Effective July 28, 2019, Engrossed House Bill 1638 removes the option for a personal/philosophical exemption to the MMR (measles, mumps, and rubella) vaccine requirement for schools and child care centers. The new law also requires employees and volunteers at child care centers to provide immunization records indicating they have received the MMR vaccine or have proof of immunity.
Based on interpretation of the state law, this change does not affect family homes licensed by the Department of Children, Youth, and Families, early intervention providers, independent contractors visiting child care centers (such as photographers), home visiting programs, or K-12 school staff who are not part of a licensed center.
Who Is Affected?
Most families with children in school will not be affected by this law, because more than nine out of 10 students are up to date on the MMR vaccine. This law will only affect those children who have a personal or philosophical exemption to the MMR vaccine and staff and volunteers at licensed child care centers. Children with medical or religious exemptions and those who are complete for the MMR vaccine requirement are not affected by the new law.
What Is the Requirement for MMR Vaccine for Child Care and School Entry?
One dose of MMR is required for all children age one year and older to attend child care or preschool. Two doses of MMR vaccine are required for all students in kindergarten through 12th grade. If a child needs both doses, the two doses must be given at least 28 days apart. This means someone needing both MMR doses will need one dose given as soon as possible, followed by another appointment scheduled a month from the first MMR dose. Children catching up with the MMR immunization schedule are considered to be in conditional status until 30 days after dose two of the MMR vaccine comes due. Conditional status means the student is in the process of getting their vaccinations completed or turning in the rest of their required paperwork.
What Do Child Care Centers Need to Do Regarding Children at Their Facility?
- All parents with personal or philosophical exemptions for the MMR vaccine for their child should be notified they will be required to provide the dates of MMR vaccination or medically verified proof of the child’s immunity to measles, mumps, and rubella by July 28, 2019.
- Per state law, any child out of compliance with immunization requirements is not allowed to attend child care until they can show satisfactory progress toward meeting the requirements.
What Is the Requirement for Staff and Volunteers?
All licensed child care center staff and volunteers must provide a medically verified record of at least one dose of MMR vaccine, or proof of immunity from measles through lab evidence, or a health care provider's attestation that the person has had measles disease.
What Do Child Care Centers Need to Do Regarding Staff and Volunteers at Their Facility?
- Notify all staff and volunteers that they will be required to provide one of the following by July 28, 2019:
- An immunization record indicating that they have received at least one dose of MMR vaccination.
- Lab evidence of immunity to measles disease (also known as a blood test or titer).
- Documentation from a health care provider that the person has had measles disease sufficient to provide immunity against measles.
- Written certification signed by a health care practitioner, licensed in Washington State—medical doctor (MD), naturopathic doctor (ND), osteopathic doctor (DO), advanced registered nurse practitioner (ARNP) or a physician’s assistant (PA)—that the MMR vaccine is, in the practitioner's judgment, not advisable for the person.
- Per state law, any staff or volunteer not in compliance with immunization requirements is not allowed to work or volunteer at a licensed child care center.
- Sample letter to parents
- Sample letter to staff/volunteers
- Changes to the state law
- Washington State Department of Health exemption law change web page, including FAQs
If you have additional questions, contact:
Frequently Asked Questions:
- Can a parent who had a personal exemption for their child now turn in a religious or medical exemption? Medical and religious exemptions for MMR did not change under the new law. If the child qualifies for a religious exemption, a parent should discuss it with the child’s Washington State licensed healthcare provider. If the parent has a medical concern about their child getting the vaccine, they should also discuss the issue with their provider who will help ensure the safest approach is taken for the best outcome for the child. Although the healthcare provider’s judgment is ultimately the deciding factor for a medical exemption, discussing it with the parent/guardian is an important part of making that clinical decision.
- Can a staff person or volunteer turn in an exemption to the requirement? Staff and volunteers may not be exempted from the requirement to provide documentation of immunity for personal and religious reasons. Only written certification signed by a health care practitioner, licensed in Washington State—medical doctor (MD), naturopathic doctor (ND), osteopathic doctor (DO), advanced registered nurse practitioner (ARNP) or a physician’s assistant (PA)—that the MMR vaccine is, in the practitioner's judgment, not advisable for the person can be used instead of the documentation of immunity requirement.
- What if staff or volunteers need more time to obtain and provide the needed records? The child care center may allow a person to be employed or volunteer on the premises for up to 30 calendar days if they sign a written statement that they have received the MMR vaccine or are immune from measles, but require additional time to obtain and provide the records.
- Will this pertain to after-school programs at child care centers (like the YMCA)? This applies to all settings licensed as child care centers
- What about a private school that operates a child care center on site? Will the law apply to kindergarten to 6th-grade teachers since they are in the same facility and/or may have some interaction with the child care children? The law applies to all staff and volunteers of licensed child care centers, including “nonemployees who provide care and supervision to children at the child care center.” If that applies to those teachers or other staff or volunteers, then yes. Public health standards encourage anyone who is consistently sharing airspace with children to be vaccinated since many diseases are airborne.
- How can a parent, staff member, or volunteer find their immunization records? They can access their family’s immunization records to check whether they or their child meets the MMR vaccine requirements. If you have medically verified vaccination records from another state or country or from earlier than 1993, bring those records to your healthcare provider. Medically verified records can be added to the state registry by your healthcare provider so it will be easier to find them in the future.
- If staff or volunteers think they had the MMR vaccine in the past and can’t find their records is it safe to get another one? In most cases, the Centers for Disease Control and Prevention recommends repeating the vaccine if there is no medically verified record that the shot was given. If that is not an option, a titer test is available to check whether you are immune to measles. Consult with your healthcare provider for the best option for you.
- Why don’t K-12 school staff or licensed family home providers also have to meet this new requirement? The new law does not include language requiring school or family home staff and volunteers to provide documentation of immunity to MMR disease. Children under the age of one year are too young to receive routine MMR vaccine and are especially vulnerable to the disease. Additionally, children under the age of five years are more likely to experience more severe complications of measles disease.
- Does the new legislation apply to independent contractors? Examples include early intervention providers visiting campus, home visitors, social workers, speech pathologists, or hired photographers. Independent contractors are not considered employees or volunteers, so the new law does not apply to them. However, an agency can encourage independent contractors and center visitors to keep up to date on their immunizations.
- If an employee or volunteer was vaccinated for measles but they did not get the MMR vaccine, is that sufficient, or do they need to get the full MMR vaccine? If they are providing documentation of being vaccinated, it needs to include vaccination against all three diseases: measles, mumps, and rubella. If they are providing lab evidence of immunity (also known as a blood test or titer), it only needs to be for measles.