National Association of School Nurses (NASN) Position Statement: Immunization and Vaccination Requirements

Badeh S. M. Elam-Evans L. D. Hill H. A. Fredua B. (2023). Disrupted routine medical visits in children and adolescents during the COVID-19 pandemic. American Journal of Pediatric Medicine Focus, 2(4), 100119. https://doi.org/10.1016/j.focus.2023.100119

Boyer-Chu L. Yonkaitis C. F. (2019). Disease prevention in schools. In Selekman J. Shannon R. A. Yonkaitis C. F. (Eds.), School nursing: A comprehensive text (3rd ed., pp. 313–334). F.A. Davis Company.

Centers for Disease Control and Prevention. (2021). Vaccine basics. https://www.cdc.gov/vaccines/basics/index.html

Centers for Disease Control and Prevention. (2023). Child and adolescent immunization schedule by age. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-age.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

Centers for Disease Control and Prevention. (2024). ACIP recommendations. https://www.cdc.gov/acip/vaccine-recommendations/index.html

Congressional Research Service. (2022). Immunization information systems: Overview and Current Issues . https://crsreports.congress.gov/product/pdf/R/R47024

Davis-Alldritt L. (2024). Immunization compliance. In Resha C. Taliaferro V. (Eds.), Legal resource for school health services (2nd ed., pp. 571–590). SchoolNurse.com.

D’Souza-Vazirani D. Behrmann E. Alvarez C. Walsh C. Griffin A. R. White S. (2023). Champions for school health—an NASN initiative to increase vaccine confidence, equity, and uptake in COVID-19 and school-required vaccinations: Part 2. NASN School Nurse, 38(6), 301–309. https://doi.org/10.1177/1942602X231202745

Guarinoni M. G. Dignani L . (2021). Effectiveness of the school nurse role in increasing the vaccination coverage rate: A narrative review. Annali di Igiene, 33(1), 55–66. https://doi.org/10.7416/ai.2021.2408

Huber K. Greene K. Perkinson L. Wells K. Bollinger J. Melton M. Less E . (2022). Priorities and policy levers to support school-located vaccination. Health Affairs Forefront. https://doi.org/10.1377/forefront.20220228.651782

Immunize.org. (2025). Leading medical organizations endorse strong school and childcare vaccination requirements and elimination of non-medical exemptions. www.immunize.org/catg.d/p2071.pdf

McCullough J. M. Sunenshine R. Rusinak R. Mead P. England B. (2020). Association of presence of a school nurse with increased sixth grade immunization rates in low-income Arizona schools in 2014–2015. The Journal of School Nursing, 36(5), 360–368. https://doi.org/10.1177/1059840518824639

National Conference of State Legislatures. (2024). States with religious and philosophical exemptions from school immunization requirements. https://www.ncsl.org/health/state-non-medical-exemptions-from-school-immunization-requirements

O’Shea P. John J. Aassar M. Baffoe N. Vierra K . (2023). Reframing the conversation about child and adolescent vaccinations. FrameWorks Institute. https://www.frameworksinstitute.org/wp-content/uploads/2023/01/reframing-the-conversation-about-child-and-adolescent-vaccinations_Jan272023.pdf

Park K. Cartmill R. Johnson-Gordon B. Landes M. Malik K. Sinnott J. Wallace K. Wallin R. (2021). Preparing for a school-located COVID-19 vaccination clinic. NASN School Nurse, 36(3), 156–163. https://doi.org/10.1177/1942602X21991643

Pediatric Infectious Diseases Society. (2019). Pediatric Infectious Diseases Society position on non-medical immunization exemption. https://pids.org/wp-content/uploads/2020/10/Pediatric_Infectious_Diseases_Society_Position_on_Non.pdf

Pingali D. Yankey D. Elam-Evans L. D. Markowitz L. E. Williams C. L. Fredua B. McNamara L. A. Stokley S. Singleton J. A. (2021). National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years—United States, 2020. MMWR Morbidity and Mortality Weekly Report, 70(35), 1183–1190. https://doi.org/10.15585/mmwr.mm7035a1

Public Health Foundation. (2024a). Evidence-based strategies and resources to increase routine vaccination rates and confidence: A toolkit for healthcare providers . https://www.phf.org/resourcestools/Documents/Lets_RISE_HCP_Toolkit.pdf

Public Health Foundation. (2024b). Ways schools can support routine vaccination catch-up among school-aged children: A toolkit for educational professionals . https://www.phf.org/resourcestools/Documents/Lets_RISE_School_Toolkit.pdf

Public Health Law. (2022). State school immunization requirements and vaccine exemption laws. Centers for Disease Control and Prevention’s Center for State, Tribal, Local, and Territorial Support. https://www.cdc.gov/phlp/docs/school-vaccinations.pdf

Seither R. Yusuf O. Dramann D. Calhoun K. Mugerwa-Kasujja A. Knighton C. L. (2023). Coverage with selected vaccines and exemption from school vaccine requirements among children in kindergarten–United States, 2022–23 school year. Morbidity and Mortality Weekly Report, 72(45), 1217–1224. https://doi.org/10.15585/mmwr.mm7245a2

Sela Y. Grinberg K. Nissanholtz-Gannot R . (2023). The dilemma of compulsory vaccinations–ethical and legal considerations. Healthcare (Basel), 11(8), 1140. https://doi.org/10.3390/healthcare11081140

Talbird S. E. Carrico J. La E. M. Carias C. Marshall G. S. Roberts C. S. Chen Y. Nyaku M. K. (2022). Impact of routine childhood immunization in reducing vaccine-preventable diseases in the United States. Pediatrics, 150(3), e2021056013. https://doi.org/10.1542/peds.2021-056013

Tomlinson H . (2023). The impact of non-medical vaccine exemptions on childhood vaccination rates. Association of State and Territorial Health Officials. https://www.astho.org/communications/blog/impact-of-non-medical-vaccine-exemptions-on-childhood-vaccination-rates/

U.S. Department of Health and Human Services. (2021). Confronting health misinformation: The US Surgeon General’s advisory on building a healthy information environment. https://www.hhs.gov/sites/default/files/surgeon-general-misinformation-advisory.pdf

U.S. Department of Health and Human Services. (2024). CDC call to action: What schools can do to promote routine vaccination catch-up among school aged children . https://www.cdc.gov/vaccines/events/downloads/CDC-Call-to-Action-schools.pdf

Weber D. J. Talbot T. R. Weinmann A. Mathew T. Heil E. Stenehjem E. Duncan R. Gross A. Stinchfield P. Baliga C. Wagner J. Schaffner W. Echevarria K. Drees M . (2021). Policy statement from the society for healthcare epidemiology of America (SHEA): Only medical contraindications should be accepted as a reason for not receiving all routine immunizations as recommended by the centers for disease control and prevention. Infection Control & Hospital Epidemiology, 42(1), 1–5. https://doi.org/10.1017/ice.2020.342

Wilson O. F. Mote S. L. Morse B. L. (2023). Addressing vaccine hesitancy among students and families: Interventions for school nurses. NASN School Nurse, 38(3), 146–154. https://doi.org/10.1177/1942602X221106945

Wodi A. P. Murthy N. McNally V. Cineas S. Ault K. (2023). Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger–United States. MMWR Morbidity and Mortality Weekly Report, 72(6), 137–140. https://doi.org/10.15585/mmwr.mm7206a1