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Source: Journal of Infectious Diseases

By: Stadlin, Stephanie ; Bednarczyk, Robert A. ; Omer, Saad B.

08/29/2012

Medical exemptions from school entry immunization requirements are allowed by all 50 states, but how frequently they are granted and the ease with which they are obtained have not previously been examined in detail. In this study, researchers evaluated the counts and rates of state-level medical exemptions to kindergarten entry requirements during seven school years (2004–2005 through 2010–2011), finding that 0.26 percent to 0.41 percent of enrolled children received medical exemptions. In states with easier medical exemption criteria, medical exemption rates were significantly higher. The researchers compared state-level kindergarten entry medical exemption rates across the 2004–2005 through 2010–2011 school years. States were categorized by criteria required for medical exemptions and length of medical exemptions that could be granted (permanent only; temporary only; permanent and temporary). Medical exemption criteria were ranked based on the presence or absence of six administrative requirements: written physician statement, separate medical exemption form, health department approval, physician certified to practice in-state, annual approval, and notarization of medical exemption forms. The highest rate of medical exemptions was found in states with difficult nonmedical exemption criteria and easy medical exemption criteria. The researchers concluded that the appropriate use of medical exemptions is important to maintaining sufficient herd immunity to protect those who require these medical exemptions from vaccinations. It is important to ensure that medical exemptions are actually medically indicated in order to protect children who should not be vaccinated because of medical conditions that can arise from adverse reactions to vaccination. The authors note, “Medical exemption rates need to be monitored and continuously evaluated to ensure that medical exemptions are not granted solely because they are easier to obtain than other types of exemptions.”