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. 2018 Nov;142(5):e20181051.
doi: 10.1542/peds.2018-1051.

Experiences With Medical Exemptions After a Change in Vaccine Exemption Policy in California

Salini Mohanty  1 , Alison M Buttenheim  2   3 , Caroline M Joyce  2 , Amanda C Howa  4 , Daniel Salmon  5 , Saad B Omer  4   6   7   8
Affiliations

Experiences With Medical Exemptions After a Change in Vaccine Exemption Policy in California

Salini Mohanty et al. Pediatrics. 2018 Nov.

Abstract

: media-1vid110.1542/5804909532001PEDS-VA_2018-1051Video Abstract OBJECTIVES: In 2015, California passed Senate Bill 227 (SB277), eliminating nonmedical vaccine exemptions for school entry. Our objective for this study was to describe the experiences of health officers and immunization staff addressing medical exemption requests under SB277.

Methods: We conducted semistructured telephone interviews between August 2017 and September 2017 with health officers and immunization staff from local health jurisdictions in California. Interviews were recorded, transcribed, and analyzed for key themes.

Results: We conducted 34 interviews with 40 health officers and immunization staff representing 35 of the 61 local health jurisdictions in California. Four main themes emerged related to experiences with medical exemptions: (1) the role of stakeholders, (2) reviewing medical exemptions received by schools, (3) medical exemptions that were perceived as problematic, and (4) frustration and concern over medical exemptions. Generally, local health jurisdictions described a narrow role in providing support and technical assistance to schools. Only 5 jurisdictions actively tracked medical exemptions received by schools, with 1 jurisdiction facing a lawsuit as a result. Examples were provided of medical exemptions that listed family history of allergies and autoimmune diseases as contraindications for immunization and of physicians charging steep fees for medical exemptions. Participants also reported concerns about the increase in medical exemptions after the implementation of SB277.

Conclusions: Participants reported many challenges and concerns with medical exemptions under SB277. Without additional legal changes, including a standardized review of medical exemptions, some physicians may continue to write medical exemptions for vaccine-hesitant parents, potentially limiting the long-term impact of SB277.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

References

    1. California Legislature SB-277 public health: vaccinations. Available at: https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201.... Accessed March 20, 2018
    1. Committee on Practice and Ambulatory Medicine; Committee on Infectious Diseases; Committee on State Government Affairs; Council on School Health; Section on Administration and Practice Management . Medical versus nonmedical immunization exemptions for child care and school attendance. Pediatrics. 2016;138(3):e20162145. - PubMed
    1. American Academy of Family Physicians Immunization exemptions. Available at: https://www.aafp.org/about/policies/all/immunizations-exemptions.html. Accessed March 23, 2018
    1. California Department of Public Health Senate Bill 277 frequently asked questions. Available at: www.shotsforschool.org/laws/sb277faq/. Accessed April 3, 2018
    1. West Virginia Department of Health and Human Resources Medical exemptions information. Available at: https://dhhr.wv.gov/oeps/immunization/requirements/Pages/Medical-Exempti.... Accessed March 1, 2018

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