2.3 Immunizations and Documentation Requirements: Undergraduate

Per Texas Health and Human Services (In accordance with Texas Education Code Sec. 51.933), proof of the following immunizations is required for all students enrolled in healthrelated college courses which involve direct patient contact with potential exposure to blood or bodily fluids. Options for providing proof of immunity to meet UT Tyler School of Nursing (SON) requirements are based on Texas Health and Human Services, Centers for Disease Control, Immunization Action Coalition standards, and affiliate hospital requirements.

Vaccines required for enrollment in health-related courses must be completed before students begin their first nursing semester.

All students must be compliant with all annual requirements in the Castle Branch system before attending clinical. Failure to produce documentation of met requirements will result in missed clinical day(s). Students have the right to decline immunizations but may be denied clinical placement in specific facilities, and faculty cannot ensure alternate placement.

2.3.1.1 Immunizations required prior to enrolling in classes for the first semester of nursing school:

Immunizations are typically completed as part of childhood immunization requirements. Although being current on childhood immunizations will meet most requirements, please note there are additional requirements for some vaccines such as Hepatitis B that may take up to 7 months to be compliant (or up to 14 months if no proof of prior vaccination). Students are encouraged to obtain vaccine records from their parents or the clinic that administered the vaccines.

Hepatitis B Series:

Ultimately, proof of positive/reactive titer OR documentation verifying “nonresponder” status is required.

If you have proof of prior completion of the vaccination series:

• Complete the Hepatitis B surface antibody blood test (a serological test of immunity also known as a titer). Per Immunization Action Coalition, once a positive titer is obtained, there is no need to repeat the titer unless the individual is immunocompromised.
• If the antibody titer is positive/reactive, then immunity is confirmed. Submission of proof of the positive/reactive titer is required.
• If the antibody titer is negative/non-reactive, choose one of the below vaccine options and submit appropriate paperwork as indicated.
  • Vaccine option 1: Complete the two-dose series of Heplisav-B (doses one month apart). Then repeat the titer one month after the final (second) dose. (Total time approximately two months). Note: Heplisav-B is an “adjuvanted” vaccine by Dynavax and may display as Dynavax or Adjuvanted on vaccine records.
  • Vaccine option 2: Complete the three-dose series of Engerix-B or Recombivax HB (doses at 0, 1 & 6 months). Then repeat the titer one month after the final (second) dose. (Total time approximately seven months)
  • Note: for either 2- or 3-dose series listed above, students may choose to draw a titer one month after the first dose. If the titer is positive, the student is not required to complete the series (if negative, must complete the series).
  • Required paperwork: Submit appropriate paperwork based on the following
    results:
    • If titer positive/reactive: Submission of proof of the positive/reactive titer is required.
    • If titer negative/non-reactive: submission of each of the following is required:
      •  Proof of completion of “initial” vaccine series
      • Proof of completion of a “second” vaccine series
      • Negative/non-reactive Hepatitis B surface antibody titer (at least one month after the last dose of second series)
      • Provider statement of “non-responder”

Note: if you are a non-responder, see recommendations from Immunization Action Coalition regarding risks associated with being a non-responder

For a table view of standards, see Appendix A

If there is no proof of prior vaccination series:

First, complete the vaccine series. Options include:

• 2-dose series of Heplisav-B (doses one month apart)
• 3-dose series of Engerix-B or Recombivax HB (doses at 0, 1 & 6 months)

Then follow the above guidelines for those who have proof of vaccine series completion.
Note: this process may require completion of the entire vaccine series twice along with titer levels which can take up to 14 months to complete depending on the vaccine series option selected.

COVID-19 Series:

Submit proof of one of the following:

• Documentation of an ‘initial dosing’ of COVID-19 vaccine (any one of the following)
  • one dose of J&J Jansen (dated 2020 – 2021)
  • two doses of Pfizer, Moderna or Novavax original monovalent version of the vaccine (dated 2020 – 2022)
  • one dose of any updated or current version of the COVID-19 vaccine (dated 2022 or after).

OR

• Completed COVID-19 vaccine waiver found on the SON Policy website 
   

Influenza:

For students starting nursing school in the Spring semester, submit documentation of an influenza vaccine administered during the current flu season. The renewal date will be set to October 31 of the following flu season.

