6 Personal belief exemptions include religious, philosophical, and any other unspecified nonmedical exemption. As of March 2006, all states permitted medical exemptions to school and daycare immunization requirements 48 states allowed religious exemptions and 19 states had a provision for personal belief exemptions. ![]() 1 - 5 All states and the District of Columbia require children entering school to provide documentation that they have met the state vaccine requirements. State-mandated school immunization requirements have played a major role in achieving and maintaining low rates of vaccine-preventable diseases in the United States. States should examine their exemption policies to ensure control of pertussis and other vaccine-preventable diseases. ![]() State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence. In multivariate analyses adjusting for demographics, easier granting of exemptions (incidence rate ratio = 1.53 95% confidence interval, 1.10-2.14) and availability of personal belief exemptions (incidence rate ratio = 1.48 95% confidence interval, 1.03-2.13) were associated with increased pertussis incidence.Ĭonclusions Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. No statistically significant change was seen in states that offered only religious exemptions or that had medium and difficult exemption processes. In states that easily granted exemptions, the rate increased 5% per year, from 1.26% in 1991 to 2.51% in 2004. The mean exemption rate increased an average of 6% per year, from 0.99% in 1991 to 2.54% in 2004, among states that offered personal belief exemptions. Results From 2001 through 2004, states that permitted personal belief exemptions had higher nonmedical exemption rates than states that offered only religious exemptions, and states that easily granted exemptions had higher nonmedical exemption rates in 2002 through 2003 compared with states with medium and difficult exemption processes. ![]() Main Outcome Measures State-level exemption rates and pertussis incidence. Objective To determine if (1) the rates of nonmedical exemptions differ and have been increasing in states that offer only religious vs personal belief exemptions (2) the rates of nonmedical exemptions differ and have been increasing in states that have easy vs medium and easy vs difficult processes for obtaining exemptions and (3) pertussis incidence is associated with policies of granting personal belief exemptions, ease of obtaining exemptions, and acceptance of parental signature as sufficient proof of compliance with school immunization requirements.ĭesign, Setting, and Participants We analyzed 1991 through 2004 state-level rates of nonmedical exemptions at school entry and 1986 through 2004 pertussis incidence data for individuals aged 18 years or younger. The role of exemption policies may be especially important for pertussis, which is endemic in the United States. Exemptors are at increased risk of acquiring and transmitting disease. Most states offer nonmedical exemptions to school requirements (religious or personal belief).
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