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Taken from http://www.sos.state.tx.us/texreg/archive/January291999/index.html TITLE Health-Services 25 TAC §§97.63, 97.65, 97.67, 97.74 The Texas Department of Health (department) proposes amendments to §§97.63, 97.65, 97.67, and 97.74 concerning immunization requirements for children and students in Texas child-care facilities, elementary and secondary schools and institutions of higher education. These amendments implement departmental initiatives to enhance childhood protection against hepatitis A, hepatitis B, and varicella (chickenpox) and incorporate recent recommendations of the Advisory Committee on Immunization Practices (ACIP) for the vaccination of health care workers by requiring varicella vaccination for higher education students in the health professions whose work involves direct patient contact. Hepatitis A vaccination will be required in 32 border counties for children and students 2 years old and older who were born on or after September 2, 1993. The existing requirement for hepatitis B vaccination throughout the state will be expanded to include a cohort of adolescents. A new requirement for varicella vaccine for children entering kindergarten in Fall, 1999, and all younger children attending child-care; for 12 year-olds without a reliable history of varicella disease; and for higher education students without a reliable history of varicella disease, who are pursuing health professions degrees. Robert D. Crider, M.S., M.P.A., Director, Immunization Division, has determined that for the first five-year period that the sections will be in effect there will be fiscal implications to state and local government as a result of enforcing and administering the sections as proposed. The total cost to state government of providing hepatitis A vaccine to the children and students in the 32 border-county region should approach $3.2 million. Federal funds (from the Vaccine for Children program and the 317 Grant program) administered by state government are expected to supply $2.9 million of the needed funding. Funds allocated from the state general revenue fund are expected to cover the remaining $300,000 in costs. The cost to state government of providing hepatitis B vaccine to the students affected by the hepatitis B requirement is expected to be $8.2 million per year. Federal funds administered by state government (from the Vaccine for Children program and the 317 Grant program) will cover approximately $7.6 million of the needed funding. The remaining cost, estimated to be $600,000, is expected to be paid out of state general revenues. The total cost to state government of immunizing the children and students affected by the varicella vaccination requirement will be approximately $19.5 million per year. Federal monies (from the Vaccine for Children program and the 317 Grant program) administered by state government are expected to provide roughly $18 million of the needed funding. State funds in the amount of $1.5 million are expected to pay for the remaining costs. There will be increased costs to local health departments, primarily in increased operating expenses, e.g., labor and overhead, required to serve a larger number of children than the number currently receiving hepatitis A, hepatitis B, and varicella vaccines according to the recommended immunization schedule. These costs are estimated to be $9.3 million and may be partly offset by the collection of (sliding scale) clinic fees. Additional savings to local health departments are anticipated as the amount of indigent care provided for these diseases declines. Much of the cost of immunizing children against hepatitis A in the 32 border counties is already being expended in voluntary local vaccination programs. Similarly, many schools and local health departments have already implemented adolescent hepatitis B catch-up programs in their communities. In these areas, expenditures resulting from these new requirements will be smaller. Additional costs estimated at $847,000 will be incurred by child-care facilities, school districts, and private schools, which will be required to monitor their populations for compliance with the new requirements. Increased efforts made by these entities in monitoring compliance with these requirements should be offset by eliminating the expense of disease reporting, exclusions from attendance during periods of communicability, and (for public schools) the loss of federal funds based on average daily attendance. Mr. Crider has also determined that for each year of the first five years that the sections are in effect the public benefits anticipated as a result of enforcing and administering the sections as proposed will emerge as fewer outbreaks of hepatitis A occur, fewer people develop chronic hepatitis B infection following acute infection, and parents and guardians experience less work disruption due to their children's varicella illness. These