                                 CODE OF VIRGINIA

IMMUNIZATION OF PATIENTS AGAINST CERTAIN DISEASES (§ 32.1-46)

A. 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&#8217;s regulations shall at a minimum require:

   1. A minimum of three properly spaced doses of hepatitis B vaccine (HepB).

   2. A minimum of three or more properly spaced doses of diphtheria toxoid. One
   dose shall be administered on or after the fourth birthday.

   3. A minimum of three or more properly spaced doses of tetanus toxoid. One
   dose shall be administered on or after the fourth birthday.

   4. 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.

   5. Two or three primary doses of Haemophilus influenzae type b (Hib) vaccine,
   depending on the manufacturer, for children up to 60 months of age.

   6. Two properly spaced doses of live attenuated measles (rubeola) vaccine. The
   first dose shall be administered at age 12 months or older.

   7. One dose of live attenuated rubella vaccine shall be administered at age 12
   months or older.

   8. One dose of live attenuated mumps vaccine shall be administered at age 12
   months or older.

   9. Two properly spaced doses of varicella vaccine. The first dose shall be
   administered at age 12 months or older.

   10. 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.

   11. 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.

   12. Two doses of properly spaced human papillomavirus (HPV) vaccine. The first
   dose shall be administered before the child enters the seventh grade.

   13. Two or three properly spaced doses of rotavirus vaccine, depending on the
   manufacturer, for children up to eight months of age.

   14. Two properly spaced doses of hepatitis A vaccine (HAV). The first dose
   shall be administered at age 12 months or older.

   15. 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 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. &#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 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 &#xA7; 32.1-137.1.

B. 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.

C. 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 (&#xA7; 2.2-4006
et seq.) of the Administrative Process Act (&#xA7; 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&#8217;s adoption
of the regulations.

D. The provisions of this section shall not apply if:

   1. 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;

   2. 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

   3. Because the human papillomavirus is not communicable in a school setting, a
   parent or guardian, at the parent&#8217;s or guardian&#8217;s sole discretion,
   may elect for the parent&#8217;s or guardian&#8217;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. 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&#8217;s
name, address, telephone number, birth date, and social security number; and the
parents&#8217; names. The immunization information; the patient&#8217;s name,
address, telephone number, birth date, and social security number; and the
parents&#8217; names shall be confidential and shall only be shared for the
purposes set out in this subsection.

F. 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.

HISTORY: Code 1950, § 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.