{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-46.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-46.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-46.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-46.html"}],"law_id":80398,"edition_id":1,"section_id":80398,"structure_id":16047,"section_number":"32.1-46","catch_line":"Immunization of patients against certain diseases","history":"Code 1950, \u00a7 32-57.1; 1968, c. 592; 1972, c. 558; 1979, c. 711; 1980, c. 410; 1989, c. 382; 1991, c. 133; 1992, cc. 127, 166; 1994, c. 62; 1995, cc. 729, 742; 1996, cc. 67, 533; 1999, cc. 632, 676, 738; 2000, c. 476; 2004, c. 855; 2005, cc. 643, 684; 2006, cc. 364, 396, 716; 2007, cc. 858, 922; 2011, c. 125; 2014, cc. 316, 344; 2016, c. 81; 2019, c. 222; 2020, c. 1223; 2023, c. 183.","full_text":"A\n\nThe parent, guardian or person standing in loco parentis of each child within this Commonwealth shall cause such child to be immunized in accordance with the Immunization Schedule developed and published by the Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). The required immunizations for attendance at a public or private elementary, middle or secondary school, child care center, nursery school, family day care home, or developmental center shall be those set forth in the State Board of Health Regulations for the Immunization of School Children. The Board’s regulations shall at a minimum require:1\n\nA minimum of three properly spaced doses of hepatitis B vaccine (HepB).2\n\nA minimum of three or more properly spaced doses of diphtheria toxoid. One dose shall be administered on or after the fourth birthday.3\n\nA minimum of three or more properly spaced doses of tetanus toxoid. One dose shall be administered on or after the fourth birthday.4\n\nA minimum of three or more properly spaced doses of acellular pertussis vaccine. One dose shall be administered on or after the fourth birthday. A booster dose shall be administered prior to entry into the seventh grade.5\n\nTwo or three primary doses of Haemophilus influenzae type b (Hib) vaccine, depending on the manufacturer, for children up to 60 months of age.6\n\nTwo properly spaced doses of live attenuated measles (rubeola) vaccine. The first dose shall be administered at age 12 months or older.7\n\nOne dose of live attenuated rubella vaccine shall be administered at age 12 months or older.8\n\nOne dose of live attenuated mumps vaccine shall be administered at age 12 months or older.9\n\nTwo properly spaced doses of varicella vaccine. The first dose shall be administered at age 12 months or older.10\n\nThree or more properly spaced doses of oral polio vaccine (OPV) or inactivated polio vaccine (IPV). One dose shall be administered on or after the fourth birthday. A fourth dose shall be required if the three dose primary series consisted of a combination of OPV and IPV.11\n\nOne to four doses, dependent on age at first dose, of properly spaced pneumococcal conjugate (PCV) vaccine for children up to 60 months of age.12\n\nTwo doses of properly spaced human papillomavirus (HPV) vaccine. The first dose shall be administered before the child enters the seventh grade.13\n\nTwo or three properly spaced doses of rotavirus vaccine, depending on the manufacturer, for children up to eight months of age.14\n\nTwo properly spaced doses of hepatitis A vaccine (HAV). The first dose shall be administered at age 12 months or older.15\n\nTwo properly spaced doses of meningococcal conjugate vaccine (MenACWY). The first dose shall be administered prior to entry to seventh grade. The second dose shall be administered prior to entry to twelfth grade.\n\t\t\t\tThe parent, guardian or person standing in loco parentis may have such child immunized by a physician, a physician assistant, an advanced practice registered nurse, a registered nurse, or a licensed practical nurse, or a pharmacist who administers pursuant to a valid prescription, or may present the child to the appropriate local health department, which shall administer the vaccines required by the State Board of Health Regulations for the Immunization of School Children without charge to the parent of or person standing in loco parentis to the child if (i) the child is eligible for the Vaccines for Children Program or (ii) the child is eligible for coverages issued pursuant to Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq. (Medicare), Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. (Medicaid), Title XXI of the Social Security Act, 42 U.S.C. § 1397aa et seq. (CHIP), or 10 U.S.C. § 1071 et seq. (CHAMPUS). In all cases in which a child is covered by a health carrier, Medicare, Medicaid, CHIP, or CHAMPUS, the Department shall seek reimbursement from the health carrier, Medicare, Medicaid, CHIP, or CHAMPUS for all allowable costs associated with the provision of the vaccine. For the purposes of this section, the Department shall be deemed a participating provider with a managed care health insurance plan as defined in § 32.1-137.1.B\n\nA physician, a physician assistant, an advanced practice registered nurse, a registered nurse, a licensed practical nurse, a pharmacist, or a local health department administering a vaccine required by this section shall provide to the person who presents the child for immunizations a certificate that shall state the diseases for which the child has been immunized, the numbers of doses given, the dates when administered and any further immunizations indicated.C\n\nThe vaccines required by this section shall meet the standards prescribed in, and be administered in accordance with, the State