May 29, 2020
Immunization Requirements Summary
• All immunizations must meet minimum age and minimum interval requirements
• Grace period: vaccine doses administered <4 days before the minimum age or interval are
considered valid unless otherwise specified
The 4-day grace period does NOT apply to the interval between two different live virus vaccines (e.g., MMR
and varicella)
If not administered on the same day, a minimum interval of 4 weeks is required between two doses of
different live virus vaccines
• The use of trade names is for identification purposes only and does not imply endorsement by the
Hawaii Department of Health
• For additional information, see General Best Practice Guidelines for Immunization:
https://health.hawaii.gov/docd/files/2019/08/HAR11-157_EXHIBIT_B.pdf
• If you have any questions, please call the Hawaii Department of Health Immunization Branch at
(808) 586-8300
May 29, 2020
TABLE 1: REQUIRED IMMUNIZATIONS – CHILD CARE CENTER/PRESCHOOL*
BY THIS AGE
STUDENTS ARE REQUIRED TO HAVE
DT
A
P
(Diphtheria,
Tetanus,
Pertussis)
P
OLIO
H
IB
**
(Haemophilus
influenzae
type B)
PCV**
(Pneumococcal
Conjugate
Vaccine)
H
EPATITIS
B
EPATITIS
MMR
(Measles,
Mumps,
Rubella)
V
ARICELLA
(Chickenpox)
3
MONTHS
1 dose
1 dose
1 dose
1 dose
2 doses
Not required at
this age
Not required at
this age
5
MONTHS
2 doses
2 doses
2 doses
2 doses
2 doses
Not required at
this age
Not required at
this age
7
MONTHS
3 doses
2 doses
2 - 3 doses
†
3 doses
2 doses
Not required at
this age
Not required at
this age
16
MONTHS
3 doses
2 doses
3 - 4 doses
4 doses
§
2 doses
1 dose
1 dose
19 MONTHS
4 doses
3 doses
3 - 4 doses
4 doses
§
3 doses
1 dose
1 dose
24 MONTHS
4 doses
3 doses
3 - 4 doses
4 doses
§
3 doses
1 dose
1 dose
*SEE TABLE 6: EXCEPTIONS TO IMMUNIZATION REQUIREMENTS
**FOR INFORMATION ON CHILDREN WHO START THE HIB OR PCV SERIES AT AGE 7 MONTHS OR OLDER, SEE TABLE 5A AND 5B
†
If all PedvaxHIB® (Merck) administered, 2 doses are required
If ActHIB® (sanofi), Pentacel® (sanofi), or Hiberix® (GSK) administered, 3 doses are required
If both PedvaxHIB® and either ActHIB®, Pentacel®, or Hiberix® administered, or if product type is
UNKNOWN or not listed here, 3 doses are required
If all PedvaxHIB® (Merck) administered at the routinely recommended ages (2, 4, 12-15 months), 3 doses are required.
If ActHIB® (sanofi), Pentacel® (sanofi), or Hiberix® (GSK) administered at the routinely recommended ages (2, 4, 6, 12-15 months), 4 doses are required.
If both PedvaxHIB® and either ActHIB®, Pentacel®, or Hiberix® administered at the routinely recommended ages (2, 4, 6, 12-15 months), or if product type is
UNKNOWN or
not listed here, 4 doses are required.
The number of doses required for children who did not receive Hib at the routinely recommended ages depends on the child’s age at the time of administration of each
dose and the vaccine product. See Table 5A.
§
If administered at the routinely recommended ages (2, 4, 6, 12-15 months), 4 doses of PCV are required.
The number of doses required for children who did not receive PCV at the routinely recommended ages depends on the child’s age at the time of administration of each
dose. See Table 5B.
May 29, 2020
TABLE 2: REQUIRED IMMUNIZATIONS – GRADES KINDERGARTEN – 12*
B
Y THIS
GRADE
S
TUDENTS ARE
R
EQUIRED TO
H
AVE
DTaP
(Diphtheria,
Tetanus,
Pertussis)
Polio
Hepatitis B
Hepatitis A
MMR
(Measles,
Mumps,
Rubella)
Varicella
(Chickenpox)
HPV
(Human
Papillomavirus
Vaccine)
MCV
(Meningococcal
Conjugate
Vaccine)
Tdap
(Tetanus,
Diphtheria,
Pertussis)
A
LL
KINDERGARTEN
STUDENTS AND
NEW ENTERERS
IN GRADES 1 – 6
5 doses 4 doses 3 doses 2 doses 2 doses 2 doses
Not
required for
this grade
Not
required for
this grade
Not
required for
this grade
7
TH
G
RADE
ATTENDANCE
2 doses 1 dose 1 dose
A
LL
N
EW
ENTERERS IN
GRADES 7 – 12
5 doses 4 doses 3 doses 2 doses 2 doses 2 doses
2 or 3
doses
†
1 dose
1 dose
*SEE TABLE 6: EXCEPTIONS TO IMMUNIZATION REQUIREMENTS
†
Age 9 through 14 years at initial vaccination: 2 doses of HPV required
Age 15 years or older at initial vaccination: 3 doses of HPV required
Age 10 through 15 years upon new entrance: 1 dose of MCV required
Age 16 years and older upon new entrance: At least 1 dose of MCV on or after age 16 years required, a minimum of 8 weeks after a
previous dose
May 29, 2020
TABLE 3: REQUIRED IMMUNIZATIONS – POST-SECONDARY SCHOOL*
POST-SECONDARY SCHOOL STUDENTS ARE REQUIRED TO HAVE
MMR
(Measles Mumps, Rubella)
V
ARICELLA
(Chickenpox)
T
DAP
(Tetanus, Diphtheria,
Pertussis)
MCV
†
(Meningococcal Conjugate
Vaccine)
A
LL
A
TTENDEES
2 doses
2 doses
1 dose
At least 1 dose on or after
age 16 years
*SEE TABLE 6: EXCEPTIONS TO IMMUNIZATION REQUIREMENTS
†
Required for first-year students living in on-campus housing.
