section .0400 - IMMUNIZATION

 

10A NCAC 41A .0401       DOSAGE AND AGE REQUIREMENTS FOR IMMUNIZATION (EFFECTIVE UNTIL June 30, 2015)

(a)  Every individual in North Carolina required to be immunized pursuant to G.S. 130A-152 through 130A-157 shall be immunized against the following diseases by receiving the specified minimum doses of vaccines by the specified ages:

(1)           Diphtheria, tetanus, and whooping cough vaccine - five doses: three doses by age seven months and two booster doses, one by age 19 months and the second on or after the fourth birthday and before enrolling in school for the first time.  However:

(A)          Individuals who receive the first booster dose of diphtheria, tetanus, and whooping cough vaccine on or after the fourth birthday are not required to have a second booster dose;

(B)          Individuals attending colleges and universities are required to have three doses of tetanus/diphtheria toxoid, one of which must have been within the last 10 years. Those individuals enrolling in college or university for the first time on or after July 1, 2008 must have had three doses of tetanus/diphtheria toxoid and a booster dose of tetanus/diphtheria/pertussis vaccine if a tetanus/diphtheria toxoid or tetanus/diphtheria/pertussis vaccine has not been administered within the past 10 years. A dose of tetanus/diphtheria/pertussis vaccine is not required for any student over the age of 64 years;

(C)          A booster dose of tetanus/diphtheria/pertussis vaccine is required for individuals attending public school who are entering the sixth grade on or after August 1, 2008, if five years or more have passed since the last dose of tetanus/diphtheria toxoid. A booster dose of tetanus/diphtheria/pertussis vaccine is required for individuals not attending public schools who are 12 years of age on or after August 1, 2008, if five years or more have passed since the last dose of tetanus/diphtheria toxoid.  However, pertussis (whooping cough) vaccine is not required for individuals between 7 years of age through the fifth grade for those attending public schools and 7 through 12 years of age for those not attending public schools.

(2)           Poliomyelitis vaccine--four doses: two doses of trivalent type by age five months; a third dose trivalent type before age 19 months, and a booster dose of trivalent type before enrolling in school for the first time.  However:

(A)          An individual attending school who has attained his or her 18th birthday is not required to receive polio vaccine;

(B)          Individuals who receive the third dose of poliomyelitis vaccine on or after the fourth birthday are not required to receive a fourth dose;

(C)          The requirements for booster doses of poliomyelitis vaccine do not apply to individuals who enrolled for the first time in the first grade before July 1, 1987.

(3)           Measles (rubeola) vaccine--two doses of live, attenuated vaccine administered at least 28 days apart: one dose on or after age 12 months and before age 16 months and a second dose before enrolling in school for the first time.  However:

(A)          An individual who has been documented by serological testing to have a protective antibody titer against measles is not required to receive measles vaccine;

(B)          An individual who has been diagnosed prior to January 1, 1994, by a physician licensed to practice medicine as having measles (rubeola) disease is not required to receive measles vaccine;

(C)          An individual born prior to 1957 is not required to receive measles vaccine;

(D)          The requirement for a second dose of measles vaccine does not apply to individuals who enroll in school or in college or university for the first time before July 1, 1994.

(4)           Rubella vaccine--one dose of live, attenuated vaccine on or after age 12 months and before age 16 months.  However:

(A)          An individual who has been documented by serologic testing to have a protective antibody titer against rubella is not required to receive rubella vaccine;

(B)          An individual who has attained his or her fiftieth birthday is not required to receive rubella vaccine except in outbreak situations;

(C)          An individual who entered a college or university after his or her thirtieth birthday and before February 1, 1989 is not required to meet the requirement for rubella vaccine except in outbreak situations.

(5)           Mumps vaccine--one dose of live, attenuated vaccine administered on or after age 12 months and before age 16 months and a second dose before enrolling in school, college or university for the first time.  However:

(A)          An individual born prior to 1957 is not required to receive mumps vaccine;

(B)          The requirements for mumps vaccine do not apply to individuals who enrolled for the first time in the first grade before July 1, 1987 or in college or university before July 1, 1994;

(C)          An individual who has been documented by serological testing to have a protective antibody titer against mumps is not required to receive mumps vaccine;

(D)          An individual entering school, college or university prior to July 1, 2008 is not required to receive a second dose of mumps vaccine.

