Immunity Requirements and Exemptions Allowed for Health Professional Students, United States, 2008

Background: Health professional students are considered healthcare personnel (HCP) by the Advisory Committee on Immunization Practices (ACIP).  The number of U.S. health professional schools with student immunity requirements for ACIP-recommended vaccines for HCP has risen during the past 20 years. 

Objectives: Describe immunity requirements for U.S. health professional students, including exemptions allowed, for ACIP-recommended vaccines for HCP.

Methods: Self-administered electronic survey was fielded November 2008-March 2009, and distributed to deans of all entry-level baccalaureate nursing programs (n=603), and accredited MD-granting (n=130) and DO-granting (n=26) medical schools in the U.S. and Puerto Rico.  A student immunity requirement was defined as the requirement to produce 1) documentation of vaccine administration or 2) other evidence of immunity to a vaccine-preventable disease (e.g., laboratory evidence).

Results: The survey response rate was 75% (n=563).  Survey estimates were weighted to account for non-respondents.  The percentage of schools with immunity requirements ranged from 98.0% (rubella) to 18.4% (influenza).  Most schools accepted documented vaccine administration (range: 73.9%, varicella to 94.6%, Tdap) as presumptive evidence of immunity.  When applicable, many schools also accepted other evidence of immunity considered presumptive by ACIP.  The proportion of schools that accepted evidence of immunity not considered presumptive, per ACIP, were 12.3% (measles), 12.6% (mumps), 35.0% (rubella), 76.0% (hepatitis B), 28.1% (Tdap) and 18.8% (influenza).  Schools with requirements were least likely to allow nonmedical exemptions for Tdap vaccine (25.0%), and most likely to allow nonmedical exemptions for influenza vaccine (37.7%).  A note written by the student was often sufficient documentation to obtain medical (32%), religious (68%) and personal belief (82%) exemptions.     

Conclusions: U.S. health professional schools with immunity requirements should accept only documented vaccine administration, or other ACIP-recommended evidence of immunity, if applicable.  For schools that allow exemptions, the ease of obtaining exemptions may not be consistent with the intended purpose of the immunity requirement.