Parents of children in kindergarten in general are seeking exemptions from vaccination requirements for 1.7% of this population, according to new data released by the Centers for Disease Control and Prevention.
Of the 45 states and the District of Columbia for which data are available showing children enrolled in kindergarten who have been exempted from receiving one or more vaccines by their state, 6 states have less than 1% receiving exemption, 20 have between 1% and 2% receiving exemptions, 9 have between 2% and up to 4% receiving exemptions, and 11 have 4% or more receiving exemptions.
Dr. Anne Schuchat
The 49 states and DC reported vaccination coverage data for 4,121,322 kindergartners, and 46 states and D.C. reported exemption data, including the number of children with at least one exemption, for 3,829,686 kindergartners.
During an Aug. 28 conference call, Dr. Anne Schuchat, director of CDC’s National Center for Immunization and Respiratory Diseases, noted that the granting of exemptions does not necessarily mean a child was not vaccinated, and that while medical exemptions are available in all states, the type of nonmedical (such as religious or philosophical) exemption does vary.
“An exemption might be requested for all vaccines even if a child [missed only] a single vaccine or a single vaccine dose, and in some states, a parent or guardian might actually claim an exemption if they don’t have the child’s vaccination record available,” she said.
But Dr. Schuchat stressed that policy should be such that getting a vaccine exemption should not be an easy process.
“We know that the more difficult it is to obtain an exemption, the fewer people will exempt their children from vaccines,” Dr. Schuchat said. “We certainly think it should be easier to get a vaccine than to get an exemption from a required vaccination.”
Mississippi had the lowest exemption rate at less than 0.1%, while Idaho had the highest at 6.5%. Three states – Kansas, Maine, and Oregon – reported a decrease of greater than 1% in exemptions from the 2013-2014 school year to the 2014-2015 school year.
When reported separately, the median percentage of medical exemptions was 0.2%, with four states showing less than 0.1% (Arkansas, Colorado, Hawaii, and Mississippi) and Alaska having 1.3%. Where allowed and reported separately, the median percentage of nonmedical exemptions was 1.5%, with D.C. at the low end of the range at 0.5% and Idaho at 6.2%.
However, these data might not be fully accurate or complete.
“The current assessment methods used to estimate coverage and exemptions in many states might be insufficient for immunization programs to identify children or communities at risk for vaccine-preventable diseases and might limit the ability of immunization programs to respond to outbreaks,” Ranee Seither, an epidemiologist in the CDC’s National Center for Immunization and Respiratory Diseases, and colleagues wrote in the MMWR (2015, Aug 28. 64[33];897-904).
Dr. Schuchat also noted that 3 more states are now providing more local level information on immunization and exemption rates, increasing the number of states providing that information to 21 for the current school year from 18 in the 2013-2014 year and 11 in 2102-2013, although the detail provided is not uniform.
“Local data can be very helpful for us to understand where do we need to put our attention and where do we have real risks for vaccine-preventable diseases,” Dr. Schuchat said.