For students starting nursing school in the Summer or Fall semesters:
Summer and Fall semesters start before flu season starts. There are no influenza vaccination requirements to enroll in courses for Summer or Fall, instead a “waiver” found on the SON Policy website should be completed and submitted.

Once flu season begins in the Fall semester, submit documentation of an influenza vaccine administered during the current flu season before October 31. The renewal date will be set to 10/31 of the following flu season.

Measles, Mumps, & Rubella (MMR):

Submission of proof of either prior completion of vaccine series (2 doses) OR positive titer (for all three components) is required. A titer is recommended only if there is no proof of ever having completed the vaccine series.

If there is no proof of having prior completion of the vaccine series and titer results for any of the three components (measles, mumps, or rubella) are negative, completion of the vaccine series (2 doses with at least 28 days between doses) is required. No subsequent titer is needed.
Submit documentation of completion of the vaccine series.

Tetanus, Diphtheria, & Pertussis (Tdap):

Submit documentation of at least one Tdap vaccine and proof of tetanus-containing vaccine (Tdap or Td) within the past ten years (Tdap within the last 10 years fulfills both requirements). The renewal date will be set 10 years from the administered date.

Varicella (Chicken Pox):

Submission of proof of prior completion of vaccine series (2 doses) OR diagnosis/verification of a history of varicella or herpes zoster (shingles) by a healthcare provider OR positive titer required. A titer is recommended only if there is no proof of ever having completed the vaccine series.

If there is no proof of having prior completion of vaccine series or history of varicella or shingles, and titer results are negative, completion of the vaccine series (2 doses with at least 28 days between doses) is required. No subsequent titer is needed. Submit documentation of completion of the vaccine series.

2.3.1.2 Immunizations Required Annually Throughout the Nursing Program

Influenza:

Documentation of an influenza vaccine administered during the current flu season is required prior to October 31 each year.
If, for any reason, a student was not in clinical classes in the Fall and did not take the flu vaccine, it is required prior to starting the Spring semester.

2.3.1.3 Exemptions and Waivers

Exemptions may be allowed on an individual basis for medical contraindications and religious conflicts. Students have the right to decline immunizations, but they may be required to adhere to certain accommodations, or they may be denied clinical placement in specific facilities. Faculty cannot ensure alternate placement. Exemptions may be time-limited based on circumstances.

The Immunizations Exemption Request Form is located on the SON Policy website as item 2.3.1.3.1 for Tdap, Hep B, MMR, Varicella and Flu vaccine exemptions. 

Castle Branch is not authorized to approve exemption requests. The student is expected to notify the SON Clinical Liaison when an exemption request has been uploaded to Castle Branch. The exemption request will go through the UT Tyler SON for approval and status updated in Castle Branch if approved.

The Flu Vaccine Waiver for students starting nursing school during Summer or Fall semesters, and the COVID-19 Vaccine Waiver are located on the SON Policy website as items 2.3.1.3.4 and 2.3.1.3.5 respectively. CastleBranch is authorized to approve waivers.

2.3.2 Tuberculosis Screening 

2.3.2.1 Non-International Students

Tuberculosis Screening: It is recommended that students obtain requirements for TB screening through the University Health Clinic, 3310 Patriot Drive, Tyler, Tx 75701; Office Hours: M-F 8 a.m. - 5 p.m. 903.939.7870

Documentation of a result is required. The frequency and type of tuberculin screening depend upon if this is initial testing and the duration of time between tests:

Required prior to enrolling in classes for the first semester of nursing school

Proof of negative PPD Mantoux tuberculin skin test (TST) OR negative blood assay (IGRA)[QuantiFERON (QFT) or T-Spot] based on the below guidelines.

• Students receiving their first tuberculin screening or having their last tuberculin skin test (TST) more than one year ago select one of the following:
  • Proof of a 2-step TST (2 TST tests completed at least one week apart and no more than 12 months apart)
  • Single blood assay (IGRA) test
• Students who have received the BCG vaccine: a single blood assay (IGRA)
• Students with a TST within the previous 12 months: a single TST. Submit documentation of both TSTs performed within the last 12 months.

If results are positive, see the “Annual documentation required for positive results” below.

Annual documentation required:

A single negative tuberculin skin test (TST) or negative blood assay (IGRA): [QuantiFERON] (QFT) or T- Spot. For annual documentation required for individuals with a history of positive results, see the “For positive results” section below.

