641—7.4 (139A) Required immunizations.
	 7.4(1) Applicants enrolled or attempting to enroll shall have received the following vaccines in accordance with the doses and age requirements listed below:
IMMUNIZATION REQUIREMENTS

Institution	Age	Vaccine	Total Doses Required	
Licensed child care center	< 2 months	None	 	
 	2 through 5 months	Diphtheria/Tetanus/Pertussis1
Polio
Haemophilus influenzae type B	1 dose
1 dose
1 dose	
 	6 through 14 months	Diphtheria/Tetanus/Pertussis1
Polio
Haemophilus influenzae type B	2 doses
2 doses
2 doses	
 	15 through 18 months	Diphtheria/Tetanus/Pertussis1
Polio
Haemophilus influenzae type B	3 doses
3 doses
3 doses, with the final dose in the series received when the applicant is ≥ 12 months of age; or 1 dose received when the applicant is ≥ 15 months of age.	
 	 	Measles/Rubella2	1 dose of measles/rubella-
containing vaccine received after the applicant was at least 12 months of age; or the applicant demonstrates a positive antibody test for measles and rubella.	
 	19 months and older	Diphtheria/Tetanus/Pertussis1
Polio
Haemophilus influenzae type B	3 doses
3 doses
3 doses, with the final dose in the series received when the applicant is ≥ 12 months of age; or 1 dose received when the applicant is ≥ 15 months of age.	
 	 	Measles/Rubella2	1 dose of measles/rubella-
containing vaccine received after the applicant was at least 12 months of age; or the applicant demonstrates a positive antibody test for measles and rubella.	
 	 	Varicella	1 dose if the applicant was born on or after September 15, 1997, unless the applicant has had a reliable history of natural disease. This dose shall have been received after the applicant was at least 12 months of age.	
Elementary school/
secondary school	4 years of age and older	Diphtheria/Tetanus/Pertussis1,3	3 doses, with at least 1 dose of diptheria/tetanus/pertussis- containing vaccine received after the applicant’s fourth birthday if the applicant was born on or before September 15, 2000; or 4 doses, with at least 1 dose of diptheria/tetanus/
pertussis-containing vaccine received after the applicant’s fourth birthday if the applicant was born after September 15, 2000.
Applicants ≥ 7 years of age are exempt from receiving further doses of pertussis-containing vaccine; therefore, tetanus and diphtheria-containing vaccine should be used.	
 	 	Polio	3 doses, with at least 1 dose on or after the applicant’s fourth birthday.	
 	 	Measles/Rubella2	2 doses of measles/rubella-
containing vaccine; or the applicant demonstrates a positive antibody test for measles and rubella. The first dose shall have been received on or after the applicant’s first birthday; the second dose shall have been received no less than 28 days after the first dose.	
 	 	Hepatitis B	3 doses if the applicant was born on or after July 1, 1994.	
 	 	Varicella	1 dose if the applicant was born on or after September 15, 1997, unless the applicant has had a reliable history of natural disease. This dose shall have been received after the applicant was at least 12 months of age.	
1 Pediatric diphtheria and tetanus vaccine may be substituted for the pertussis-containing vaccine, without a medical exemption, when pertussis vaccine is contraindicated for the child < 7 years of age.
2 Mumps vaccine may be included in measles/rubella-containing vaccine.
3 If a child received the first dose of tetanus/diphtheria-containing product when the child was < 12 months of age, 4 doses are required, with 1 dose on or after the child’s fourth birthday. If a child received the first dose of tetanus/diphtheria-containing product when the child was ≥ 12 months of age, 3 doses are required, with 1 dose on or after the child’s fourth birthday.
	 7.4(2) Vaccine doses administered ≤ 4 days before the minimum interval or age shall be counted as valid. Doses administered ≥ 5 days earlier than the minimum interval or age shall not be counted as valid doses and shall be repeated as age-appropriate.
	 7.4(3) For vaccine administration, the minimum age and intervals recommended by the advisory committee on immunization practices shall be followed.