5141.3 - Health Assessments and Immunizations

5141.3(a)

Students

Health Assessments and Immunizations

The Windsor Locks Board of Education recognizes that health is an important factor in a student’s readiness to learn and to participate in the educational process. The Board of Education also recognizes the importance of periodic health assessments and adheres to those state laws that pertain to school health assessments and immunizations.

Each child must show evidence of a current health assessment (done not more than 15 months earlier) prior to entering kindergarten, grade 7 and grade 10 (or grade 9). If such health assessment has not been completed, the student will be denied enrollment in these grades.

Students entering the school system at any grade level, from a dormitory situation, will be required to have completed a tuberculin test within the last thirty (30) days. The assessment should ascertain whether such student from receiving the full benefit of school work and if so, to ascertain whether such school work should be modified in order to prevent injury to the student and/or to secure for the student a suitable program of education.

No student shall be required to undergo a health assessment if the parent or legal guardian of the student objects to such assessment based on religious grounds and so notifies the Superintendent of Schools in writing.

Each student is required to be protected by adequate immunization. The definitions of adequate immunization shall be established by CGS 10-204a. Parents will be notified of required immunization at the time of registration and by letter when requirements are modified.

The Board will deny continued attendance in school to any student who fails to obtain the required health assessments and immunizations except as exempted by law.

Health assessments and immunizations shall be at the parent/guardian’s expense except for those students whose parents/guardians meet the eligibility requirements for free and reduced price meals under the National School Lunch Program. The health assessments and immunizations for such students may be arranged for and provided by the district at no cost to the parent/guardian, if requested in writing by parent/guardian.

Legal Reference: Connecticut General Statutes

10-204 Vaccination

10-204a Required Immunizations

10-204c Immunity from Liability

10-205 Appointment of School Medical Advisers

10-206 Health Assessments

10-206b Free Health Assessments

10-207 Duties of Medical Advisers

10-208 Exemption from Examination or Treatment

10-209 Records not to be Public

10-210 Notice of Disease to be Given Parent or Guardian

10-212 School Nurses and Nurse Practitioners

10-214 Vision, Audiometric and Postural Screenings

Notification of parents re defects; record of results.

Department of Public Health, Public Health Code, 10-204a-2a, 10-204a-3a, 10-204a-4

20 U.S.C. Section 1232h, No Child Left Behind Act

Federal Family Educational Rights and Privacy Act of 1974 (section 438 of the General Education Provisions Act, as amended, added by section

513 of P.L. 93-568, codified at 20 U.S.C. 1232g)

42 U.S.C. 1320d-1320d-8, P.L. 104-191, Health Insurance Portability and

Accountability Act of 1996 (HIPAA)

Policy adopted: March 28, 2013 WINDSOR LOCKS PUBLIC SCHOOLS

Windsor Locks, Connecticut

5141.3R(a)

Students

Health Assessments and Immunizations

In accordance with Connecticut General Statutes 10-206, as amended, 10-204a, and 10-214, the following health assessment procedures are established for students in the district:

1) Proof of immunization shall be required prior to school entry. A "school-aged child" also includes any student enrolled in an adult education program that leads to a high school diploma. This immunization verification is mandatory for all new school enterers and must include complete documentation of those immunizations requiring a full series. A required immunization record includes:

a) For initial entry into school for kindergarten, regular and special education preschool programs, grades 1-6: 

• 4 doses of DTP/DTaP vaccine (Diphtheria - Pertussis - Tetanus). At least one dose is required to be administered on or after the 4th birthday for children enrolled in school at kindergarten or above. Students who start the series at age 7 or older need a total of 3 doses. 

• 3 doses of either trivalent oral polio vaccine (TOPV) or inactivated polio vaccine (IPV) with at least one dose of polio vaccine administered on or after the 4th birthday and before school entry. (This then usually results in 4 doses in total.) 

• 2 doses of MMR vaccine (measles, mumps and rubella). One dose at one (1) year of age or after and a second dose, given at least twenty-eight (28) days after the first dose, prior to school entry in kindergarten through grade twelve (12) OR disease protection, confirmed in writing, by a physician, physician assistant or advanced practical registered nurse that the child has had a confirmed case of such disease based on specific blood testing conducted by a certified laboratory. One dose on or after the child’s first birthday for enrollment in preschool.

• 3 doses of Hepatitis B vaccine (HBV) or has had protection confirmed in writing by a physician, physician assistant or advanced practice registered nurse based on specific blood testing by a certified laboratory.

