Medical Exemptions to School Immunization Requirements in the US
All 50 US states allow medical exemptions from school entry immunization requirements. The extent to which medical exemptions are granted and the relationship with ease of obtaining these exemptions has not previously been examined in detail. We evaluated counts and rates of state-level medical exemptions to kindergarten entry requirements over 7 school years (2004–2005 through 2010–2011). During this period, 0.26%–0.41% of enrolled children received medical exemptions. In states with easier medical exemption criteria, medical exemption rates were significantly higher (adjusted incidence rate ratio: 6.4 [95% confidence interval: 2.7–15.6]). Routine evaluation of medical exemption rates is needed to ensure their appropriate use.
School entry immunization requirements have resulted in low vaccine preventable disease levels and high vaccine coverage in the United States [1
]. All 50 states allow medical exemptions from immunizations required for school entry (http://www.vaccinesafety.edu/cc-exem.htm
). Improper medical exemption usage, such as granting a medical exemption when there is no diagnosed contraindication, can result in medical complications, including life-threatening illness [2
]. Changes in nonmedical exemption rates and related increases in vaccine preventable disease incidence have been reported [3
], but no similar examination of medical exemption rates or the impact of criteria required to obtain them has been done.
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