The researchers analyzed state - level rates
of nonmedical exemptions at school entry from 1991 through 2004 and data for incidence of pertussis from 1986 through 2004 for individuals age 18 years or younger.
Saad B. Omer, M.B.B.S., M.P.H., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues conducted a study to determine if the rates
of nonmedical exemptions differ and have been increasing in states that offer only religious vs. personal belief exemptions, and if the incidence of pertussis is associated with policies of granting personal belief exemptions and ease of obtaining exemptions.
California's rates
of nonmedical exemptions tripled from 0.77 percent in 2000 to 2.33 percent in 2010, and some schools had 2010 nonmedical exemption rates as high as 84 percent.
Not exact matches
Census tracts within a
nonmedical exemption cluster were 2.5 times more likely to be within a pertussis cluster, even after accounting for population characteristics including racial demographics, population density, household income, average family size, percentage
of residents with a college degree and location within a metropolitan area.
Colgrove and his co-author, Abigail Lowin
of Columbia Law School, suggest there are alternatives to eliminating
nonmedical exemptions entirely.
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, such as religious, philosophical, and any other unspecified
nonmedical exemption.
While all 50 states allow
exemptions for children who have a valid medical reason, and almost all states allow
nonmedical exemptions for parents with either religious or philosophical objections, the political climate has recently shifted in favor
of making
exemptions more difficult to obtain.
In 2015, California, long known as a state with lenient provisions and high rates
of opting out, followed the example
of Mississippi and West Virginia and eliminated
nonmedical exemptions.
Moreover, state - level policies on
nonmedical exemptions and documentation
of immunization status should be viewed as part
of the efforts to control or eliminate vaccine - preventable diseases,» the authors conclude.