Vaccination Status and School Practices Among California Kindergartens with High Number of Personal Beliefs Exemptors

Background:  California law allows school personal beliefs exemptions (PBEs).  Data collected yearly indicates that the number of PBEs continue to rise.   

Objectives:  To examine immunization coverage rates among kindergarten exemptors and to gain a better understanding of school immunization practices.

Methods:  We compared immunization coverage and school practices in a random sample of California kindergarten schools to 50 schools with the highest number of PBEs.  We also included results from an anonymous online survey of school PBE practices.

Results:  Between 2000 and 2008, rates of PBEs in California increased from 0.7% to 1.9%.  During the same period, the percent of schools with greater than 10% PBEs increased from 2.6% to 6.8%.   The percentage of PBEs with shot record information recorded by their schools has also declined by 25% during the last five years.  When shot record information among PBEs was compared in high PBE schools to a random sample of schools, the average number of doses received by PBEs in high PBE schools was significantly lower.  The vaccine doses most likely to be missed in both groups were 1-Varicella, 3-HepB and 2-MMR.  Staff from schools with high PBEs were also more likely to report offering parents the option of taking a PBE as a short-term alternative than staff from the randomly sampled schools. 

Conclusions: Immunization programs will need to continue to monitor exemption trends.  Our data indicate that exemptors attending high PBE schools were undervaccinated compared to PBE students in general.  In addition, staff from high PBE schools were more likely to report that they offered parents the option of taking a PBE as a short-term solution.   Schools with high number of PBEs may warrant special attention.