Every child in the state shall be vaccinated against vaccine-preventable diseases caused by infectious agents, in accordance with the following immunization schedule. While the department recommends that providers immunize children according to the recommendations found on the department's website at www.ImmunizeTexas.com, this section sets out minimum immunization requirements for school entry for the child. The child must have the indicated vaccinations by the grade level indicated. The vaccination schedule also indicates the grade before which the child should not obtain the specific vaccination. A copy of the current recommended schedule is available at www.ImmunizeTexas.com, or by mail by writing the Department of State Health Services, Mail Code 1946, P.O. Box 149347, Austin, Texas 78714-9347.
  (1) For those vaccines where it is stated in this section that a certain dose must be received on or after a certain birthday, a vaccine administered up to four days prior to the birthday is considered compliant.
  (2) For diseases listed below, a child or student shall show acceptable evidence of vaccination prior to entry, attendance, or transfer to a child-care facility or public or private elementary or secondary school.
    (A) Children enrolled in child-care facilities, pre-kindergarten, or early childhood programs shall be immunized against: diphtheria, pertussis, tetanus, poliomyelitis, Haemophilus influenzae type b (Hib), measles, mumps, rubella, hepatitis B, hepatitis A, invasive pneumococcal, and varicella diseases. In recognition of the fact that immunization needs vary depending on the age of the child, the minimum number of doses required for each vaccine is indicated in the schedule below:
Attached Graphic
    (B) Students in kindergarten through twelfth grade shall have the following vaccines, according to the schedule listed.
      (i) Poliomyelitis.
        (I) Kindergarten through twelfth grade. Students are required to have four doses of polio vaccine--one of which must have been received on or after the fourth birthday. Or, if the third dose was administered on or after the fourth birthday, only three doses are required. Four doses of oral polio vaccine (OPV) or inactivated poliovirus vaccine (IPV) in any combination by age four to six years old is considered a complete series, regardless of age at the time of the third dose.
        (II) Polio vaccine is not required for persons eighteen years of age or older.
      (ii) Diphtheria/Tetanus/Pertussis.
        (I) Kindergarten through sixth grade. Students are required to have five doses of a diphtheria/tetanus/pertussis-containing vaccine -- one of which must have been received on or after the fourth birthday. Or, if the fourth dose was administered on or after the fourth birthday, only four doses are required.
        (II) Students seven years of age or older. Students seven years of age or older are required to have at least three doses of a tetanus/diphtheria-containing vaccine, provided at least one dose was administered on or after the fourth birthday. Any combination of three doses of a tetanus/diphtheria-containing vaccine will meet this requirement.
        (III) Tdap.
          (-a-) Seventh grade. Students are required to have one booster dose of a tetanus/diphtheria/pertussis-containing vaccine for entry into the 7th grade, if at least five years have passed since the last dose of a tetanus-containing vaccine. If five years have not elapsed since the last dose of a tetanus-containing vaccine at entry into the 7th grade, then this dose will become due as soon as the five-year interval has passed. Td vaccine is an acceptable substitute, if Tdap vaccine is medically contraindicated.
          (-b-) Grades 8 - 12. Students who have not already received Tdap vaccine are required to receive one booster dose of Tdap when ten years have passed since the last dose of a tetanus-diphtheria-containing vaccine.
        (IV) Children who were enrolled in school, grades K - 12, prior to August 1, 2004, and who received a booster dose of DTaP or polio vaccine in the calendar month of (or prior to) their fourth birthday, shall be considered in compliance with clause (i)(I) (polio) and clause (ii)(I) (DTaP) of this subparagraph.
      (iii) MMR. Beginning SY 2016 - 2017, students enrolling in kindergarten through 12th grade are required to have two doses of MMR vaccine with the first dose received on or after the first birthday. Students vaccinated prior to 2009 with two doses of measles and one dose each of rubella and mumps satisfy this requirement.
      (iv) Hepatitis B.
        (I) Students enrolling in kindergarten through 12th grade are required to have three doses of hepatitis B vaccine.
        (II) In some circumstances, the United States Food and Drug Administration may officially approve in writing the use of an alternative dosage schedule for this vaccine. Such an alternative regimen may be used to meet the requirements under this section only when alternative regimens are fully documented. Such documentation must include vaccine manufacturer and dosage received for each dose of that vaccine.
      (v) Varicella. Beginning SY 2016 - 2017, students enrolling in kindergarten through 12th grade are required to have two doses of varicella vaccine received on or after the first birthday.
      (vi) Hepatitis A. For SY 2016 - 2017, students are required to have two doses of hepatitis A vaccine with the first dose received on or after the first birthday for the following grades and school years:
        (I) SY 2016 - 2017: K - 7;
        (II) SY 2017 - 2018: K - 8;
        (III) SY 2018 - 2019: K - 9;
        (IV) SY 2019 - 2020: K - 10;
        (V) SY 2020 - 2021: K - 11; and
        (VI) SY 2021 - 2022: K - 12.
        (VII) Effective SY 2022-2023, students enrolling in kindergarten through 12th grade are required to have two doses of hepatitis A vaccine with the first dose received on or after the first birthday.
      (vii) Meningococcal. Effective SY 2016 - 2017, students enrolling in 7th - 12th grades are required to have one dose of quadrivalent meningococcal conjugate vaccine (MCV4) on or after the student's 11th birthday.

Source Note: The provisions of this §97.63 adopted to be effective April 1, 2004, 29 TexReg 3188; amended to be effective December 10, 2006, 31 TexReg 9835; amended to be effective March 5, 2009, 34 TexReg 1433; amended to be effective July 20, 2011, 36 TexReg 4563; amended to be effective June 7, 2015, 40 TexReg 3170; amended to be effective July 28, 2016, 41 TexReg 5422