Board of Health Regulations for the Immunization of School Children. The State Board of Health shall amend the State Board of Health Regulations for the Immunization of School Children as necessary from time to time to maintain conformity with evidence-based, routinely recommended vaccinations for children. The adoption of such regulations shall be exempt from the requirements of Article 2 (§ 2.2-4006 et seq.) of the Administrative Process Act (§ 2.2-4000 et seq.). However, the Department shall (i) provide a Notice of Intended Regulatory Action and (ii) provide for a 60-day public comment period prior to the Board’s adoption of the regulations.D\n\nThe provisions of this section shall not apply if:1\n\nThe parent or guardian of the child objects thereto on the grounds that the administration of immunizing agents conflicts with his religious tenets or practices, unless an emergency or epidemic of disease has been declared by the Board;2\n\nThe parent or guardian presents a statement from a physician licensed to practice medicine in Virginia, a licensed advanced practice registered nurse, or a local health department that states that the physical condition of the child is such that the administration of one or more of the required immunizing agents would be detrimental to the health of the child; or3\n\nBecause the human papillomavirus is not communicable in a school setting, a parent or guardian, at the parent’s or guardian’s sole discretion, may elect for the parent’s or guardian’s child not to receive the human papillomavirus vaccine, after having reviewed materials describing the link between the human papillomavirus and cervical cancer approved for such use by the Board.E\n\nFor the purpose of protecting the public health by ensuring that each child receives age-appropriate immunizations, any physician, physician assistant, advanced practice registered nurse, licensed institutional health care provider, or local or district health department, the Virginia Immunization Information System, and the Department of Health may share immunization and patient locator information without parental authorization, including, but not limited to, the month, day, and year of each administered immunization; the patient’s name, address, telephone number, birth date, and social security number; and the parents’ names. The immunization information; the patient’s name, address, telephone number, birth date, and social security number; and the parents’ names shall be confidential and shall only be shared for the purposes set out in this subsection.F\n\nThe State Board of Health shall review this section annually and make recommendations for revision by September 1 to the Governor, the General Assembly, and the Joint Commission on Health Care.","order_by":null,"text":{"0":{"id":287973,"text":"The parent, guardian or person standing in loco parentis of each child within this Commonwealth shall cause such child to be immunized in accordance with the Immunization Schedule developed and published by the Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). The required immunizations for attendance at a public or private elementary, middle or secondary school, child care center, nursery school, family day care home, or developmental center shall be those set forth in the State Board of Health Regulations for the Immunization of School Children. The Board’s regulations shall at a minimum require:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":287974,"text":"A minimum of three properly spaced doses of hepatitis B vaccine (HepB).","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":287975,"text":"A minimum of three or more properly spaced doses of diphtheria toxoid. One dose shall be administered on or after the fourth birthday.","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"A3"},"3":{"id":287976,"text":"A minimum of three or more properly spaced doses of tetanus toxoid. One dose shall be administered on or after the fourth birthday.","type":"section","prefixes":["A","3"],"prefix":"3","entire_prefix":"A3","prefix_anchor":"A3","level":2,"prior_prefix":"A2","next_prefix":"A4"},"4":{"id":287977,"text":"A minimum of three or more properly spaced doses of acellular pertussis vaccine. One dose shall be administered on or after the fourth birthday. A booster dose shall be administered prior to entry into the seventh grade.","type":"section","prefixes":["A","4"],"prefix":"4","entire_prefix":"A4","prefix_anchor":"A4","level":2,"prior_prefix":"A3","next_prefix":"A5"},"5":{"id":287978,"text":"Two or three primary doses of Haemophilus influenzae type b (Hib) vaccine, depending on the manufacturer, for children up to 60 months of age.","type":"section","prefixes":["A","5"],"prefix":"5","entire_prefix":"A5","prefix_anchor":"A5","level":2,"prior_prefix":"A4","next_prefix":"A6"},"6":{"id":287979,"text":"Two properly spaced doses of live attenuated measles (rubeola) vaccine. The first dose shall be administered at age 12 months or older.","type":"section","prefixes":["A","6"],"prefix":"6","entire_prefix":"A6","prefix_anchor":"A6","level":2,"prior_prefix":"A5","next_prefix":"A7"},"7":{"id":287980,"text":"One dose of live attenuated rubella vaccine shall be administered at age 12 months or older.","type":"section","prefixes":["A","7"],"prefix":"7","entire_prefix":"A7","prefix_anchor":"A7","level":2,"prior_prefix":"A6","next_prefix":"A8"},"8":{"id":287981,"text":"One dose of live attenuated mumps vaccine shall be administered at age 12 months or older.","type":"section","prefixes":["A","8"],"prefix":"8","entire_prefix":"A8","prefix_anchor":"A8","level":2,"prior_prefix":"A7","next_prefix":"A9"},"9":{"id":287982,"text":"Two