HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) An erratum has been published An erratum has been published Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (9) Citing Articles via Google Scholar Google Scholar Articles by Salmon, D. A. Articles by Halsey, N. A. Search for Related Content PubMed PubMed Citation Articles by Salmon, D. A. Articles by Halsey, N. A. Related Collections Health Law Health Policy Immunization/Vaccines School Health

Daniel A. Salmon, PhD, Saad B. Omer, MBBS, Lawrence H. Moulton, PhD, Shannon Stokley, MPH, M. Patricia deHart, ScD, Susan Lett, MD, Bryan Norman, PhD, Stephen Teret, JD and Neal A. Halsey, MD

Daniel Salmon, Saad B. Omer, Lawrence H. Moulton, and Neal A. Halsey are with the Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. Shannon Stokley is with the National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga. M. Patricia deHart is with the Immunization Program, Washington State Department of Health, Olympia. Susan Lett is with the Immunization Program, Massachusetts Department of Public Health, Jamaica Plain. Bryan Norman is with the Immunization Program, Missouri Department of Health and Senior Services, Jefferson City. Stephen Teret is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health.

Correspondence: Requests for reprints should be sent to Daniel A. Salmon, PhD, Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room W5034, Baltimore, MD 21205 (e-mail: dsalmon{at}jhsph.edu).

Objectives. Our goal was to determine whether school-level variability in implementation of immunization requirements is associated with the likelihood of a child having received an exemption to school immunization requirements.

Methods. We surveyed 1000 school immunization personnel in Colorado, Massachusetts, Missouri, and Washington. We explored associations between school implementation of immunization requirements and the likelihood of a child having an exemption using logistic regression models.

Results. School policies associated with an increased likelihood of children having exemptions included lack of provision of written instructions for completing the school immunization requirement before enrollment, administrative procedures making it easier to claim an exemption, and granting of philosophical exemptions. In the 2 states we surveyed where philosophical exemptions are not authorized (Massachusetts and Missouri), 17.0% and 18.1% of schools reported permitting philosophical exemptions.

Conclusions. Inconsistencies in the interpretation and implementation of school immunization laws contribute to variability in rates of exemptions. School policies should be reviewed to ensure consistency with the intent of state laws.

This article has been cited by other articles:

				S. B. Omer, K. S. Enger, L. H. Moulton, N. A. Halsey, S. Stokley, and D. A. Salmon Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis Am. J. Epidemiol., December 15, 2008; 168(12): 1389 - 1396. [Abstract] [Full Text] [PDF]

				V.-P. Sneller, D. B. Fishbein, C. M. Weinbaum, A. Lombard, P. Murray, J. A. McLaurin, L. Friedman, and for the Working Group on Vaccination of High-Risk Vaccinating Adolescents in High-Risk Settings: Lessons Learned From Experiences With Hepatitis B Vaccine Pediatrics, January 1, 2008; 121(Supplement_1): S55 - S62. [Abstract] [Full Text] [PDF]

				S. W. Roush, T. V. Murphy, and and the Vaccine-Preventable Disease Table Working Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States JAMA, November 14, 2007; 298(18): 2155 - 2163. [Abstract] [Full Text] [PDF]

				S. Basu, B. T. Segraves, and J. Colgrove Compulsory HPV Vaccination N. Engl. J. Med., March 8, 2007; 356(10): 1074 - 1075. [Full Text] [PDF]

				D. A. Salmon, J. W. Sapsin, S. Teret, R. F. Jacobs, J. W. Thompson, K. Ryan, and N. A. Halsey Public Health and the Politics of School Immunization Requirements Am J Public Health, May 1, 2005; 95(5): 778 - 783. [Abstract] [Full Text] [PDF]

				D. A. Salmon, L. H. Moulton, S. B. Omer, M. P. deHart, S. Stokley, and N. A. Halsey Factors Associated With Refusal of Childhood Vaccines Among Parents of School-aged Children: A Case-Control Study Arch Pediatr Adolesc Med, May 1, 2005; 159(5): 470 - 476. [Abstract] [Full Text] [PDF]