Communicable Disease

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Science  19 Jul 2013:
Vol. 341, Issue 6143, pp. 216
DOI: 10.1126/science.341.6143.216-d

In the United States, states have the authority to grant exemptions so that children can begin to attend school without having been vaccinated against childhood diseases. Medical exemptions can be granted when a child has a history of allergic reactions or is immunocompromised. However, there has been a noticeable increase in the numbers of unvaccinated children resulting from nonmedical exemptions, based on religious or philosophical grounds; in 2011–2012, roughly 80% of all exemptions were nonmedical. Blank et al. have gathered information from public health officials, health departments, the Centers for Disease Control and Prevention, the National Conference of State Legislatures, and state legislature databases. Policies were characterized as easy, medium, or difficult, according to the level of effort they would pose for parents requesting exemptions. The lower the barrier, the more nonmedical exemptions were observed, with a twofold difference between the easiest and most difficult procedures. For 2011–2012, at least 21 bills were introduced at the state level to change the exemption procedures, and exemptions would have been made easier if bills in 10 states had passed. As of February 2013, three bills have been introduced in two states to tighten exemptions, and five bills have been introduced in four states to loosen them. The authors advocate social and policy efforts to promote parental education and to stem the spread of vaccine-preventable diseases.

Health Affairs 32, 1282 (2013).

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