Analysis: More Calif. Children Obtaining Vaccine Exemptions

An increasing number of kindergarten students in California are obtaining exemptions to avoid receiving state-mandated vaccinations -- a trend that experts say could increase the risk of disease outbreaks, according to an analysis of state Department of Public Health data by the Los Angeles Times.

Background

California law requires children entering kindergarten to obtain vaccinations for:

• Chicken pox;
• Diphtheria;
• Hepatitis B;
• Measles;
• Pertussis;
• Polio;
• Mumps;
• Rubella; and
• Tetanus.

However, parents can obtain exemptions to those requirements if immunizations are against their personal beliefs. They also can obtain medical or temporary exemptions, according to the Times.

This year, the state has faced outbreaks of several vaccine-preventable diseases. For example, more than 7,500 cases of pertussis, or whooping cough, and 61 cases of measles have been reported in the state this year.

Experts say that epidemics can become a risk when 8% or more of kindergarteners do not obtain vaccinations.

Details of Vaccine Exemption Rates

According to the Times analysis, the rate of personal belief exemptions in the state increased from 1.5% in 2007 to 3.1% in fall 2013.

An increase in the number of personal belief exemptions is particularly apparent among private schools. Nearly 25% of private-school kindergartens reported that 8% or more of their students filed such exemptions last year for at least one vaccine, compared with 11% of public schools (Esquivel/Poindexter, Los Angeles Times, 9/2).

In addition, the vaccination rates vary significantly by area and school. For example:

• Sky Mountain Charter in San Bernardino, a public school with 193 students, has a personal belief exemption rate of 65.3%; while
• Porter Elementary in San Diego, a public school with 199 students, has a personal belief exemption rate of 0.5% (Smith et al., Times analysis, 9/2).

Meanwhile, wealthier areas in Los Angeles County were more likely to file personal belief exemptions, according to the Times. More than 150 schools in the county in which 8% or more students filed exemptions were located in census areas with average annual incomes of $94,500 -- 60% higher than the median income in the county.

Reaction

Public health experts say the upward trend in exemptions could lead to disease outbreaks, according to the Times.

Gil Chavez, deputy director of DPH's Center for Infectious Diseases, said, "We have schools in California where the percent of children who exercise the personal belief exemption is well above 50%," adding, "That's going to be a challenge for any disease that is vaccine preventable."

Assembly member Richard Pan (D-Sacramento) authored a new state law (AB 2109) that requires parents to obtain documentation proving that health care practitioners have informed parents about vaccines and diseases before they can opt out of vaccinating their children. Pan said, "Hopefully we do not need to have children hospitalized and die before people will recognize how important it is to get their child immunized -- and how important it is not just for their own child, but for the community at large."

However, Dawn Richardson with the National Vaccine Information Center, which advocates for parents' right to choose whether their child receives immunizations, said, "It's only ethical for a person to decide what risk they are willing to take with their body," adding, "No one group should demand that another group take a risk to benefit them, that's where it crosses the line" (Los Angeles Times, 9/2).