Hawaii Administrative Rules
Title 11 - DEPARTMENT OF HEALTH
Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS
Chapter 157 - DEPARTMENT OF HEALTH
Exhibit C - Guide to Hawaii Post-Secondary School Immunization And Tuberculosis Examination Requirements

a. A certificate of TB examination is required before post-secondary school attendance in any course of study longer than 6 months. This requirement may not be deferred or postponed.

b. The Mantoux tuberculin skin test must have been given within 12 months before first attending post-secondary school in Hawaii.

c. The certificate of TB examination may be issued by the Hawaii Department of Health or a U.S. licensed Medical Doctor (MD), Doctor of Osteopathy (DO), Advanced Practice Registered Nurse (APRN), or Physician Assistant (PA). The certificate must include:

* the dates of administration and reading of the Mantoux skin test (PPD)

* the transverse diameter of induration in millimeters

* the signature or stamp of the MD, DO, APRN, PA, or clinic.

d. If the diameter of induration is 10mm or greater, a chest x-ray is also required as part of the TB examination. Written documentation of a negative chest x-ray must be provided prior to first attendance at a post-secondary school in Hawaii.

e. A student with written documentation of a past positive Mantoux tuberculin skin test (including the name of the practitioner or clinic administering the test, the dates of administration and reading and the diameter of induration) may have a chest x-ray performed and certificate issued without a repeat skin test.

f. A copy of the certificate must be kept in the student's health record at the post-secondary school.

g. A valid certificate of TB examination issued within 12 months prior to first attendance at a Hawaii post-secondary school may be used for transfer into all other post-secondary schools in Hawaii.

a) A record of immunizations, signed or stamped by a MD, DO, APRN, PA, or clinic, must be presented for school attendance. This record must include complete dates (month/day/year) for each immunization. An immunization with only the month and year may be accepted if it can be determined that the immunization met the minimum age and interval requirements.

b) Two doses of measles-containing vaccine are required, with at least one of the two being Measles-Mumps-Rubella (MMR) vaccine. The first dose must have been given on or after 12 months of age and the second must have been given at least 4 weeks after the first dose. A grace period of 4 days applies to each minimum age and interval, (e.g., if the minimum interval shown is 4 weeks, the dates of administration must be separated by at least 24 days. Intervals listed in months are measured in calendar months.)

c) Laboratory evidence of immunity to measles, mumps and rubella may be substituted for a record of immunizations. A laboratory report, signed by an MD, DO, APRN, or PA certifying that the student is immune to the specified diseases is required.

d) Students born prior to 1957 are exempt from the measles, mumps, and rubella immunization requirement.

e) A copy of the immunization record or evidence of immunity shall be kept in the student's health record at the post-secondary school.

f) A record of each student's immunizations or evidence of immunity shall be retained in the student's health file.

a. Students who have not met the immunization requirement by the first day of school may be allowed provisional attendance ONLY upon submitting a medical appointment card or letter from a practitioner showing that the student is in the process of obtaining the required immunization(s). A student without a record of the completed immunizations or an appointment card showing that the student is in the process of completing the missing requirements should NOT be allowed to attend classes or extra-curricular activities.

b. Students allowed provisional attendance must complete the missing requirements within 45 days after the date of first attendance.

c. Any student who has not fulfilled the requirements within 45 days shall be excluded from all school activities until documentation that the requirement has been met is presented to the school.

d. Provisional entrance may be suspended by the Department of Health when there is a danger of an epidemic from any or the diseases for which immunization is required.

a. A medical exemption may be granted to specific vaccines.

b. A religious exemption may be granted if the student signs a statement certifying that the student's religious beliefs prohibit the practice of immunization.

c. If the Director of Health determines that there is a danger of an outbreak from any of the diseases for which immunization is required, no exemption shall be recognized and inadequately immunized students shall be excluded from school until the Director has determined that the outbreak is over.

d. A copy of each exemption must be kept in the student's health record at school.