BACKGROUND:
California school immunization law allows a personal belief exemption (PBE) to school/child care entry immunization requirements. California collects annual reports from schools on their PBE rates (1.1% from fall assessment 2002), but no information has yet been collected on the specifics of PBEs among these students.

OBJECTIVE:
To explore which specific vaccines were received or lacking in kindergarten PBE records.

METHOD:
We collected and analyzed immunization records of all PBE students from a random sample of kindergartens.

RESULT:
119 PBE records were collected from 215 schools during Selective Review. Immunization coverage and PBE rates in this sample were comparable to rates from the fall assessment conducted in all kindergartens. A child is considered fully immunized if s/he complies with California school immunization law (Total ³ 13 doses (4+ doses of DTaP, 3+ doses of Polio, 2 doses of MMR, 3 doses of Hepatitis B, and 1+ dose of varicella)). From the 119 signed PBE records, 10.9% of children were fully immunized, 54.6% were missing only 1 to 2 doses, 9.2% were missing 3 to 10 doses, and 25.2% had blank records. Of the group missing 1 to 2 doses (n=65), 60.0% lacked only varicella, 26.2% lacked the second dose of MMR, 9.2% lacked the final dose of 1 or 2 antigens, and 4.6% lacked only the final 1 or 2 dose(s) of hepatitis B. It is unclear whether the 30 blank PBE records represent waiving of all vaccines or simply a failure to complete the form.

CONCLUSION:
Our pilot study result indicated a PBE waiver does not mean all immunizations have been waived. Indeed, 10.9% of children were fully immunized and 33% were missing only varicella. Further studies are needed to better understand PBEs among California children.

LEARNING OBJECTIVES:
To explore the characteristics of PBEs in California.