properly spaced doses of varicella vaccine. The first dose shall be administered at age 12 months or older.","type":"section","prefixes":["A","9"],"prefix":"9","entire_prefix":"A9","prefix_anchor":"A9","level":2,"prior_prefix":"A8","next_prefix":"A10"},"10":{"id":287983,"text":"Three or more properly spaced doses of oral polio vaccine (OPV) or inactivated polio vaccine (IPV). One dose shall be administered on or after the fourth birthday. A fourth dose shall be required if the three dose primary series consisted of a combination of OPV and IPV.","type":"section","prefixes":["A","10"],"prefix":"10","entire_prefix":"A10","prefix_anchor":"A10","level":2,"prior_prefix":"A9","next_prefix":"A11"},"11":{"id":287984,"text":"One to four doses, dependent on age at first dose, of properly spaced pneumococcal conjugate (PCV) vaccine for children up to 60 months of age.","type":"section","prefixes":["A","11"],"prefix":"11","entire_prefix":"A11","prefix_anchor":"A11","level":2,"prior_prefix":"A10","next_prefix":"A12"},"12":{"id":287985,"text":"Two doses of properly spaced human papillomavirus (HPV) vaccine. The first dose shall be administered before the child enters the seventh grade.","type":"section","prefixes":["A","12"],"prefix":"12","entire_prefix":"A12","prefix_anchor":"A12","level":2,"prior_prefix":"A11","next_prefix":"A13"},"13":{"id":287986,"text":"Two or three properly spaced doses of rotavirus vaccine, depending on the manufacturer, for children up to eight months of age.","type":"section","prefixes":["A","13"],"prefix":"13","entire_prefix":"A13","prefix_anchor":"A13","level":2,"prior_prefix":"A12","next_prefix":"A14"},"14":{"id":287987,"text":"Two properly spaced doses of hepatitis A vaccine (HAV). The first dose shall be administered at age 12 months or older.","type":"section","prefixes":["A","14"],"prefix":"14","entire_prefix":"A14","prefix_anchor":"A14","level":2,"prior_prefix":"A13","next_prefix":"A15"},"15":{"id":287988,"text":"Two properly spaced doses of meningococcal conjugate vaccine (MenACWY). The first dose shall be administered prior to entry to seventh grade. The second dose shall be administered prior to entry to twelfth grade.\n\t\t\t\tThe parent, guardian or person standing in loco parentis may have such child immunized by a physician, a physician assistant, an advanced practice registered nurse, a registered nurse, or a licensed practical nurse, or a pharmacist who administers pursuant to a valid prescription, or may present the child to the appropriate local health department, which shall administer the vaccines required by the State Board of Health Regulations for the Immunization of School Children without charge to the parent of or person standing in loco parentis to the child if (i) the child is eligible for the Vaccines for Children Program or (ii) the child is eligible for coverages issued pursuant to Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq. (Medicare), Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. (Medicaid), Title XXI of the Social Security Act, 42 U.S.C. § 1397aa et seq. (CHIP), or 10 U.S.C. § 1071 et seq. (CHAMPUS). In all cases in which a child is covered by a health carrier, Medicare, Medicaid, CHIP, or CHAMPUS, the Department shall seek reimbursement from the health carrier, Medicare, Medicaid, CHIP, or CHAMPUS for all allowable costs associated with the provision of the vaccine. For the purposes of this section, the Department shall be deemed a participating provider with a managed care health insurance plan as defined in § 32.1-137.1.","type":"section","prefixes":["A","15"],"prefix":"15","entire_prefix":"A15","prefix_anchor":"A15","level":2,"prior_prefix":"A14","next_prefix":"B"},"16":{"id":287989,"text":"A physician, a physician assistant, an advanced practice registered nurse, a registered nurse, a licensed practical nurse, a pharmacist, or a local health department administering a vaccine required by this section shall provide to the person who presents the child for immunizations a certificate that shall state the diseases for which the child has been immunized, the numbers of doses given, the dates when administered and any further immunizations indicated.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A15","next_prefix":"C"},"17":{"id":287990,"text":"The vaccines required by this section shall meet the standards prescribed in, and be administered in accordance with, the State Board of Health Regulations for the Immunization of School Children. The State Board of Health shall amend the State Board of Health Regulations for the Immunization of School Children as necessary from time to time to maintain conformity with evidence-based, routinely recommended vaccinations for children. The adoption of such regulations shall be exempt from the requirements of Article 2 (§ 2.2-4006 et seq.) of the Administrative Process Act (§ 2.2-4000 et seq.). However, the Department shall (i) provide a Notice of Intended Regulatory Action and (ii) provide for a 60-day public comment period prior to the Board’s adoption of the regulations.