School Health » Immunization Information

Immunization Information

The Tennessee Department of Health is responsible for immunization requirements for those who attend child care, pre-school, school and college.  The current immunization requirements are in the Tennessee Department of Health Rules.

The Official Immunization Certificate is available in local health departments through the Tennessee Immunization Information System (TennIIS).  This certificate can also be obtained through most primary care providers who provide services to children.   In addition, immunization documentation from other states can be keyed into the TennIIS by our school nurses.   Parents are responsible for complying with the requirements of Tennessee law.  


The state’s immunization schedule follows the current schedule published by the Centers for Disease Control and Prevention (CDC) and endorsed by the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP).


Children with medical or religious exemption to requirements

Medical – Physician (MD, DO) or department Public Health Nurse authorized to indicate specific vaccines medically exempted (because of risk of harm) on the new form.  Other vaccines remain required.  The medical reason for the exemption does not need to be provided.

Religious – This exemption requires a signed statement by the parent/guardian that vaccination conflicts with their religious tenets or practices.  If the child needs documentation of a health examination for the school, it must be noted by the healthcare provider on the immunization certificate.  In that case, the provider should check the box that the parent has sought a religious exemption to explain why immunization information is absent or incomplete.

Minimum ages or dose intervals – Tennessee follows published CDC guidelines.  For vaccines with critical minimum age requirements (e.g., MMR, varicella) or minimum dose intervals, doses are considered valid if given up to 4 days before the minimum age or dose interval.  Doses administered more than 4 days early are considered invalid and should be repeated as recommended.

Injectable or nasally administered live vaccines not administered on the same day should be administered at least 4 weeks apart. The 4-day "grace period" should not be applied to the 28-day interval between injectable or nasally administered live vaccines not administered at the same visit. If injectable or nasally administered live vaccines are separated by less than 4 weeks, the second vaccine administered should not be counted as a valid dose and should be repeated. The repeat dose should be administered at least 4 weeks after the last invalid dose.

Alternative proof of immunity for certain diseases – A positive serology (year of test documented) is acceptable as an alternative to immunization for measles, mumps, rubella, hepatitis A, hepatitis B or varicella.  For varicella, documentation of provider diagnosed varicella (year) or provider-verified credible history of disease given by a parent or guardian (year) also is acceptable.  By documenting a history of disease, the provider is asserting that he or she is convinced that the child has had chickenpox.