Schools and Child Care

Minimum Number of Doses Required by Age

2-3 Months

• 1 Dose Rotavirus
• 1 Dose Hib (Haemophilus influenzae type b)
• 1 Dose HBV (Hepatitis B)
• 1 Dose IPV (Polio)
• 1 Dose PCV (Pneumococcal)
• 1 Dose DTaP/DT (Diphtheria-Tetanus-Pertussis)

4-5 Months

• 2 Doses Rotavirus
• 2 Doses Hib (Haemophilus influenzae tybe b)
• 2 Doses HBV (Hepatitis B)
• 2 IPV (Polio)
• 2 PCV (Pneumococcal)
• 2 DTaP/DT (Diphtheria-Tetanus-Pertussis)

6-7 Months

• 2 or 3 Doses Rotavirus
• 2 or 3 Doses Hib (Haemophilus influenzae type b)
• 3 Doses HBV (Hepatitis B)
• 3 Doses IPV (Polio)
• 3 Doses PCV (Pneumococcal)
• 3 Doses DTaP/DT (Diphtheria-Tetanus-Pertussis)

8-11 Months

• 2 or 3 Doses Hib (Haemophilus influenzae type b)
• 3 Doses HBV (Hepatitis B)
• 3 Doses IPV (Polio)
• 3 Doses PCV (Pneumococcal)
• 3 Doses DTaP/DT (Diphtheria-Tetanus-Pertussis)

12-17 Months

• 1 Dose MMR (Measles-Mumps-Rubella)
• 1 Dose Varicella (Chickenpox)
• 3 or 4 Doses Hib (Haemophilus influenzae type b)
• 3 Doses HBV (Hepatitis B)
• 3 Doses IPV (Polio)
• 4 Doses PCV (Pneumococcal)
• 4 Doses DTaP/DT (Diphtheria-Tetanus-Pertussis)

18-24 Months

• 1 Dose MMR (Measles-Mumps-Rubella)
• 1 Dose Varicella (Chickenpox)
• 2 Doses HAV (Hepatitis A)
• 3 or 4 Doses Hib (Haemophilus influenzae type b)
• 3 Doses HBV (Hepatitis B)
• 3 Doses IPV (polio)
• 4 Doses PCV (Pneumococcal)
• 4 Doses DTaP/DT (Diphtheria-Tetanus-Pertussis)

2-5+ Years

• 1 Dose MMR (Measles-Mumps-Rubella)
• 1 Dose Varicella (Chickenpox)
• 3 or 4 Doses Hib (Haemophilus influenzae type b)
• 3 Doses HBV (Hepatitis B)
• 3 Doses IPV (Polio)
• 4 Doses PCV (Pneumococcal)
• 4 Doses DTaP/DT (Diptheria-Tetanus-Pertussis)

Certificate of Immunization and/or Exemption

Children may be exempt from immunization requirements for the following reasons:

• Medical Exemption: Requires a certificate signed by a licensed physician stating that the physical condition of the child is such that immunization would endanger the life or health of the child.
• History of Disease: Requires a certificate signed by a physician stating that the child has a history of disease. History of disease exemptions may be claimed for measles, mumps, rubella, chickenpox, hepatitis A, or hepatitis B.
• Personal Belief or Religious Belief Exemption: Requires a certificate signed by the parent or guardian whose sincerely held philosophical, moral or religious belief is opposed to such immunization.

Certificate of Immunization and/or Exemption

Regardless of the disease, children should be excluded from child care if they meet any of the following exclusion criteria:

1. The staff determines that the illness is preventing the child from participating in activities.
2. The staff determines that they cannot care for the sick child without compromising their ability to care for the health and safety of the other children in the group.
3. The child has illness suggested by a fever (temperature at or above 101.0°F any location) along with difficulty breathing, changes in behavior, lethargy, irritability, persistent crying, or progressive rash). Infants younger than two months, exclude if the temperature is at or above 100.4°F with or without behavior change or other symptoms.
4. The child experiences vomiting two or more times in the preceding 24 hours unless determined to be caused by a non-communicable condition and the child is able to remain hydrated and participate in activities.
5. The child has diarrhea and stool is not contained in diaper or if fecal accidents occur in a child who is toilet trained, or if stool frequency exceeds two or more stools above normal for that child, or if stool contains blood or mucus.
6. Persistent abdominal pain (two or more hours) or intermittent abdominal pain associated with fever, dehydration, or other systemic signs and symptoms.
7. Oral lesions if the child is unable to contain oral secretions or if unable to participate because of other symptoms or until the child is considered to be noninfectious.
8. Skin lesions if they are weeping/draining/oozing and unable to be kept covered with a waterproof dressing.

