W. Va. Code R. § 64-95-1

Current through Register Vol. XLI, No. 44, November 1, 2024
Section 64-95-1 - General
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-3-1et. seq.).

W. Va. Code R. § 64-95-1