(6)           Haemophilus influenzae, b, conjugate vaccine--three doses of HbOC or PRP-T or two doses of PRP-OMP before age seven months and a booster dose of any type on or after age 12 months and by age 16 months. However:

(A)          Individuals born before October 1, 1988 are not required to be vaccinated against Haemophilus influenzae, b;

(B)          Individuals who receive the first dose of Haemophilus influenzae, b, vaccine on or after 12 months of age and before 15 months of age are required to have only two doses of HbOC, PRP-T or PRP-OMP;

(C)          Individuals who receive the first dose of Haemophilus influenzae, b, vaccine on or after 15 months of age are required to have only one dose of any of the Haemophilus influenzae conjugate vaccines, including PRP-D;

(D)          No individual who has passed their fifth birthday is required to be vaccinated against Haemophilus influenzae, b.

(7)           Hepatitis B vaccine--three doses: one dose by age three months, a second dose before age five months and a third dose by age 19 months.  However:

(A)          The last dose of the hepatitis B vaccine series shall not be administered prior to 24 weeks of age;

(B)          Individuals born before July 1, 1994 are not required to be vaccinated against hepatitis B.

(8)           Varicella vaccine--1 dose administered on or after age 12 months and before age 19 months. However:

(A)          An individual with a laboratory test indicating immunity or with a history of varicella disease, documented by a health care provider, parent, guardian or person in loco parentis is not required to receive varicella vaccine.  Serologic proof of immunity or documentation of previous illness must be presented whenever a certificate of immunization is required by North Carolina General Statute. The documentation shall include the name of the individual with a history of varicella disease and the approximate date or age of infection.  Previous illness shall be documented by:

(i)            a written statement from a health care provider documented on or attached to the lifetime immunization card or certificate of immunization; or

(ii)           a written statement from the individual's parent, guardian or person in loco parentis attached to the lifetime immunization card or certificate of immunization.

(B)          An individual born prior to April 1, 2001 is not required to receive varicella vaccine.

(b)  The healthcare provider shall administer immunizations in accordance with this Rule.  However, if a healthcare provider administers vaccine up to and including the fourth day prior to the required minimum age, the individual dose is not required to be repeated.  Doses administered more than 4 days prior to the requirements are considered invalid doses and shall be repeated.

(c)  The State Health Director may suspend temporarily any portion of the requirements of this Rule due to emergency conditions, such as the unavailability of vaccine.  The Department shall give notice in writing to all local health departments and other providers currently receiving vaccine from the Department when the suspension takes effect and when the suspension is lifted. When any vaccine series is disrupted by such a suspension, the next dose shall be administered within 90 days of the lifting of the suspension and the series resumed in accordance with intervals determined by the most recent recommendations of the Advisory Committee on Immunization Practices.

 

History Note:        Authority G.S. 130A-152(c); 130A-155.1;

Eff. February 1, 1976;

Amended Eff. July 1, 1977;

Readopted Eff. December 5, 1977;

Temporary Amendment Eff. February 1, 1988, for a period of 180 days to expire on July 29, 1988;

Amended Eff. October 1, 1995; October 1, 1994; January 1, 1994; January 4, 1993;

Temporary Amendment Eff. February 23, 2000; August 20, 1999; May 21, 1999;

Amended Eff. August 1, 2000;

Temporary Amendment Eff. May 17, 2002; April 1, 2002; February 18, 2002; August 1, 2001;

Amended Eff. January 1, 2008; November 1, 2005; January 1, 2005; April 1, 2003.

 

10A NCAC 41A .0401       DOSAGE AND AGE REQUIREMENTS FOR IMMUNIZATION (effective July 1, 2015)

(a)  Every individual in North Carolina required to be immunized pursuant to G.S. 130A-152 through 130A-157 shall be immunized against the following diseases and have documentation of age-appropriate vaccination in accordance with the Advisory Committee on Immunization Practices (ACIP).

