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Back-to-School Vaccinations? Nurses Explain Which Shots Your Kids Need and Why

Maura Deering, J.D.
Updated September 27, 2023
    With K-12 students heading back into the classroom this fall, families need to know which vaccinations schools require. Two experienced nurses provide answers.
    Young Latina girl smiles while getting a vaccination at a doctor's office

    As parents of school-aged children look toward fall, many may wonder which vaccinations will be required. COVID-19 vaccines have taken center stage over the past few months, but other immunizations remain important too. To help clarify requirements for the upcoming school year, we asked two experienced nurses to answer questions about school vaccine protocol.

    Common Vaccines Students Need Before School Starts

    Since the late 18th century, vaccines have eradicated or greatly reduced the incidence of diseases and prevented millions of deaths. In the United States, widespread immunization led to the elimination of polio in 1979 and a decline in measles and influenza.

    Vaccinations remain integral to children’s health and school safety. The list below summarizes current school-required vaccines.

    K-12 Back-to-School Vaccination Checklist

    Nurse Tip: Schedule an annual physical exam for your child in early summer so they are vaccinated by fall. Here is a list of vaccines needed for each age group.

    Kindergarten (ages 4-6):

    • Chickenpox (varicella vaccine)
    • Diphtheria, tetanus, and pertussis (DTaP vaccine)
    • Flu (flu vaccine)
    • Measles, mumps and rubella (MMR vaccine)
    • Polio (IPV vaccine)

    Elementary School (ages 7-10):

    • Flu (flu vaccine)

    Middle School (ages 11-12):

    • Flu (flu vaccine)
    • Human papillomavirus (HPV vaccine)
    • Meningococcal disease (meningococcal conjugate vaccine)
    • Tetanus, diphtheria, and pertussis (Tdap vaccine)

    High School (ages 13-18):

    • Flu (flu vaccine)
    • Meningococcal disease (meningococcal conjugate vaccine)
    • Serogroup B meningococcal infection (serogroup B meningococcal vaccine)

    Note: Children over age 12 will also be offered the Pfizer-BioNTech COVID-19 vaccine, which protects against COVID-19.

    Are Vaccines Required for Back to School?

    All U.S. states require vaccines for K-12 students but allow exemptions for medical and religious reasons.

    According to Melanie Wilhelm, a certified pediatric nurse practitioner and nurse educator with a doctor of nursing practice (DNP), all public schools will likely enforce vaccine requirements, but private schools may not.

    Each state and public institution has particular guidelines and how they enforce these guidelines varies. Daycare centers and preschools can also require vaccinations. Check with your local school and state rules to confirm requirements.

    Most schools will require some proof of vaccinations, but even requirements for proof vary by school and state.

    “In the state of Florida, a child must provide a school form which states vaccination history and physical for the upcoming school year every year,” says pediatric critical care nurse practitioner Alceste Villasuso.

    Regardless of their school situation, the American Academy of Pediatrics and Centers for Disease Control and Prevention recommend full vaccination of all children. Those who are homeschooled or in virtual classrooms should also be vaccinated since they still interact with others.

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    Why Do States Mandate K-12 Vaccines?

    Governments began to recognize the potential for diseases to spread among schoolchildren during smallpox outbreaks in the early 1800s. Today, all U.S. states impose K-12 school vaccine mandates.

    “There has been a significant decline since 1980 with the initiation of vaccination for diphtheria, mumps, pertussis, and tetanus, a 92% decline in cases as well as 99% decline in deaths,” Villasuso, who also holds a DNP, explains. Smallpox, specifically, has been eradicated worldwide.

    “It is important for students to be up to date on vaccines so that they do not become ill and do not spread diseases in the classroom, at home, or in the community,” Wilhelm emphasizes.

    What About the COVID-19 Vaccine?

    Even though children ages 12 and older can get the Pfizer vaccine, many experts feel that state-required COVID-19 vaccination for K-12 students remains unlikely due to the vaccine’s emergency use authorization status.

    Even without school-based mandates, Villasuso expresses optimism, predicting that vaccination for children should increase as it has for adults.

    “As the COVID vaccination becomes more available, I believe similar trends of vaccination will continue,” she says. “As the pandemic continues, preventable techniques, such as vaccination, social distancing, mask-wearing, etc., will aid in controlling the spread of this disease.”

    Vaccination Enforcements and Exemptions in K-12

    Individual state and local laws govern K-12 school vaccinations. Proof of vaccination typically involves submission of student immunization records from healthcare providers unless an exemption applies.

    “As for enforcement of vaccination requirements, K-12 institutions have strict guidelines per the Department of Health, in both public and private institutions, on vaccination fulfillment,” Villasuso adds.

    In public schools, Wilhelm states that inadequately vaccinated children may be sent home and not be allowed to return to in-person classes until they have received and provided proof of their appropriate vaccinations.

    There are three kinds of vaccine exemptions:

    • Medical Exemptions: These exemptions are typically based on severe allergies or immune system disorders.
    • Philosophical/Personal Exemptions: These exemptions may be based on someone’s personal beliefs or preferences.
    • Religious Exemptions: These exemptions are based on an organized religion’s principles that prohibit vaccinations.

    Exemptions vary on state and local levels. For example, the Washington State Department of Health in May 2019 removed philosophical/personal exemptions from the MMR vaccine required for K-12 schoolchildren. Check with your school or state to see which exemptions are allowed for vaccines.

    Staying Up to Date Protects Yourself and Others

    The importance of vaccinating K-12 students cannot be overstated — staying up to date on vaccinations protects yourself and others. In fact, vaccine administration is estimated to prevent 4-5 million deaths per year, according to 2020 World Health Organization research.

    Parents and guardians can ensure that their children comply with state- and school-mandated vaccine requirements by checking with their schools and state’s health department. Nurses advise guardians to schedule annual physicals for school-aged children in early summer so students are vaccinated in time for the school year.

    “Vaccines are a safe and effective way to prevent the spread of serious diseases,” says Wilhelm. “Your child may need vaccines that protect against deadly diseases as they return to the classroom.”

    Meet Our Contributors

    Portrait of Melanie Wilhelm, DNP, CPNP

    Melanie Wilhelm, DNP, CPNP

    Melanie Wilhelm, DNP, CPNP, is a faculty member in Walden University’s master of science in nursing program and has 35 years of experience in pediatric nursing. She is board certified as a certified pediatric nurse practitioner through the Pediatric Nursing Certification Board. Wilhelm is licensed in both Virginia and Minnesota as a registered nurse and a certified pediatric nurse practitioner.

    Portrait of Alceste Villasuso, ARNP

    Alceste Villasuso, ARNP

    Alceste Villasuso, ARNP, holds a bachelor of science in health education and promotion and a doctor of nursing practice from the University of Florida. Prior to joining Pediatric Critical Care of South Florida, Villasuso worked in South Florida as a registered nurse in pediatric critical care. Villasuso has a special interest in caring for critically ill children and is passionate about health education for her patients, families, and community.