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

Nonmedical exemptions from school immunization requirements: a systematic review

Eileen Wang  1 , Jessica Clymer, Cecilia Davis-Hayes, Alison Buttenheim
Affiliations

Nonmedical exemptions from school immunization requirements: a systematic review

Eileen Wang et al. Am J Public Health. 2014 Nov.

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.

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Figures

FIGURE 1—
FIGURE 1—
Flow diagram of study selection for systematic review of research on nonmedical exemptions from school immunization requirements.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention. Childcare and school vaccination requirements 2007–2008. 2008. Available at: http://www2a.cdc.gov/nip/schoolsurv/CombinedLaws2007.pdf. Accessed August 4, 2014.
    1. Malone K, Hinman A. Vaccination mandates: the public health imperative and individual rights. Available at: http://www.cdc.gov/vaccines/imz-managers/guides-pubs/downloads/vacc_mand.... Accessed August 4, 2014.
    1. Omer SB, Salmon DA, Orenstein WA, deHart MP, Halsey N. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. N Engl J Med. 2009;360(19):1981–1988. - PubMed
    1. Salmon DA, Siegel AW. Religious and philosophical exemptions from vaccination requirements and lessons learned from conscientious objectors from conscription. Public Health Rep. 2001;116(4):289–295. - PMC - PubMed
    1. Silverman RD. No more kidding around: restructuring non-medical childhood immunization exemptions to ensure public health protection. Ann Health Law. 2003;12(2):277–294. - PubMed

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