dose of Varicella (chickenpox) vaccine
  2. Mandatory vaccines for school students between ages 4 to 6 (7)

    • Five doses of DTaP vaccines; or four doses if one was given on or after the fourth birthday
    • Four doses of polio vaccine; or three doses if one was given on or after the fourth birthday
    • Three doses of hepatitis B vaccine
    • Two doses of MMR vaccine, both to be given on or after the first birthday
    • One dose of varicella (chickenpox) vaccine
  3. Mandatory vaccines for school students between ages 7 to 17 (7)

    • Four doses of DTaP vaccine; or three doses if the last dose was given on or after the second birthday
    • Four doses of polio vaccine; or three doses if one was given on or after the second birthday
    • One dose of MMR vaccine; or at least two doses required in seventh grade
    • One to two doses of varicella (chickenpox) vaccine; students seeking admission at ages 7 to 12 years need one dose; students seeking admission at ages 13 to 17 years need two doses.
    • One dose of tetanus, diphtheria, and pertussis (TDaP) vaccine in seventh grade or for out-of-state transfer students seeking admission to grades 8 to 12; or one dose on or after the seventh birthday.

    So overall, the US law requires that children should be vaccinated against measles, polio, chickenpox, meningitis, whooping cough, and hepatitis before they seek admission to schools, preschools, or childcare facilities.

    These vaccines have been made mandatory for children attending schools and daycare in order to keep all children safe from various infectious diseases in childhood.

    Meningococcal meningitis and HIB are known to be severe and fatal conditions in children, and today, these diseases have become rare because of this very requirement for vaccination of school-going children. For example, the pneumococcal vaccine Prevnar alone is known to have prevented countless hospitalizations and severe cases in children under the age of three years.(8, 9, 10) Pneumococcal bacteria are known to cause many types of illnesses, including pneumonia, blood infections, and ear infections in children, and it was one of the leading causes of hospitalization before the year 2000. The influenza vaccine has also prevented the need for hospitalization and severe flu symptoms in children every year.(11, 12, 13)

COVID-19 Vaccination

Advertisement
Advertisement

The COVID-19 pandemic kick started a race like never before to discover a vaccine against the deadly virus. The US Food and Drug Administration approved the Pfizer-BioNTech and Moderna COVID-19 vaccines for infants and children after they went through an extensive review for pediatric safety. However, owing to the speed at which the vaccines were developed, many parents remain concerned about the exact implications of these vaccines. These concerns have since been addressed by many medical experts as well as pediatricians. At the same time, since the release of the COVID-19 vaccines, billions of vaccines have been administered all over the world and have been found to be effective and safe at preventing hospitalization and severe disease.(14, 15, 16)

Many states have not made the COVID-19 vaccines mandatory at schools yet, but discussions are ongoing about making this vaccine also compulsory. As per the recommendations of the CDC, everyone above the age of six months should get vaccinated against the COVID-19 virus as the vaccine has been shown to reduce the risk of developing severe complications from the virus as well as its new, evolving variants.(17)

Conclusion

Many doctors and pediatricians often recommend that school children should also get some additional vaccines, including the HPV vaccine, which prevents infections by the human papillomavirus (HPV), which causes cervical cancer and other types of cancers as well. This is especially recommended to be administered to children between 9 to 11 years old. To find out if your child should get any further vaccinations done before entering school, you should speak to your child’s pediatrician.

Advertisement
Advertisement

References:

  1. Stern, A.M. and Markel, H., 2005. The history of vaccines and immunization: familiar patterns, new challenges. Health affairs, 24(3), pp.611-621.
  2. Artenstein, A.W. ed., 2009. Vaccines: a biography. Springer Science & Business Media.
  3. Hsu, J.L., 2013. A brief history of vaccines: smallpox to the present. South Dakota Medicine.
  4. Immunization managers (2022) Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/vaccines/imz-managers/index.html (Accessed: October 7, 2022).
  5. Current trends childhood immunization initiative, United States — 5-year follow-up (no date) Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/00001091.htm#:~:text=In%201977,%20approximately%2020%20million,,%20diphtheria,%20measles,%20mumps, (Accessed: October 7, 2022).
  6. Birth-18 years immunization schedule (2022) Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html (Accessed: October 7, 2022).
  7. Immunization schedules (2022) Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/vaccines/schedules/index.html (Accessed: October 7, 2022).
  8. Isaacman, D.J., Fletcher, M.A., Fritzell, B., Ciuryla, V. and Schranz, J., 2007. Indirect effects associated with widespread vaccination of infants with heptavalent pneumococcal conjugate vaccine (PCV7; Prevnar). Vaccine, 25(13), pp.2420-2427.
  9. Caspary, H., Welch, J.C., Lawson, L., Darrow, D., Buescher, S., Shahab, S. and Derkay, C.S., 2004. Impact of pneumococcal polysaccharide vaccine (Prevnar) on middle ear fluid in children undergoing tympanostomy tube insertion. The Laryngoscope, 114(6), pp.975-980.
  10. Rozenbaum, M.H., Van Hoek, A.J., Hak, E. and Postma, M.J., 2010. Huge impact of assumptions on indirect effects on the cost-effectiveness of routine infant vaccination with 7-valent conjugate vaccine (Prevnar®). Vaccine, 28(12), pp.2367-2369.
  11. Klein, J.O., 1981. The epidemiology of pneumococcal disease in infants and children. Reviews of infectious diseases, 3(2), pp.246-253.
  12. Johnson, H.L., Deloria-Knoll, M., Levine, O.S., Stoszek, S.K., Freimanis Hance, L., Reithinger, R., Muenz, L.R. and O’Brien, K.L., 2010. Systematic evaluation of serotypes causing invasive pneumococcal disease among children under five: the pneumococcal global serotype project. PLoS medicine, 7(10), p.e1000348.
  13. Giebink, G.S., 2001. The prevention of pneumococcal disease in children. New England Journal of Medicine, 345(16), pp.1177-1183.
  14. Biswas, N., Mustapha, T., Khubchandani, J. and Price, J.H., 2021. The nature and extent of COVID-19 vaccination hesitancy in healthcare workers. Journal of community health, 46(6), pp.1244-1251.
  15. Ioannidis, J.P., 2021. COVID‐19 vaccination in children and university students. European journal of clinical investigation, 51(11), p.e13678.
  16. Eberhardt, C.S. and Siegrist, C.A., 2021. Is there a role for childhood vaccination against COVID‐19?. Pediatric Allergy and Immunology, 32(1), pp.9-16.
  17. Zhang, K.C., Fang, Y., Cao, H., Chen, H., Hu, T., Chen, Y.Q., Zhou, X. and Wang, Z., 2020. Parental acceptability of COVID-19 vaccination for children under the age of 18 years: cross-sectional online survey. JMIR pediatrics and parenting, 3(2), p.e24827.
Advertisement