Religious Exemptions to Vaccination in Illinois Schools, 2013-2014

BACKGROUND: In Illinois, religious exemptions to required school vaccinations have been rising in recent years. During the 2012-2013 school year, 4.8% of children enrolled in kindergarten had a reported religious exemption to vaccination, the fourth highest rate in the country. The Illinois Administrative Code and the Illinois Department of Public Health (IDPH) Rules and Regulations specify guidelines for the review of religious exemptions to vaccination. The objective of this study is to examine reasons and criteria for granting or denying requests for religious exemptions to vaccinations in Illinois schools.

METHODS:  An online survey using the software Inquisite was distributed via email to 2,143 school nurses in Illinois. The survey was filled out by the school nurse, regardless of whether or not the nurse reviews requests for religious exemptions to vaccinations for that school or school district. Data management was performed in Excel and statistical analysis was performed using SAS 9.3.

RESULTS:  As of January 15, 2014, 250 surveys have been completed for a preliminary response rate of 12%; 305,033 students in 560 schools were represented. Most (88%) respondents worked in a public school system and 8% in a private system. Among 2,559 requests for religious exemptions submitted, 2,546 had been approved. About half (52%) of respondents reported that requests are never denied at their schools.Requests are most often reviewed by school nurses (72%), followed by the district or regional superintendent (22%), principal or vice principal (19%),  and school board (2%).  Resources used to evaluate requests include Illinois Administrative code (66%), Illinois Department of Public Health Rules (56%), personal opinion or beliefs (24%), and none used (4%). Specific criteria used to evaluate requests were a written letter from parent or guardian (85%), documentation or reference of a religious tenet (48%), specific religion mentioned in letter in (7%), no specific criteria (6%), and written letter from a religious leader (4%).

CONCLUSIONS:  In the schools represented by this survey, requests for religious exemption to vaccination are rarely denied. The process of reviewing requests lacks consistency across the school districts represented in this survey. Practices for reviewing religious exemption requests should be standardized across the state to ensure that the approved exemptions correctly reflect an objection based on religious grounds. The findings of this study will help guide revisions to existing policies regarding religious exemptions to vaccination in Illinois.