West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-95 - Immunization Requirements and Recommendations for Children Attending School and Enrolled in State-Regulated Child Care › Section 64-95-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1.
Scope.
				--
This rule establishes dosages and interval schedules for vaccines
				mandated by law for admission to a public, private, or parochial school in this
				state, or a state-regulated child care center. Additionally, the rule includes
				additional recommendations for immunizations to promote public health. Finally,
				this rule establishes the process for requesting a medical exemption from
				compulsory immunizations required of children attending a public, private, or
				parochial school in this state, or a state-regulated child care
				center.
1.2.
Authority.
				--
Generally, the Secretary of the Department of Health and Human
				Resources is authorized to "adopt rules ... to obstruct and prevent the
				introduction or spread of . . . communicable or infectious diseases into or
				within the state, and the [State Health Officer] shall have the power to
				enforce these regulations ..."
W.Va. Code
§
									16-3-1. The
				Commissioner is authorized to require additional immunizations for public
				health purposes.
W.Va. Code
§ 5-16-9(i). Furthermore, the
				Secretary of the Department of Health and Human Resources is generally
				authorized to propose legislative rules necessary and proper to effectuate the
				purposes of Chapter 16.
W.Va.
Code §
									16-1-4.
More specifically, a child may not be admitted or received in
				  any of the schools of the state or a state-regulated child care center until he
				  or she has been appropriately immunized against chickenpox, hepatitis-b,
				  measles, meningitis, mumps, diphtheria, polio, rubella, tetanus and whooping
				  cough or produces a certificate from the Commissioner granting the child or
				  person, an exemption from the compulsory immunization requirements.
W.Va. Code
§
									16-3-4(c).
				  Although, state law provides for the immunizations required of children
				  attending the schools of the state or state-regulated child care centers,
W.Va. Code
§
									16-3-4,
				  does not include specific guidance regarding the manner in which compulsory
				  immunization must be administered.
The Commissioner has the authority to provide information or
				  guidance to the public regarding the agency's interpretations, policy or
				  opinions upon the law enforced or administered by the Commissioner.
W.Va. Code
§ 29A-1-2. This rule is not intended to be
				  determinative of any issue affecting constitutional, statutory or common law
				  rights, privileges or interests. Instead, the rule will provide the public with
				  information and clearly define the requirements and recommendations for
				  immunizations for all children enrolled in a public, private, or parochial
				  school in this state, or a state-regulated child care center.
1.3.
Filing Date.
				--
1.4.
Effective
				Date. --
1.5.
Summary. --
The Bureau for Public Health is promulgating this
				interpretive rule to set forth the Bureau's interpretation of the provisions of
W.Va. Code
§
									16-3-4,
				which provides that "[n]o child or person may be admitted or received in any of
				the schools of the state or a state-regulated child care center until he or she
				has been immunized against chickenpox, hepatitis-b, measles, meningitis, mumps,
				diphtheria, polio, rubella, tetanus and whooping cough or produces a
				certificate from the Commissioner granting the child or person an exemption
				from the compulsory immunization requirements of this section." The Bureau
				interprets the provisions of
W.Va. Code
§
									16-3-4,
				to incorporate the most current recommendations issued by the U.S. Department
				of Health and Human Services, Advisory Committee on Immunization Practices
				(ACIP), the American Academy of Pediatrics (AAP), the American Academy of
				Family Physicians (AAFP) and the Centers for Disease Control and Prevention
				(CDC).
1.6.
Applicability
				--
This rule applies to all children enrolled in a public, private, or
				parochial school in this state, or a state-regulated child care
				center.
1.7.
Purpose
-- The purpose of this rule is to clearly define the
				requirements and recommendations for immunizations for all children enrolled in
				a public, private, or parochial school in this state, or a state-regulated
				child care center. Additionally, the rule series establishes the procedure for
				granting, renewing, conditioning, denying, suspending or revoking a request for
				a medical exemption from the compulsory immunization requirements of
W.
				Va. Code
§
									16-3-4.
1.8.
Background --
The
				Legislature has granted the Commissioner/State Health Officer extensive powers
				to protect the public health, i.e., restricting the liberty of persons through
				measures such as quarantine, enter upon and inspecting private property,
				asserting authority of any epidemic or endemic conditions, compelling physical
				examinations and compelling vaccination. Indeed,
W.Va. Code
§
									16-3-1,
				provides, "the state board of health [now the Secretary] may adopt rules and
				regulations to obstruct and prevent the introduction or spread of smallpox or
				other communicable or infectious diseases into or within the State[.]"
