Assessment of Exemptions From Vaccination in California, 2015 to 2027
Authors: Paul L. Delamater, Alison M. Buttenheim, Nicola P. Klein, Salini Mohanty, Daniel A. Salmon, Saad B. Omer
Journal: Annals of Internal Medicine (2019)

Letters3 March 2020Assessment of Exemptions From Vaccination in California, 2015 to 2027Paul L. Delamater, PhD, Alison M. Buttenheim, PhD, Nicola P. Klein, MD, PhD, Salini Mohanty, DrPH, Daniel A. Salmon, PhD, and Saad B. Omer, MBBS, PhDPaul L. Delamater, PhDUniversity of North Carolina at Chapel Hill, Chapel Hill, North Carolina (P.L.D.)Search for more papers by this author, Alison M. Buttenheim, PhDUniversity of Pennsylvania School of Nursing, Philadelphia, Pennsylvania (A.M.B., S.M.)Search for more papers by this author, Nicola P. Klein, MD, PhDKaiser Permanente Vaccine Study Center, Oakland, California (N.P.K.)Search for more papers by this author, Salini Mohanty, DrPHUniversity of Pennsylvania School of Nursing, Philadelphia, Pennsylvania (A.M.B., S.M.)Search for more papers by this author, Daniel A. Salmon, PhDJohns Hopkins University, Baltimore, Maryland (D.A.S.)Search for more papers by this author, and Saad B. Omer, MBBS, PhDYale School of Medicine and Yale School of Public Health, New Haven, Connecticut (S.B.O.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1933 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: In 2015, California passed Senate Bill 277 (SB277), which banned nonmedical exemptions from school-entry vaccine mandates. However, some provisions limit the bill's effectiveness, including grandfathering of pre-SB277 nonmedical exemptions, exemption of homeschooled children and those not in classroom-based environments from vaccination requirements, and relaxation of allowable medical exemption criteria (1). In the first 3 years after SB277 was passed, rates of medical exemptions and students who were exempt from requirements and not up-to-date on vaccinations increased (1).Objective: To estimate the percentage of California schoolchildren with an exemption from vaccination from 2015 to 2027 under 3 scenarios.Methods and ...References1. Delamater PL, Pingali SC, Buttenheim AM, et al. Elimination of nonmedical immunization exemptions in California and school-entry vaccine status. Pediatrics. 2019;143. [PMID: 31113831] doi:10.1542/peds.2018-3301 CrossrefMedlineGoogle Scholar2. Delamater PL, Leslie TF, Yang YT. California Senate Bill 277's grandfather clause and nonmedical vaccine exemptions in California, 2015–2022. JAMA Pediatr. 2016;170:619-20. [PMID: 27018540] doi:10.1001/jamapediatrics.2015.4856 CrossrefMedlineGoogle Scholar3. California Legislative Information. SB-276 Immunizations: medical exemptions. 2019. Accessed at https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200SB276 on 22 April 2019. Google Scholar4. Buttenheim AM, Jones M, Mckown C, et al. Conditional admission, religious exemption type, and nonmedical vaccine exemptions in California before and after a state policy change. Vaccine. 2018;36:3789-93. [PMID: 29778514] doi:10.1016/j.vaccine.2018.05.050 CrossrefMedlineGoogle Scholar5. McDonald P, Limaye RJ, Omer SB, et al. Exploring California's new law eliminating personal belief exemptions to childhood vaccines and vaccine decision-making among homeschooling mothers in California. Vaccine. 2019;37:742-50. [PMID: 30626531] doi:10.1016/j.vaccine.2018.12.018 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (P.L.D.)University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania (A.M.B., S.M.)Kaiser Permanente Vaccine Study Center, Oakland, California (N.P.K.)Johns Hopkins University, Baltimore, Maryland (D.A.S.)Yale School of Medicine and Yale School of Public Health, New Haven, Connecticut (S.B.O.)See Also: Editorial comment (page 358).Financial Support: This research was supported by grant R01AI125405 from the National Institutes of Health (NIH). The NIH had no role in the design and conduct of the study; management, analysis, and interpretation of the data; or preparation of the final manuscript.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1933.Reproducible Research Statement: Study protocol: Not applicable. Statistical code and data set: Available from Dr. Delamater (e-mail, [email protected]unc.edu).This article was published at Annals.org on 5 November 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoNarrowing Vaccination Exemption Laws: Lessons From California and Beyond Michelle M. Mello Metrics Cited byWhen measles came to class: a look back at the 1989 Kent State University measles epidemicParental vaccine attitudes, beliefs, and practices: initial evidence in California after a vaccine policy changeNarrowing Vaccination Exemption Laws: Lessons From California and BeyondMichelle M. Mello, JD, PhD 3 March 2020Volume 172, Issue 5Page: 362-363KeywordsBehaviorChildrenDisclosureForecastingLegislationPrevention, policy, and public healthStatistical dataVaccine hesitancyVaccines ePublished: 5 November 2019 Issue Published: 3 March 2020 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...