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"18":{"id":287991,"text":"The provisions of this section shall not apply if:","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"D1"},"19":{"id":287992,"text":"The parent or guardian of the child objects thereto on the grounds that the administration of immunizing agents conflicts with his religious tenets or practices, unless an emergency or epidemic of disease has been declared by the Board;","type":"section","prefixes":["D","1"],"prefix":"1","entire_prefix":"D1","prefix_anchor":"D1","level":2,"prior_prefix":"D","next_prefix":"D2"},"20":{"id":287993,"text":"The parent or guardian presents a statement from a physician licensed to practice medicine in Virginia, a licensed advanced practice registered nurse, or a local health department that states that the physical condition of the child is such that the administration of one or more of the required immunizing agents would be detrimental to the health of the child; or","type":"section","prefixes":["D","2"],"prefix":"2","entire_prefix":"D2","prefix_anchor":"D2","level":2,"prior_prefix":"D1","next_prefix":"D3"},"21":{"id":287994,"text":"Because the human papillomavirus is not communicable in a school setting, a parent or guardian, at the parent’s or guardian’s sole discretion, may elect for the parent’s or guardian’s child not to receive the human papillomavirus vaccine, after having reviewed materials describing the link between the human papillomavirus and cervical cancer approved for such use by the Board.","type":"section","prefixes":["D","3"],"prefix":"3","entire_prefix":"D3","prefix_anchor":"D3","level":2,"prior_prefix":"D2","next_prefix":"E"},"22":{"id":287995,"text":"For the purpose of protecting the public health by ensuring that each child receives age-appropriate immunizations, any physician, physician assistant, advanced practice registered nurse, licensed institutional health care provider, or local or district health department, the Virginia Immunization Information System, and the Department of Health may share immunization and patient locator information without parental authorization, including, but not limited to, the month, day, and year of each administered immunization; the patient’s name, address, telephone number, birth date, and social security number; and the parents’ names. The immunization information; the patient’s name, address, telephone number, birth date, and social security number; and the parents’ names shall be confidential and shall only be shared for the purposes set out in this subsection.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D3","next_prefix":"F"},"23":{"id":287996,"text":"The State Board of Health shall review this section annually and make recommendations for revision by September 1 to the Governor, the General Assembly, and the Joint Commission on Health Care.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E"}},"ancestry":[{"id":16047,"edition_id":1,"name":"Disease Control Measures","identifier":"3","label":"article","depth":3,"order_by":1,"parent_id":13607,"metadata":{},"date_created":"2026-06-26 04:04:37","date_modified":"2026-06-26 04:04:37","permalink":{"id":201951,"object_type":"structure","relational_id":16047,"identifier":"3","token":"32.1\/2\/3","url":"\/32.1\/2\/3\/","edition_id":1,"permalink":0,"preferred":1}},{"id":13607,"edition_id":1,"name":"Disease Prevention and Control","identifier":"2","label":"chapter","depth":2,"order_by":1,"parent_id":12727,"metadata":{},"date_created":"2026-06-26 03:45:22","date_modified":"2026-06-26 03:45:22","permalink":{"id":201743,"object_type":"structure","relational_id":13607,"identifier":"2","token":"32.1\/2","url":"\/32.1\/2\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12727,"edition_id":1,"name":"Health","identifier":"32.1","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":201099,"object_type":"structure","relational_id":12727,"identifier":"32.1","token":"32.1","url":"\/32.1\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":76165,"structure_id":16047,"section_number":"32.1-42","catch_line":"Emergency rules and regulations","url":"\/32.1-42\/","token":"32.1\/2\/3\/32.1-42","metadata":false},{"id":66908,"structure_id":16047,"section_number":"32.1-42.1","catch_line":"Administration and dispensing of necessary drugs, devices and vaccines during a declared disaster or emergency","url":"\/32.1-42.1\/","token":"32.1\/2\/3\/32.1-42.1","metadata":false},{"id":78441,"structure_id":16047,"section_number":"32.1-42.2","catch_line":"Declared emergency; priority for personal protective equipment and immunization; funeral service licensees and funeral service establishment employees","url":"\/32.1-42.2\/","token":"32.1\/2\/3\/32.1-42.2","metadata":false},{"id":65793,"structure_id":16047,"section_number":"32.1-43","catch_line":"Authority of State Health Commissioner to require quarantine, etc","url":"\/32.1-43\/","token":"32.1\/2\/3\/32.1-43","metadata":false},{"id":62960,"structure_id":16047,"section_number":"32.1-44","catch_line":"Isolated or quarantined persons","url":"\/32.1-44\/","token":"32.1\/2\/3\/32.1-44","metadata":false},{"id":73376,"structure_id":16047,"section_number":"32.1-45","catch_line":"Expense of treatment","url":"\/32.1-45\/","token":"32.1\/2\/3\/32.1-45","metadata":false},{"id":71237,"structure_id":16047,"section_number":"32.1-45.1","catch_line":"Deemed consent to testing and release of test results related to infection with human immunodeficiency virus or hepatitis B or C viruses","url":"\/32.1-45.1\/","token":"32.1\/2\/3\/32.1-45.1","metadata":false},{"id":68561,"structure_id":16047,"section_number":"32.1-45.2","catch_line":"Public safety employees; testing for blood-borne pathogens; procedure available for certain citizens; definitions","url":"\/32.1-45.2\/","token":"32.1\/2\/3\/32.1-45.2","metadata":false},{"id":83229,"structure_id":16047,"section_number":"32.1-45.3","catch_line":"Repealed","url":"\/32.1-45.3\/","token":"32.1\/2\/3\/32.1-45.3","metadata":false},{"id":73569,"structure_id":16047,"section_number":"32.1-45.4","catch_line":"Comprehensive