(1)           Diphtheria, tetanus, and pertussis (whooping cough) - five doses:  three doses by age seven months; and 2 booster doses, the first by age 19 months and the second on or after the fourth birthday and before entering school for the first time.  However:

(A)          Individuals who receive the first booster dose of diphtheria/tetanus/pertussis vaccine on or after the fourth birthday are not required to have a second booster.

(B)          Individuals entering college or university for the first time on or after July 1, 2008 must have had three doses of tetanus/diphtheria toxoid; one of which must be tetanus/diphtheria/pertussis.

(C)          A booster dose of tetanus/diphtheria/pertussis vaccine is required for individuals who have not previously received it and are entering the seventh grade or by 12 years of age, whichever comes first.

(2)           Poliomyelitis vaccine - four doses: two doses of trivalent type by age five months; a third dose trivalent type before age 19 months; and a booster dose of trivalent type on or after his or her fourth birthday and before entering school for the first time.  However:

(A)          An individual attending school who has attained his or her 18th birthday is not required to receive a polio vaccine.

(B)          The requirements for the booster dose on or after the fourth birthday do not apply to individuals who began school before July 1, 2015.

(C)          Individuals who receive the third dose of poliomyelitis vaccine on or after the fourth birthday are not required to receive a fourth dose if the third dose is given at least six months after the second dose.

(3)           Measles (rubeola) vaccine - two doses of live, attenuated vaccine administered at least 28 days apart: the first dose on or after age 12 months and before age 16 months; and a second dose before entering school for the first time.  However:

(A)          An individual who has been documented by serological testing to have a protective antibody titer against measles is not required to receive measles vaccine.

(B)          An individual who has been diagnosed before January 1, 1994, by a physician (or designee such as a nurse practitioner or physician's assistant) as having measles (rubeola) disease is not required to receive measles vaccine.

(C)          An individual born before 1957 is not required to receive measles vaccine except in measles outbreak situations.

(D)          The requirement for a second dose of measles vaccine does not apply to individuals who enter school or in college or university for the first time before July 1, 1994.

(4)           Rubella vaccine - one dose of live, attenuated vaccine on or after age 12 months and before age 16 months.  However:

(A)          An individual who has laboratory confirmation of rubella disease or who has been documented by serological testing to have a protective antibody titer against rubella is not required to receive rubella vaccine.

(B)          An individual who has attained his or her fiftieth birthday is not required to receive rubella vaccine except in outbreak situations.

(C)          An individual who entered a college or university after his or her thirtieth birthday and before February 1, 1989 is not required to meet the requirement for rubella vaccine except in outbreak situations.

(5)           Mumps vaccine – two doses: the first dose of live, attenuated vaccine administered on or after age 12 months and before age 16 months; and a second dose before entering school, college or university for the first time.  However:

(A)          An individual who has laboratory confirmation of disease, or has been documented by serological testing to have a protective antibody titer against mumps is not required to receive the mumps vaccine.

(B)          An individual born before 1957 is not required to receive the mumps vaccine.

(C)          The requirements for the mumps vaccine do not apply to individuals who entered the first grade for the first time before July 1, 1987 or college or university before July 1, 1994.

(D)          An individual entering school, college or university before July 1, 2008 is not required to receive a second dose of mumps vaccine.

(6)           Haemophilus influenzae, b conjugate vaccine - three doses of HbOC or PRP-T or two doses of PRP-OMP before age 7 months and a booster dose of any type on or after age 12 months and by age 16 months.  However:

(A)          Individuals who receive the first dose of Haemophilus influenzae, b vaccine on or after 7 months of age and before 12 months of age are required to have two doses of HbOC, PRP-T or PRP-OMP and a booster dose on or after 12 months of age and by age 16 months.

(B)          Individuals who receive the first dose of Haemophilus influenzae, b vaccine on or after 12 months of age and before 15 months of age are required to have only 2 doses of HbOC, PRP-T or PRP-OMP and a booster dose two months later.

(C)          Individuals who receive the first dose of Haemophilus influenzae, b vaccine on or after 15 months of age are required to have only one dose of any of the Haemophilus influenzae b conjugate vaccines.

(D)          No individual who has passed his or her fifth birthday is required to be vaccinated against Haemophilus influenzae, b.

