Vaccination Coverage for Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2017–18 School Year

Seither, Ranee; Loretan, Caitlin; Driver, Kendra; Mellerson, Jenelle L.; Knighton, Cynthia L; Black, Carla L.

doi:10.15585/mmwr.mm6740a3

Cited by 79 publications

(47 citation statements)

References 8 publications

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“…We performed a cross-sectional, retrospective, state-level analysis of publicly available aggregated data from the Centers for Disease Control and Prevention yearly vaccine reports for kindergartners (2011-2012 through 2017-2018 school years). [12][13][14][15][16][17][18] We chose this time frame to extend and provide meaningful comparisons to a previous study of exemption data for kindergartners from 2011-2012 through 2015-2016. 6 For each report, states provide estimates of the proportion of children with medical and nonmedical (ie, religious and/or personal beliefs) exemptions as well as the proportion of kindergartners who are up to date on several vaccines of interest (eg, measles, mumps, and rubella; diphtheria, tetanus, and acellular pertussis; and varicella).…”

Section: Methodsmentioning

confidence: 99%

Religious Vaccine Exemptions in Kindergartners: 2011–2018

et al. 2019

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BACKGROUND: Forty-five states permit religious exemptions to school immunization laws; 15 allow personal belief exemptions. Updated religious exemption estimates are lacking, and it is unclear if personal belief exemption availability impacts religious exemption rates. We aimed to (1) update religious exemption trends in kindergartners, (2) compare states' proportions of kindergartners with religious exemptions by personal belief exemption availability, and (3) describe whether the proportion of kindergartners with religious exemptions changed in Vermont after it eliminated personal belief exemptions in 2016. METHODS: We analyzed Centers for Disease Control and Prevention data on exemptions for children entering kindergarten from 2011 to 2018, including 295 state-years in our final analysis. Using a quasi-binomial regression analysis, we compared mean proportions of kindergartners with religious exemptions in states allowing both nonmedical exemptions against states with religious exemptions only, adjusting for policy strength and school year. RESULTS: States with religious and personal belief exemptions were one-fourth as likely to have kindergartners with religious exemptions as states with religious exemptions only (risk ratio 0.25; 95% confidence interval 0.16-0.38). After Vermont's policy change, the mean proportion of kindergartners with a religious exemption increased from 0.5% to 3.7%. States were significantly more likely to have kindergartners with religious exemptions during the 2017-2018 school year compared with the 2011-2012 school year (P = .04). CONCLUSIONS: Religious exemption rates appear to be associated with personal belief exemption availability, may be subject to a replacement effect on personal belief exemption elimination, and are increasing. Researchers and policy makers should confirm findings with individuallevel studies and reconsider the purpose and nature of religious exemption laws.

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Section: Methodsmentioning

confidence: 99%

Religious Vaccine Exemptions in Kindergartners: 2011–2018

et al. 2019

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“…However, the data available for the 2017-2018 school year indicates that NMEs are already at near zero, with only 5 NMEs left in the entire state [15]. The immediate benefits may also markedly differ depending on whether non-medical exemptions are granted for several years (as was the case in California) or whether they require annual renewal because of state or school policies [37].…”

Section: Discussionmentioning

confidence: 99%

“…To assess the association between non-medical exemption rates and vaccination rates at the beginning of school years 2016-2017 and 2017-2018, we used data in kindergarten from 48 states and the District of Columbia [14, 15]. No vaccination data were available for Oklahoma in 2016-2017, and neither vaccination or non-medical exemption rates were reported for Wyoming in both years.…”

Section: Methodsmentioning

confidence: 99%

“…Finally, the state of California has strengthened its school immunization policies twice in the past decade: non-medical exemptions were made harder to obtain in 2013, and in 2015 new non-medical exemptions were barred from the beginning of the 2016-2017 school year [19]. For these states, we compiled data on non-medical exemptions in kindergartens from the Centers for Disease Control and Prevention (CDC) online annual school report results between 2003-2004 and 2010-2011, and from published annual surveys from school year 2011-2012 to school year 2017-2018 [20, 21, 22, 14, 23, 24, 15]. Data were not reported consistently for Illinois and Missouri for the period of 2012-2013 to 2016-2017.…”

Section: Methodsmentioning

confidence: 99%

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Getting personal: how vaccination exemptions shape herd immunity

Garnier

Sb³

et al. 2018

Preprint

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Background: State-mandated school entry immunization requirements in the United States play an important role in achieving high vaccine coverage and preventing outbreaks of vaccine-preventable diseases. Most states allow non-medical exemptions that let children remain unvaccinated on the basis of personal beliefs. However, the ease of obtaining such exemptions varies, resulting in a patchwork of state vaccination exemption laws, contributing to heterogeneity in vaccine coverage across the country. In this study, we evaluate epidemiological effects and spatial variations in non-medical exemption rates in the context of vaccine 1 policies. Methods and Findings:We first analyzed the correlation between non-medical exemption rates and vaccine coverage for three significant childhood vaccinations and found that higher rates of non-medical exemptions were associated with lower vaccination rates of school-aged children in all cases. We then identified a subset of states where exemption policy has recently changed and found that the effects on statewide non-medical exemption rates varied widely.Focusing further on Vermont and California, we illustrated how the decrease in non-medical exemptions due to policy change was concurrent to an increase in medical exemptions (in CA) or religious exemptions (in VT). Finally, a spatial clustering analysis was performed for Connecticut, Illinois, and California, identifying clusters of high non-medical exemption rates in these states before and after a policy change occurred. The clustering analyses show that policy changes affect spatial distribution of non-medical exemptions within a state.Conclusions: Our work suggests that vaccination policies have significant impacts on patterns of herd immunity. Our findings can be used to develop evidence-based vaccine legislation.Immunization requirements for school-entry date back to 1922 and have played a key role in 1 achieving high levels of vaccine coverage against communicable diseases in the United States 2 [1]. This patchwork of childhood immune protection, however, is punctured by a hetero-3 geneous set of state-specific vaccination exemption rules. Medical exemptions to mandated 4 vaccinations are available in all 50 states, and 47 offer non-medical exemptions in some form. 5Namely, 18 states offer personal belief exemptions for those who object to vaccinations for 6 philosophical or moral reasons. In the remaining states offering non-medical exemptions, 7 they are limited to religious beliefs. In the remaining three states (California, Mississippi, 8 and West Virginia), only medical exemptions are available. While this has been the policy 9 in Mississippi and West Virginia for decades [2], the ban on non-medical exemptions in Cal-10 ifornia (enacted by CA Senate Bill 277 in January 2016) was motivated by the 2015 measles 11 outbreak in the state [3] in which suboptimal vaccination rates in school-aged children was 12 an important factor in the magnitude of the outbreak [4]. 13The ease of obtaining non-medical exemptions vari...

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“…Another report by the CDC2 said that 2017 was the third consecutive year in which the number of student immunisation exemptions for non-medical reasons climbed slightly.…”

mentioning

confidence: 99%

Number of unvaccinated US children has quadrupled since 2001

Dyer

2018

BMJ

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Vaccination Coverage for Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2017–18 School Year

Cited by 79 publications

References 8 publications

Religious Vaccine Exemptions in Kindergartners: 2011–2018

Religious Vaccine Exemptions in Kindergartners: 2011–2018

Getting personal: how vaccination exemptions shape herd immunity

Number of unvaccinated US children has quadrupled since 2001

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