Exemption rate for students exempt varies by county in Massachusetts, data show; flu shot now required during pandemic

In an effort to curb respiratory breathing during the coronavirus pandemic, state officials announced Wednesday that nearly all students in Massachusetts are required to get a flu this year.

Students are expected to receive a flu vaccine for the 2020-2021 flu season on December 31, unless a medical or religious exemption is provided. Besides medical and religious exemption, the only other students who are not required to get the shot are college and college students who attend online classes exclusively and never visit the campus in person, the Department of Public Health said.

The flu shot is now under a selection of required immunizations to attend school. While some school districts, such as Worcester and Springfield, are starting the new school year with distance education, about 70% of districts in the state have at least some form of personal learning planned for the fall.

Primary and secondary school students in districts using a distance learning model are not exempt from the flu shot requirement, DPH said.

While the flu shot is a new requirement during the pandemic, other vaccines have been required for years. There is a selection of students in the state who have exemptions for vaccinations, rates that vary by province.

Although the Department of Public Health outlines the required faxes for school, local districts are responsible for ensuring compliance. Elderly and caregivers may show a medical exemption, written by a physician and document documentation, as a religious exemption, written by the parent or caregiver depending on how the vaccine conflicts with the religious belief.

Most exemptions claimed in Massachusetts are religious exemptions, DPH said, noting that there are pockets of higher exemption rates in the western and southeastern parts of the state, particularly the Cape and islands.

In Franklin County, 6% of nursery school students had an exemption, per DPH data as of February. Dukes and Nantucket counties had 7.5% and 2.9% students with an exemption, respectively. The statewide average is 1.3%.

The state said many students have an exemption for only one or two faxes and otherwise have immunizations.

The amount of nursery students with an exemption and no faxes varies by state. According to DPH data as of February, that category comprised 3.5% of students in Franklin County and 4.4% in Dukes County, with a state average of 0.6%.

There are some nursery school students in the state who do not meet school requirements, which means they are not fully vaccinated for entering nursery schools and have no exemption.

Suffolk, Franklin, Nantucket and Berkshire counties have the highest number of kindergartens in that category, with 9.9%, 7.2%, 6.8% and 6.6%, respectively. The state average is 2.8%, as of February, according to DPH.

Some school districts allow students on a daycare plan to attend classes if they do not meet immunization requirements, while other school districts allow students to attend classes while awaiting updated documentation on immunization.

In addition to the new flu shot requirement, this year there are immunization requirements for the meningococcal vaccine for school entry.

Here are the state’s immunization requirements for the coming school year, all in addition to the new mandate for flu vaccines.

Childcare / Preschool

• Hib: one to four doses; the number of doses is determined by vaccine product and age begins the series.
• DTaP: four doses.
• Polio: three doses.
• Hepatitis B: three doses; laboratory evidence of immunity acceptable.
• MMR: one dose; must be given on or after the first birthday; laboratory evidence of immunity acceptable.
• Varicella: one dose; must be given on or after the first birthday; a reliable history of chickenpox as laboratory evidence of immunity acceptable.

Grades kindergarten through six

• DTaP: five doses; four doses are acceptable if the fourth dose is given on or after the fourth birthday. DT is only acceptable with a letter stating a medical contraindication to DTaP.
• Polio: four doses; a fourth dose should be given on or after the fourth birthday and ≥6 months after the previous dose, if a fifth dose is required. Three doses are acceptable if the third dose is given on or after the fourth birthday and ≥6 months after the previous dose.
• Hepatitis B: three doses; laboratory evidence of immunity acceptable.
• MMR: two doses; first dose should be given on or after the first birthday and second dose should be given ≥28 days after the first dose; laboratory evidence of immunity acceptable.
• Varicella: two doses; first dose should be given on or after the first birthday and second dose should be given ≥28 days after the first dose; a reliable history of chickenpox as laboratory evidence of immunity acceptable.

Grades seven to twelve

• Tdap: one dose; and history of primary series of DTaP as age-appropriate vaccination. Tdap given at ≥7 years may be counted, but a dose at the age of 11-12 is recommended if Tdap was previously given as part of a reception scheme. Td or Tdap should be given if it is ≥10 years since the last Tdap.
• Polio: four doses; a fourth dose should be given on or after the fourth birthday and ≥6 months after the previous dose, if a fifth dose is required. Three doses are acceptable if the third dose is given on or after the fourth birthday and ≥6 months after the previous dose.
• Hepatitis B: three doses; laboratory evidence of immunity acceptable. Two doses of Heplisav-B given at or after 18 years of age are acceptable.
• MMR: two doses; first dose should be given on or after the first birthday and second dose should be given ≥28 days after the first dose; laboratory evidence of immunity acceptable.
• Varicella: two doses; first dose should be given on or after the first birthday and second dose should be given ≥28 days after the first dose; a reliable history of chickenpox as laboratory evidence of immunity acceptable.

New Meningococcal Requirements

• Grade 7: one dose; one dose MenACWY (formerly MCV4) required. Meningococcal B vaccine is not required and does not meet this requirement.
• Grade 11: two doses; second dose MenACWY (formerly MCV4) should be given on or after the 16th birthday and ≥ 8 weeks after the previous dose. One dose is acceptable if given on or after the 16th birthday. Meningococcal B vaccine is not required and does not meet this requirement.

Colleges and post-secondary institutions

• Tdap: one dose; and history of a DTaP primary series as age-appropriate vaccination. Tdap given at ≥7 years may be counted, but a dose at the age of 11-12 is recommended if Tdap was previously given as part of a reception scheme. Td or Tdap should be given if it has been Tdap since 10 years ago.
• Hepatitis B: three doses; laboratory evidence of immunity acceptable; Two doses of Heplisav-B given at or after 18 years of age are acceptable
• MMR: two doses; first dose should be given on or after the first birthday and second dose should be given ≥28 days after the first dose; laboratory evidence of immunity acceptable. Birth in the US before 1957 acceptable only to students of non-health sciences
• Varicella: two doses; first dose should be given on or after the first birthday and second dose should be given ≥28 days after the first dose; a reliable history of chickenpox as laboratory evidence of immunity acceptable. Birth in the US before 1980 acceptable only for students non-health sciences
• Meningococcus: one dose; 1 dose MenACWY (formerly MCV4) required for all full-time students 21 years of age or younger. The dose of MenACWY vaccine should have been received on or after the student’s 16th birthday. Doses received at a younger age do not count towards this requirement. Students may reject MenACWY vaccine after reading and signing the MDPH Meningococcal Information and Washing Form through their institution. Meningococcal B vaccine is not required and does not meet this requirement

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