Journal of Infectious Diseases
Volume 206 Issue 7 October 1, 2012
http://www.journals.uchicago.edu/toc/jid/current

EDITORIAL COMMENTARY
Keeping the M in Medical Exemptions: Protecting Our Most Vulnerable Children
Daniel A. Salmon and Neal A. Halsey

(See the brief report by Stadlin et al, on pages 989–92.)

In this issue of the journal, Stadlin et al report that, although the rates of medical exemptions to school immunization requirements are rather modest, easier processes for offering medical exemptions were associated with higher rates of medical exemptions [1]. This finding is consistent with previous studies that found that the ease of obtaining nonmedical religious or philosophical exemptions was associated with higher rates of exemptions [2, 3]. Interestingly, states with more difficult procedures for nonmedical exemptions had higher rates of medical exemptions, suggesting that some parents may be opting for medical exemptions when it is difficult to obtain nonmedical exemptions. This observation is consistent with our unpublished …

MAJOR ARTICLES AND BRIEF REPORTS
PUBLIC POLICY
Stephanie Stadlin, Robert A. Bednarczyk, and Saad B. Omer
Editor’s choice: Medical Exemptions to School Immunization Requirements in the United States—Association of State Policies With Medical Exemption Rates (2004–2011)
J Infect Dis. (2012) 206(7): 989-992 doi:10.1093/infdis/jis436

Abstract
All 50 US states allow medical exemptions from school entry immunization requirements. The extent to which medical exemptions are granted and the relationship with ease of obtaining these exemptions has not previously been examined in detail. We evaluated counts and rates of state-level medical exemptions to kindergarten entry requirements over 7 school years (2004–2005 through 2010–2011). During this period, 0.26%–0.41% of enrolled children received medical exemptions. In states with easier medical exemption criteria, medical exemption rates were significantly higher (adjusted incidence rate ratio: 6.4 [95% confidence interval: 2.7–15.6]). Routine evaluation of medical exemption rates is needed to ensure their appropriate use.