SUBJECT: |
STUDENT AFFAIRS |
TITLE: |
STUDENT IMMUNIZATIONS & HEALTH REQUIREMENTS
|
||||
CODING: |
00-01-25-40:00 |
ADOPTED: |
06/01/91 |
AMENDED: |
09/25/07 |
||
To prevent outbreaks of vaccine-preventable communicable diseases among UMDNJ students; to prevent or reduce the risk of transmission of vaccine-preventable and other communicable diseases between UMDNJ students and patients and other persons at UMDNJ and UMDNJ-affiliated health care units; and to comply with N.J.S.A. 18A:61 D-1 et seq. and the regulations promulgated at N.J.A.C. 8:57-6.1 et seq.
II. ACCOUNTABILITY
Under the direction of the Executive Vice President for Academic and Clinical Affairs, the Deans shall ensure compliance with this policy. The Associate Dean for Student Affairs or equivalent at each School shall implement this policy.
III. APPLICABILITY
This policy shall apply to every student matriculated or enrolled full-time or part-time in a UMDNJ school or program, including joint and collaborative programs with other institutions, and to all visiting, exchange and special-program students from other institutions. The sole exceptions/exemptions are listed in Section V. B.
IV. REFERENCES
A. Disabilities and UMDNJ Students/Applicants 00-01-20-91:00
B. HIV, HBV and HCV 00-01-45-52:00
C. Centers for Disease Control and Prevention, Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-care Settings, 2005, MMWR 2005;54 (RR-17), i-141.
D. National Research Council, Occupational Health and Safety in the Care and Use of Research Animals, National Academy Press, Washington, D.C., 1997.
E. Immunization of Health-Care Workers, MMWR 1997;46(No. RR-18).
F. Centers for Disease Control and Prevention, Guidelines for Infection Control in Dental Health-Care Settings – 2003. MMWR 2003;52(No. RR-17).
V. POLICY
A. Immunization and Health Requirements (Summary in EXHIBIT A):
1. History and physical exam: All students shall undergo a complete history and physical examination within six months prior to first matriculation or enrollment and at annual or other appropriate intervals thereafter if indicated by the initial findings. The results of the history and physical examination must be reported to the appropriate student health service or school administrator's office.
2. Hepatitis B: Students who may have patient contact with risk of exposure to blood or other potentially infectious body fluids, or laboratory/research contact with blood or other potentially infectious body fluids or laboratory material shall undergo testing for HBV infection and immunity prior to enrollment or matriculation, and prior to patient contact, despite previous immunization against HBV. These tests should ordinarily consist of hepatitis B surface antigen (HBsAg), antibody to HBsAg (HBsAb) and antibody to hepatitis B core antigen (HBcAb), followed by additional tests as deemed appropriate by the campus Student Health Service.
a. If students test negative for HBV infection and immunity, and they have not been previously immunized, they shall begin immunization against HBV prior to patient contact or contact with blood or other potentially infectious body fluids or laboratory material. If a student cannot complete the full three-dose series of immunizations prior to enrollment or matriculation, at least one dose of vaccine must be taken prior to commencing any activities with any risk of exposure. If students test negative for HBV infection and have been previously immunized but have inadequate levels of antibodies despite such previous immunization, they shall receive a booster dose of the vaccine prior to patient contact or contact with other potentially infectious body fluids or laboratory material. Testing for antibody titers (HBsAb) 1-2 months post-immunization must be performed; non-responders to a primary series of immunizations or booster dose must complete a second three-dose immunization series and be tested again for serologic response. Students who still do not respond with antibody production following a second series of immunizations are considered susceptible to HBV infection, and shall be counseled regarding precautions to prevent HBV infection and the need to obtain hepatitis B immune globulin (HBIG) prophylaxis for any known or probable significant exposure to HbsAg-positive blood.
In all instances, current CDC recommendations should be followed regarding initial HBV immunization, post-immunization antibodytiters, re-immunization or booster doses for inadequate antibody titers, and post-exposure immunoglobulin prophylaxis for non-responders.
b. If the initial HBV tests are positive and indicate a significant potential for transmission of the virus, an evaluation shall be made prior to patient contact of the need for monitoring of clinical performance and/or of the scope of assigned or permitted clinical activities consistent with patient protection, especially the performance of exposure-prone procedures. This evaluation shall be made by a designated individual or individuals at each School who may consult with infectious disease experts knowledgeable about the most current information and recommendations of groups such as CDC, and national medical and dental professional and educational organizations. If enrolled under these circumstances, students may be restricted in their clinical activities. Enrollment and continuing enrollment of students who are potentially infectious for hepatitis B are contingent upon their ability to perform all essential functions required for matriculation and completion of the curriculum of the degree program. ( See University policy on Disabilities and UMDNJ Students/Applicants, 00-01-20-91:00).