• 1 dose of Hib (Hemophilus Influenza type b) given on or after the first birthday, is required of all school children who enter school prior to their fifth birthday or had a laboratory confirmed infection at age 24 months or older, confirmed in writing by a physician, physician assistant or advanced practice registered nurse. Children five and older do not need proof of Hib vaccination.

a) For initial entry into school for kindergarten, regular and special education preschool programs, grades 1-6: (continued) 

• Varicella (Chickenpox) Immunity –

(i) 1 dose on or after the 1st birthday or must show proof of immunity to varicella (chickenpox) for entry into licensed pre-school programs and kindergarten; or on or after August 1, 2011 for entry into kindergarten two (2) doses shall be required, given at least three (3) months apart, the first dose on or after the 1st birthday.

(ii) Proof of immunity includes any of the following:

Documentation of age appropriate immunizations considered to be one dose administered on or after the student’s first birthday (if the student is less than 13 years old) or two doses administered at least 30 days apart for students whose initial vaccination is at thirteen years of age or older.

Note: The National Advisory Committees on Immunization Practices (ACIP) changed the recommendation for routine vaccination against chicken pox (Varicella) from a single dose for all children beginning at 12 months of age to two doses, with the second dose given just prior to school entry. The ACIP also recommends that all school-aged children, up to 18 years of age, who have only had a single dose of Varicella vaccine to be vaccinated with a second dose.

Serologic evidence of past infection, confirmed in writing by a physician, physician assistant or advanced practice registered nurse based on specific blood testing by a certified laboratory, or

Statement signed and dated by a physician, physician assistant or advanced practice registered nurse indicating a child has already had varicella (chickenpox) based on diagnosis of varicella or verification of history of varicella. (Date of chickenpox illness not required)

(iii) All students are required to show proof of immunity (see above) to Varicella for entry into 7th grade.

Note: The Connecticut Department of Public Health has indicated that a school-aged child, 13 years of age or older, will only be considered fully immunized if he/she has had two doses of the Varicella vaccine, given at least 4 weeks apart.

a) For initial entry into school for kindergarten, regular and special education preschool programs, grades 1-6: (continued) 

• Hepatitis A – Requirement for PK and K for children born on or after January 1 2007, is enrolled in preschool or kindergarten on or after August 1, 2011.

(i) Two (2) doses of hepatitis A vaccine given at least six (6) months apart, the first dose given on or after the child’s first birthday; or

(ii) Has had protection against hepatitis A confirmed in writing by a physician, physician assistant or advanced practice registered nurse based on specific blood testing by a certified laboratory.

• Influenza Requirement for PK.

(i) Effective January 1, 2012 and each January 1 thereafter, children aged 24-59 months enrolled in preschool are required to receive at least one (1) dose of influenza vaccine between August 1 and December 31 of the preceding year (effective August 1, 2011).

(ii) Children aged 24-59 months who have not received vaccination against influenza previously must be given a second dose at least twenty-eight (28) days after the first dose.

• Pneumococcal Disease Requirement for PK and K

(i) Effective August 1, 2011 all students born on or after January 1, 2007, enrolled in PK and K who are less than five (5) years of age must show proof of having received one (1) dose of pneumococcal conjugate vaccine on or after the student’s first birthday.

(ii) An individual shall be considered adequately protected if currently aged five (5) years or older.

b) For entry into seventh (7th) grade:

All students in grades K-12 are required to show proof of 2 doses of measles, mumps, rubella vaccine at least 28 days apart with the first dose administered on or after the first (1st) birthday, or laboratory confirmation of immunity confirmed in writing by a physician, physician assistant or advanced practice registered nurse.

• Proof of having received 2 doses of measles-containing vaccine.

In those instances at entry to seventh grade, where an individual has not received a second dose of measles contained vaccine, a second dose shall be given. If an individual has received no measles containing vaccines, the second dose shall be given at least 4 weeks after the first. (Students entering 7th grade must show proof of having received 2 doses of measles-containing vaccine)

• Proof of Varicella (Chickenpox) Immunity.

(i) On or after August 1, 2011, two doses, given at least three (3) months apart, the first dose on or after the individual’s first (1st) birthday and before the individual’s thirteenth (13th) birthday or two doses given at least twenty-eight (28) days apart if the first dose was given on or after the individual’s thirteenth (13th) birthday, or

(ii) Serologic evidence of past infection, or

(iii) A statement signed and dated by a physician, physician assistant, or advanced practice registered nurse indicating that the child has already had varicella (chickenpox) based on family and/or medical history. (Date of chickenpox illness not required)

• Proof of at least three doses of Hepatitis B vaccine or show proof of serologic evidence of infection with Hepatitis B.

