Salmon DA, Moulton LH, Omer SB, et al: Factors associated with refusal of childhood vaccines among parents of school-aged children: A case-control study. Arch Pediatr Adolesc Med 2005;159(5):470-6.
All states require children entering school to receive certain vaccines, but many states permit medical, religious, personal, and philosophical exemptions. Using a case-control study, the authors surveyed parents of 815 children who were exempt from one or more vaccines for school entry. The children were from private and public elementary schools in Colorado, Massachusetts, Missouri, and Washington. Most children with nonmedical exemptions received at least some vaccines. Varicella was the most common vaccine excluded. Children with non-medical exemptions were 35 times more likely to contract measles and 5.9 times more likely to contract pertussis. Parents of exempt children were more likely to report their child's primary care provider to be a nurse practitioner or complementary alternative medicine professional, but then some pediatricians and family physicians refuse to care for unvaccinated children. Immunization programs must maintain public confidence to sustain high immunization coverage rates or vaccine-preventable diseases will continue to rise.