Unit Policy
Title
School of Medicine: Policy on Health, Safety, and Immunization
Introduction
Purpose
This Policy establishes the requirements for immunizations, health insurance and annual and periodic medical testing to ensure compliance with State of North Carolina and University of North Carolina at Chapel Hill ("UNC-Chapel Hill") School of Medicine (SOM) standards in the clinical environment.
Scope
This Policy is applicable to medical students enrolled in the UNC-Chapel Hill SOM.
Policy
Policy Statement
General Requirements
- Students enrolled in the SOM are required to meet immunization standards set by the State of North Carolina in addition to those set by the SOM to ensure safety in the clinical environment.
- Upon matriculation, students are required to upload immunization documentation required by the State into their ConnectCarolina portal. Information about specific immunization requirements can be found at https://campushealth.unc.edu/services/immunizations/.
- Students can receive all vaccinations and tests by appointment at Campus Health. Seasonal influenza and COVID‐19 booster vaccines are frequently available at walk‐in clinics across campus during the fall semester.
- Health sciences students, including medical students, have additional health and safety requirements that promote student health and help to “minimize the potential for transmission of communicable diseases within our community” (Campus Health website). Accordingly, all medical students must complete additional requirements listed in the Appendix, Additional Health and Safety Requirements, to this Policy.
- Upon matriculation, students are required to complete an initial background check. Upon the completion of the Foundation Phase of the SOM curriculum, students entering the Application Phase of the curriculum are required to complete a second background check and a urine drug screen. Each regional campus of SOM where students may be participating in phases of the school curriculum may have different deadlines for specific completion of these requirements and students are required to meet the applicable campus deadlines.
- Students are required to maintain continuity in compliance with these requirements from matriculation through the date of graduation. Students on academic leave and who are enrolled in a UNC‐sponsored degree program are required to maintain compliance.
Additional Health and Safety Requirements
HEPATITIS B
The Hepatitis B requirement includes both a primary Hepatitis B vaccination series and a positive, quantitative surface antibody titer (HBsAb; lab report required, which should include numerical value with a reference range). The positive (>10 mIU/mL) serological quantitative Hepatitis B surface antibody titer must be performed no earlier than six (6) weeks and no later than eight (8) weeks after the final vaccine of a series.
Two different primary Hepatitis B series are available as follows:
- Traditional three (3) vaccine series and titer (completed in ~6.5 months):
- Vaccine #1: Birth or anytime
- Vaccine #2: At least one (1) month after first vaccine
- Vaccine #3: At least five (5) months after second vaccine
- Quantitative antibody titer: At least six (6) weeks after final vaccine
- Hepislav‐B® vaccine series and titer (completed in ~2.5 months):
- Vaccine #1: Birth or anytime
- Vaccine #2: At least four (4) weeks after first vaccine
- Quantitative antibody titer: At least six (6) weeks after final vaccine
Students who have completed both a childhood Hepatitis B series and an adult series and whose final titer is negative must be evaluated and counseled appropriately by a UNC Campus Health provider.
CHICKEN POX
The chicken pox vaccination requirement may be met in one of two ways as described here:
- Two (2) chicken pox vaccinations:
- Vaccine #1: Birth (or anytime)
- Vaccine #2: At least one month after first vaccine
- No titer is required
- Positive antibody titer (results documented by medical professional or lab report; qualitative is acceptable, for example: "Positive" or "Immunity")
Chicken pox titers can be qualitative. A notation of "positive" or "immunity" without a quantitative (numerical) value is acceptable. If you have had two chicken pox vaccinations, a titer is not required. History of disease is not acceptable as meeting the vaccination requirements. However, if you have had chicken pox, discuss with your healthcare provider the option of receiving a titer instead of the vaccines.
TETANUS, DIPHTHERIA, & PERTUSSIS (DPT)
Students who have not received tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) or for whom pertussis vaccination status is unknown are required to receive one (1) dose of Tdap, followed by a tetanus and diphtheria toxoids (Td) booster every ten (10) years.
