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Parental Attitudes About Vaccination Exemptions

PLoS One; ePub 2018 Jun 14; Pottinger, Jacobs, et al

Exemptors in a cohort of Arizona elementary schools do not appear to be exempting their children from vaccinations due to convenience, as has been hypothesized in other settings, according to a recent study that aimed to assess attitudes and perceptions towards vaccinations and compare them for exemptors and non-exemptors. Researchers administered surveys to parents in high-exemption (>10%) elementary schools in Arizona during the 2012–13 school year. A total of 404 surveys were completed by parents among schools in Maricopa (n=7) and Yavapai (n=2) counties. They found:

  • Of these, 35% (n=141) were exemptors and 65% (n=261) were non-exemptors.
  • Exemptors were more likely than non-exemptors to be concerned about serious side-effects.
  • They were more likely to report knowing someone who had been diagnosed with a vaccine-preventable disease but less likely to report that this had been a serious illness in that person and they believed it is better for a child to develop immunity through illness than vaccination.
  • They were less likely to trust physicians and information about vaccines and were more likely to obtain their health care from a naturopath.


Pottinger HL, Jacobs ET, Haenchen SD, Ernst KC. Parental attitudes and perceptions associated with childhood vaccine exemptions in high-exemption schools. [Published online ahead of print June 14, 2018]. PLoS One. doi:10.1371/journal.pone.0198655.


This study looked at parental attitudes to vaccination in high vaccine-hesitant elementary schools in Arizona. The results were not surprising, but it is not clear how this information can be used to help change vaccine exemptors perceptions and increase vaccine uptake. Previous studies have shown that more education of vaccine-hesitant parents can be counterproductive, and more successful approaches need to be identified. One thing that has been shown to increase vaccination rates is changing the state exemption laws to reduce or remove personal and religious exemptions and only considering medical exemptions. This remains controversial, however.—Sarah Rawstron, MB, BS, FAAP, FIDSA; Pediatric Residency Program Director, The Brooklyn Hospital Center, NY; Clinical Associate Professor, Icahn School of Medicine, Mount Sinai, NY.

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