(7)           Hepatitis B vaccine – three doses: the first dose by age 3 months, a second dose before age 5 months and a third dose by age 19 months.  However:

(A)          The last dose of the hepatitis B vaccine series shall not be administered before 24 weeks of age.

(B)          Individuals born before July 1, 1994 are not required to be vaccinated against hepatitis B.

(8)           Varicella vaccine – two doses administered at least 28 days apart; one dose on or after age 12 months of age and before age 19 months; and a second dose before entering school for the first time. However:

(A)          An individual who has laboratory confirmation of varicella disease immunity or has been documented by serological testing to have a protective antibody titer against varicella is not required to varicella vaccine.

(B)          An individual who has documentation from a physician, nurse practitioner, or physician's assistant verifying history of varicella disease is not required to receive varicella vaccine. The documentation shall include the name of the individual with a history of varicella disease, the approximate date or age of infection, and a healthcare provider signature.

(C)          An individual born before April 1, 2001 is not required to receive varicella vaccine.

(D)          The requirement for the second dose of varicella vaccine shall not apply to individuals who enter Kindergarten or first grade for the first time before July 1, 2015.

(9)           Pneumococcal conjugate vaccine – Four doses; 3 doses by age 7 months and a booster dose at 12 through 15 months of age.  However:

(A)          Individuals who receive the first dose of pneumococcal conjugate vaccine on or after 7 months of age and before 12 months of age are required to have 2 doses at least 4 weeks apart; and a booster dose at 12 through 15 months of age.

(B)          Individuals who receive the first dose of pneumococcal conjugate vaccine on or after 12 months of age and before 24 months of age are required to have 2 doses at least 8 weeks apart to complete the series.

(C)          Individuals who receive the first dose of pneumococcal conjugate vaccine on or after 24 months of age and before 5 years are required to have 1 dose to complete the series.

(D)          No individual who has passed his or her fifth birthday shall be required to be vaccinated against pneumococcal disease.

(E)           An individual born before July 1, 2015 shall not be required to receive pneumococcal conjugate vaccine.

(10)         Meningococcal conjugate vaccine – two doses: one dose is required for individuals entering the seventh grade or by 12 years of age, whichever comes first, on or after July 1, 2015.  A booster dose is required by 17 years of age or by entering the 12th grade.  However:

(A)          The first dose does not apply to individuals who entered seventh grade before July 1, 2015.

(B)          The booster dose does not apply to individuals who entered the 12th grade before August 1, 2020.

(C)          If the first dose is administered on or after the 16th birthday, a booster dose is not required.

(D)          An individual born before January 1, 2003 shall not be required to receive a meningococcal conjugate vaccine.

(b)  The healthcare provider shall administer immunizations in accordance with this Rule.  However, if a healthcare provider administers vaccine up to and including the fourth day prior to the required minimum age, the individual dose is not required to be repeated.  Doses administered more than four days prior to the requirements are considered invalid doses and shall be repeated.

(c)  The State Health Director may suspend temporarily any portion of the requirements of this Rule due to emergency conditions, such as the unavailability of vaccine.  The Department shall give notice in writing to all local health departments and other providers currently receiving vaccine from the Department when the suspension takes effect and when the suspension is lifted. When any vaccine series is disrupted by such a suspension, the next dose shall be administered within 90 days of the lifting of the suspension and the series resumed in accordance with intervals determined by the most recent recommendations of the Advisory Committee on Immunization Practices. These recommendations may be accessed free of charge at http://www.cdc.gov/vaccines/acip/.

 

History Note:        Authority G.S. 130A-152(c); 130A-155.1;

Eff. February 1, 1976;

Amended Eff. July 1, 1977;

Readopted Eff. December 5, 1977;

Temporary Amendment Eff. February 1, 1988, for a period of 180 days to expire on July 29, 1988;

Amended Eff. October 1, 1995; October 1, 1994; January 1, 1994; January 4, 1993;

Temporary Amendment Eff. February 23, 2000; August 20, 1999; May 21, 1999;

Amended Eff. August 1, 2000;

Temporary Amendment Eff. May 17, 2002; April 1, 2002; February 18, 2002; August 1, 2001;

Amended Eff. July 1, 2015; January 1, 2008; November 1, 2005; January 1, 2005; April 1, 2003.