37.95.140    IMMUNIZATION

(1) Before a child may attend a Montana day care facility, that facility must be provided with the documentation required by (5) that the child has been immunized as required for the child's age group against measles, rubella, mumps, poliomyelitis, diphtheria, pertussis (whooping cough), tetanus, varicella, hepatitis B, pneumococcal, and Haemophilus influenza type B, unless the child qualifies for conditional attendance in accordance with (7):

 

Age at Entry                                  Number of Doses-Vaccine Type

 

under 2 months old                       no vaccinations required

 

by 3 months of age                       1 dose of polio vaccine

                                                      1 dose of DTP vaccine

                                                      1 dose of Hib vaccine

                                                      1 dose of Hep B vaccine

                                                      1 dose of PCV vaccine

 

by 5 months of age                       2 doses of polio vaccine

                                                      2 doses of DTP vaccine

                                                      2 doses of Hib vaccine

                                                      2 doses of Hep B vaccine

                                                      2 doses of PCV vaccine

 

by 7 months of age                       2 doses of polio vaccine

                                                      3 doses of DTP vaccine

                                                    *2 or 3 doses of Hib vaccine

                                                      2 doses of Hep B vaccine

                                                      3 doses of PCV vaccine

 

by 16 months of age                     2 doses of polio vaccine

                                                      3 doses of DTP vaccine

                                                      1 dose of varicella vaccine

                                                      1 dose of MMR vaccine

                                                     *3 or 4 doses of Hib vaccine

                                                      2 doses of Hep B vaccine

                                                     *4 doses of PCV vaccine

 

by 19 months of age                     1 dose of varicella vaccine

                                                      3 doses of polio vaccine

                                                      4 doses of DTP vaccine

                                                      1 dose of MMR vaccine

                                                    *3 or 4 doses of Hib vaccine

                                                     3 doses of Hep B vaccine

                                                    *4 doses of PCV vaccine

 

By 6 years of age                         3 doses of polio vaccine, one given after the 4th birthday

                                                     4 doses of DTP vaccine, one given after the 4th birthday

                                                     2 doses of varicella vaccine

                                                     2 doses of MMR vaccine

                                                     3 doses of Hep B vaccine

 

By 12 years of age                       3 doses of polio vaccine, one given after the 4th birthday

                                                     1 dose of Tdap vaccine

                                                     2 doses of varicella vaccine

                                                     2 doses of MMR vaccine

                                                     3 doses of Hep B vaccine

 

(*) varies depending on vaccine type used or the ACIP catch-up schedule.

 

(2) Hib and PCV vaccines are not required or recommended for children five years of age and older.

(3) Doses of MMR and varicella vaccines, to be acceptable under this rule, must be given no earlier than 12 months of age and a child who received a dose prior to 12 months of age must be revaccinated; however, vaccine doses given up to four days before the minimum interval or age are counted as valid. Live vaccines not administered at the same visit must be separated by at least four weeks.

(4) Vaccines immunizing against diphtheria, pertussis, and tetanus must be administered as follows:

(a) a child less than seven years of age must be administered four or more doses of DTP or DTaP vaccine, at least one dose of which must be given after the fourth birthday;

(b) DT vaccine administered to a child less than seven years of age is acceptable for purposes of this rule only if accompanied by a medical exemption meeting the requirements of ARM 37.114.715 that exempt the child from pertussis vaccination; and

(c) a child seven years old or older who has not completed the requirement in (1) must receive additional doses of Tdap vaccine or Td vaccine to become current in accordance with the ACIP schedule.

(5) Immunization history must be recorded on the Montana certificate of immunization form (HES-101) provided by the department or on a physician- or clinic-provided immunization record, which must include:

(a) the name of the physician or clinic;

(b) the name and birth date of the child; and

(c) the date and type of immunization.

(6) In order to continue to attend a day care facility, a child must continue to be immunized on the schedule described in (1) and must be immediately excluded from attendance in the day care facility if the child is not vaccinated on that schedule with all of the required vaccines, or does not have on file at the day care facility a record of medical exemption or a conditional enrollment form which indicates that no vaccine dose is past due.

(7) A child may initially conditionally attend a day care facility if:

(a) the child has received at least one dose of each of the vaccines required for the child's age;

(b) a form prescribed by the department documenting the child's conditional immunization status is on file at the day care facility and is attached to the department's Montana certificate of immunization (HES-101); and

(c) the child is not past due for the next required dose (as noted on the conditional enrollment form) of the vaccine in question.

(8) If a child in attendance at the day care facility, a resident of the day care facility, or a staff member, or volunteer contracts any of the diseases for which this rule requires immunization, all individuals infected and all persons attending the day care facility who are not completely immunized against the disease in question or who are exempted from immunization must be excluded from the day care facility until the local health authority indicates to the day care facility that the outbreak is over.

(9) The day care facility must maintain a written record of immunization status of each staff member, enrolled child, and each child of a staff member who resides at the day care facility. The facility must make those records available during normal working hours to representatives of the department or the local health authority.

(10) A child under five years of age seeking to attend a day care facility is not required to be immunized against Haemophilus influenza type B if the parent or guardian of the child objects thereto in a signed, written statement indicating that the proposed immunization interferes with the free exercise of the religious beliefs of the person signing the statement. A claim of exemption on religious grounds must be notarized and maintained on an Affidavit of Exemption on Religious Grounds form (HES-113) provided by the department.

(11) A child is not required to have any immunizations which are medically contraindicated. A written and signed statement from a physician that an immunization otherwise required by (1) is medically contraindicated will exempt a child from those immunization requirements as deemed necessary by the physician. It is preferred, but not mandatory, that a physician's medical exemption be recorded on HES-101. Medical exemption documentation must include:

(a) which specific immunization is contraindicated;

(b) the period of time during which the immunization is contraindicated;

(c) the reasons for the medical contraindication; and

(d) when deemed necessary by a physician, the results of immunity testing. The tests must indicate serological evidence of immunity and must be performed by a CLIA approved lab.

(12)  A child experiencing homelessness or a child in foster care is exempt from required immunizations outlined in (1) for a 30-day grace period beginning the first day the child attends a child care facility as verified on the sign-in/sign-out records.

(a) The child experiencing homelessness must meet the definition in Section 725 of Subtitle VII-B of the McKinney-Vento Act (42 U.S.C. 11434a) (98.2).

(b) A child is in foster care when the foster care environment meets ARM 37.50.101(4).

(c) A child must meet the immunization requirement for conditional enrollment outlined in (7) before the end of the 30-day period.

(d) A child may not be granted grace periods consecutively.

History: 52-2-704, 52-2-735, MCA; IMP, 52-2-704, 52-2-735, MCA; NEW, 2000 MAR p. 2415, Eff. 9/8/00; AMD, 2006 MAR p. 1424, Eff. 6/2/06; AMD, 2018 MAR p. 191, Eff. 6/1/18; AMD, 2021 MAR p. 1787, Eff. 12/11/21.