Vaccination Status of Children Exempted from School-Entry Immunization Mandates

Alison M. Buttenheim, University of Pennsylvania

The child immunization schedule is one of the most successful public health interventions of the past century. Despite this success, parental vaccine hesitancy is widespread and increasing. One manifestation of vaccine hesitancy is rising rates of non-medical or “personal beliefs” exemptions (PBEs) from school-entry immunization mandates. Exemptions have been shown to be associated with increased risk of disease outbreak, but the strength of this association depends critically on the true vaccination status of children with exemptions, which has not been assessed. Additionally, little is known about school-level policies and practices that may promote exemp-tions independent of parental preferences. In this study, I use administrative data collected by the California Department of Public Health to estimate the true vaccination status of children with PBEs and to identify school factors associated with PBE rates. The study provides an important baseline prior to implementation of a new exemption policy in California in 2014.