3. Tuberculosis (TB): Each student shall undergo TB testing using the Mantoux method (5 tuberculin units of purified protein derivative (PPD) injected intradermally), or an FDA-approved blood assay for TB, within three months prior to first matriculation or enrollment, and annually thereafter if the initial test result was negative. Students with non-human primate contact shall receive periodic testing every six months in accordance with the National Research Council's Occupational Health and Safety in the Care and Use of Research Animals.
If the result of a new student’s PPD test taken within three months of matriculation or enrollment is negative and the student does not have another documented negative PPD test during the 12 months preceding matriculation or enrollment, the two-step method should be used in order to detect boosting phenomena that might be misinterpreted at a subsequent testing as a skin-test conversion (new infection). Under the two-step method, a second test is performed 1-3 weeks after the first test. If the second test is positive, this is most likely a boosted reaction and not a skin-test conversion, and the student should be considered previously infected and cared for accordingly. If the second test remains negative, the student can be considered uninfected; a positive reaction to a subsequent test is likely to represent a new infection with M. tuberculosis (i.e., a skin-test conversion). Initial testing of new students who have documented negative PPD tests within 12 months of matriculation or enrollment can be done using one PPD test. Annual re-testing of continuing students may also be done using one PPD test.
If baseline TB testing is performed with an FDA-approved blood assay for TB, the above-described two-step method is not necessary.
Students with a history of BCG (bacille Calmette-Guerin) vaccination are not exempt from the TB testing requirement because there are no data to indicate that these individuals experience an excessively severe reaction to PPD testing, and because anyone with a history of BCG with a positive PPD test result is considered infected with TB and is treated accordingly.
All PPD tests must be administered, read and interpreted in accordance with current Centers for Disease Control and Prevention (CDC) guidelines (see Section IV, References), and should be performed by trained personnel at a UMDNJ Student Health Service, other UMDNJ site or UMDNJ-approved site. All FDA-approved blood assays for TB must be administered, read and interpreted according to guidelines issued by the CDC, FDA and the manufacturer.
Students who have initial positive TB test results, subsequent TB test conversions, or symptoms suggestive of TB must be evaluated promptly for active TB. This evaluation should include a history, clinical examination and a chest X-ray. If the history, clinical examination or chest X-ray is compatible with active TB, additional tests, such as sputum microscopy and culture, should be performed. If symptoms compatible with active TB are present, the student should be excluded from educational activities until either (a) a diagnosis of active TB is ruled out or (b) a diagnosis of active TB is established, treatment is begun and a determination is made by the director of a UMDNJ Student Health Service that the student is noninfectious. Students who do not have active TB should be evaluated for preventive therapy according to published CDC guidelines. However preventive therapy for latent infection in the absence of active disease cannot be required. If the evaluation for active TB, treatment for active TB and/or preventive therapy for latent infection is carried out at a facility other than a UMDNJ site or UMDNJ-approved site, all test results and documentation of care provided must be shared with the director of the appropriate UMDNJ Student Health Service. Students receiving preventive treatment for latent TB infection need not be restricted from usual educational activities.
4. Measles-mumps-rubella: All students must submit documented proof of immunity to measles, mumps and rubella prior to matriculation or enrollment. Immunity can be proved by:
a. serologic (laboratory) evidence of immunity to each disease, or
b. documentation of receipt of two doses of live-virus measles vaccine, the first dose administered on or after the first birthday and the second dose no earlier than one month after the first dose; plus one dose of live-virus mumps vaccine administered on or after the first birthday; plus one dose of live-virus rubella vaccine administered on or after the first birthday. This requirement may be met by two doses of live-virus MMR (measles-mumps-rubella) vaccine or any combination of MMR, bivalent and monovalent vaccines that result in two doses of measles vaccine and one dose each of mumps and rubella. An official record of measles, mumps and rubella immunizations administered by a public health department or by any physician licensed to practice medicine in any jurisdiction of the United States or foreign country, or by any other health professional licensed to administer immunizations in New Jersey constitutes adequate documentation of measles-mumps-rubella immunization.
