Chapter DHS 144

IMMUNIZATION OF STUDENTS

DHS 144.01   Introduction.

DHS 144.02   Definitions.

DHS 144.03   Minimum immunization requirements.

DHS 144.04   Waiver for health reasons.

DHS 144.05   Waiver for reason of religious or personal conviction.

DHS 144.06   Responsibilities of parents and adult students.

DHS 144.07   Responsibilities of schools and child care centers.

DHS 144.08   Responsibilities of local health departments.

DHS 144.09   Responsibilities of the department.

Ch. DHS 144 Note Note: Chapter H 44 as it existed on June 30, 1981, was repealed and a new chapter HSS 144 was created, effective July 1, 1981. Chapter HSS 144 was renumbered chapter HFS 144 under s. 13.93 (2m) (b) 1., Stats., and corrections made under s. 13.93 (2m) (b) 1., 6. and 7., Stats., Register, June, 1997, No. 498. Chapter HFS 144 was renumbered chapter DHS 144 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 144.01 DHS 144.01 Introduction.

DHS 144.01(1) (1) Purpose and authority. This rule implements s. 252.04, Stats., which requires the department to carry out a statewide immunization program to eliminate, immunize, and protect against certain diseases specified in statute or by department rule. This chapter addresses immunization requirements for vaccine-preventable diseases, by students admitted into schools or children admitted into child care settings.

DHS 144.01(2) (2) Relationship to infant and preschool immunization schedules. The emphasis placed in this chapter on meeting minimum immunization requirements upon entry to Wisconsin schools at any grade level or to a child care center complements efforts by the department to promote early immunization of infants and preschoolers according to accepted immunization schedules.

DHS 144.01 History History: Cr. Register, June, 1981, No. 306, eff. 7-1-81; am. (1), Register, June, 1988, No. 390, eff. 7-1-88; correction in (1) made under s. 13.93 (2m) (b) 7., Stats., Register, August, 1995, No. 476; am. (1), Register, June, 1997, No. 498, eff. 7-1-97; am. (1), Register, May, 2001, No. 545, eff. 6-1-01; CR 07-077: am. (1) Register February 2008 No. 626, eff. 3-1-08; CR 19-079: r. and recr. (1), am. (2) Register January 2023 No. 805, eff. 2-1-23.

DHS 144.02 DHS 144.02 Definitions.

DHS 144.02(1) (1) “Advanced practice nurse prescriber” has the meaning given in s. N 8.02 (2).

DHS 144.02(2) (2) “Child care center” has the meaning given in s. 49.136 (1) (ad), Stats.

DHS 144.02(3) (3) “Department” means the Wisconsin department of health services, unless otherwise specified.

DHS 144.02(4) (4) “DT” means pediatric diphtheria and tetanus vaccine.

DHS 144.02(5) (5) “DTaP” means pediatric diphtheria, tetanus, and acellular pertussis vaccine.

DHS 144.02(6) (6) “DTP” means pediatric diphtheria, tetanus, and pertussis vaccine.

DHS 144.02(7) (7) “Hib” means Haemophilus influenzae type b vaccine.

DHS 144.02(8) (8) “Hep B” means hepatitis B vaccine.

DHS 144.02(9) (9) “Immunization” means the process of inducing immunity artificially by receiving an immunobiologic.

DHS 144.02(10) (10) “Local health department” has the meaning given in s. 250.01 (4), Stats.

DHS 144.02(11) (11) “Mening” means a meningococcal vaccine containing, at a minimum, serogroups A, C, W, and Y.

DHS 144.02(12) (12) “MMR” means measles, mumps, and rubella vaccine received in combination or as separate vaccines.

DHS 144.02(13) (13) “Municipality” means any town, village, city, or county.

DHS 144.02(14) (14) “Parent” means the parent, parents, guardian, or legal custodian of any minor student.

DHS 144.02(15) (15) “PCV” means pneumococcal conjugate vaccine.

DHS 144.02(16) (16) “Physician” means an individual possessing the degree of doctor of medicine or doctor of osteopathy or an equivalent degree as determined by the medical examining board under s. 448.05 (2), Stats., and holding a license granted by the medical examining board under s. 448.06, Stats.

DHS 144.02(17) (17) “Physician assistant” has the meaning given in s. 448.971 (2), Stats.

DHS 144.02(18) (18) “School” means any public or private elementary, middle, junior or senior high school, which provides educational instruction to students in any grade kindergarten through 12, or in an ungraded educational setting, or to preschool children enrolled in early childhood programs.

