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Immunization Requirements

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The Tennessee Department of Health (TDOH) maintains immunization requirements for individuals who attend child care, pre-school or K-12 school. The State of Tennessee's list of required immunizations is created through the normal, open rule-making process.

For more information about these requirements, go to the Tennessee Department of Health.


Children enrolling in child care facilities, pre-school, pre-Kindergarten: Infants entering child care facilities must be up to date at the time of enrollment and are required to provide an updated certificate after completing all of the required vaccines due by 18 months of age.
  • Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
  • Hepatitis B (HBV) (July 2010)
  • Poliomyelitis (IPV or OPV)
  • Haemophilus influenzae type B (Hib): age younger than 5 years only (this requirement is resumed following suspension during a national Hib vaccine shortage 2008-2009)
  • Pneumococcal conjugate vaccine (PCV): age younger than 5 years only (July 2010)
  • Measles, Mumps, Rubella (MMR) 1 dose of each, usually given together as MMR
  • Varicella (Chicken Pox) 1 dose or history of disease
  • Hepatitis A (1 dose by 18 months of age) (July 2010)


  • DTP-DTaP-DT-DTP/hib-Td
    • 4 doses, one of which was given on or after the fourth birthday. If age seven or older three doses are required.
  • Poliomyelitis (OPV/IPV)
    • 4 doses of OPV or IPV. Final dose on or after the 4th birthday now required.
  • MMR (Measles, Mumps, Rubella)
    • 2 doses must be given on or after the first birthday, for entrance into grades K, 4, 8, and 12. A second dose of MMR is required and should be administered at least 30 days following the first dose.
  • Chickenpox (Varicella) 2 doses or history of disease: previously only one dose was required.
    • 3 doses, for entrance into kindergarten. Proof of immunity to Hepatitis B is mandatory for entrance into the 7th grade.
    • 2 doses: effective July 1, 2011

7th Grade

  • Tetanus-diphtheria-pertussis booster (“Tdap”) – not required if a Td booster dose given less than 5 years before 7th grade entry is recorded on the DTaP/Td line (no later than October 1, 2010)
  • Verification of immunity to varicella – 2 doses or history of disease (July 1, 2010)

Children with exemptions to requirements

  • Medical:  Healthcare provider must indicate which specific vaccines are medically exempted (because of risk of harm) on the new form. Other vaccines remain required.
  • Religious:  Requires only a signed statement by the parent/guardian that vaccination conflicts with their religious tenets or practices. If documentation of a health examination is required, it must be noted by the health care provider on the immunization certificate. In that case, the provider may explain the absence of immunization information by checking that the parent has obtained a religious exemption.
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