COVID‐19
Students are required to receive an initial series against Covid‐19 with one of the Food and Drug Administration’s three authorized/licensed vaccination products:
- Pfizer‐BioNTech and Moderna
- Novavax
- J&J/Janssen (no longer available for use in the United States; vaccination must have been received before May 6, 2023)
While annual booster vaccines are not required, they have been demonstrated to significantly reduce the severity and duration of Covid‐19 symptoms.
TUBERCULOSIS TESTING
Matriculating students who have not previously tested positive for tuberculosis (TB) must provide documentation of one of the following two (2) testing methods:
- IGRA blood test (QuantiFERON Gold or T‐Spot; lab report required) within the past twelve (12) months
- Two‐ (2) step TB skin test: an initial two-step skin test (TST), followed by repeat TST 1‐3 weeks later if initial test is negative, within the past twelve (12) months. The (TST) requires four (4) visits to a healthcare provider:
- TST #1 placed
- TST #1 read (no earlier than forty-eight (48) hours and no later 72 hours after placement)
- TST #2 placed (no earlier than one week and no later than three weeks after the first read)
- TST #2 read (no earlier than forty-eight (48) hours and no later 72 hours after placement)
This requirement must be renewed annually. Students who completed an initial TST upon matriculation may renew annually with a one‐step skin test. Students who completed an initial IGRA test are encouraged to annually continue to receive the blood test. A student who previously tested using the IGRA and who wishes to renew with a skin test must first get the TST skin test and may renew each year thereafter with a one‐ (1) step skin test.
A student who has previously tested positive for TB (i.e., latent tuberculosis) must provide both:
- Chest x‐ray (CXR) performed after the initial positive TB test result. Chest x‐ray report and positive TB screening test result are both required.
- Completed school form (TB Symptom Questionnaire) including healthcare provider clearance within the past twelve (12) months. This clearance can be completed at Campus Health.
Students who have previously tested positive for TB must annually renew this requirement with an updated provider clearance form.
The Bacillus Calmette‐Guérin (BCG) vaccine for TB, frequently administered in childhood in persons not born in the United States, is not an acceptable alternative to annual TB testing. Students who have received the BCG vaccine are strongly encouraged to complete the IGRA test rather than the skin test, as the BCG vaccination may cause a false‐positive reaction.
INFLUENZA
Documentation of an annual influenza vaccine is required. Students are not required to complete this vaccination upon matriculation but must receive the seasonal vaccination in the fall of each year to meet the annual September 20 deadline.
HEALTH INSURANCE
Upon matriculation, students must upload verification of health insurance for the current year. If a student will not have coverage until they are enrolled as a SOM student, they can upload their proof immediately following the start of classes.
While the UNC System has approved faith‐based community health sharing programs (health share) as an acceptable alternative to the University's mandatory student health plan, UNC Health and other clinical partners do not accept health shares as valid health insurance. Students on such health share plans (e.g., Medi‐Share, Christian Health Ministries, Shared Health Alliance) must purchase health insurance from a valid insurer. This can be done through StudentBlue at Campus Health; through the federal government health insurance marketplace, or through a private insurer.
Students are required to upload their proof of health insurance into Viewpoint by January 31 of each year.
Exceptions
- Students who are on personal, medical or administrative leave from the medical school curriculum are not required to comply with this Policy during the approved period of leave.
Noncompliance
- Noncompliance puts patients, physicians, and fellow learners at risk for serious illness or transmission of disease. Students who are noncompliant with the expectations defined in this Policy will not be permitted to attend classes, with such absence designated as an unexcused absence. Noncompliant students will be referred to the Committee for Professionalism Education (COPE).
- Students with repeated missed compliance deadlines may be referred to the Student Progress Committee at the discretion of the Associate Dean for Student Affairs.
Definitions
- Compliance: A medical student’s immunization and test records are:
- approved in SOM’s compliance platform, Viewpoint,
- up-to-date, and
- valid until the next renewal deadline in accordance with each student’s immunization and test records.
Related Requirements
External Regulations
Unit Policies, Standards, and Procedures
Contact Information
Primary Contact
Name: Valerie Glassman, EdD, Senior Director for Student Affairs
Email: valerie_glassman@med.unc.edu