DHS 144.02(18m) (18m) “School day,” in reference to schools, has the meaning prescribed in s. 115.01 (10), Stats. “School day,” in reference to child care centers, means any day that the center is open and caring for children.

DHS 144.02(19) (19) “Student” means any individual enrolled in or attending a school or child care center.

DHS 144.02(20) (20) “Subsided” in reference to a substantial outbreak means passage of 2 incubation periods for the disease causing the outbreak without additional cases, unless a shorter period of time is judged adequate by the department.

DHS 144.02(21) (21) “Substantial outbreak” means occurrence of any of the following diseases at the threshold determined by the department using epidemiological factors such as time and place:

DHS 144.02(21)(a) (a) Measles.

DHS 144.02(21)(b) (b) Mumps.

DHS 144.02(21)(c) (c) Rubella.

DHS 144.02(21)(d) (d) Polio.

DHS 144.02(21)(e) (e) Pertussis.

DHS 144.02(21)(f) (f) Diphtheria.

DHS 144.02(21)(g) (g) Haemophilus influenzae type b.

DHS 144.02(21)(h) (h) Varicella.

DHS 144.02(21)(i) (i) Meningococcal disease.

DHS 144.02(22) (22) “Td” means adolescent and adult tetanus and diphtheria vaccine.

DHS 144.02(23) (23) “Tdap” means adolescent and adult tetanus, diphtheria and acellular pertussis vaccine.

DHS 144.02(24) (24) “Vaccine provider” means a health care facility, as defined in s. 155.01 (6), Stats., which administers vaccines, or a local health department, or a physician’s office which administers vaccines.

DHS 144.02(25) (25) “Var” means varicella vaccine.

DHS 144.02 Note Note: Varicella is commonly known as chickenpox.

DHS 144.02(26) (26) “Written evidence of immunization” means a paper or an electronic record, which at a minimum indicates the date that each required dose of vaccine was administered to a student or the results of a laboratory test indicating immunity to the disease. Students who have not previously attended a Wisconsin school must provide the month, day, and year for each required dose of vaccine.

DHS 144.02 History History: Cr. Register, June, 1981, No. 306, eff. 7-1-81; r. and recr. (12) (b), Register, June, 1988, No. 390, eff. 7-1-88; correction in (12) made under s. 13.93 (2m) (b) 7., Stats., Register, August, 1995, No. 476; am. (3), cr. (3g), (3m), (3r), (4m) and (13), r. and recr. (4), (6), (7) and (12), renum. (13) to be (14), Register, June, 1997, No. 498, eff. 7-1-97; cr. (13m), Register, May, 2001, No. 545, eff. 6-1-01; CR 07-077: am. (3) and (14), cr. (6m) Register February 2008 No. 626, eff. 3-1-08; correction in (2) made under s. 13.92 (4) (b) 6., Stats., Register January 2009 No. 637; CR 19-079: r. and recr. Register January 2023 No. 805, eff. 2-1-23; correction in (17) made under s. 13.92 (4) (b) 7., Stats., correction in and numbering of (18m) made under s. 13.92 (4) (b) 1. and 35.17, Stats., Register January 2023 No. 805.

DHS 144.03 DHS 144.03 Minimum immunization requirements.

DHS 144.03(1) (1) Individuals included. The minimum immunization requirements authorized by s. 252.04, Stats., and required under this chapter, apply to any student admitted to a Wisconsin elementary, middle, junior or senior high school, or to a Wisconsin child care center.

DHS 144.03(2) (2) Requirements for the 2021-2022 school year and for school years following the 2021-2022 school year.

DHS 144.03(2)(a) (a) Table DHS 144.03-A, as qualified by pars. (b) to (k), lists the number of doses of each required vaccine that each student in the 2021-2022 school year and following school years shall have received since birth for the age or grade of the student. These comprise the minimum immunizations required under s. 252.04 (2), Stats. They do not, however, represent all the recommended immunizations according to currently accepted immunization schedules.

DHS 144.03 Note Note: CR 19-079 did not take effect until February 1, 2023, and the rule was therefore not in effect for the 2021-22 or 2022-23 school years.

DHS 144.03(2)(b) (b) Immunization against measles, mumps, and rubella shall be received no sooner than 4 days before the student’s first birthday. A second dose of MMR shall be received no sooner than 4 weeks after the first dose.

DHS 144.03 Note Note: CR 19-079 did not take effect until February 1, 2023, and the rule was therefore not in effect for the 2021-22 or 2022-23 school years.

