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States that easily grant immunization exemptions have higher incidence of whooping cough

States that have personal belief exemptions for school immunization requirements, and exemptions that are easily obtained, have higher rates of new cases of pertussis (whooping cough) than states in which obtaining immunization exemptions is more difficult, according to a study in the October 11 issue of JAMA.

State-mandated school immunization requirements have played a major role in achieving and maintaining low rates of vaccine-preventable diseases in the United States. All states and the District of Columbia require children entering school to provide documentation that they have met the state vaccine requirements, according to background information in the article. As of March 2006, all states permitted medical exemptions to school and daycare immunization requirements; 48 states allowed religious exemptions; and 19 states had a provision for personal belief exemptions, such as religious, philosophical, and any other unspecified nonmedical exemption.

States that make exemptions widely available to parents, either by offering a personal belief exemption or making the exemption option easy to obtain, may have higher rates of exemptions or may experience substantial increases in exemption rates. Increasing exemption rates can increase individual and community risk to vaccine-preventable diseases, the authors write. The role of exemption policies may be especially important for pertussis, which remains present in certain areas of the United States and has been increasing in incidence during the past decade.

Saad B. Omer, M.B.B.S., M.P.H., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues conducted a study to determine if the rates of nonmedical exemptions differ and have been increasing in states that offer only religious vs. personal belief exemptions, and if the incidence of pertussis is associated with policies of granting personal belief exemptions and ease of obtaining exemptions. The researchers
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Contact: Tom Fortner
352-273-5814
JAMA and Archives Journals
10-Oct-2006


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