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BACKGROUND: In the state of Kansas, two legal alternatives to school required vaccination are allowed, medical exemption and religious exemption. To receive a medical exemption, a physician must annually sign a form stating the reason for exemption and from which vaccine(s) the child is exempt. To receive a religious exemption, a parent or guardian must write a statement explaining that the child is an adherent of a religious denomination whose religious teachings are opposed to vaccination. The objective of this study is to examine the trend in medical and religious vaccine exemption in Kansas kindergarteners over a four-year period.
METHODS: Records from all vaccine-exempt Kindergarteners in Kansas public and private schools were requested for all school years from 2010-2014. These records were categorized as either religious or medical exemptions. Vaccination status was analyzed for exempt children with some vaccination history, called partial exemptions, to determine up-to-date status for the five vaccines required for entry into kindergarten (DTaP, Polio, MMR, Varicella, and Hepatitis B). Exemption rates were calculated as percentages and chi-square statistical analysis was performed using SAS 9.3.
RESULTS: Exemption records from 1794 Kansas kindergarten students were received from 2010 to 2014. The number of children with any type of exemption increased significantly from 1.03% to 1.63% over the four school years (p<0.0001). The percentage of children with a medical exemption did not significantly increase; however, the percentage of students with a religious exemption increased from 0.75% to 1.33% over the four school years (p<0.0001). In the 2013-2014 school year, 68.4% of children with a religious exemption and 35.6% of children with a medical exemption were fully exempt from all five required vaccines. Varicella and MMR were the two vaccines most exempt children had not received (71.8% and 70.1%, respectively). The percentage of exempt children not receiving varicella and MMR vaccines was higher among children with religious exemptions (78.6% versus 42.6% and 76.7% versus 41.6% respectively) than those with medical exemptions.
CONCLUSIONS: Significant increases in the percentage of kindergarten children with religious exemptions have been observed in Kansas between 2010 and 2014. The increase in religious exemptions may increase the risk for vaccine-preventable diseases. Although medical exemptions require a signature from a medical professional, religious exemptions do not have such a requirement, thereby making religious exemptions easier to obtain. Instituting a more stringent review process, including record review, for religious exemptions could have an effect on the number of children claiming religious exemption.