1. In Washington State, legislation requiring physicians to counsel patients seeking vaccine exemption led to significant decrease in patients actually obtaining exemptions.
2. Legislature-mandated counseling also led to a decrease in the geographic clustering of vaccine-exempt children.
Evidence Rating Level: 2 (Good)
Study Rundown: In the United States, patients may pursue vaccine exemption based on the regulations of their individual state, some allowing exemption for medical or religions reasons, and some for reasons of personal belief. In recent years, the state of Washington changed its exemption laws, requiring parents seeking exemptions for their children entering kindergarten to discuss with their healthcare providers the risks and benefits of immunization and to sign a form confirming they had completed this discussion. After the implementation of this law, data from the State Department revealed a significant decrease in the number of patients receiving exemptions as well as a relative decrease in the rate of exemptions. There was also a decrease in the likelihood that kindergartners without exemptions would encounter those with exemptions. Additionally, the likelihood that kindergartners with exemptions would interact with other such kindergartners also decreased. Finally, there was a notable decrease in the expected exemption rates, particularly in geographic areas with an anticipated high-density of vaccine exemption. Though vaccine counseling adds time to an already short well-child visit, this study clearly demonstrates its benefit in decreasing the rate of vaccine exemptions, particularly in a traditionally vaccine-hesitate state.
Relevant Reading: Effective Messages in Vaccine Promotion: A Randomized Trial
In-Depth [retrospective cohort]: Researchers gathered data about kindergartener vaccination and exemption rates from the Washington State Department of Health from school year 1997-1998 to school year 2013-2014. The law requiring healthcare provider counseling on vaccine risks and benefits, known as Senate Bill 5005 (SB5005), was implemented in July 22, 2011. Researched used linear fit models to assess for the absolute changes in vaccination and exemption rates after the law’s implementation. Interaction and aggregation indices were used to calculate the likelihood of exposure of children with exemptions to children without exemptions as well as to other children with exemptions. After the implementation of SB5005, there was a 40.2% (95% Confidence Interval [CI]: -42.6% to -36.6%) decrease in the rates of exemption in Washington State. This decrease translated to an absolute reduction of vaccine exemption of 2.9% (95% CI: -4.2% to -1.7%). There was a general decrease in the likelihood that a kindergartener with an exemption would encounter other such kindergarteners. Furthermore, regions in the northern part of the state, where high rates of exemption are generally concentrated, saw a decrease in exemptions in many regions after the law’s implementation.
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