Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance

Simon, Geoffrey R.; Edwards, Anne; Holmes, Breena; Boudreau, Alexy D. Arauz; Baker, Cynthia; Barden, Graham A.; Hackell, Jesse M.; Hardin, Amy Peykoff; Meade, Kelley; Moore, Scot; Richerson, Julia E.; Sobczyk, Elizabeth; Byington, Carrie L.; Maldonado, Yvonne; Barnett, Elizabeth D.; Davies, H. Dele; Edwards, Kathryn M.; Lynfield, Ruth; Muñoz, Flor M.; Nolt, Dawn; Nyquist, Ann Christine; Rathore, Mobeen H.; Sawyer, Mark H.; Steinbach, William J.; Tan, Tina Q.; Zaoutis, Theoklis E.; Kimberlin, David W.; Brady, Michael T.; Jackson, Mary Anne; Long, Sarah S.; Bernstein, Henry H.; Meissner, H. Cody; Campos‐Outcalt, Douglas; Cohn, Amanda C.; Farizo, Karen M.; Fischer, Marc; Gellin, Bruce G.; Gorman, Richard L.; Halasa, Natasha; Robinson, Joan; Deseda-Tous, Jamie; Starke, Jeffrey R.; Frantz, Jennifer; Wheeler, J. Gary; Brooks, Tami H.; Graff, Nancy R.; McManus, Michael L.; Pérez, Víctor Hugo; Raulerson, Marsha Dendler; Dinther, Ian Van; Allison, Mandy A.; Ancona, Richard; Attisha, Elliott; Beers, Nathaniel; Pinto, Cheryl De; Gorski, Peter A.; Kjolhede, Chris L.; Lerner, Marc; Weiss-Harrison, Adrienne; Young, Thomas; Fekaris, Nina; Johnson, Veda; Kataoka, Sheryl H.; Leonard, Sandra; Diasio, Christoph; Cain, Kathleen K.; Lessin, Herschel R.; Marconi, Jeanne Marie; Schonfeld, Gail Ann; Shenkin, Budd N.; Wong, Rudolph; Moore, John Eiland; Ferguson, Elisha

doi:10.1542/peds.2016-2145

Cited by 34 publications

(8 citation statements)

References 15 publications

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“…The statewide increase in the number of children with MEs in 2016 and the county-level correlation with past PBE use suggest that some vaccine-hesitant parents may have successfully located physicians willing to exercise the broader discretion provided by SB 277 for granting MEs. If true, this practice would be inconsistent with the recommendation from the American Academy of Pediatrics to reserve MEs for children having contraindications . However, the study has limitations.…”

Section: Discussionmentioning

confidence: 93%

Change in Medical Exemptions From Immunization in California After Elimination of Personal Belief Exemptions

Delamater

Leslie

Yang

2017

JAMA

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California Senate bill (SB) 277 eliminated the personal belief exemption (PBE) provision from the state's school-entry vaccine mandates prior to the 2016-2017 school year. Previously, vaccine-hesitant parents could acquire a PBE for their child based on philosophical or religious beliefs. Now, the only pathway for an unvaccinated kindergartener to enter a public or private school in California is with a medical exemption (ME), which requires a written statement from a licensed physician describing the medical reasons that immunization is unsafe. 1 Previously, MEs were only granted to children with a contraindication to vaccination; however, SB 277 gave physicians broader discretion to grant MEs for reasons other than a contraindication, including family medical history. 2,3 One concern voiced after the passage of SB 277 was whether vaccine-hesitant parents would seek MEs as replacements for PBEs and would find physicians willing to oblige them. 4 We evaluated the statewide change in MEs in the first year under SB 277 and whether MEs increased in regions with high PBE use prior to its enactment.Methods | We used publicly available data from the California Department of Public Health's yearly Kindergarten Immunization Assessment reports. Each year, all schools are required to submit kindergarten enrollment, vaccination, and exemption data; more than 95% of all kindergarteners are represented in the yearly reports, which include statewide and county-level data. We extracted the statewide ME and PBE percentages for incoming kindergarteners from 1996 to 2016. We calculated and mapped the 1-year change in ME percentage (2015 to 2016) for counties and used Pearson correlation to test whether county-level change in ME percentage was associated with PBE use in the year prior to the implementation of SB 277. We used ArcGIS (Esri), version 10.