Table 4: Minimum Ages and Intervals Between Immunization Doses
Ɨ
VACCINE
DOSE
MINIMUM AGE/INTERVAL
NOTES
Diphtheria, Tetanus, Pertussis
(Diphtheria-Tetanus-acellular Pertussis [DTaP]
or Diphtheria-Tetanus-Pertussis [DTP])
1
st
dose
Not before age 6 weeks
• DTaP 4 does not need to be repeated if administered at least 4 months
after DTaP 3 AND not before age 12 months
• A 5
th
dose is not needed if 4
th
dose is given at age >4 years AND at least 6
months after DTaP 3
2
nd
dose
4 weeks after 1
st
dose
3
rd
dose
4 weeks after 2
nd
dose
4
th
dose
6 months after 3
rd
dose AND not before age 12
months
5
th
dose
6 months after 4
th
dose AND not before age 4 years
Haemophilus influenzae type B (Hib)
1
st
dose
Not before age 6 weeks
• If PRP-T (ActHIB®, Pentacel®, Hiberix®) administered, 4 doses are required
• If PRP-OMP (PedvaxHIB®) administered, 3 doses are required: 1
st
dose:
not before age 6 weeks; 2
nd
dose: at minimum 4 weeks after 1
st
dose; 3
rd
dose: at minimum 8 weeks after 2
nd
dose AND not before age 12 months
• If both PRP-T and PRP-OMP were administered, 4 doses are required
• For children who start the Hib vaccination series at age 7 months or older,
see Table 5A
2
nd
dose
4 weeks after 1
st
dose
3
rd
dose
4 weeks after 2
nd
dose
4
th
dose
8 weeks after 3
rd
dose AND not before age 12
months
Hepatitis A
1
st
dose
Not before age 12 months
2
nd
dose
6 months after 1
st
dose
Hepatitis B
1
st
dose
Birth
2
nd
dose
4 weeks after 1
st
dose
3
rd
dose
8 weeks after 2
nd
dose AND 16 weeks after 1
st
dose
AND not before age 24 weeks
Human Papilloma Virus (HPV)
1
st
dose
Not before age 9 years
• If 2-dose minimum interval not met, follow 3 dose schedule (see below)
• Students aged 15 years or older at initial vaccination require 3 doses: 1
st
dose: not before age 9 years; 2
nd
dose: at minimum 4 weeks after 1
st
dose; 3
rd
dose: at minimum 12 weeks after 2
nd
dose AND 5 months after
1
st
dose.
2
nd
dose
5 months after 1
st
dose
Measles [Rubeola], Mumps, Rubella (MMR)
1
st
dose
Not before age 12 months
2
nd
dose
4 weeks after 1
st
dose
Meningococcal Conjugate Vaccine (MCV)
One dose
Not before age 10 years
• Students aged 16 years & older at new entrance and post-secondary
school students must have at least one dose on or after AGE 16 YEARS, a
minimum of 8 weeks after a previous dose.
Pneumococcal Conjugate Vaccine (PCV)
1
st
dose
Not before age 6 weeks
• For children who start the PCV series at age 7 months or older, see Table
5B
2
nd
dose
4 weeks after 1
st
dose
3
rd
dose
4 weeks after 2
nd
dose
4
th
dose
8 weeks after 3
rd
dose AND not before age 12
months
Polio
(Inactivated Polio Vaccine [IPV])
1
st
dose
Not before age 6 weeks
• A 4
th
dose is not needed if 3
rd
dose is given at age >4 years AND at least 6
months after 2
nd
dose.
2
nd
dose
4 weeks after 1
st
dose
3
rd
dose
4 weeks after 2
nd
dose
Final dose
6 months after previous dose AND not before age 4
years
Tetanus, diphtheria, acellular pertussis (Tdap)
One dose
Not before age 10 years
• For students aged >7 years never vaccinated with DTaP, see Table 6.
Varicella
(chickenpox)
1
st
dose
Not before age 12 months
• For students aged 12 months to 12 years, dose 2 does not need to be
repeated if administered at least 4 weeks after the 1
st
dose (no grace
period may be added to 4 weeks).
