The facts on NJ schools and vaccines: What’s required and when

New Jersey continues to wrestle with the issue of personal rights versus public health requirements when it comes to daycare and classrooms, as a proposed measure to get rid of most religious exemptions for vaccines for New Jersey students is expected to be reintroduced in the 2020 Legislative session.

According to the Immunization Action Coalition, there are five states that do not allow parents to opt out of vaccinating their children for personal, philosophical or religious reasons: California, Maine, Mississippi, New York and West Virginia.

The World Health Organization named vaccine hesitancy among the top 10 threats to global health in 2019, identifying "the reluctance or refusal to vaccinate despite the availability of vaccines," which WHO said "threatens to reverse progress made in tackling vaccine-preventable diseases."

The state Department of Health Vaccine Preventable Disease Program says state immunization requirements are in accordance with the guidelines of the American Academy of Pediatrics, the American Academy of Family Physicians, and CDC/Advisory Committee on Immunization Practices.

Which vaccines are required under state law for children to enter/attend/transfer into a licensed child care/preschool or school?

Under Immunization of Pupils in School regulations, the minimum required number of vaccine (shots) doses for children in New Jersey are as follows:

— Haemophilus influenzae type b (Hib)
Child Care/Preschool: Children 2-11 months old are required to receive a minimum of two age-appropriate doses of aseparate or a combination Hib conjugate vaccine, or fewer as appropriate for the child’s age.
Children 12-59 months old are required to receive at least one dose of a separate or combination Hib conjugate vaccine, on or after the first birthday.
Not required for kindergarten.

— Pneumococcal Conjugate (PCV)
Child Care/Preschool: Children 2-11 months old are required to receive a minimum of two age-appropriate doses of PCV, or fewer as appropriate for the child’s age.
Children 12-59 months old are required to receive at least one dose of PCV, on or after the first birthday.
Not required for kindergarten.

— DTaP (Diphtheria, tetanus, and pertussis vaccine for younger children)
Child Care/Preschool: receive a minimum of four doses of a DTaP-containing vaccine, or fewer as appropriate for child’s age per ACIP Recommended Schedule.
Kindergarten/First Grade: Students need four to five doses of a DTaP-containing vaccine depending on age of school entry. (Kindergarten is not mandatory across as of January 2020.)
Children 7 and older who have not completed the primary DTaP series or have not received any DTaP-containing vaccines, should receive three or fewer doses (as appropriate) of tetanus diphtheria (Td) vaccine.

— Tdap (Tetanus, diphtheria, and pertussis vaccine for adolescents and adults)
Children a least 11 years and older are required to receive a one-time dose (Tdap) vaccine at the 6th grade level or higher (or comparable age level special education program)

— Polio Inactivated Polio Vaccine (IPV)
Child Care/Preschool: a minimum of three doses of a polio-containing vaccine or fewer as appropriate for child’s age.
Kindergarten/First Grade: students need three to four doses of a polio-containing vaccine depending upon age of school entry.
Children 7 years and older are required to have a minimum of three doses of polio.
Polio vaccine is not required for students 18 years and older.

— MMR (Measles, Mumps, Rubella)
Child Care/Preschool: Children are required to receive a minimum of one dose of MMR vaccine by 15 months old.
K-12: Students are required to receive two doses of measles, one dose of mumps, and one dose of rubella.  Most children receive two MMR vaccines, as separate components of the vaccine are not available in the U.S.

On the MMR vaccine, the Antibody Titer Law (Holly’s Law), passed in 2004, allows guardians to seek testing to determine a child’s immunity to measles, mumps, and rubella, before receiving the second dose of the vaccine. If a sufficient level of antibodies is present in a blood sample, written lab proof of immunity exempts a child from the second dose of MMR vaccine.

— Varicella (Chickenpox)
Child Care/Preschool: minimum of one dose of varicella vaccine by 19 months old.
K-12: Students are required to receive at least one dose of varicella vaccine.

— Hepatitis B
Children are not required to receive hepatitis B vaccine for child care/preschool attendance.
K-12: Students are required to receive three doses of hepatitis B vaccine, or any combination vaccine containing hepatitis B virus.

— Meningococcal
Children who are at least 11 years and older are required to receive a one-time dose of meningococcal-containing vaccine at the 6th grade level or higher (or comparable age level special education program)

What about the flu vaccine?

In New Jersey, children, between the ages of six months and just under 5 years enrolled in a licensed child care center or preschool facility must receive one dose of influenza vaccine prior to Dec. 31 of each year.

Students in K-12 are not required to receive the flu vaccine for school attendance.

What about the HPV vaccine?

Student vaccination against human papillomavirus is not required under law.

According to the National Conference of State Legislatures, Rhode Island, Virginia and the District of Columbia require HPV vaccines for school attendance.

How do medical exemptions for school attendance factor in?

"A written statement shall be submitted to the school, preschool, or child care center from a physician licensed to practice medicine or osteopathy or an advanced practice nurse (certified registered nurse practitioner or clinical nurse specialist) indicating that an immunization is medically contraindicated for a specific period of time, and the reason(s) for the medical contraindication, based upon valid medical reasons as enumerated by the Advisory Committee on Immunization Practices (ACIP) or the American Academy of Pediatrics (AAP) guidelines."

For a look at CDC guidelines of conditions under which vaccines should not be administered, click here.

Amid existing religious exemptions, are there religions with a current stance against vaccines?

The major world religions support vaccination of children.

Under current law, religious exemption from mandatory immunization is granted “if the parent or guardian of the pupil objects thereto in a written statement signed by the parent or guardian upon the grounds that the proposed immunization interferes with the free exercise of the pupil’s religious rights.”

As outlined in a May 2017 memo from the Department of Health, the written request does not need to identify membership in a recognized church or religious denomination, or describe how the administration of immunizing agents conflicts with the student’s religious beliefs in order for the request to be granted.

Some people who practice Catholicism point to the use of cell lines original taken from two voluntary aborted fetuses in the 1960s to develop certain vaccines as the means for religious objection.

As clarified by the Children's Hospital of Philadelphia, the vaccines do not contain “parts of fetuses" or fetal cells, but viruses are grown within the cells before being removed and further developed.

In 2014, a Vatican Statement on "Vaccines Derived from Human Fetal Tissue” was issued which said in part “In any case, there remains a moral duty to continue to fight and to employ every lawful means in order to make life difficult for the pharmaceutical industries which act unscrupulously and unethically. However, the burden of this important battle cannot and must not fall on innocent children and on the health situation of the
population — especially with regard to pregnant women.”

“The Orthodox Union (OU) and the Rabbinical Council of America (RCA) strongly urge all parents to vaccinate their healthy children on the timetable recommended by their pediatrician,” in a November 2018 statement amid a CDC monitored measles outbreak.

Islamic leaders signed the Dakar Declaration on Vaccination in 2017, which supported the necessity for vaccination to protect children from infectious diseases. “Vaccination remains to date the most effective method of protection against a variety of mankind’s illnesses and epidemics, and safeguards the wellbeing of the body, which is God’s gift to us”.

Further resources:
Summary of NJ Child Care/Preschool Immunization Requirements
NJDOH Immunization Regulations Pertaining to Children Attending School/Higher Education