Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Vaccination Coverage & Exemption Rates in US

Open Forum Infect Dis; ePub 2018 Jun 2; Shaw, et al

Higher vaccination coverage and lower non-medical exemption rates for measles, mumps, and rubella (MMR), diphtheria, tetanus, and pertussis (DTaP) vaccines were found in states which adopted Advisory Committee on Immunization Practices (ACIP) guidelines at school entry, a new study found. Researchers conducted a retrospective longitudinal analysis of the effect of state immunization laws on vaccination coverage and exemptions among US kindergarteners from school year (SY) 2008 to SY 2014. The primary outcome measures were state-level kindergarten entry vaccination coverage rates for 2-dose MMR and 4-dose DTaP vaccines. They found:

  • State policies that referenced ACIP recommendations were associated with 3.5% and 2.8% increases in MMR and DTaP vaccination rates.
  • Parental education was associated with a 5.1% and 4.5% increase in vaccination rates.
  • Permission of religious and philosophical exemptions was associated with a 2.3% and 1.9% decrease in MMR and DTaP covered, respectively, and 1.5% increase in both total exemptions and non-medical exemptions, respectively.


Shaw J, Mader EM, Bennett BE, Vernyi-Kellogg OK, Yang YT, Morley CP. Immunization mandates, vaccination coverage and exemption rates in the United States. [Published online ahead of print June 2, 2018]. Open Forum Infect Dis. doi:10.1093/ofid/ofy130.


This study shows several things. It clearly shows that when a system is in place to make it easier for parents to choose not to vaccinate their children, they are less likely to do so. It also shows that some parents do not vaccinate their children because they do not feel like they have enough information. As of 2018, only 3 states in the US do not allow any non-medical exemptions for giving vaccines to children to attend school (CA, MS, WV). More states need to get on board. An article in the June issue of PLOS showed increases in parents opting out of vaccinations in counties across the 18 states that allow a personal exemption. — John Russell, MD

This Week's Must Reads

Antibiotic Use Among US Older Adults, BMJ; ePub 2018 Jul 27; Olesen, Barnett, et al

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Modifiable Risk Factors in New BP Categories, Am J Med; ePub 2018 Jul 26; Gu, Yue, et al

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Must Reads in Vaccines

Parental Attitudes in Childhood Vaccine Exemptions, PLoS One; ePub 2018 Jun 14; Pottinger, Jacobs, et al

Measles in Vaccinated & Unvaccinated Patients, Clin Infect Dis; ePub 2018 Jun 7; Cherry, et al

Increases in HPV Vaccination in Young Males, J Infect Dis; 2018 Jun; Patel, Grabowski, et al

Influenza Vaccination Among Health Care Personnel, JAMA Network Open; 2018 Jun; Greene, et al

Prior Vaccination & Carriage Rates in Older Adults, Vaccine; 2018 Jul 5; Branche, Yang, et al