• Proof of Diphtheria-Pertussis-Tetanus Vaccination (Adolescent Tdap Vaccine Requirement for Grade 7 Students)

(i) On or after August 1, 2011, an individual eleven (11 years of age or older, enrolled in the seventh (7th) grade, shall show proof of one (1) dose of diphtheria, tetanus and pertussis containing vaccine, (Tdap booster) in addition to completion of the recommended primary diphtheria, tetanus and pertussis containing vaccination series unless:

b) For entry into seventh (7th) grade - (continued)

• Proof of Diphtheria-Pertussis-Tetanus Vaccination (Adolescent Tdap Vaccine Requirement for Grade 7 Students) (continued)

(ii) Such individual has a medical exemption for this dose confirmed in writing by a physician, physician assistant or advanced practice registered nurse based on having last received diphtheria, tetanus and pertussis containing vaccine less than five (5) years earlier and no increased risk of pertussis according to the most recent standards of care for immunization in Connecticut (C.G.S. 19a-7f)

• Meningococcal Vaccine (MCV4) Required for Grade 7 Students

(i) Effective August 1, 2011, one dose of meningococcal vaccine

NOTE: Students must show proof of 3 doses of Hepatitis B vaccine or serologic evidence of infection to enter eighth grade.

• Immunization requirements are satisfied if a student:

(i) presents verification of the above mentioned required immunizations;

(ii) presents a certificate from a physician, physician assistant, advanced practice registered nurse or a local health agency stating that initial immunizations have been administered to the child and additional immunizations are in process;

(iii) presents a certificate from a physician stating that in the opinion of the physician immunization is medically contraindicated in accordance with the current recommendation of the National Centers for Disease Control and Prevention Advisor Committee on Immunization Practices because of the physical condition of the child;

(iv) presents a statement from the parents or guardian of the child that such immunization would be contrary to religious beliefs of the child;

(v) he/she has had a natural infection confirmed in writing by a physician, physician assistant, advanced practice registered nurse or laboratory.

Health assessment and health screening requirements are waived if the parent legal guardian of the student or the student (if he or she is an emancipated minor or is eighteen years of age or older) notifies the school personnel in writing that the parent, guardian or student objects on religious grounds. (CGS 10-204a)

Students failing to meet the above requirements shall not be allowed to attend school.

2) A physical examination including blood pressure, height, weight, hematocrit or hemoglobin, and a chronic disease assessment which shall include, but not be limited to, asthma and which must include public health related screening questions for parents to answer and other screening questions for providers and screenings for hearing, vision, speech, gross dental and posture shall be required for all new school enterers, and students in grade 6 and grade 9 or 10. This health assessment must be completed either prior to school entry or 30 calendar days after the beginning of school for new school enterers. This assessment must be conducted within the school year for students in grade 6 or grade 9 or 10. Parents of students in grade 6 or grade 9 or 10 shall be notified, in writing, of the requirement of a health assessment and shall be offered an opportunity to be present at the time of assessment.

The assessment shall also include tests for tuberculosis, sickle cell anemia or Cooley’s anemia and test for lead levels in the blood when the Board of Education, after consultation with the school medical advisor and the local health department, determine such tests are necessary.

A test for tuberculosis, as indicated above, is not mandatory, but should be performed if any of the following risk factors prevail:

1. birth in a high risk country of the world (to include all countries in Africa, Asia, the former Soviet Union, Eastern Europe, Central and South America, Dominican Republic and Haiti, see list of countries in Appendix B) and do not have a record of a TST (tuberculin skin test) or IGRA (interferon-gamma release assay) performed in the United States.

2. travel to a high risk country staying at least one week with substantial contact with the indigenous population since the previously required examination;

3. extensive contact with persons who have recently come to the United States from high risk countries since the previously required examination;

4. contact with persons suspected to have tuberculosis; or

5. lives with anyone who has been in a homeless shelter, jail or prison, uses illegal drugs or has HIV infection.

The results of the risk assessment and testing, when done, should be recorded on the State of Connecticut Health Assessment Record (HAR-3) or directly in the student’s Cumulative Health Record (CHR-1). Health assessments completed within two calendar years of new school entry or grades 6 or grade 9 or 10 will be accepted by the school system. Failure of students to satisfy the above mentioned health assessment timeliness and/or requirements shall result in exclusion from school.

(*Note: As an alternative health assessment could be held in grade 7.)

The District shall annually report to the Department of Public Health and to the local health director the asthma data pertaining to the total number of students per school and in the district obtained through school assessments, including student demographics. Such required asthma diagnosis shall occur at the time of mandated health assessment at the time of enrollment, in either grade 6 or 7, and in either grade 9 or 10. Such asthma diagnosis shall be reported whether or not it is recorded on the health assessment form, at the aforementioned intervals.