For positive results:

The following is required:

• Proof of a negative chest x-ray is required (annual x-rays are not required)
• The student must be referred to a health department for further evaluation.
• Treatment for latent TB infection (LTBI) should be considered in accordance with CDC guidelines.
• Documentation of treatment (beginning and completion) will be scanned into the designated immunization tracking system for reference.
• Students will be followed by the school’s staff and/or administrators regarding requirements yearly after the student is admitted.
• Annual documentation required: Completed TB symptom screening form signed by a health care provider.

Students with potential active TB should wear a mask and receive medical care immediately, according to the health department or the student’s health care provider.

2.3.2.2 International Students

International Student Services (ISS) supports all F and J visa international students who attend UT Tyler for academic study) and students that originate from a country that is defined as high burden for TB.
Does the TB screen hold apply to me? - Refer to the Mandatory Tuberculosis Screening Documentation Form

2.3.3 Liability Insurance

Professional liability insurance fees will be added to the bill at registration.

2.3.4 BLS/CPR

Submit your current Basic Life Support (BLS) or Cardiopulmonary Resuscitation (CPR) certification. Must be either an American Heart Association (AHA) or American Red Cross BLS/CPR course designed for healthcare providers. Heart Saver, Lifeguard, or other nonhealthcare provider level BLS courses are NOT accepted. Courses from other companies that use AHA guidelines but do not result in either an AHA or American Red Cross card are NOT accepted.

A copy of both the front and back of your card (including your signature) or e-card containing the name of the course and your name is required. The renewal date will be set based on the expiration of certification.

2.3.5 Health Insurance

Current health insurance is required. Students will be enrolled into the UT Student Health Insurance Plan (SHIP) as part of clinical course registration fees. Students with comparable health insurance coverage from another source can submit proof and waive enrollment in UT SHIP.

The cost of any evaluation or treatment related to an injury that occurs during a clinical rotation or
simulation lab is the responsibility of the student and is to be covered under their personal health
insurance. The university or health care facility is not responsible for any costs incurred.

2.3.6 Student Guide

Please view the Nursing Student Guide and download, print, sign, scan, and upload the “UG Acceptance Affirmation Form” to Castle Branch. The guide and form are available on the SON Policy website. The guide is located at the top of the webpage, and the UG Acceptance Affirmation Form is under Appendices/Forms.

Appendix A Table of Hepatitis B Series Guidelines

1) Complete serological test of immunity (also known as a titer) At least one month after the last dose in the vaccine series must have passed before drawing the initial titer.
If positive antibody titer	If negative antibody titer: Choose from 2 below vaccine options (link to visual of schedule options)
2) Submit to Castle Branch proof of positive titer required. Recommend submit: completion of vaccine series  positive antibody titer	2) Complete 2 dose series of Heplisav-B (doses one month apart)   3) Repeat titer one month after final (second) dose. Total time approximately 2 months *See note at bottom of table for additional option	2) Complete 3 dose series of Engerix-B or Recombivax HB (doses at 0, 1 & 6 months).   3) Repeat titer one month after final (third) dose. Total time approximately 7 months *See note at bottom of table for additional option
	4) For either 2 or 3 dose booster series, submit to Castle Branch one of the following: If positive final titer, submit the positive titer results  If negative final titer, discuss results with provider and submit the following documents: completion of “initial” vaccine series completion of a “second” vaccine series results of final titer (1 month after last vaccine) provider statement that you are a “non-responder” Note: if you are a non-responder, see recommendations from Immunization Action Coalition regarding risks associated with being a non-responder
	* Note: for either 2 or 3 dose series students may choose to draw a titer 1 month after first dose. If titer is positive, student is not required to complete the series (if negative must complete series). If titer positive after one “booster” dose, submit to Castle Branch proof of positive titer.

 

Sources
CDC Hepatitis B Standards
CDC MMR Standards
CDC Morbidity and Mortality Report
CDC Varicella Standards
Immunization Action Coalition Standards
Texas Department of State Health Services Administrative Code Title 25 Rule 97.64
Texas Department of State Health Services Administrative Code Title 25 Rule 97.65
Texas Health and Human Services Vaccine Requirements for Healthcare or Veterinary Students