2
nd
dose
12 weeks after 1
st
dose (for students aged 12 months
to 12 years)
4 weeks after 1
st
dose (for students aged 13 years
and older)
Ɨ
Intervals listed in months are measured in calendar months. A grace period of 4 days applies to each minimum age and interval. EXCEPTION: The 4-day grace period does NOT apply to the interval between two
different live virus vaccines (e.g., MMR and varicella vaccine). If not administered on the same day, a minimum interval of 4 weeks is required between two doses of different live virus vaccines. Use of trade
names is for identification only and does not constitute endorsement by the Hawaii Department of Health.
May 29, 2020
May 29, 2020
TABLE 5A: HAEMOPHILUS INFLUENZAE TYPE B (HIB)
For children who start the Hib vaccination series at age 7 months or older, the number of doses required depends on the child’s
age at the time of initial vaccination, regardless of the product(s) used for the first dose.
Required Haemophilus influenzae type b conjugate vaccine (Hib) doses for children whose initial vaccination is delayed until age
7 months or older
Age at 1
st
Dose
Number of
Required Doses
Initial Dose(s)
Final Dose
7 – 11 months
3
2 doses, at least 4 weeks apart
At least 8 weeks after previous dose and not before age 12 months
12 – 14 months
2
1 dose
At least 8 weeks after previous dose
15 – 59 months
1
The number of doses required for children who did not receive Hib according to the “late start” schedule above depends on the child’s age at the time of
administration of each dose and the vaccine product. Refer to the CDC’s Haemophilus influenzae type b-Containing Vaccines Catch-Up Guidance for Children
4 months through 4 years of Age at: https://www.cdc.gov/vaccines/schedules/downloads/child/job-aids/hib-actHib.pdf
(for ActHIB, Pentacel, Hiberix, or
Unknown) or https://www.cdc.gov/vaccines/schedules/downloads/child/job-aids/hib-pedvax.pdf (for PedvaxHIB).
TABLE 5B: PNEUMOCOCCAL CONJUGATE VACCINE (PCV)
Unvaccinated children 7 months of age or older do not require a full PCV series of four doses. The number of required doses to
complete the series depends on the child’s age at the time of receipt of vaccination.
Required Pneumococcal Conjugate Vaccine (PCV) doses for children whose initial vaccination is delayed until age 7 months or
older
Age at 1
st
dose
Number of
Required Doses
Initial Dose(s)
Final Dose
7 – 11 months
3
2 doses, at least 4 weeks apart
At least 8 weeks after previous dose and not before age 12 months
12 – 23 months
2
1 dose
At least 8 weeks after first dose
24 – 59 months
1
The number of doses required for children who did not receive PCV according to the “late start” schedule above depends on the child’s age at the time of
administration of each dose. Refer to the CDC’s Pneumococcal Conjugate Vaccine (PCV) Catch-Up Guidance for Children 4 months through 4 years of Age at:
https://www.cdc.gov/vaccines/schedules/downloads/child/job-aids/pneumococcal.pdf
May 29, 2020
TABLE 6: EXCEPTIONS TO IMMUNIZATION REQUIREMENTS
DTaP, DT
For children aged <7 years with a contraindication to pertussis vaccination, DT should be used instead of DTaP.
• Primary series:
o Previously unvaccinated children who receive their first DT dose at age <12 months need 4 doses of DT
Doses 1, 2, and 3: at minimum, 4-week intervals
Dose 4: at minimum, 6 months after dose #3
o Unvaccinated children aged >12 months should receive 2 doses of DT at minimum 4 weeks apart, followed by a 3
rd
dose at
minimum 6 months later.
o Children who have already received 1 or 2 doses of DT or DTaP after their first birthday should receive a total of 3 doses, with
the 3
rd
dose at minimum 6 months after dose #2.
• Children aged 4 – 6 years who complete a primary series of DT before their fourth birthday should receive a dose of DT at
kindergarten entry.
Tdap/Td
• Students aged 7 – 18 years not fully immunized with DTaP vaccine should receive one dose of Tdap as the first dose of the catch-up
series. If additional doses are needed, either Td or Tdap vaccine may be used.
• Persons aged 7 years and older who have never been vaccinated against pertussis, tetanus, or diphtheria should receive a series of 3
vaccinations: Tdap, followed by a dose of Td or Tdap at least 4 weeks after the initial dose, and another dose of Td or Tdap at least 6
months after the previous dose.
MMR
•
Students born prior to 1957: MMR vaccination not required
Varicella
• Students born in the United States prior to 1980: varicella vaccination not required
• A signed, documented diagnosis or verification of a history of varicella disease or herpes zoster by a practitioner may be substituted
for a record of varicella vaccination
Documentation of serologic evidence of immunity
• Serologic evidence of immunity may be substituted for a record of immunizations for diphtheria, tetanus, hepatitis A, measles, or
rubella (ACIP’s General Best Practice Guidelines for Immunization: https://health.hawaii.gov/docd/files/2019/08/HAR11-
157_EXHIBIT_B.pdf
• Documentation must include a laboratory report, signed by a practitioner, certifying that the student is immune to the named
disease(s).
Online students
• All students and post-secondary students who attend classes exclusively online or electronically via remote learning are excluded
from the immunization requirements.