Mandatory Health Care Provider Counseling For Parents Led To A Decline In Vaccine Exemptions In California

Malia Jones · Alison M. Buttenheim · Daniel A. Salmon · Saad B. Omer

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Vaccine Coverage and Hesitancy Child and Adolescent Health Ethics and Legal Issues in Pediatric Healthcare

Abstract

Receipt of childhood vaccinations in the US has been declining, and outbreaks of preventable infectious diseases have become more common. In response, in 2014 California implemented a policy change for exemptions from mandatory vaccines for school enrollment. Data on fifteen successive cohorts of kindergarteners enrolled in public and private schools between school years 2001-02 and 2015-16 were analyzed for changes in vaccination trends. The results show an increase in the prevalence and clustering of vaccine exemptions from 2001-02 through 2013-14, followed by a modest decline after implementation of a policy mandating health care provider counseling for vaccine exemption. Clustering of vaccine exemptions increased over the study period and was less responsive to the policy change than were exemption rates overall. Nor did the policy change uniformly reduce the clustering of at-risk students across counties. Trends in the use of conditional admission showed strong school-level clustering and remained relatively stable. The policy change was effective at reducing exemption rates but did not uniformly reduce clustering of exemptions. The results suggest the need to evaluate the causes of local-area clustering and to adopt a statewide policy that addresses clustering of vaccine exemptions within schools and counties.

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References

2014Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012 2009Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases 2016Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States 2000Individual and Community Risks of Measles and Pertussis Associated With Personal Exemptions to Immunization 2011Confidence About Vaccines In The United States: Understanding Parents’ Perceptions 2008Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis 2010Measles Outbreak in a Highly Vaccinated Population, San Diego, 2008: Role of the Intentionally Undervaccinated 2016Countering Vaccine Hesitancy

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2020Efficient burdens decrease nonmedical exemption rates: A cross-county comparison of Michigan’s vaccination waiver education efforts 2022Convergence on Coercion: Functional and Political Pressures as Drivers of Global Childhood Vaccine Mandates 2019Associations of Statewide Legislative and Administrative Interventions With Vaccination Status Among Kindergartners in California

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