Health Insurance and Immunizations

As part of the matriculation process into the PA Program, the Department of Physician Assistant Studies requires all students to meet the immunization requirements recommended by the Centers for Disease Prevention and Control (CDC) for Health Personnel.

Students are required to present evidence that they are in good health and free from communicable disease*. With the exception of the hepatitis B immunization series and titer demonstrating immunity, all immunizations must be completed within 30 days of matriculation. Students must maintain compliance with all recommended immunizations by the CDC throughout the Program or they will not be allowed to volunteer at Open Door Clinic or participate in patient care in clinical settings. Students are required to maintain immunization compliance and renew immunizations before they lapse.

Health and immunization forms of each student must meet the requirements of Elon University, the DPAS program, and the North Carolina Department of Health and Human Services.  A copy of the student’s immunization records, including the tuberculosis screening results, as well as those required for supervised clinical experiences, will be uploaded by the student into the clinical education database, Exxat. Students should also keep copies for themselves readily available.  In order to allow the Program to release the information to clinical sites, students will sign the Student Release of Information Form provided in this manual.  All other student health records are confidential and will not be accessible by Program faculty or staff.

*A student with chronic hepatitis B infection will be allowed to enroll if they meet all other Program requirements but will be monitored to ensure that they are in compliance with the 2012 Centers for Disease Control and Prevention (CDC) Updated CDC Recommendations for the Management of Hepatitis B Virus-Infected Health-Care Providers and Students found at: http://www.cdc.gov/mmwr/pdf/rr/rr6103.pdf

The CDC noted that since its last update in 1991, there have been no reports of hepatitis B transmission in the United States or other developed countries from “medical or dental students . . . or any others who would not normally perform exposure-prone invasive procedures.”

In brief: The CDC’s updated recommendations provide current medical information about managing students in health-related schools who have hepatitis B. The CDC recommends that DNA serum levels be relied on, rather than hepatitis B e-antigen status, to monitor infectivity and states that individuals with hepatitis B can conduct exposure-prone invasive procedures if a low or undetectable hepatitis B viral load is documented by regular testing at least every six months. The CDC also recommends that a hepatitis B viral level of 1,000 IU/ml (5,000 GE/ml) or its equivalent is an appropriate viral load threshold for a review panel to adopt. The CDC stresses that for most students with chronic hepatitis B “who conform to current standards for infection control, [hepatitis B virus] infection status alone does not require any curtailing of their supervised learning experiences.” Students with chronic hepatitis B virus infection may have restrictions imposed on their participation in exposure-prone invasive procedures, CDC notes the challenges posed in defining exposure-prone invasive procedures that pose a risk for hepatitis B virus transmission and cautions against defining “exposure-prone procedures too broadly; the great majority of surgical and dental procedures have not been associated with the transmission of [hepatitis B virus].” CDC classifies exposure-prone invasive procedures as “limited to major abdominal, cardiothoracic, and orthopedic surgery, repair of major traumatic injuries, abdominal and vaginal hysterectomy, caesarean section, vaginal deliveries, and major oral or maxillofacial surgery (e.g., fracture reductions).”

Refer to the School of Health Sciences Immunization Packet that was provided to students prior to matriculation into the Program for the list of specific requirements and their descriptions, also detailed below.

Specific Requirements:

1. Proof of current health insurance. As required by Elon University and the Department of Physician Assistant Studies, current health insurance is mandatory for each year of enrollment in the Program. Students will be required to provide a copy of their insurance card to the Program in January each year. This will be maintained in the student file.
2. Proof of two immunizations against measles, mumps, and rubella (MMR) or laboratory evidence of a positive (immune) titer against each of the three infections. In the absence of proof of either immunization or immunity, students must be immunized at the RN Ellington Center for Health and Wellness or by their primary care provider.
3. Proof of a negative PPD skin test for tuberculosis* (by Mantoux) within the past year; and, if positive, proof of a chest x-ray negative for active disease. Additionally, the TB skin test must be repeated in the latter part of the academic year (October-November) and again 1 year later in the clinical education phase. * An acceptable alternative test is a negative Interferon- Gamma Release Assay (IGRA), which is a blood test for TB Infection from your health care provider. The commercial names of these tests are QuantiFERON- TB Gold In-tube or T-SPOT.
4. Documentation of two varicella (chickenpox) immunizations or proof of positive (immune) varicella titer. In the absence of proof of either immunization or immunity, students must be immunized at the RN Ellington Center for Health and Wellness or by their primary care provider.
5. Diphtheria, Pertussis and Tetanus: Documentation of a completed primary series with Tdap or DTP and booster within the last ten years. All students must have documentation of a one-time dose of Tdap either as part of their primary series or as a booster. Students may be immunized at the RN Ellington Center for Health and Wellness or by their primary care provider.
6. Proof of the three-dose immunization against hepatitis B. This series must be started within 30 days of matriculation. Following completion of the Hepatitis B series, a positive (immune) titer must be completed prior to patient contact. Non-converters may require additional immunizations per the CDC recommendations.
   1. For students with chronic hepatitis B infection*, the program will follow the Updated CDC Recommendations for the Management of Hepatitis B Virus-Infected Health-Care Providers and Students detailed above and require DNA serum levels every 6 months to monitor infectivity levels. Students whose hepatitis B level is not undetectable or below level of 1,000 IU may require limitation of exposure-prone invasive procedures or modifications in their clinical training as required by the Program or clinical education sites.
7. Proof of influenza vaccination annually.

