Understanding the Immunization of School Pupils Act (ISPA): which vaccines are required for school, how exemptions work, who you report to, and what to do if you receive a letter from public health.
The key idea in one paragraph
Ontario's Immunization of School Pupils Act (ISPA) requires children attending primary and secondary school to be immunized against a specific list of diseases — or to have a valid exemption on file with their local public health unit. The requirement is based on diseases, not specific vaccine brand names. Parents and caregivers are responsible for making sure their local public health unit has an up-to-date record. If records are incomplete and no exemption is on file, a child may be suspended from school until the matter is resolved.
Please note: this page is for general education and is not legal advice. School immunization requirements, documentation, suspension and outbreak-exclusion processes, and exemption procedures are administered through local public health units and may change. Families should confirm their child's status and any current requirements directly with their local public health unit.
Under ISPA, children must be immunized against the following designated diseases, unless they have a valid medical or non-medical exemption on file:
*About varicella (chickenpox)
The varicella requirement applies specifically to children born in 2010 or later. For older children born before 2010, varicella is recommended but is not part of the school attendance requirement. Always confirm current details with your local public health unit.
These diseases are covered by the vaccines in Ontario's routine schedule — for example, the 5-in-1 vaccine covers diphtheria, tetanus, pertussis, and polio; MMR and MMRV cover measles, mumps, rubella, and varicella; and the meningococcal vaccines cover meningococcal disease. You don't need to track individual brand names — your public health unit matches your child's record against the required diseases.
This is one of the most common sources of confusion. In Grade 7, public health nurses visit schools to offer several vaccines. But not all of them are required for attendance:
Required for attendance (ISPA)
Meningococcal (Men-C-ACYW) protects against meningococcal disease, which is on the ISPA list — so it is required for school attendance (unless exempt). See the Men-C-ACYW profile.
Offered at school, but NOT required for attendance
Hepatitis B and HPV are publicly funded and offered through the Grade 7 school program, and both are recommended — but neither is currently an ISPA-designated disease for routine school attendance. Missing them does not usually trigger the same ISPA suspension process as missing a required vaccine, though families should confirm current requirements with their local public health unit. Participation is a choice.
In short: being offered a vaccine at a school clinic doesn't automatically make it a requirement for attendance. The requirement comes from the ISPA disease list, not from where the vaccine happens to be offered.
The most important thing to know
In Ontario, healthcare providers do not automatically report your child's vaccines to public health. Parents and caregivers are responsible for making sure their local public health unit has the records. This is the single most common reason families receive "missing immunization" letters — the vaccine was given, but the record never reached public health.
After your child is vaccinated:
Make sure it's on your child's record
Ask the provider to update your child's immunization record (the "yellow card") at each visit, and keep it somewhere safe.
Report it to your public health unit
Submit the update to your local public health unit. Many units use Immunization Connect Ontario (ICON), an online tool where you can report doses yourself.
Keep doing it after each new dose
Reporting isn't a one-time task — each new vaccine needs to be reported so the record stays current as your child moves through the schedule.
See the Resources page for the ICON link and the public health unit locator.
These letters can feel alarming, but they're usually a records issue, not a sign that anything is wrong. Public health sends them when their records show one or more required vaccines as missing — which often simply means a dose your child already received was never reported to them.
Don't panic — read the letter carefully
It will say which vaccines or diseases their records show as missing, and give a deadline and contact information. The goal is to resolve the records gap before the deadline.
Check your child's record
Compare the letter against the immunization record (the "yellow card") or clinic records. In many cases, the vaccine was given but never reported.
If the vaccine was already given: report it
Submit the record to public health (through ICON or however your unit prefers). This usually resolves the letter.
If a vaccine is genuinely missing: make a plan
Book with a provider or public health to catch up, or — if you're seeking an exemption — begin that process. See Catch-Up Help or the Exemptions section below.
Contact public health with any questions
The contact details are on the letter. They can tell you exactly what they have on file and what's needed to resolve it.
About suspension orders
If records aren't updated and no exemption is filed by the deadline, public health can issue a suspension order. A suspension is not permanent — it's lifted once the records or exemption are provided. Acting before the deadline is the best way to avoid this.
Ontario law allows two types of exemption from the ISPA requirements. This section describes the process neutrally; it is not legal advice, and the exact steps can vary by public health unit.
Medical exemption
For children who cannot receive a vaccine for medical reasons. A physician or nurse practitioner completes and signs the official Statement of Medical Exemption form, which is then submitted to your local public health unit.
Non-medical exemption (conscience or religious belief)
For parents or guardians seeking an exemption on the basis of conscience or religious belief. The process generally involves three steps: (1) complete a vaccine education session through your local public health unit and obtain a Vaccine Education Certificate; (2) complete the official Statement of Conscience or Religious Belief form, which must be sworn or affirmed before an authorized official such as a commissioner of oaths or notary public; and (3) submit both documents to your local public health unit.
Both official forms are available through the Government of Ontario, with links on our Resources page. Because the process — particularly for non-medical exemptions — involves specific steps and an education session, it's best to contact your local public health unit early to understand exactly what they require.
Exemptions allow a child to attend school without certain vaccines under normal circumstances. However, during an outbreak of a vaccine-preventable disease (such as measles), public health has the authority to temporarily exclude children who are not protected against that disease — including those with exemptions — to limit the spread and protect them and others.
This exclusion is temporary and specific to the outbreak situation. If this happens, your local public health unit will provide guidance on when the child can return to school. It's one reason public health encourages families to keep immunizations up to date even when an exemption is on file.
Sources
Please note: This is an independent website. It is not affiliated with, endorsed by, or operated by the Government of Ontario, the Ministry of Health, or any public health unit. The information here is for general education only and is not medical advice — always consult a licensed healthcare provider about your or your child's immunizations.