Nonmedical Exemptions From School Immunization Requirements: A Systematic Review

Am J Public Health. 2014 Nov;104(11):e62-84. doi: 10.2105/AJPH.2014.302190. Epub 2014 Sep 11.

Abstract

We summarized studies describing the prevalence of, trends in, and correlates of nonmedical exemptions from school vaccination mandates and the association of these policies with the incidence of vaccine-preventable disease. We searched 4 electronic databases for empirical studies published from 1997 to 2013 to capture exemption dynamics and qualitatively abstracted and synthesized the results. Findings from 42 studies suggest that exemption rates are increasing and occur in clusters; most exemptors questioned vaccine safety, although some exempted out of convenience. Easier state-level exemption procedures increase exemption rates and both individual and community disease risk. State laws influence exemption rates, but policy implementation, exemptors' vaccination status, and underlying mechanisms of geographical clustering need to be examined further to tailor specific interventions.

Publication types

  • Research Support, N.I.H., Extramural
  • Review
  • Systematic Review

MeSH terms

  • Child
  • Humans
  • Immunization Programs / statistics & numerical data*
  • Prevalence
  • Public Policy
  • School Health Services / statistics & numerical data*
  • Treatment Refusal / statistics & numerical data*
  • United States / epidemiology