Childcare – 12th Grade Immunization Requirements

The Tennessee Department of Health has immunization requirements for those who attend child care, pre-school, and school.  The requirements can be found in the Tennessee Department of Health Rules.

The state’s immunization requirements follow the current schedule published by the Centers for Disease Control and Prevention (CDC) and endorsed by the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP).

Required immunizations for children attending child care, pre-school, and school must be documented on the Official Immunization Certificate.  This certificate is available in local health departments and at many medical offices in Tennessee. Registered TennIIS users can access the certificate on the Tennessee Immunization Information System (TennIIS) website. Tennessee healthcare providers who give vaccine can register as TennIIS users.

Detailed guidance for healthcare providers on the rules and certificate is available here:

TDH Summary of Immunization Rules - Certificate Instructions

TN Immunization Requirements Summary Table

TN Immunization Certificate Sample

A brief summary of the required immunizations for child care facilities and schools is listed below.

Children enrolling in child care facilities, pre-school, pre-Kindergarten
Infants entering child care facilities must be up to date at the time of enrollment and are required to provide an updated certificate after completing all of the required vaccines due no later than 18 months of age.

• Hepatitis B (HBV)
• Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
• Poliomyelitis (IPV or OPV)
• Haemophilus influenzae type B (Hib) - age younger than 5 years only
• Pneumococcal conjugate vaccine (PCV) - age younger than 5 years only
• Measles, Mumps, Rubella - 1 dose of each, normally given together as MMR
• Varicella - 1 dose or credible history of disease
• Hepatitis A - 1 dose, required by 18 months of age or older

All children entering 7th grade (including currently enrolled students)

• Tetanus-diphtheria-pertussis booster (Tdap) - evidence of one Tdap dose given before 7th grade entry (administered at or after age 10) is required regardless of Td history
• Update to 7th Grade Chickenpox (Varicella) Immunization Requirements

Children who are new enrollees in a TN school in grades other than Kindergarten

• Hepatitis B (HBV)
• Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
• Poliomyelitis (IPV or OPV - final dose on or after the 4th birthday
• Measles, Mumps, Rubella - 2 doses of each, normally given together as MMR
• Varicella - 2 doses or credible history of disease
• New students entering grades other than 7th grade are not required to have Tdap

Children with medical or religious exemption to requirements

Medical - Physicians (MD or DO) or Public Health Nurses are authorized to indicate specific vaccines medically exempted (because of risk of harm) on the certificate. Other vaccines remain required. The medical reason for the exemption does not need to be provided.

Religious - This exemption requires a signed statement by the parent/guardian that vaccination conflicts with their religious tenets or practices. If the child needs documentation of a health examination for the school, it must be noted by the healthcare provider on the immunization certificate.  In that case, the provider should check the box in section 1a. that the parent has sought a religious exemption to explain why immunization information is absent or incomplete.

Minimum ages or dose intervals - Tennessee follows published CDC guidelines. For vaccines with critical minimum age requirements (e.g., MMR, varicella) or minimum dose intervals, doses are considered valid if given up to 4 days before the minimum age or dose interval. Doses administered more than 4 days early are considered invalid and should be repeated as recommended.

Injectable or nasally administered live vaccines not administered on the same day should be administered at least 4 weeks apart. The 4-day "grace period" should not be applied to the 28-day interval between injectable or nasally administered live vaccines not administered at the same visit.  If injectable or nasally administered live vaccines are separated by less than 4 weeks, the second vaccine administered should not be counted as a valid dose and should be repeated.  The repeat dose should be administered at least 4 weeks after the last invalid dose.

Alternative proof of immunity for certain diseases - A positive serology (year of test documented) is acceptable as an alternative to immunization for measles, mumps, rubella, hepatitis A, hepatitis B or varicella.  For varicella, documentation of provider diagnosed varicella or provider-verified credible history of disease given by a parent or guardian also is acceptable. By documenting a history of disease, the provider is asserting that he or she is convinced that the child has had chickenpox.