3) Parents or guardians of students being excluded from school due to failure to meet health assessment requirements shall be given a thirty calendar day notice in writing, prior to any effective date of school exclusion. Failure to complete required health assessment components within this thirty day grace period shall result in school exclusion. This exclusion shall be verified, in writing, by the Superintendent of Schools or his/her designee. Parents of excluded students may request administrative hearing of a health assessment-related exclusion within five days of final exclusion notice. An administrative hearing shall be conducted and a decision rendered within fifteen calendar days after receipt of request. A subcommittee of the Board of Education shall conduct an administrative hearing and will consider written and/or oral testimony offered by parents and/or school officials.

4) Health screenings shall be required for all students according to the following schedule: 

Vision Screening Grades K-6, 9

Audiometric Screening Grades K-3, 5, 8

Postural Screening Grades 5, 6, 7, 8, 9

The school system shall provide these screening to students at no cost to parents. Parents shall be provided an annual written notification of screenings to be conducted. Parents wishing to have these screenings to be conducted by their private physician shall be required to report screening results to the school nurse.

(Health assessments may be conducted by a licensed physician, advanced practice registered nurse, registered nurse, physician assistant or by the School Medical Advisor.)

5) Parents of students failing to meet standards of screening or deemed in need of further testing shall be notified by the Superintendent of Schools. Students eligible for free health assessments shall have them provided by the health services staff. Parents of these students choosing to have a health assessment conducted by medical personnel outside of the school system shall do so at no cost to the school system.

6) Health records shall be maintained in accordance with Policy #5125.

7) All candidates for all athletic teams shall be examined annually by the designated school physician at a time and place determined by the Director of Athletics and/or coach. 

No candidate will be permitted to engage in either a practice or a contest unless this requirement has been met, and he or she has been declared medically fit for athletics. 

An athlete need not be re-examined upon entering another sport unless the coach requests it.

If a student is injured, either in practice, a contest, or from an incident outside of school activities at requires him or her to forego either a practice session of contest, that student will not be permitted to return to athletic activity until the school physician examines the student and pronounces him/her medically fit for athletics.

Legal Reference: Connecticut General Statutes

10-204a Required immunizations

10-204c Immunity from liability

10-205 Appointment of school medical adviser

10-206 Health assessments (as amended by June Special Session PA 01-4, PA 01-9, PA 05-272 and PA 07-58)

10-207 Duties of medical advisers

10-206a Free health assessments (as amended by June Special Session PA 01-1)

10-208 Exemption from examination or treatment

10-208a Physical activity of student restricted; board to honor notice

10-209 Records not to be public. Provision of reports to schools.

10-212 School nurses and nurse practitioners

10-214 Vision, audiometric and postural screenings. When required. Notification of parents re defects; record of results, as amended by PA 96-229, An Act Concerning Scoliosis Screening.

Department of Public Health, Public Health Code, 10-204a-2a,10-204a-3a and 10-204a-4

20 U.S.C. Section 1232h, No Child Left Behind Act

Regulation approved: March 28, 2013 WINDSOR LOCKS PUBLIC SCHOOLS

Windsor Locks, Connecticut

5141.3R

Appendix

Risk Assessment Questionnaire for Tuberculosis Exposure

1. Was your child born outside the United States?

If yes, where was your child born? If born in any of the countries on the attached list, a TST or IGRA should be performed. (Note: IGRAs are not recommended for children under five years of age.)

2. Has your child traveled outside the United States?

If the child traveled to any of the listed countries, stayed for one week or more and interacted with the local population, including friends or local family, then a TST or IGRA should be performed.

For most children, testing, after evaluation for possible signs and symptoms of TB disease or exposure to a person with contagious pulmonary TB can take place 8-10 weeks after return to the United States.

3. Has your child been exposed to anyone with TB disease?

If yes, determine whether the person had TB disease or latent TB infection, when the exposure occurred, and what the nature of the contact was. If confirmed that contact was with a person with known or suspected TB disease, a TST or IGRA should be performed.

4. Does your child have close contact with someone with a positive TST or IGRA?

If yes, see the previous question for follow-up information needed.

5. Does your child live with anyone who has been in jail, prison or a shelter, who injects illegal drugs, or has HIV?

If yes, then a TST or IGRA should be performed.

6. Has your child eaten unpasteurized cheese from Mexico or Central American since the last TST or IGRA?

If yes, then a TST or IGRA should be performed. 

TST: a tuberculin skin test; IGRA: an interferon-gamma release assay