Students lacking the necessary documentation of immunity as described above must receive at least one dose of MMR before being permitted to begin classes; a second dose must be taken no less than one month later.
5. Influenza: Students with patient contact or who are located in any patient-care facility shall be immunized each year during the fall season with the current influenza vaccine. All students should be encouraged to obtain annual influenza vaccinations in order to help prevent large-scale outbreaks on campus and within health care units and to keep absenteeism due to influenza at a minimum.
6. Varicella: All students without evidence of immunity to varicella should receive 2 doses of varicella vaccine 4 to 8 weeks apart. Students with patient contact or who are located in any patient-care facility must, prior to matriculation or enrollment, receive 2 doses of varicella vaccine 4 to 8 weeks apart or prove immunity to varicella-zoster virus via serology. Because of potential transmission of the vaccine virus to susceptible high-risk patients, such as immunocompromised patients, newborns and pregnant women, contact with high-risk susceptible patients should be avoided if a vaccine-related rash develops within three weeks of receipt of either the first or second dose of the vaccine.
7. Tetanus-diphtheria-pertussis: All students should have completed a primary series of tetanus, diphtheria and pertussis immunizations (DPT), and received a booster dose of Td (tetanus-diphtheria) every 10 years since. Effective for students matriculating or enrolling in the 2007 Fall semester or later, with the availability of Tdap (tetanus-diphtheria-acellular pertussis) immunization, students with patient contact or who are located in any patient-care facility must, prior to matriculation or enrollment, receive one dose of Tdap if two or more years have passed since the last Td booster dose or since the primary DPT series. Students without patient contact and who are not located in a patient-care facility are strongly encouraged to receive Tdap if two or more years have passed since the last Td booster dose or since the primary DPT series.
8. Polio: All students should have completed a full 3-dose primary series of poliovirus vaccine. Students who have not completed or cannot document a primary series of poliovirus vaccine should receive at least one additional dose or a full 3-dose series, as appropriate, of enhanced-potency inactivated polio vaccine.
9. Students who receive part of their educational program at any clinical affiliate of the University must be in compliance with all health and immunization requirements of the other institution as well as with the applicable requirements of this policy.
B. Exemptions/Exceptions
Other than the exceptions/exemptions listed below, this policy shall apply to every student matriculated or enrolled full-time or part-time in a UMDNJ school or program, including joint and collaborative programs with other institutions, and to all visiting, exchange and special-program students from other institutions. However, under no circumstances shall students be permitted to have contact with patients or with blood or other potentially infectious body fluids or laboratory material if they have not received at least the first of three hepatitis B immunizations or cannot provide serologic evidence of current immunity to hepatitis B. In addition, under no circumstances shall students be permitted to have contact with patients unless they have received TB testing and any required follow up (see Section V.A.3).
1. Students who have a documented history of a positive TB test, a documented history of previous or current adequate treatment for active TB disease, or a documented history of completion of adequate preventive therapy for latent TB infection may be exempt from any further PPD testing unless they develop signs or symptoms suggestive of TB. However students excluded from TB skin testing due to a prior positive test or treatment for past active disease must be evaluated for current active disease when symptoms suggestive of active TB occur.
2. The student affairs dean, following consultation with the student health services director, may exempt from one or more of the requirements listed in section V.A a non-matriculated less-than-half-time student who will not have any patient contact nor other activity with risk of exposure. However any such student studying in a patient-care facility should nevertheless comply with the requirements for a complete history and physical exam, TB testing, measles-mumps-rubella immunity, annual influenza immunization, varicella immunity, and tetanus-diphtheria-pertussis booster.
3. For visiting, exchange and special program students from other institutions who are not matriculated or enrolled in a regular UMDNJ program, documentation from another educational or health-care institution of having met the requirements listed in section V.A may be accepted by the student affairs dean in consultation with the student health services director.
4. Students enrolled only in distance education courses or programs who will never physically attend any classes on a UMDNJ Campus shall be encouraged to be immunized and tested according to this policy, but shall not be required to follow this policy. However distance-education students who are located at a UMDNJ-affiliated facility must meet the requirements of that facility.