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Section: Discussionmentioning

confidence: 93%

Change in Medical Exemptions From Immunization in California After Elimination of Personal Belief Exemptions

Delamater

Leslie

Yang

2017

JAMA

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“…Importantly, refusal of care in the hospital may indicate that these mothers are more likely to refuse preventive care for their children and could indicate the need for a specified counseling approach that accounts for their needs and preferences. Likewise, the notable regional and ideological differences suggest a possible need for targeted education efforts in the Western United States and may provide support for the recent AAP call for elimination of nonmedical exemptions for immunizations prior to school entry (Simon, Byington, Diasio, Edwards, & Holmes, 2016).…”

Section: Discussion Id:ti0035mentioning

confidence: 95%

Distinguishing Subgroups in Opposition to Infant Immunization: Results From the Listening to Mothers III Survey

Ranchoff¹,

Declercq²

2019

J Perinat Educ

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ObjectiveTo investigate factors associated with parental intention of refusing or altering their child's vaccination schedule.MethodsData were from the 2011–2012 Listening to Mothers III survey (N = 1,053). Weighted bivariate and multivariate analyses examined factors related to refusing or altering vaccination.Results3.2% of mothers planned to refuse vaccination and 12.3% preferred to alter the recommended schedule. Preference to refuse was associated with maternal age <25 years (AOR 4.33; 95% CI: 1.18, 15.9), prior refusal of maternity care (AOR 6.04; 95% CI: 1.88, 19.4), and living outside of the Northeast. Schedule modification was only associated with prior refusal of care.ConclusionsMothers preferring not to immunize their children and those wishing to alter the vaccination schedule represent two distinct groups.

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“…One avenue, shown to work in California, is the elimination of all non-medical exemptions [45]. The American Academy of Pediatrics supports this direction, and has produced a policy statement calling for all states to eliminate non-medical exemptions from their state-level immunization policies [156]. However, the unintended consequence of an increase in medical exemption rates -which notably tripled in California -highlights a potential pitfall with this approach.…”

Section: Expert Commentarymentioning

confidence: 99%

Current landscape of nonmedical vaccination exemptions in the United States: impact of policy changes

Bednarczyk

King

Lahijani

et al. 2019

Expert Review of Vaccines

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Introduction: In the United States, high childhood vaccination coverage has reduced the morbidity and mortality due to vaccine-preventable diseases. The success of vaccination programs in achieving this high coverage is due, in part, to vaccination mandates for school entry. All states have such mandates, but there is heterogeneity across the states in the allowance of non-medical exemptions (e.g. religious or personal belief exemptions) to these mandates. Areas covered:We examine historical trends in non-medical exemption prevalence in the US, discuss recent state-level policy changes that may impact non-medical exemption prevalence, and review recent studies on the association between non-medical exemptions and infectious disease outbreaks. Expert commentary:State-level implementation of mandates, and related allowances for medical and non-medical exemptions, varies greatly across the United States. Non-medical exemption rates have increased over the last two decades, with an increased risk of disease outbreaks in clusters of children with non-medical exemptions due to differences in state laws. Recent efforts to address non-medical exemption rates range from incorporating additional administrative requirements for exemptions and disallowance of any non-medical exemptions. Continued monitoring is needed to evaluate the impact of these changes on exemption rates, to develop optimal childhood vaccination policy across the United States.

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Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance

Cited by 34 publications

References 15 publications

Change in Medical Exemptions From Immunization in California After Elimination of Personal Belief Exemptions

Change in Medical Exemptions From Immunization in California After Elimination of Personal Belief Exemptions

Distinguishing Subgroups in Opposition to Infant Immunization: Results From the Listening to Mothers III Survey

Current landscape of nonmedical vaccination exemptions in the United States: impact of policy changes

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