Frequency and erroneous usage of temporary medical exemptions and knowledge of immunization guidelines among some Miami-Dade County Florida providers

Vaccine. 2014 Jul 31;32(35):4500-4504. doi: 10.1016/j.vaccine.2014.06.041. Epub 2014 Jun 21.


Objective: We assessed knowledge and practices regarding immunization guidelines and the Florida Certificate of Immunization (DH-680) based on FL-DOH and CDC recommendations, to identify the cause of the increasing number of erroneously issued temporary medical exemptions (TME) among selected health care providers in Miami-Dade County Florida.

Methodology: After reviewing immunization certificates from all public schools, a list of physicians who improperly issued 3 or more TMEs, defined as one given to a child who was up to date for their kindergarten and seventh grade requirements, was compiled. The DOH-Miami-Dade developed educational materials and questionnaires, and conducted face-to-face interviews and interventions during site visits to these providers (n=134). Data was analyzed using SAS 9.2.

Results: Of the 104 questionnaires completed, 4 (3.85%) had correct answers to all 10 vaccine knowledge and practice related questions, while 10 (9.62%) had 7 or more incorrect answers. Frequently missed questions included: the required doses of varicella vaccine for seventh grade students entering the 2011-12 school year (86, 82.7%) and the proper scenario for issuing a TME (57, 54.8%).

Conclusions: In order to eliminate the improper use of TMEs, long-term efforts are needed to provide immunization-related educational materials and trainings to the medical community regarding vaccinations. These findings also suggest a need for enhanced explanation in multiple languages on the current Florida Immunization Certificate. Due to enhanced surveillance and education, the number of TMEs for kindergarten and seventh grade students was reduced by 12% and 4.9%, respectively, during the 2011 and 2012 school year.

Keywords: Knowledge; Pediatricians; Practice; School health; School immunizations; Temporary medical exemptions.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Florida
  • Guideline Adherence*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Immunization / standards*
  • Immunization / statistics & numerical data*
  • Immunization Schedule*
  • Interviews as Topic
  • Practice Patterns, Physicians'*