harm reduction programs","url":"\/32.1-45.4\/","token":"32.1\/2\/3\/32.1-45.4","metadata":false},{"id":80398,"structure_id":16047,"section_number":"32.1-46","catch_line":"Immunization of patients against certain diseases","url":"\/32.1-46\/","token":"32.1\/2\/3\/32.1-46","metadata":false},{"id":70560,"structure_id":16047,"section_number":"32.1-46.01","catch_line":"Virginia Immunization Information System","url":"\/32.1-46.01\/","token":"32.1\/2\/3\/32.1-46.01","metadata":false},{"id":73649,"structure_id":16047,"section_number":"32.1-46.02","catch_line":"Administration of influenza vaccine to minors","url":"\/32.1-46.02\/","token":"32.1\/2\/3\/32.1-46.02","metadata":false},{"id":75856,"structure_id":16047,"section_number":"32.1-46.1","catch_line":"Board to establish protocol for identification of children with elevated blood-lead levels","url":"\/32.1-46.1\/","token":"32.1\/2\/3\/32.1-46.1","metadata":false},{"id":74454,"structure_id":16047,"section_number":"32.1-46.2","catch_line":"Certain testing or determination of low risk for elevated blood-lead levels required","url":"\/32.1-46.2\/","token":"32.1\/2\/3\/32.1-46.2","metadata":false},{"id":78372,"structure_id":16047,"section_number":"32.1-47","catch_line":"Exclusion from school of children not immunized","url":"\/32.1-47\/","token":"32.1\/2\/3\/32.1-47","metadata":false},{"id":73049,"structure_id":16047,"section_number":"32.1-47.1","catch_line":"Vaccination of children; plan enhancements","url":"\/32.1-47.1\/","token":"32.1\/2\/3\/32.1-47.1","metadata":false},{"id":69455,"structure_id":16047,"section_number":"32.1-48","catch_line":"Powers of Commissioner in epidemic","url":"\/32.1-48\/","token":"32.1\/2\/3\/32.1-48","metadata":false},{"id":78035,"structure_id":16047,"section_number":"32.1-48.001","catch_line":"(For contingent effective date, see Acts 2021, Sp. Sess. I, c. 472, cl. 2) Real-time information sharing for emergency medical services agencies","url":"\/32.1-48.001\/","token":"32.1\/2\/3\/32.1-48.001","metadata":false}],"previous_section":{"id":73569,"structure_id":16047,"section_number":"32.1-45.4","catch_line":"Comprehensive harm reduction programs","url":"\/32.1-45.4\/","token":"32.1\/2\/3\/32.1-45.4","metadata":false},"next_section":{"id":70560,"structure_id":16047,"section_number":"32.1-46.01","catch_line":"Virginia Immunization Information System","url":"\/32.1-46.01\/","token":"32.1\/2\/3\/32.1-46.01","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-46\/","history_text":"

The record of this law\u2019s original creation isn\u2019t available online. It has been modified 22 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 1968, chapter 592; in 1972, chapter 558; in 1979, chapter 711; in 1980, chapter 410; in 1989, chapter 382; in 1991, chapter 133; in 1992, chapters 127 and 166; in 1994, chapter 62<\/a>; in 1995, chapters 729<\/a> and 742<\/a>; in 1996, chapters 67<\/a> and 533<\/a>; in 1999, chapters 632<\/a>, 676<\/a>, and 738<\/a>; in 2000, chapter 476<\/a>; in 2004, chapter 855<\/a>; in 2005, chapters 643<\/a> and 684<\/a>; in 2006, chapters 364<\/a>, 396<\/a>, and 716<\/a>; in 2007, chapters 858<\/a> and 922<\/a>; in 2011, chapter 125<\/a>; in 2014, chapters 316<\/a> and 344<\/a>; in 2016, chapter 81<\/a>; in 2019, chapter 222<\/a>; in 2020, chapter 1223<\/a>; in 2023, chapter 183<\/a>.<\/p>","references":[{"id":68537,"section_number":"22.1-271.1","catch_line":"Definitions","order_by":null,"url":"\/22.1-271.1\/"},{"id":68882,"section_number":"22.1-271.2","catch_line":"Immunization requirements","order_by":null,"url":"\/22.1-271.2\/"},{"id":58904,"section_number":"22.1-271.4","catch_line":"Health requirements for home-instructed, exempted, and excused children","order_by":null,"url":"\/22.1-271.4\/"},{"id":77926,"section_number":"22.1-289.031","catch_line":"Child day center operated by religious institution exempt from licensure; annual statement and documentary evidence required; enforcement; injunctive relief","order_by":null,"url":"\/22.1-289.031\/"},{"id":70560,"section_number":"32.1-46.01","catch_line":"Virginia Immunization Information System","order_by":null,"url":"\/32.1-46.01\/"},{"id":74954,"section_number":"63.2-603","catch_line":"Eligibility for TANF; childhood immunizations","order_by":null,"url":"\/63.2-603\/"}],"refers_to":[{"id":86911,"section_number":"2.2-4000","catch_line":"Short title; purpose","order_by":null,"url":"\/2.2-4000\/"},{"id":78729,"section_number":"2.2-4006","catch_line":"Exemptions from requirements of this article","order_by":null,"url":"\/2.2-4006\/"}],"permalink":{"id":201993,"object_type":"law","relational_id":80398,"identifier":"32.1-46","token":"32.1\/2\/3\/32.1-46","url":"\/32.1-46\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-46\/","token":"32.1\/2\/3\/32.1-46","dublin_core":{"Title":"Immunization of patients against certain diseases","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-46","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> The parent, guardian or person<\/span> standing in loco parentis of each child within this Commonwealth shall cause such child to be immunized in accordance with the Immunization Schedule developed and published by the Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). The required immunizations for attendance at a public or private elementary, middle or secondary school, child care center, nursery school, family day care home, or developmental center shall be those set forth in the State Board<\/span> of Health Regulations for the Immunization of School Children. The Board’s regulations shall at a minimum require: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> A minimum of three properly spaced doses of hepatitis B vaccine (HepB). <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> A minimum of three or more properly spaced doses of diphtheria toxoid. One dose shall be administered on or after the fourth birthday. