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| Montana Administrative Register Notice 37-814 | No. 2 01/26/2018 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons
1. On November 9, 2017, the Department of Public Health and Human Services published MAR Notice No. 37-814 pertaining to the public hearing on the proposed amendment and repeal of the above-stated rules at page 2022 of the 2017 Montana Administrative Register, Issue Number 21.
2. The department has amended the following rules as proposed: ARM 37.51.102, 37.95.102, 37.95.160, 37.95.184. The department has repealed ARM 37.51.307 as proposed.
3. The department has amended the following rules as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:
37.51.306 YOUTH FOSTER HOMES: IMMUNIZATION REQUIREMENTS (1) All children residing in the foster home other than the foster child shall be immunized against measles, rubella, mumps, poliomyelitis, diphtheria, pertussis, tetanus, varicella, hepatitis B, pneumococcal, and Haemophilus influenza type B according to the following schedule:
Total Immunizations Required, By Age
Age Number 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 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) through (7) remain as proposed.
AUTH: 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA IMP: 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, 52-2-735, MCA
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 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) through (11) remain as proposed.
4. The department has thoroughly considered the comments and testimony received. A summary of the comments received and the department's responses are as follows:
COMMENT #1: One commenter stated that the department should change the age requirement from "By 11 years of age" to "By 12 years of age" in immunizations required in both Youth Foster Home and Child Care.
RESPONSE#1: The department agrees with the comment. ARM 37.51.306(1) and 37.95.140(1) have been further amended to reflect this change.
COMMENT #2: One commenter requested that the rotavirus vaccine be added to the required immunizations to attend daycare, unless there is a medical contraindication.
RESPONSE #2: Rotavirus is not commonly required for childcare settings with only 5 of 50 states mandating its use (data from the Immunization Action Coalition). Related rules in Montana prohibit children with a diarrheal illness from attending daycare. While we know spread is possible before and after the presence of symptoms, reported outbreaks related to this condition in child care setting have been rare in Montana. COMMENT #3: One commenter commented that the number of booster doses required for vaccines such as DTaP and polio, are less than the recommended number of vaccines by the ACIP.
RESPONSE #3: The department looked closely at the current and proposed rule for DTaP and polio. The rule requires that children have 4 doses of DTaP and 3 doses of polio by 19 months. A booster dose of each vaccine is then required by age 6. This aligns with the ACIP’s routine and catch-up schedules.
COMMENT #4: One commenter requested that the public school system and DPHHS should have the same recommendations in reference to an MMR vaccine that was administered a few days prior to the first birthday.
RESPONSE #4: ARM 37.114.702 does recognize the ACIP recommendation allowing a 4 day "grace" period for selected vaccines and does align with the child care rule. The rule states: "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."
5. These rule amendments and repeal are effective June 1, 2018.
/s/ Nicholas Domitrovich /s/ Sheila Hogan Nicholas Domitrovich Sheila Hogan, Director Rule Reviewer Public Health and Human Services
Certified to the Secretary of State January 16, 2018 |
A directory of state agencies is available online at http://www.mt.gov/govt/agencylisting.asp.
For questions about the organization of the ARM or this web site, contact [email protected].
