Missouri Childcare Immunization Requirements (2026)

Missouri childcare licensing requires age-appropriate Required for any child enrolled in or attending a child care facility, preschool, or nursery school caring for 10 or more children, per 19 CSR 20-28.040 (Day Care Immunization Rule, DHSS — retained under Title 19) and referenced at 5 CSR 25-500.192(4) immunization for enrolled children (subject to documented medical or legally permitted exemptions).

Missouri childcare licensing requires age-appropriate DTaP/DT (diphtheria, tetanus, acellular pertussis) — age-appropriate doses immunization for enrolled children (subject to documented medical or legally permitted exemptions).

Missouri childcare licensing requires age-appropriate IPV / Polio — age-appropriate doses immunization for enrolled children (subject to documented medical or legally permitted exemptions).

Missouri childcare licensing requires age-appropriate Hib (Haemophilus influenzae type b) — incl. 1 dose on or after 12 months immunization for enrolled children (subject to documented medical or legally permitted exemptions).

Missouri childcare licensing requires age-appropriate Hepatitis B immunization for enrolled children (subject to documented medical or legally permitted exemptions).

Missouri childcare licensing requires age-appropriate PCV (pneumococcal conjugate) immunization for enrolled children (subject to documented medical or legally permitted exemptions).

Missouri childcare licensing requires age-appropriate MMR (measles, mumps, rubella) — at/after 12 months immunization for enrolled children (subject to documented medical or legally permitted exemptions).

Missouri childcare licensing requires age-appropriate Varicella (chickenpox) — at/after 12 months immunization for enrolled children (subject to documented medical or legally permitted exemptions).

Missouri childcare licensing requires age-appropriate Doses must follow the Missouri Child Care/Preschool Immunization Requirements schedule (ACIP-aligned, incl. catch-up spacing) immunization for enrolled children (subject to documented medical or legally permitted exemptions).

Missouri childcare licensing requires age-appropriate Exemptions allowed: Medical exemption (form Imm.P.12, licensed physician) and Parent/Guardian (religious/parental) exemption (form Imm.P.11) filed with the facility; 'in progress' status permitted only with an Immunizations In Progress form (Imm.P.14) on file showing the next-dose due date immunization for enrolled children (subject to documented medical or legally permitted exemptions).

Missouri childcare licensing requires age-appropriate Facility/administrator must keep an immunization record for each child and submit an annual immunization status summary report (survey) to DHSS by January 15 each year immunization for enrolled children (subject to documented medical or legally permitted exemptions).

Which vaccines does Missouri require for childcare enrollment?

Missouri requires age-appropriate immunization records for: Required for any child enrolled in or attending a child care facility, preschool, or nursery school caring for 10 or more children, per 19 CSR 20-28.040 (Day Care Immunization Rule, DHSS — retained under Title 19) and referenced at 5 CSR 25-500.192(4), DTaP/DT (diphtheria, tetanus, acellular pertussis) — age-appropriate doses, IPV / Polio — age-appropriate doses, Hib (Haemophilus influenzae type b) — incl. 1 dose on or after 12 months, Hepatitis B, PCV (pneumococcal conjugate), MMR (measles, mumps, rubella) — at/after 12 months, Varicella (chickenpox) — at/after 12 months, Doses must follow the Missouri Child Care/Preschool Immunization Requirements schedule (ACIP-aligned, incl. catch-up spacing), Exemptions allowed: Medical exemption (form Imm.P.12, licensed physician) and Parent/Guardian (religious/parental) exemption (form Imm.P.11) filed with the facility; 'in progress' status permitted only with an Immunizations In Progress form (Imm.P.14) on file showing the next-dose due date, Facility/administrator must keep an immunization record for each child and submit an annual immunization status summary report (survey) to DHSS by January 15 each year.

Are immunization exemptions allowed in Missouri?

Missouri permits documented medical exemptions and, where state law allows, certain non-medical exemptions. Confirm the current exemption rules with the Missouri Department of Elementary and Secondary Education (DESE), Office of Childhood — Section for Child Care Regulation/Compliance (licensing of Group Child Care Homes and Child Care Centers under 5 CSR 25-500). Licensing authority and rulemaking transferred from the Dept. of Health and Senior Services (DHSS) to the DESE Office of Childhood in 2021; the licensing rules were formally MOVED from 19 CSR 30-62 to 5 CSR 25-500 (Title 5, Division 25, Chapter 500) and the old 19 CSR 30-62 sections now read 'Moved to 5 CSR 25-500.XXX'. DHSS retains the day care immunization rule (19 CSR 20-28.040) and the Family Care Safety Registry..

When must immunization records be on file in Missouri?

Missouri requires up-to-date immunization documentation at enrollment, with records kept current in each child's file thereafter.