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> A minimum of three or more properly spaced doses of tetanus toxoid. One dose shall be administered on or after the fourth birthday. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> A minimum of three or more properly spaced doses of acellular pertussis vaccine. One dose shall be administered on or after the fourth birthday. A booster dose shall be administered prior to entry into the seventh grade. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> Two or three primary doses of Haemophilus influenzae type b (Hib) vaccine, depending on the manufacturer, for children up to 60 months of age. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

6.<\/span> Two properly spaced doses of live attenuated measles (rubeola) vaccine. The first dose shall be administered at age 12 months or older. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

7.<\/span> One dose of live attenuated rubella vaccine shall be administered at age 12 months or older. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

8.<\/span> One dose of live attenuated mumps vaccine shall be administered at age 12 months or older. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

9.<\/span> Two properly spaced doses of varicella vaccine. The first dose shall be administered at age 12 months or older. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

10.<\/span> Three or more properly spaced doses of oral polio vaccine (OPV) or inactivated polio vaccine (IPV). One dose shall be administered on or after the fourth birthday. A fourth dose shall be required if the three dose primary series consisted of a combination of OPV and IPV. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

11.<\/span> One to four doses, dependent on age at first dose, of properly spaced pneumococcal conjugate (PCV) vaccine for children up to 60 months of age. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

12.<\/span> Two doses of properly spaced human papillomavirus (HPV) vaccine. The first dose shall be administered before the child enters the seventh grade. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

13.<\/span> Two or three properly spaced doses of rotavirus vaccine, depending on the manufacturer, for children up to eight months of age. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

14.<\/span> Two properly spaced doses of hepatitis A vaccine (HAV). The first dose shall be administered at age 12 months or older. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

15.<\/span> Two properly spaced doses of meningococcal conjugate vaccine (MenACWY). The first dose shall be administered prior to entry to seventh grade. The second dose shall be administered prior to entry to twelfth grade.\n\t\t\t\tThe parent, guardian or person<\/span> standing in loco parentis may have such child immunized by a physician, a physician assistant, an advanced practice registered nurse, a registered nurse, or a licensed practical nurse, or a pharmacist who administers pursuant to a valid prescription, or may present the child to the appropriate local health department<\/span>, which shall administer the vaccines required by the State Board<\/span> of Health Regulations for the Immunization of School Children without charge to the parent of or person<\/span> standing in loco parentis to the child if (i) the child is eligible for the Vaccines for Children Program or (ii) the child is eligible for coverages issued pursuant to Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq. (Medicare), Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. (Medicaid), Title XXI of the Social Security Act, 42 U.S.C. § 1397aa et seq. (CHIP), or 10 U.S.C. § 1071 et seq. (CHAMPUS). In all cases in which a child is covered by a health carrier, Medicare, Medicaid, CHIP, or CHAMPUS, the Department<\/span> shall seek reimbursement from the health carrier, Medicare, Medicaid, CHIP, or CHAMPUS for all allowable costs associated with the provision of the vaccine. For the purposes of this section, the Department<\/span> shall be deemed a participating provider with a managed care health insurance plan as defined in § 32.1-137.1<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> A physician, a physician assistant, an advanced practice registered nurse, a registered nurse, a licensed practical nurse, a pharmacist, or a local health department<\/span> administering a vaccine required by this section shall provide to the person<\/span> who presents the child for immunizations a certificate that shall state the diseases for which the child has been immunized, the numbers of doses given, the dates when administered and any further immunizations indicated. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> The vaccines required by this section shall meet the standards prescribed in, and be administered in accordance with, the State Board<\/span> of Health Regulations for the Immunization of School Children. The State Board<\/span> of Health shall amend<\/span> the State Board<\/span> of Health Regulations for the Immunization of School Children as necessary from time to time to maintain conformity with evidence<\/span>-based, routinely recommended vaccinations for children. The adoption of such regulations shall be exempt from the requirements of Article 2 (§ 2.2-4006<\/a> et seq.) of the Administrative Process Act (§ 2.2-4000<\/a> et seq.). However, the Department<\/span> shall (i) provide a Notice of Intended Regulatory Action and (ii) provide for a 60-day public comment period prior to the Board’s adoption of the regulations. