What immunizations are required for a nursing degree?

Immunization Requirements for Nursing Students

Nursing students must verify immunity or receive vaccination for hepatitis B, MMR (measles, mumps, rubella), varicella, Tdap (tetanus, diphtheria, pertussis), and annual influenza vaccine before clinical rotations, as these are the core vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) for all healthcare personnel. 1

Core Required Immunizations

Hepatitis B

• All nursing students must complete the 3-dose hepatitis B vaccine series (doses at 0,1 month, and 6 months) due to high risk of occupational exposure to blood and body fluids 1
• Serologic testing for anti-HBs antibody is required 1-2 months after completing the series to document adequate immune response (≥10 mIU/mL) 1
• Students at high risk for continued percutaneous or mucosal exposure to blood must have documented immunity before patient contact 1

Measles, Mumps, and Rubella (MMR)

• Two doses of MMR vaccine administered ≥28 days apart are required for all students born in 1957 or later 1
• Acceptable proof of immunity includes:
  • Written documentation of 2 doses of MMR vaccine 1
  • Laboratory evidence of immunity to all three diseases 1
  • Laboratory confirmation of disease 1
• Healthcare students require 2 doses of mumps vaccine specifically, as the 2006 mumps outbreak demonstrated inadequate protection with single-dose regimens 1

Varicella (Chickenpox)

• Two doses of varicella vaccine or laboratory evidence of immunity are required 1
• Acceptable documentation includes:
  • Written documentation of 2-dose vaccination series 1
  • Laboratory evidence of immunity 1
  • Healthcare provider verification of typical varicella disease history 1
• Self-reported history alone is insufficient without provider verification or laboratory confirmation 1

Tetanus, Diphtheria, and Pertussis (Tdap)

• One dose of Tdap is required regardless of interval since last tetanus-diphtheria (Td) booster 1
• Td boosters are needed every 10 years thereafter 1
• Pertussis is resurgent among healthcare workers, making Tdap particularly important for nursing students 1

Annual Influenza Vaccine

• Annual influenza vaccination is mandatory for all healthcare personnel, including students 1
• This is an occupational requirement, not optional 1
• Students should receive vaccination before each influenza season during their training 1

Additional Recommended Immunizations

Meningococcal Vaccine

• Recommended for students living in dormitories or congregate settings 1
• Particularly important for first-year students in residential programs 1

Poliomyelitis

• Students with close contact to patients who might be excreting polioviruses should have completed primary series 1
• One lifetime booster may be given if at continued increased risk 1

Hepatitis A

• Recommended for students who will work in settings with potential fecal-oral transmission risk 1
• Not universally required but may be mandated by specific clinical sites 1

Documentation Requirements

Schools must verify immunity through one of the following 1, 2:

• Written vaccination records showing dates, vaccine names, and lot numbers
• Laboratory serologic testing demonstrating protective antibody levels
• Healthcare provider documentation of disease history (for varicella only)

Common Pitfalls to Avoid

Inadequate Documentation

• Self-reported vaccination history without written records is insufficient 1, 2
• Childhood vaccination cards may be incomplete or lost; serologic testing may be more efficient 3

Assuming Immunity Based on Birth Year

• While persons born before 1957 are generally considered immune to measles and mumps, healthcare students born before 1957 should still receive at least one dose of MMR if they lack other evidence of immunity 1

Incomplete Hepatitis B Series

• Do not allow clinical rotations to begin without documented completion of the 3-dose series and post-vaccination serologic testing 1
• Studies show 84% immunity rates among healthcare students, meaning 16% remain susceptible despite vaccination 3

Varicella History Misinterpretation

• Mild or atypical cases may be misidentified; require either laboratory confirmation or epidemiologic linkage to a confirmed case 1
• When documentation is lacking, students should not be considered immune 1

Compliance Rates and Gaps

Research demonstrates significant immunity gaps among nursing students 2, 3:

• Only 66-75% of schools require Tdap despite ACIP recommendations 2
• Fewer than 30% of healthcare students are in full compliance with all recommended vaccinations 3
• More than 90% of medical and nursing schools now require hepatitis B, MMR, and varicella vaccines 2

Implementation Strategy

Schools should 1, 2:

• Implement prematriculation vaccination requirements as the earliest opportunity to ensure compliance
• Offer influenza vaccines free of charge to students (78% of MD-granting schools do this versus only 31% of nursing schools) 2
• Establish occupational health programs that include vaccination as a fundamental component 1
• Conduct annual immunization coverage assessments 1

Students identified as non-immune should be referred immediately to vaccination clinics, with compliance assessed within 3 months 3