amendments are designed to enhance understanding of the requirements, which should simplify the work performed by the above entities as they monitor compliance. Health benefit plans will be affected by these proposed rules, which increase the number of vaccines and vaccinations for which they are required to provide first-dollar coverage. Health-care providers who administer uncompensated vaccination and private-pay parents will experience increased costs for vaccines and vaccine and administration. These visits are estimated to cost $90 on average. There is no anticipated impact on local employment. Comments on the proposal may be submitted to Mr. Robert D. Crider, M.S., M.P.A., Director, Immunization Division, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, (512) 458-7284, or (800) 252-9152. Comments will be accepted for 60 days following publication of this proposal in the Texas Register . These amendments are proposed under Health and Safety Code §§81.023, which requires the Board of Health (board) to develop immunization requirements for children; Education Code §38.001, which allows the board to develop immunization requirements for admission to any elementary or secondary school; Education Code §51.933, which allows the board to develop immunization requirements for students at any institution of higher education who are pursuing a course of study in a health profession; Texas Human Resources Code, §42.043, which requires the department to make rules regarding the immunization of children admitted to day-care facilities; and Health and Safety Code §12.001, which provides the board with the authority to adopt rules for the performance of every duty imposed by law on the board, the department and the commissioner of health. These sections affect Health and Safety Code §81.023; Texas Education Code, §38.001, §51.933; and Texas Human Resource Code §42.043. §97.63.Required Immunizations. (a)-(b) (No change.) (c) The following immunizations are required in the respective age groupings. A child or student must meet all the immunization requirements specific to an age group upon first entering the age group. (1) Children less than five years of age: polio vaccine; diphtheria-tetanus- pertussis (DTP)
or diphtheria-tetanus-acellular pertussis (DTaP) vaccine; measles, mumps, and rubella vaccine (MMR);
[ (A)-(D) (No change.) Children 12 months of age, but not yet 15 months of age (12 months through 14 months of age): (i)-(ii) (No change.) (iii) one dose of MMR vaccine is required. Only doses received on or after the first birthday
will meet this requirement. Serologic confirmation of measles, mumps, or rubella immunity or
serologic evidence of infection is acceptable in lieu of vaccination for that disease only. For
further information see §97.67 of this title (relating to Verification of Immunity to Measles,
Rubella, Mumps, [ (iv) (No change.). (v) one dose of varicella vaccine is required. This vaccine must have been received on or after the first birthday. A parent- or physician- validated history of varicella illness (chickenpox) or serologic confirmation of varicella immunity is acceptable in lieu of vaccine. For further information, see §97.67 of this title. (F) Children 15 months of age, but not yet 5 years of age (15 months through four years of age): (i)-(iv) (No change.) (v) one dose of varicella vaccine is required. This vaccine must have been received on or after the first birthday. A parent- or physician- validated history of varicella illness (chickenpox) or serologic confirmation of varicella immunity is acceptable in lieu of vaccine. For further information, see §97.67 of this title; and (vi) children subject to these requirements as described in §97.61 (relating to Children and Students Included in Requirements) must comply with the following requirement for hepatitis A vaccine if the facility, school or institution attended is located in any of the following counties: Brewster, Brooks, Cameron, Crockett, Culberson, Dimmitt, Duval, Edwards, El Paso, Frio, Hidalgo, Hudspeth, Jeff Davis, Jim Hogg, Kenedy, Kinney, La Salle, Maverick, McMullen, Pecos, Presidio, Real, Reeves, Starr, Sutton, Terrell, Uvalde, Val Verde, Webb, Willacy, Zapata, and Zavala. Serologic confirmation of immunity to hepatitis A or serologic evidence of infection is acceptable in lieu of vaccine. For further information, see §97.67 of this title. Doses of hepatitis A vaccine are required as follows: (I) children 2 years of age but not yet 3 years of age are required to show proof by 30 days past their second birthday of one dose of hepatitis A vaccine administered on or after their second birthday; and (II) children 3 years of age but not yet 5 years of age are required to have received two doses of hepatitis A vaccine administered on or after their second birthday. (2) Children and students five years of age or older. (A)-(E) (No change.) (F) Hepatitis B. (i) Effective August 1, 1998, children born