<?xml version="1.0"?>
<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>80398</law_id><section_number>32.1-46</section_number><catch_line>Immunization of patients against certain diseases</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>22.1-271.1</reference><reference>22.1-271.2</reference><reference>22.1-271.4</reference><reference>22.1-289.031</reference><reference>32.1-46.01</reference><reference>63.2-603</reference></referred_to_by><structure><unit label="title" level="1" order_by="1" identifier="32.1">Health</unit><unit label="chapter" level="2" order_by="1" identifier="2">Disease Prevention and Control</unit><unit label="article" level="3" order_by="1" identifier="3">Disease Control Measures</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> The parent, guardian or <span class="dictionary">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 <span class="dictionary">State Board</span> of Health Regulations for the Immunization of School Children. The Board&#x2019;s regulations shall at a minimum require: <a id="paragraph-287973" class="section-permalink" href="https://vacode.org/32.1-46/#A"><i class="fa fa-link"/></a></p></section>
						<section id="A1" class="indent-1"><p><span class="prefix-number">1.</span> A minimum of three properly spaced doses of hepatitis B vaccine (HepB). <a id="paragraph-287974" class="section-permalink" href="https://vacode.org/32.1-46/#A1"><i class="fa fa-link"/></a></p></section>
						<section id="A2" class="indent-1"><p><span class="prefix-number">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. <a id="paragraph-287975" class="section-permalink" href="https://vacode.org/32.1-46/#A2"><i class="fa fa-link"/></a></p></section>
						<section id="A3" class="indent-1"><p><span class="prefix-number">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. <a id="paragraph-287976" class="section-permalink" href="https://vacode.org/32.1-46/#A3"><i class="fa fa-link"/></a></p></section>
						<section id="A4" class="indent-1"><p><span class="prefix-number">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. <a id="paragraph-287977" class="section-permalink" href="https://vacode.org/32.1-46/#A4"><i class="fa fa-link"/></a></p></section>
						<section id="A5" class="indent-1"><p><span class="prefix-number">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. <a id="paragraph-287978" class="section-permalink" href="https://vacode.org/32.1-46/#A5"><i class="fa fa-link"/></a></p></section>
						<section id="A6" class="indent-1"><p><span class="prefix-number">6.</span> Two properly spaced doses of live attenuated measles (rubeola) vaccine. The first dose shall be administered at age 12 months or older. <a id="paragraph-287979" class="section-permalink" href="https://vacode.org/32.1-46/#A6"><i class="fa fa-link"/></a></p></section>
						<section id="A7" class="indent-1"><p><span class="prefix-number">7.</span> One dose of live attenuated rubella vaccine shall be administered at age 12 months or older. <a id="paragraph-287980" class="section-permalink" href="https://vacode.org/32.1-46/#A7"><i class="fa fa-link"/></a></p></section>
						<section id="A8" class="indent-1"><p><span class="prefix-number">8.</span> One dose of live attenuated mumps vaccine shall be administered at age 12 months or older. <a id="paragraph-287981" class="section-permalink" href="https://vacode.org/32.1-46/#A8"><i class="fa fa-link"/></a></p></section>
						<section id="A9" class="indent-1"><p><span class="prefix-number">9.</span> Two properly spaced doses of varicella vaccine. The first dose shall be administered at age 12 months or older. <a id="paragraph-287982" class="section-permalink" href="https://vacode.org/32.1-46/#A9"><i class="fa fa-link"/></a></p></section>
						<section id="A10" class="indent-1"><p><span class="prefix-number">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. <a id="paragraph-287983" class="section-permalink" href="https://vacode.org/32.1-46/#A10"><i class="fa fa-link"/></a></p></section>
						<section id="A11" class="indent-1"><p><span class="prefix-number">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. <a id="paragraph-287984" class="section-permalink" href="https://vacode.org/32.1-46/#A11"><i class="fa fa-link"/></a></p></section>
						<section id="A12" class="indent-1"><p><span class="prefix-number">12.</span> Two doses of properly spaced human papillomavirus (HPV) vaccine. The first dose shall be administered before the child enters the seventh grade. <a id="paragraph-287985" class="section-permalink" href="https://vacode.org/32.1-46/#A12"><i class="fa fa-link"/></a></p></section>
						<section id="A13" class="indent-1"><p><span class="prefix-number">13.</span> Two or three properly spaced doses of rotavirus vaccine, depending on the manufacturer, for children up to eight months of age. <a id="paragraph-287986" class="section-permalink" href="https://vacode.org/32.1-46/#A13"><i class="fa fa-link"/></a></p></section>
						<section id="A14" class="indent-1"><p><span class="prefix-number">14.</span> Two properly spaced doses of hepatitis A vaccine (HAV). The first dose shall be administered at age 12 months or older. <a id="paragraph-287987" class="section-permalink" href="https://vacode.org/32.1-46/#A14"><i class="fa fa-link"/></a></p></section>
						<section id="A15" class="indent-1"><p><span class="prefix-number">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.
