Purpose of review
This review summarizes the current state of school-entry vaccination
requirements and related exemption policies in the United States and examines recent changes to these policies.
With recent infectious disease outbreaks in the United States, there has been heightened awareness on unvaccinated individuals, and the state-level policies that allow individuals to be exempted from school-entry vaccination
requirements. Between 2015 and 2017, there have been eleven states that have altered their policies regarding school-entry vaccination
requirements and related reporting for which no formal evaluations have been published. One policy change during that period, California SB 277, which became law in 2016, reduced the nonmedical exemption and increased the childhood vaccination
coverage rate in that state, though with some evidence of exemption replacement through the use of medical exemptions
. Through September 2019, five additional state law changes have been enacted.
The large number of heterogeneous changes to state-level policies for school-entry vaccination
requirements in recent years need rigorous evaluation to identify best practices for balancing public health authority and parental autonomy while seeking to achieve the highest level of infectious disease prevention for children.