For guidance on specific diseases, please see the Child Care and School Infectious Disease Exclusion Guide.

Schools play an important role in the health and well-being of North Dakota’s young people. One of the most important ways to ensure children are healthy and able to attend school is by maintaining high rates of immunization against vaccine-preventable diseases.

North Dakota Century Code 23-07-17 mandates all students in kindergarten through 12th grade meet a minimum number of required immunizations prior to school entrance or have a documented exemption. Each school is responsible for excluding non-compliant students after October 1. Children enrolling in school after October 1 have 30 days to be up to date or claim an exemption. Those who are not in compliance must be excluded from school. Schools should have notified parents of incoming students about immunization requirements for this fall.

With the return of once eliminated diseases such as polio and measles in the United States and across the world, the importance of vaccines and maintaining immunization rates has become more critical. Having vaccine-preventable diseases circulating within a school would lead to large numbers of school absences and adversely affect the health of our students. Immunization rates must reach 95% to keep diseases from spreading if introduced into a school. Once rates fall below the 95% threshold, schools become vulnerable to outbreaks of diseases. You can view and compare your school’s immunization rates to other schools, county and state rates on our website.

To assist in tracking immunizations and completing the annual School Immunization Survey, schools may have access to the North Dakota Immunization Information System (NDIIS). Please contact the North Dakota Immunization Unit at 701-328-3386 or toll-free at 800-472-2180 with any questions or concerns regarding school immunizations.

Children may be exempt from immunization requirements for the following reasons:

• Medical Exemption: Requires a certificate signed by a licensed physician stating that the physical condition of the child is such that immunization would endanger the life or health of the child.
• History of Disease: Requires a certificate signed by a physician stating that the child has a history of disease. History of disease exemptions may be claimed for measles, mumps, rubella, chickenpox, hepatitis A, or hepatitis B.
• Personal Belief or Religious Belief Exemption: Requires a certificate signed by the parent or guardian whose sincerely held philosophical, moral or religious belief is opposed to such immunization.

Certificate of Immunization and/or Exemption

Regardless of the disease, children should be excluded from school if they meet any of the following exclusion criteria:

1. The staff determines the child is unwilling or unable to participate in activities due to illness.
2. The staff determines that they cannot care for the sick child without compromising their ability to care for the health and safety of the other children in the group.
3. The child has illness suggested by a fever (temperature at or above 101.0°F any location) along with difficulty breathing, changes in behavior, lethargy, irritability, persistent crying, or progressive rash fever.
4. The child experiences vomiting two or more times in the preceding 24 hours, unless determined to be caused by a non-communicable condition and the child is able to remain hydrated and participate in activities.
5. The individual has diarrhea and cannot self-contain stool. 

If you suspect or know of a child attending your child care center or school that has one of the conditions listed below with a reportable conditions symbol (), please call the HHS Division of Disease Control at 800-472-2180 to report.

For guidance on specific diseases, please see the Child Care and School Infectious Disease Exclusion Guide.

• Any student enrolled at any NDUS institution or living on campus shall provide documentation of vaccination against measles, mumps, and rubella (MMR). The Chancellor shall adopt procedures implementing this policy.
• Students ages 21 and younger shall provide documentation of vaccination against strains A, C, Y, and W-135 of meningococcal disease at the age of sixteen or older. The Chancellor shall adopt procedures implementing these requirements.
• While proof of vaccinations is not a condition of employment in the NDUS, NDUS employees enrolled in courses are subject to this policy.
• Each institution shall establish procedures for tuberculosis (TB) screening of international students. Testing is required of new students from all countries except those classified by the World Health Organization as low risk for tuberculosis.

Exemptions are provided for:

• Students enrolled only in distance learning courses, courses taught off campus, continuing education, or noncredit courses while living off campus;
• Students in attendance at camps, workshops or programs and classes delivered under contract to a third party;
• Vaccination is contraindicated by a medical condition; or
• The student's beliefs preclude participation in an immunization program.