on or after September 2, 1992, will be required to show proof of either: (I) [ (II) [ (ii) Effective August 1, 1999, children born on or after September 2, 1987, but before September 2, 1992 will be required to show at the time of their 12th birthday, proof of either: (I) three doses of hepatitis B vaccine; or (II) serologic confirmation of immunity to hepatitis B or serologic evidence of infection. For further information see §97.67 of this title. (G) Varicella. (i) Effective August 1, 1999, children born on or after September 2, 1993, will be required to show proof of either: (I) one dose of varicella vaccine received on or after the first birthday; or (II) a parent- or physician-validated history of varicella illness (chickenpox) or serologic confirmation of varicella immunity. For further information, see §97.67 of this title. (ii) Effective August 1, 1999, children born on or after September 2, 1987, but before September 2, 1993, will be required to show at the time of their 12th birthday, proof of either: (I) one dose of varicella vaccine received on or after the first birthday; or (II) a parent- or physician-validated history of varicella illness (chickenpox) or serologic confirmation of varicella immunity. For further information, see §97.67 of this title. (H) Hepatitis A. Effective August 1, 1999, children subject to these requirements as described in §97.61 of this title must comply with the following requirement for hepatitis A vaccine if the facility, school or institution attended is located in any of the following counties: Brewster, Brooks, Cameron, Crockett, Culberson, Dimmitt, Duval, Edwards, El Paso, Frio, Hidalgo, Hudspeth, Jeff Davis, Jim Hogg, Kenedy, Kinney, La Salle, Maverick, McMullen, Pecos, Presidio, Real, Reeves, Starr, Sutton, Terrell, Uvalde, Val Verde, Webb, Willacy, Zapata, and Zavala. Serologic confirmation of immunity to hepatitis A or serologic evidence of infection is acceptable in lieu of vaccine. For further information, see §97.67 of this title. Children and students born on or after September 2, 1992, will be required to have received two doses of hepatitis A vaccine administered on or after their second birthday. (3) Students in institutions of higher education (colleges, universities, and other teaching facilities above the high school level). (A)-(I) (No change.) (J) Varicella. Beginning August 1, 1999, varicella vaccine is required of medical interns, residents, fellows, and students enrolled in health-related courses as defined in subparagraph (A) of this paragraph. One dose of vaccine is required for students who received this vaccine prior to 13 years of age; two doses are required for students who were not vaccinated before their thirteenth birthday. All doses of this vaccine must have been received on or after the first birthday. A history of varicella illness (chickenpox) validated by the student, the student's parent or the student's physician or serologic confirmation of varicella immunity is acceptable in lieu of vaccine. For further information, see §97.67 of this title. §97.65.Pregnancy. Requirements for polio, measles, rubella, [ §97.67.Verification of Immunity to Measles, Rubella, Mumps, [ Section 97.63 of this title (relating to Required Immunizations) states that serologic confirmation of immunity to measles, rubella, mumps, hepatitis A, or hepatitis B are acceptable in lieu of vaccine against the serologically confirmed disease. If a child or student is unable to submit serological proof of immunity or serologic evidence of infection, then measles, rubella, mumps, or hepatitis B vaccine is required. Evidence of measles, rubella, mumps, or hepatitis B illnesses must consist of a laboratory report indicating confirmation of immunity or confirmation of infection. A copy of the report must be attached to the child's or student's immunization record, and the original should be returned to the child/student or the child's/student's parent or guardian. All histories of varicella illness must be supported by a written statement from a physician or the child's/student's parent or guardian containing wording such as: "This is to verify that (name of student) had varicella disease (chickenpox) on or about (date) and does not need varicella vaccine." or by serologic confirmation of varicella immunity. A copy of the statement or laboratory report must be attached to the child's/student's school immunization record and the original should be returned to the child/student or the child's/student's parent, or guardian. If a child or student is unable to submit such a statement or serologic evidence, varicella vaccine is required. §97.74.Transfer of Records. When a student transfers from one school or district to another, a copy of the
immunization record, [ This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt. Filed with the Office of the Secretary of State on January 14, 1999. TRD-9900203 |
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