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> The provisions of this section shall not apply if: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The parent or guardian of the child objects<\/span> thereto on the grounds that the administration of immunizing agents conflicts with his religious tenets or practices, unless an emergency or epidemic of disease has been declared by the Board; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The parent or guardian presents a statement from a physician licensed to practice medicine in Virginia, a licensed advanced practice registered nurse, or a local health department<\/span> that states that the physical condition of the child is such that the administration of one or more of the required immunizing agents would be detrimental to the health of the child; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Because the human papillomavirus is not communicable in a school setting, a parent or guardian, at the parent’s or guardian’s sole discretion, may elect for the parent’s or guardian’s child not to receive the human papillomavirus vaccine, after having reviewed materials<\/span> describing the link between the human papillomavirus and cervical cancer approved for such use by the Board. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> For the purpose of protecting the public health by ensuring that each child receives age-appropriate immunizations, any physician, physician assistant, advanced practice registered nurse, licensed institutional health care provider, or local or district health department<\/span>, the Virginia Immunization Information System, and the Department<\/span> of Health may share immunization and patient locator information without parental authorization, including, but not limited to, the month, day, and year of each administered immunization; the patient’s name, address, telephone number, birth date, and social security number; and the parents’ names. The immunization information; the patient’s name, address, telephone number, birth date, and social security number; and the parents’ names shall be confidential and shall only be shared for the purposes set out in this subsection. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> The State Board<\/span> of Health shall review this section annually and make recommendations for revision by September 1 to the Governor, the General Assembly, and the Joint Commission on Health Care. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nIMMUNIZATION OF PATIENTS AGAINST CERTAIN DISEASES (\u00a7 32.1-46)\n\nA. The parent, guardian or person standing in loco parentis of each child within\nthis Commonwealth shall cause such child to be immunized in accordance with the\nImmunization Schedule developed and published by the Centers for Disease Control\nand Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), the\nAmerican Academy of Pediatrics (AAP), and the American Academy of Family\nPhysicians (AAFP). The required immunizations for attendance at a public or\nprivate elementary, middle or secondary school, child care center, nursery\nschool, family day care home, or developmental center shall be those set forth\nin the State Board of Health Regulations for the Immunization of School\nChildren. The Board’s regulations shall at a minimum require:\n\n 1. A minimum of three properly spaced doses of hepatitis B vaccine (HepB).\n\n 2. A minimum of three or more properly spaced doses of diphtheria toxoid. One\n dose shall be administered on or after the fourth birthday.\n\n 3. A minimum of three or more properly spaced doses of tetanus toxoid. One\n dose shall be administered on or after the fourth birthday.\n\n 4. A minimum of three or more properly spaced doses of acellular pertussis\n vaccine. One dose shall be administered on or after the fourth birthday. A\n booster dose shall be administered prior to entry into the seventh grade.\n\n 5. Two or three primary doses of Haemophilus influenzae type b (Hib) vaccine,\n depending on the manufacturer, for children up to 60 months of age.\n\n 6. Two properly spaced doses of live attenuated measles (rubeola) vaccine. The\n first dose shall be administered at age 12 months or older.\n\n 7. One dose of live attenuated rubella vaccine shall be administered at age 12\n months or older.\n\n 8. One dose of live attenuated mumps vaccine shall be administered at age 12\n months or older.\n\n 9. Two properly spaced doses of varicella vaccine. The first dose shall be\n administered at age 12 months or older.\n\n 10. Three or more properly spaced doses of oral polio vaccine (OPV) or\n inactivated polio vaccine (IPV). One dose shall be administered on or after\n the fourth birthday. A fourth dose shall be required if the three dose primary\n series consisted of a combination of OPV and IPV.\n\n 11. One to four doses, dependent on age at first dose, of properly spaced\n pneumococcal conjugate (PCV) vaccine for children up to 60 months of age.\n\n 12. Two doses of properly spaced human papillomavirus (HPV) vaccine. The first\n dose shall be administered before the child enters the seventh grade.\n\n 13. Two or three properly spaced doses of rotavirus vaccine, depending on the\n manufacturer, for children up to eight months of age.\n\n 14. Two properly spaced doses of hepatitis A vaccine (HAV). The first dose\n shall be administered at age 12 months or older.