5. A student may be exempted from any required immunization if he/she has a medical contraindication for that immunization and if failure to receive this immunization does not prevent fulfillment of the requirements of the academic program. Conditions comprising valid medical contraindications to vaccine administration are those set forth by the Centers for Disease Control and Prevention. Such students must present a written statement from a physician licensed to practice medicine in the United States or a foreign country stating that a specific immunization is medically contraindicated, and giving the reasons for and duration of this contraindication. These written physician's statements shall become part of the student's immunization record (see Section V.C) and shall be reviewed annually by the student affairs dean in conjunction with a health professional from the student health service of that school or campus or an infectious disease expert to determine whether this exemption shall remain in effect for the next year. When a medical contraindication no longer exists, the student must then comply with the immunization requirements. The University shall provide reasonable accommodations to those students whose medical condition contraindicates immunizations so long as the failure to be immunized will not prevent the student from fulfilling the requirements of the academic program. Each school/program shall determine the immunization and testing requirements for its academic program(s) in accordance with section V.A of this policy. Students should be informed of the immunization and testing requirements prior to matriculation or enrollment, or upon adoption of new requirements.
6. A student may be exempted from any required immunization if the student submits a bona fide written signed statement explaining how immunization conflicts with his or her religious beliefs and if failure to receive this immunization does not prevent fulfillment of the requirements of the academic program. The student shall be required to acknowledge in writing that he or she was informed of the value of immunizations and has knowingly declined to have such immunizations for religious reasons ( EXHIBIT B). The University shall provide reasonable accommodations to those students whose religious beliefs bar immunizations so long as the failure to be immunized will not prevent the student from fulfilling the requirements of the academic program. Each school/program shall determine the immunization and testing requirements for its academic program(s) in accordance with section V.A of this policy. Students should be informed of the immunization and testing requirements prior to matriculation or enrollment, or upon adoption of new requirements.
7. Students who are not accepted into a UMDNJ educational program in sufficient time to produce required documentation or to complete immunizations and tests by the start of classes in the first year of his or her educational program may be enrolled on a provisional basis for the first semester or trimester of classes if temporary exemption is granted in writing by the student affairs dean. However, depending upon which documentation, immunization or test is lacking, these students may be excluded from certain activities such as patient contact or laboratory work. For example, students shall not be permitted to have contact with patients or with blood or other potentially infectious body fluids or laboratory material if they have not received at least one dose of hepatitis B vaccine or cannot provide serologic evidence of current immunity to hepatitis B; students shall not be permitted to have contact with patients unless they have received tuberculin testing and any required follow up. Provisional enrollment on this basis may not continue beyond the first semester or trimester.
C. Record-Keeping Requirements:
1. Acceptable evidence of required immunizations, immune status or health status listed in section V.A is required for each non-exempt student prior to initial or subsequent registration.
2. Acceptable documents serving as evidence of previous immunization and/or immunity shall be determined by the student health services directors or student affairs deans and may include:
a. an official school immunization record or copy thereof from any primary, secondary, undergraduate, graduate, health professions or other school;
b. a record from any public health department;
c. a medical record or form summarizing a medical record and prior immunizations signed by a physician licensed to practice medicine in any jurisdiction of the United States or foreign country or other licensed health professional approved by the New Jersey State Department of Health;
d. a report of serology from a licensed laboratory.
3. Each school shall ensure the maintenance of records of the immunizations and/or immune status of all students including those on provisional status, if any. Documents pertaining to previous immunizations, immune status, and medical and religious exemptions shall also be maintained. A summary of student measles-mumps-rubella immunizations shall be sent annually in November to the Office of Academic Affairs for the filing of required University-wide reports with the New Jersey Department of Health and Senior Services in accordance with N.J.A.C. 8:57-6.13. Immunization records shall be kept for at least three years following graduation, termination, transfer or other departure of a student from UMDNJ. Because of the necessity for immunization records to be available for inspection by the State (see item 4 below), they shall be kept separate from student academic, health and other confidential records.
4. Summaries of measles-mumps-rubella student immunization/immune status shall be available for inspection by authorized representatives of the New Jersey Department of Health and Senior Services, and the local board of health within 24 hours of notification, as required by N.J.A.C. 8:57-6.14.
VI. EXHIBITS
A. Summary of Student Immunization and Health Requirements
B. Declination of Immunizations for Religious Reasons
By Direction of the President:
__________________________________
Vice President for Academic Affairs
EXHIBIT A
SUMMARY OF STUDENT IMMUNIZATION AND HEALTH REQUIREMENTS*
click here to download MS Word 
format