				The parent, guardian or <span class="dictionary">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 <span class="dictionary">department</span>, which shall administer the vaccines required by the <span class="dictionary">State Board</span> of Health Regulations for the Immunization of School Children without charge to the parent of or <span class="dictionary">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. &#xA7; 1395 et seq. (Medicare), Title XIX of the Social Security Act, 42 U.S.C. &#xA7; 1396 et seq. (Medicaid), Title XXI of the Social Security Act, 42 U.S.C. &#xA7; 1397aa et seq. (CHIP), or 10 U.S.C. &#xA7; 1071 et seq. (CHAMPUS). In all cases in which a child is covered by a health carrier, Medicare, Medicaid, CHIP, or CHAMPUS, the <span class="dictionary">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 <span class="dictionary">Department</span> shall be deemed a participating provider with a managed care health insurance plan as defined in &#xA7; <a class="law" title="Definitions" href="/32.1-137.1/">32.1-137.1</a>. <a id="paragraph-287988" class="section-permalink" href="https://vacode.org/32.1-46/#A15"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">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 <span class="dictionary">department</span> administering a vaccine required by this section shall provide to the <span class="dictionary">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. <a id="paragraph-287989" class="section-permalink" href="https://vacode.org/32.1-46/#B"><i class="fa fa-link"/></a></p></section>
						<section id="C"><p><span class="prefix-number">C.</span> The vaccines required by this section shall meet the standards prescribed in, and be administered in accordance with, the <span class="dictionary">State Board</span> of Health Regulations for the Immunization of School Children. The <span class="dictionary">State Board</span> of Health shall <span class="dictionary">amend</span> the <span class="dictionary">State Board</span> of Health Regulations for the Immunization of School Children as necessary from time to time to maintain conformity with <span class="dictionary">evidence</span>-based, routinely recommended vaccinations for children. The adoption of such regulations shall be exempt from the requirements of Article 2 (&#xA7; <a class="law" title="Exemptions from requirements of this article" href="/2.2-4006/">2.2-4006</a> et seq.) of the Administrative Process Act (&#xA7; <a class="law" title="Short title; purpose" href="/2.2-4000/">2.2-4000</a> et seq.). However, the <span class="dictionary">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&#x2019;s adoption of the regulations. <a id="paragraph-287990" class="section-permalink" href="https://vacode.org/32.1-46/#C"><i class="fa fa-link"/></a></p></section>
						<section id="D"><p><span class="prefix-number">D.</span> The provisions of this section shall not apply if: <a id="paragraph-287991" class="section-permalink" href="https://vacode.org/32.1-46/#D"><i class="fa fa-link"/></a></p></section>
						<section id="D1" class="indent-1"><p><span class="prefix-number">1.</span> The parent or guardian of the child <span class="dictionary">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; <a id="paragraph-287992" class="section-permalink" href="https://vacode.org/32.1-46/#D1"><i class="fa fa-link"/></a></p></section>
						<section id="D2" class="indent-1"><p><span class="prefix-number">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 <span class="dictionary">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 <a id="paragraph-287993" class="section-permalink" href="https://vacode.org/32.1-46/#D2"><i class="fa fa-link"/></a></p></section>
						<section id="D3" class="indent-1"><p><span class="prefix-number">3.</span> Because the human papillomavirus is not communicable in a school setting, a parent or guardian, at the parent&#x2019;s or guardian&#x2019;s sole discretion, may elect for the parent&#x2019;s or guardian&#x2019;s child not to receive the human papillomavirus vaccine, after having reviewed <span class="dictionary">materials</span> describing the link between the human papillomavirus and cervical cancer approved for such use by the Board. <a id="paragraph-287994" class="section-permalink" href="https://vacode.org/32.1-46/#D3"><i class="fa fa-link"/></a></p></section>
						<section id="E"><p><span class="prefix-number">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 <span class="dictionary">department</span>, the Virginia Immunization Information System, and the <span class="dictionary">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&#x2019;s name, address, telephone number, birth date, and social security number; and the parents&#x2019; names. The immunization information; the patient&#x2019;s name, address, telephone number, birth date, and social security number; and the parents&#x2019; names shall be confidential and shall only be shared for the purposes set out in this subsection. <a id="paragraph-287995" class="section-permalink" href="https://vacode.org/32.1-46/#E"><i class="fa fa-link"/></a></p></section>
						<section id="F"><p><span class="prefix-number">F.</span> The <span class="dictionary">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. <a id="paragraph-287996" class="section-permalink" href="https://vacode.org/32.1-46/#F"><i class="fa fa-link"/></a></p></section></text><history>Code 1950, &#xA7; 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.</history><metadata></metadata></law>
