Vaccinations Save Lives

Vaccine medical exemptions may hurt communities

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) It may seem like a hassle to get all those vaccinations out of the way as school starts up. But it's more of a hassle to get exemptions — and that's a good thing.

A recent study has found that states with lower restrictions for medical exemptions for vaccination have higher rates of medical exemptions.

Researchers said these exemptions put all children at risk.

"Fully vaccinate your child."

The report, led by Stephanie Stadlin, MPH, of the Hubert Department of Global Health at Emory University Rollins School of Public Health in Atlanta, looked specifically at medical exemptions for vaccines in the U.S.

All 50 states offer medical exemptions, which are important for children who have immune disorders, allergic reactions to vaccine ingredients or other conditions which make it unsafe for them to be vaccinated.

These are different from religious and philosophical exemptions, which not all states offer.

Their study covered the seven school years from the 2004-2005 year to the 2010-2011 year, and they compared the medical exemption rates among the kindergartens in all 50 states.

They classified each state's criteria for medical exemptions based on how strict the requirements were and whether the exemptions were issued for "permanent" or "temporary" time periods.

The six requirements they looked at included whether the state required or didn't require the following: a doctor's statement, a separate medical exemption form, health department approval, a doctor certified to practice in-state, annual approval for the child and notarization of the forms.

The states were then labeled "easy," "medium" or "difficult" for obtaining a medical exemption.

The results revealed that about 0.26 percent to 0.41 percent of enrolled kindergarten children had received medical exemptions, but some states had rates over 1 percent.

Overall, the fewer hoops parents had to jump through to get a medical exemption, the higher that state's medical exemption rates were.

States that had easier criteria to receive a medical exemption had rates up to 6.4 times higher than states that were "hard" to get an exemption in.

The authors found evidence that parents who live in states where religious or philosophic exemptions are unavailable or hard to get were more likely to seek a medical exemption.

They said that it's important to make sure the requirements are appropriate for those who need the exemptions but that they do not become used when a medical need is not actually present to avoid vaccination.

"Our findings suggest that administrative requirements requiring accountability of the physician and parent(s) for granting medical exemptions can be effective in ensuring they are used when there are valid contraindications, and not just as a replacement for non-medical exemptions," the authors wrote.

"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," they said, noting a case where a child with an inappropriately issued medical exemption contracted tetanus and became seriously ill.

The authors said that reserving medical exemptions exclusively for those who have a medical need for them is important especially in areas where there are more religious and/or philosophic exemptions.

This is important to maintaining "herd immunity," the concept that a large population is protected from disease — including those who cannot be vaccinated for medical reasons — because enough of the people in the community do have immunity from vaccines.

"Judicious use of the medical exemption option helps ensure that individual children and the broader community can benefit from high immunization coverage," the authors wrote. "It is known that immunization exemptors cluster geographically, increasing the possibility for local areas of increased disease incidence."

This concern was echoed in an accompanying editorial by Daniel A Salmon, PhD, MPH, and Neal Halsey, MD, of the Johns Hopkins Bloomberg School of Public Health.

"Children with valid medical exemptions need to be protected from exposure to vaccine preventable diseases by insuring high coverage rates among the rest of the population," they wrote.

"Granting medical exemptions for invalid medical contraindications may promote unfounded vaccine safety concerns."

The authors concluded that states should ensure their requirements are appropriate for making sure that only children with a medical need for a vaccination exemption receive them.

"Medical exemption rates need to be monitored and continuously evaluated to ensure that medical exemptions are not granted solely because they are easier to obtain than other types of exemptions," they wrote.

The study was published August 29 in The Journal of Infectious Diseases. The report did not note a source of funding for the resource, but the authors declared no conflicts of interest.

Reviewed by: 
Review Date: 
August 29, 2012
Last Updated:
August 31, 2012