DHS 144.03(2)(c) (c) The fourth dose of polio vaccine shall be received no sooner than 4 days before the student’s fourth birthday. A student receiving a third dose of polio vaccine after the student’s fourth birthday is not required to receive additional doses. No further doses of polio vaccine are required if the student has not met minimum polio vaccine requirements by the eighteenth birthday.

DHS 144.03(2)(d) (d) The fourth or fifth dose of DTP/DT/DTaP/Td/Tdap shall be received no sooner than 4 days before the student’s fourth birthday. Students receiving a third dose of DTP/DT/DTaP/Td/Tdap after the fourth birthday are not required to receive additional doses.

DHS 144.03(2)(e) (e) For students age 5 years or older who attend a school that does not use grades, the immunization requirements are those for the grade which would normally correspond to the individual’s age. Immunizations are required for all students age 19 years or older, as prescribed for Grade 12 in table DHS 144.03-A.

DHS 144.03(2)(f) (f) Students who begin the Hib series at 12 to 14 months of age are only required to receive 2 doses of Hib, at least 2 months apart. Students who receive 1 dose of Hib 4 days before 15 months of age, or after, are not required to receive additional doses of Hib.

DHS 144.03(2)(g) (g) The first dose of Var shall be received no sooner than 4 days before the first birthday. A second dose of Var shall be received no sooner than 4 weeks after the first dose. Students who have a reliable history of varicella disease are not required to receive Var. A physician, physician assistant, or an advanced practice nurse prescriber, must document a reliable history of varicella disease by indicating on the department’s student immunization record form that the student has had varicella disease.

DHS 144.03 Note Note: The student immunization record form (DHS Form 04020L) is available by accessing: https://www.dhs.wisconsin.gov/library/F-04020L.htm.

DHS 144.03(2)(h) (h) Students between the ages of 11 and 15 years who receive 2 doses of a 2 dose formulation of Hep B are not required to receive a third dose of Hep B.

DHS 144.03(2)(i) (i) Students who begin the PCV series at 12 to 23 months of age are only required to receive 2 doses of PCV at least 2 months apart. Students who receive their first dose of PCV 4 days before their second birthday or after are not required to receive additional PCV doses.

DHS 144.03(2)(j) (j) Students who receive a dose of Td or Tdap within 5 years of entering a grade for which Tdap is required are not required to receive additional doses of Tdap.

DHS 144.03(2)(k) (k) A 2nd dose of mening shall be received between the ages of 16 and 18 years to students who received a first dose of mening between the ages of 11 and 15 years. A second dose is not required for students who received their first dose of mening at age 16 years or older.

DHS 144.03(4) (4) First deadline. Within 30 school days after having been admitted to a school or child care center, each student who has not filed a waiver form shall submit written evidence of having completed at least the first dose of each vaccine required for that student’s age or grade, as outlined in Table DHS 144.03-A.

DHS 144.03(5) (5) Second deadline. Within 90 school days after having been admitted to a school or child care center, each student who has not filed a waiver form shall submit written evidence of having received the second dose of each vaccine required for that student’s age or grade, as outlined in Table DHS 144.03-A.

DHS 144.03(6) (6) Final deadline. Within 30 school days after having been admitted to a school or child care center for the following school year, each student who has not filed a waiver form shall submit written evidence of having received the third and, if required, the fourth dose of both DTP/DTaP/DT/Td/Tdap and polio vaccines and the final dose of Hep B as required under sub. (2) and, for students in child care centers, the final dose of Hib vaccine, if a dose has not been received at or after 15 months of age.

DHS 144.03(7) (7) Records of vaccination. Any person who immunizes a student under s. 252.04, Stats., shall maintain records identifying the manufacturer and lot number of the vaccine used, the date of immunization and the name and title of the person who immunized the student.

DHS 144.03(10) (10) Release of immunization information.

DHS 144.03(10)(a) (a) Between vaccine providers and schools or child care centers. Vaccine providers shall disclose a student’s immunization information, including the student’s name, date of birth, gender, and the day, month, and year the vaccine was administered, and the name of vaccine administered, to a school or child care center upon written or verbal request from the school or child care center. Written or verbal permission from a student or parent is not required to release this information to a school or child care center.

DHS 144.03(10)(b) (b) Among vaccine providers. Immunization information, including the student’s name, date of birth and gender and the day, month, year and name of vaccine administered, shall be provided by one vaccine provider to another without written or verbal permission from the student or the parent.