H.   Proof of immunization or exemption request is required per Healthy Elon guidelines. Clinic sites may not accept exemptions, which may prolong the clinical phase of training.

Remain aware of the immunizations listed below that require annual renewal and update prior to expiration. Keep your student passport/profile in Exxat up to date with current immunization documentation.

1. The tuberculosis PPD test must be repeated in the latter part of the academic year (November) and again 1 year later in the clinical education phase.
2. Influenza vaccination
3. Proof of completed COVID-19 vaccination to include evidence of any boosters
4. Basic Life Support for Healthcare Providers (BLS)
5. Reminder: Urine Drug Screen and Criminal Background Check are to be completed through Viewpoint annually as well.

Students are financially responsible for the cost of maintaining compliance with all health, health insurance and immunization requirements.

International Rotation Immunization Requirements: In addition to the above health and immunization requirements for all Elon PA students, there will be supplementary immunization and health requirements for students going to international rotations. This will include any routine and required immunizations and health recommendations for the country as recommended by the Centers for Disease Control and Prevention Travel Medicine website at: http://wwwnc.cdc.gov/travel/page/vaccinations.htm Students traveling abroad will be instructed to follow safety precautions for the country of interest which are available through the US Department of State website: https://travel.state.gov/content/travel/en/international-travel.html

Students completing international rotations also will be required to obtain medical and evacuation insurance. This is available through one of through the following companies: https://travel.state.gov/content/travel/en/international-travel/before-you-go/your-health-abroad/insurance-providers-overseas.html

Additional information for students traveling internationally is available through the Elon University Isabella Cannon International Center website: http://www.elon.edu/e-web/academics/international_studies/default.xhtml

Infectious Disease/Environmental Exposure – Didactic Year

The Elon University Department of Physician Assistant Studies has a commitment to protect the health and well-being of students, faculty, staff, and patients. As part of their training, students may encounter exposure to infectious and environmental hazards. This may include being exposed to human donors and preservative chemicals such as formaldehyde in the anatomy lab, latex, or other products such as gloves that may contain allergens, and exposure to communicable infectious disease which may be transferred via airborne, mucous membrane splashes, or needle-stick exposures in the clinical setting. While the risk of transmission is small, the Program has a number of policies and procedures in place to minimize risk.

1. Students in the Department of Physician Assistant Studies are required to show proof of appropriate immunity, or documented immunization, as part of their matriculation requirements and prior to the onset of actual patient contact. Furthermore, each student matriculating into the Program will be required to have a negative test for COVID-19 before beginning classes in the Francis Center. Ultimately, each student is responsible for their health and safety in the educational and clinical settings. Therefore, it is the goal of the Department of Physician Assistant Studies that all students learn appropriate policies and procedures to follow in the event they are injured or potentially exposed to blood-borne pathogens or other communicable diseases. Examples of blood-borne pathogens and communicable disease may include tuberculosis, hepatitis B, hepatitis C, and HIV. Women of child-bearing age may also have additional considerations, such as minimizing exposure to infectious diseases, possible teratogens or chemical exposures, or exposure to ionizing radiation.
2. During the academic year of training, presentations are given on universal blood and body fluid precautions, infection control, and prevention of the spread of communicable disease. In addition to instruction on how to prevent exposures, students will receive instruction on what constitutes an “exposure” and the procedures for care and treatment after an exposure. In the event of respiratory or gastrointestinal illness, students are advised to follow health provider recommendations to self-isolate at home until they are no longer potentially infectious to others. Students will need to notify the program of the intended absence and fill out an absence request form upon their return to class.

   Students also will be provided with safety policies to follow in the anatomy laboratory (as detailed in the DPT Safety Manual located in the Anatomy Lab). Allergy to formaldehyde and/or latex (previous and subsequent to enrollment) must be verified by a physician, PA, or NP. The student must give this information to the RN Ellington Center for Health and Wellness and the Coordinator of Disabilities Services, in order for protective mask/cartridge or other accommodations to be approved. Additional instruction on procedures for care and treatment of exposures in the clinical setting will be provided as part of orientation to the clinical education phase.

3. The student is financially responsible for any costs incurred secondary to infectious and/or environmental hazardous exposures.
4. Effects of infectious or environmental disease or disability – acquisition of an infectious or environmental disease may impact student learning activities and outcomes. Students must be able to meet published health requirements at all times in order to continue matriculation in the Program and to provide care at clinical sites. Based upon outcomes and degree of infectious or environmental hazard exposure, a student’s continued participation in classroom and/or clinical activities as part of the PA Program may be delayed or prevented. In the event that the student contracts a communicable disease which potentially poses a risk to patients or co-workers (e.g., tuberculosis, COVID-19), steps will be taken to prevent dissemination in accordance with Student Health Services, public health, and/or Centers for Disease Control and Prevention protocols. Certain communicable diseases may also be reported to county or state health authorities, as required by law. A list of reportable disease for North Carolina may be found at: https://epi.dph.ncdhhs.gov/cd/lhds/manuals/cd/reportable_diseases.html