Conditional admission, religious exemption type, and nonmedical vaccine exemptions in California before and after a state policy change

• Type of Material: Article
• Authors: Alison M. Buttenheim, University of Pennsylvania; Malia Jones, University of Wisconsin; Caitlin Mckown, University of Wisconsin; Daniel Salmon, Johns Hopkins University; Saad Omer, Emory University
• Language: English
• Date: 2018-06-18
• Publisher: Elsevier Science Ltd.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier Ltd.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.vaccine.2018.05.050
• Title of Journal or Parent Work: Vaccine
• Volume: 36
• Issue: 26
• Start Page: 3789
• End Page: 3793
• Grant/Funding Information: This work was supported by funding from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (R03HD080732) and from the Robert Wood Johnson Foundation.
• Keywords: Law; Measles; State policy; School health; Research & Experimental Medicine; Immunization; Medicine, Research & Experimental; Life Sciences & Biomedicine; School immunization requirements; Surveillance; Pertussis; Vaccines; Science & Technology; United States; Infectious disease; Immunology
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Immunology; Health Sciences, Public Health

Abstract

Recent measles and pertussis outbreaks in the US have focused national attention on state laws governing exemptions from mandatory vaccines for school entry. After several years of increases in nonmedical exemptions in California, the state assembly passed Assembly Bill 2109 in 2012, making nonmedical exemptions more difficult to obtain by requiring parents to obtain a signature from a health care provider. We used data from the California Department of Public Health to describe changes in the overall prevalence of personal belief exemptions and compositional changes in immunization status for the school years 2012–2013 through 2015–2016. Following the implementation of Assembly Bill 2109, the statewide exemption rate declined from 3.1% in 2013 to 2.5% in 2014 and then to 2.3% in 2015, representing a 25% reduction from the 2013 peak. Continued surveillance of exemption rates and vaccine refusal are needed to monitor and protect herd immunity against vaccine-preventable diseases.