DHS 144.03 History History: Cr. Register, June, 1981, No. 306, eff. 7-1-81; r. and recr. (2) and (3), am. (4) to (6), Register, June, 1988, No. 390, eff. 7-1-88; am. (2) (a) to (d), (3) (a) and (b), r. (2) (e), Register, January, 1989, No. 397, eff. 2-1-89; am. (2) (a), (4) and (5), r. and recr. (3), tables 144.03-A and B, Register, July, 1990, No. 415, eff. 8-1-90; corrections made under s. 13.93 (2m) (b) 7., Stats., Register, August, 1995, No. 476; r. and recr. (2) (a), Table 144.03-A and (3), am. (2) (c) and (4) to (7), cr. (2) (e) and (10), r. Table 144.03-B, Register, June, 1997, No. 498, eff. 7-1-97; r. and recr. (2) (a) and Table 144.03-A, cr. (2) (f), (g) and (3m), am. (3) (a) and (6), Register, May, 2001, No. 545, eff. 6-1-01; CR 03-033: am. (2) (b), (c), (e) and Table 144.03-A Register December 2003 No. 576, eff. 1-1-04; CR 07-077: r. and recr. (2) (a), (f), (3), (3m) and Table-A, cr. (2) (h) and (i), am. (10) (a) and (b) Register February 2008 No. 626, eff. 3-1-08; CR 19-079: am. (1), (2) (title), (a), (b), r. and recr. Table 144.03-A, (2) (c) to (i), cr. (2) (j), (k), r. (3), (3m), am. (4) to (6), (10) (a) Register January 2023 No. 805, eff. 2-1-23; correction in (6) made under s. 13.92 (4) (b) 7., Stats., Register January 2023 No. 805.

DHS 144.04 DHS 144.04 Waiver for health reasons. Upon certification by a physician that an immunization required under s. 252.04, Stats., is or may be harmful to the health of a student, the requirements for that immunization shall be waived by the department. Written evidence of any required immunization which the student has previously received shall be submitted to the school or child care center with the waiver form.

DHS 144.04 History History: Cr. Register, June, 1981, No. 306, eff. 7-1-81; correction made under s. 13.93 (2m) (b) 7., Stats., Register, August, 1995, No. 476; CR 19-079: am. Register January 2023 No. 805, eff. 2-1-23.

DHS 144.05 DHS 144.05 Waiver for reason of religious or personal conviction. Immunization requirements under s. 252.04, Stats., shall be waived by the department upon presentation of a signed statement by the parent of a minor student or by the adult student which declares an objection to immunization on religious or personal conviction grounds. Written evidence of any required immunization which the student has previously received shall be submitted to the school or child care center with the waiver form.

DHS 144.05 History History: Cr. Register, June, 1981, No. 306, eff. 7-1-81; correction made under s. 13.93 (2m) (b) 7., Stats., Register, August, 1995, No. 476; am. Register, June, 1997, No. 498, eff. 7-1-97; CR 19-079: am. Register January 2023 No. 805, eff. 2-1-23.

DHS 144.06 DHS 144.06 Responsibilities of parents and adult students. The parent of any minor student, or the adult student, shall secure the immunizations required under s. 252.04, Stats., from available health care sources such as physicians’ offices, hospitals or local health departments, or shall submit the waiver form.

DHS 144.06 History History: Cr. Register, June, 1981, No. 306, eff. 7-1-81; correction made under s. 13.93 (2m) (b) 7., Stats., Register, August, 1995, No. 476; am. Register, June, 1997, No. 498, eff. 7-1-97; CR 19-079: am. Register January 2023 No. 805, eff. 2-1-23.

DHS 144.07 DHS 144.07 Responsibilities of schools and child care centers.

DHS 144.07(1) (1) The responsibilities of schools under these rules shall be those of the local school board and the school administrator. The licensee for each child care center shall be responsible for compliance with these rules. The school or child care center shall assure compliance with s. 252.04 (2), Stats.

DHS 144.07(1m) (1m) By the 15th school day after a student is admitted to a school or child care center and again by the 25th school day after a student is admitted to a school or child care center, the school or child care center shall notify the adult student or the parent of any minor student who has not submitted either written evidence of immunization or a waiver form. Notification shall include instructions for complying with the requirements of s. 252.04 (2), Stats., including a list of missing immunizations, the availability of waivers for reasons of health, religion, or personal conviction, and an explanation of the penalty for noncompliance.