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OLR Research Report


October 9, 2009

 

2009-R-0373

CHILDHOOD IMMUNIZATIONS

By: John Kasprak, Senior Attorney

You asked for information on Connecticut's childhood immunization law, particularly whether the state has a “forced vaccination policy” if the a parent or guardian refuses to have a child immunized.

SUMMARY

State law requires children to be immunized against certain diseases and conditions in order to attend a child day care center or group day care home, as well as upon entry into a public or nonpublic school. The law provides exemptions in cases of medical contraindication or religious beliefs. In such cases, the child's parents or guardians must complete certain forms (see attached).

Connecticut's public health emergency law authorizes the Department of Public Health (DPH) commissioner to issue vaccination orders if the governor authorizes him to do so when the governor declares a public health emergency. Individuals can refuse the vaccination for any reason, including health, religion, or conscience. Parent or guardians for minor children, must give written consent before the child is vaccinated. If a person cannot or will not be vaccinated, the law allows the commissioner to order the individual into quarantine or isolation. An appeal process is part of the law.

CHILDHOOD IMMUNIZATION SCHEDULE

State law provides that “the standard of care for immunization for the children of this state shall be the recommended schedule for active immunization for normal infants and children published by the committee on infectious diseases of the American Academy of Pediatrics or the schedule published by the National Immunization Practices Advisory Committee, as determined by the Commissioner of Public Health” (CGS 19a-7f).

CHILD DAY CARE SERVICES

The law requires the DPH commissioner to adopt regulations to assure that child day care centers and group day care homes meet the health, educational, and social needs of children utilizing them. The regulations must specify that before being permitted to attend any child center or home, each child must be protected as age-appropriate by adequate immunization against diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella, hemophilus influenzae type B and any other vaccine required by the schedule of active immunization (see above). The regulations must include appropriate exemptions for children (1) when such immunization is medically contraindicated or (2) whose parents object to the immunization on religious grounds (CGS 19a-79(a); see attached DPH regs.).

SCHOOL CHILDREN

Under state law, each local or regional board of education, or similar body governing a nonpublic school, must require each child to be protected by adequate immunization against diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella, hemophilus influenzae type B, and any other vaccine required by the schedule for active immunization before the child can enroll in any program operated by the school. Exemptions are available if the child presents (1) a certificate from a physician stating that in the physician's opinion, such immunization is medically contraindicated because of the child's physical condition or (2) a statement from his or her parents or guardians that the immunization would be contrary to the child's religious beliefs (CGS 10-204a; see attached DPH regs).

PUBLIC HEALTH EMERGENCIES

Public Act 03-236, “An Act Concerning Public Health Emergency Response Authority,” authorizes the DPH commissioner to issue vaccination orders if the governor authorizes him to do so when she declares a public health emergency. The commissioner can order vaccinations for people, including those who were present in a specific geographic area, as he deems reasonable and necessary to prevent the introduction or stop the progress of the disease or contamination that caused the emergency. He must inform those subject to vaccination orders (1) of the vaccine's benefits and risks and (2) that they can refuse the vaccination for any reason, including health, religious, or conscientious reasons. Adults, and parents or guardians for minor children, must give written consent before they or the children are vaccinated.

If a person or group cannot or will not be vaccinated, the commissioner can order them into quarantine or isolation, as appropriate. A parent may refuse vaccination on behalf of a child under age 18. But refusing vaccination is not grounds for confinement without a reasonable belief that the individual or group poses a reasonable threat to public health because they (1) are infected or contaminated; (2) may be, have been, or become exposed to the disease or contamination; or (3) are at reasonable risk of having a communicable disease or having been contaminated.

A person can appeal a vaccination order to the probate court within 48 hours after receiving it by submitting a written request, which can include mail, fax, Internet, or other means, and the court must hold the hearing within 72 hours of receiving his request. The Judicial Department must pay the court fees unless no funds have been budgeted for this purpose, in which case the court must waive the fees.

The law allows the commissioner to ask the court to extend the time for the hearing based on extraordinary circumstances. (The court may do this on its own in quarantine and isolation appeals.) In deciding whether to grant the extension, the court must consider the rights of those affected by the order, the public's health, the severity of the need, and the availability of witnesses and evidence.

The law gives people appealing vaccination orders the same due process rights as it gives those who appeal quarantine and isolation orders. It also applies the same due process procedures on (1) notice, (2) hearing extensions, (3) access to hospital and other records, (4) appointment and payment of counsel for indigent people, (5) appointment of attorneys to represent groups in a geographic area, and (6) recording and transcribing hearings. In addition, the law allows appellants to present testimony from any licensed healing arts practitioner.

At the hearing, the commissioner has the burden of showing by a preponderance of the evidence that the individual was present in a specific geographic area, and vaccination is reasonable and necessary to prevent the introduction or stop the progress of the disease or contamination that caused the emergency. The court must order the vaccination, or confinement for those who are unable or refuse to be vaccinated, if it finds vaccination is needed and the least restrictive way to protect the public health. If it does not find this, it must vacate the vaccination order.

The law permits anyone aggrieved by the probate court's decision to appeal to Superior Court. The appeal is confined to the record, that is, the transcript and any evidence the probate court received or considered (CGS 19a-131e).

JK:ts