\n\n 15. Two properly spaced doses of meningococcal conjugate vaccine (MenACWY).\n The first dose shall be administered prior to entry to seventh grade. The\n second dose shall be administered prior to entry to twelfth grade.\n \t\t\t\tThe parent, guardian or person standing in loco parentis may have such\n child immunized by a physician, a physician assistant, an advanced practice\n registered nurse, a registered nurse, or a licensed practical nurse, or a\n pharmacist who administers pursuant to a valid prescription, or may present\n the child to the appropriate local health department, which shall administer\n the vaccines required by the State Board of Health Regulations for the\n Immunization of School Children without charge to the parent of or person\n standing in loco parentis to the child if (i) the child is eligible for the\n Vaccines for Children Program or (ii) the child is eligible for coverages\n issued pursuant to Title XVIII of the Social Security Act, 42 U.S.C. §\n 1395 et seq. (Medicare), Title XIX of the Social Security Act, 42 U.S.C.\n § 1396 et seq. (Medicaid), Title XXI of the Social Security Act, 42\n U.S.C. § 1397aa et seq. (CHIP), or 10 U.S.C. § 1071 et seq.\n (CHAMPUS). In all cases in which a child is covered by a health carrier,\n Medicare, Medicaid, CHIP, or CHAMPUS, the Department shall seek reimbursement\n from the health carrier, Medicare, Medicaid, CHIP, or CHAMPUS for all\n allowable costs associated with the provision of the vaccine. For the purposes\n of this section, the Department shall be deemed a participating provider with\n a managed care health insurance plan as defined in § 32.1-137.1.\n\nB. A physician, a physician assistant, an advanced practice registered nurse, a\nregistered nurse, a licensed practical nurse, a pharmacist, or a local health\ndepartment administering a vaccine required by this section shall provide to the\nperson who presents the child for immunizations a certificate that shall state\nthe diseases for which the child has been immunized, the numbers of doses given,\nthe dates when administered and any further immunizations indicated.\n\nC. The vaccines required by this section shall meet the standards prescribed in,\nand be administered in accordance with, the State Board of Health Regulations\nfor the Immunization of School Children. The State Board of Health shall amend\nthe State Board of Health Regulations for the Immunization of School Children as\nnecessary from time to time to maintain conformity with evidence-based,\nroutinely recommended vaccinations for children. The adoption of such\nregulations shall be exempt from the requirements of Article 2 (§ 2.2-4006\net seq.) of the Administrative Process Act (§ 2.2-4000 et seq.). However,\nthe Department shall (i) provide a Notice of Intended Regulatory Action and (ii)\nprovide for a 60-day public comment period prior to the Board’s adoption\nof the regulations.\n\nD. The provisions of this section shall not apply if:\n\n 1. The parent or guardian of the child objects thereto on the grounds that the\n administration of immunizing agents conflicts with his religious tenets or\n practices, unless an emergency or epidemic of disease has been declared by the\n Board;\n\n 2. The parent or guardian presents a statement from a physician licensed to\n practice medicine in Virginia, a licensed advanced practice registered nurse,\n or a local health department that states that the physical condition of the\n child is such that the administration of one or more of the required\n immunizing agents would be detrimental to the health of the child; or\n\n 3. Because the human papillomavirus is not communicable in a school setting, a\n parent or guardian, at the parent’s or guardian’s sole discretion,\n may elect for the parent’s or guardian’s child not to receive the\n human papillomavirus vaccine, after having reviewed materials describing the\n link between the human papillomavirus and cervical cancer approved for such\n use by the Board.\n\nE. For the purpose of protecting the public health by ensuring that each child\nreceives age-appropriate immunizations, any physician, physician assistant,\nadvanced practice registered nurse, licensed institutional health care provider,\nor local or district health department, the Virginia Immunization Information\nSystem, and the Department of Health may share immunization and patient locator\ninformation without parental authorization, including, but not limited to, the\nmonth, day, and year of each administered immunization; the patient’s\nname, address, telephone number, birth date, and social security number; and the\nparents’ names. The immunization information; the patient’s name,\naddress, telephone number, birth date, and social security number; and the\nparents’ names shall be confidential and shall only be shared for the\npurposes set out in this subsection.\n\nF. The State Board of Health shall review this section annually and make\nrecommendations for revision by September 1 to the Governor, the General\nAssembly, and the Joint Commission on Health Care.\n\nHISTORY: Code 1950, \u00a7 32-57.1; 1968, c. 592; 1972, c. 558; 1979, c. 711; 1980,\nc. 410; 1989, c. 382; 1991, c. 133; 1992, cc. 127, 166; 1994, c. 62; 1995, cc.\n729, 742; 1996, cc. 67, 533; 1999, cc. 632, 676, 738; 2000, c. 476; 2004, c.\n855; 2005, cc. 643, 684; 2006, cc. 364, 396, 716; 2007, cc. 858, 922; 2011, c.\n125; 2014, cc. 316, 344; 2016, c. 81; 2019, c. 222; 2020, c. 1223; 2023, c. 183.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}