The Legislature has declared as the public policy of this
				  State:
* That early immunization for preventable diseases represents
				  one of the most cost-effective means of disease prevention.
* the savings which can be realized from immunization,
				  compared to the cost of health care necessary to treat the illness and lost
				  productivity, are substantial. Immunization of children at an early age serves
				  as a preventative measure both in time and money and is essential to maintain
				  our children's health and well-being.
* the costs of childhood immunizations should not be allowed
				  to preclude the benefits available from a comprehensive, medically supervised
				  child immunization service.
* the federal government has established goals that require
				  ninety percent of all children to be immunized by age two and provided funding
				  to allow uninsured children to meet this goal.
W. Va. Code
§
										16-3-5(a)
Consistent with this expressed public policy, the Legislature
				  has mandated compulsory immunization for all children enrolled in a public,
				  private, or parochial school in this state, or a state-regulated child care
				  center.
W.Va. Code
§
									16-3-4.
				  However, the legislature only mandated particular immunizations without
				  providing any further guidance. This rule is intended to provide specific
				  guidance with regard to dosage and interval schedules based upon the most
				  current recommendations issued by the U.S. Department of Health and Human
				  Services, Advisory Committee on Immunization Practices (ACIP), the American
				  Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP)
				  and the Centers for Disease Control and Prevention (CDC).
Optimal response to a vaccine depends on multiple factors,
				  including the type of vaccine, age of the recipient, and immune status of the
				  recipient. Recommendations for the age at which vaccines are administered are
				  influenced by age-specific risks for disease, age-specific risks for
				  complications, age-specific responses to vaccination, and potential
				  interference with the immune response by passively transferred maternal
				  antibodies. Vaccines are recommended for members of the youngest age group at
				  risk for experiencing the disease for which efficacy and safety have been
				  demonstrated.
Certain products, including inactivated vaccines, toxoids,
				  recombinant subunit vaccines, polysaccharide conjugate vaccines, and live
				  vaccines, require >=2 doses to elicit an adequate antibody response. Tetanus
				  and diphtheria toxoids require booster doses to maintain protective antibody
				  concentrations. Unconjugated polysaccharide vaccines do not induce T-cell
				  memory, and additional doses (although they elicit the same or a lower antibody
				  concentration) might increase the level of protection. Conjugation with a
				  protein carrier improves the effectiveness of polysaccharide vaccines by
				  inducing T-lymphocyte-dependent immunologic function. Many vaccines that
				  stimulate both cell-mediated immunity and neutralizing antibodies (e.g., live,
				  attenuated virusvaccines) usually can induce prolonged immunity, even if
				  antibody titers decline over time. Subsequent exposure to such viruses usually
				  results in a rapid anamnestic antibody response without viremia.
Approximately 90%-95% of recipients of a single dose of
				  certain live vaccines administered by injection at the recommended age (i.e.,
				  measles, rubella, and yellow fever vaccines) develop protective antibodies,
				  generally within 14 days of the dose. For varicella and mumps vaccines, 80%-85%
				  of vaccinees are protected after a single dose. However, because a limited
				  proportion (5%-15%) of measles, mumps, and rubella (MMR) or varicella vaccinees
				  fail to respond to 1 dose, a second dose is recommended to provide another
				  opportunity to develop immunity. Of those who do not respond to the first dose
				  of MMR or varicella vaccine, 97%-99% respond to a second dose.
The recommended immunization schedule for Persons Aged 0
				  Through 18 Years childhood immunization is the schedule jointly approved by the
				  Advisory Committee on Immunization Practices, the American Academy of
				  Pediatrics, and the American Academy of Family Physicians. This schedule is
				  issued annually and can be found at
http://www.cdc.gov/vaccines
.
1.9.
Revising immunization
				requirements.
-- Upon a finding of the existence of an emergency that
				may adversely affect the public health and safety, the Commissioner may modify
				the immunization requirements of this rule, to remove, modify or add a vaccine,
				in accordance with the requirements of the State Administrative Procedures Act
(W. Va. Code
§§ 29A-3-1
et.
				seq.).