Parents PACK

Schools and Vaccines

When a child enters school, one of the considerations is vaccines. Schools require proof of immunization or exemption at the time of registration. Here we address some of the things you may be thinking about at that time.

School entry requirements

Are you unsure about which vaccines are required for your child to enter school? Are you going to be moving to a new state and need to check on vaccine requirements? The National Network for Immunization Information (NNii) has gathered all of this information into one place for you.

Exemptions and herd immunity

Some parents are confused about whether their children need vaccines. They may have heard that vaccines cause autism or other chronic conditions or that the vaccines were made using aborted-fetal tissue, or they may feel that vaccines are not necessary, because they haven't seen anyone they know getting the diseases that vaccines prevent.

In most states, vaccines are required for entry into school or child care centers. However, there are cases in which a child may be able to go to school without having a particular vaccine. In these cases, the parent must exercise an "exemption," which is a legal option to forego a vaccine.

Different states have different laws regarding exemptions (see "School Entry Requirements" above). There are three kinds of exemptions:

Medical exemptions

These are allowed when a child has a medical condition or allergy that may make receiving the vaccine dangerous. All 50 states allow medical exemptions. For school entry purposes, these exemptions require a physician's note supporting the medical necessity of the exemption.

Religious exemptions

These are allowed when immunizations are not in agreement with the parents' religious beliefs. Forty-eight of the 50 states allow these exemptions.

Philosophical exemptions

These are allowed when non-religious, but strongly held beliefs, prevent a parent from allowing their child to be immunized. Twenty states allow these exemptions.

In certain situations an exemption can be challenged by the state. These situations include those that would put the child at a higher risk of disease than is reasonable (medical neglect) or those that would put society at risk (e.g., epidemic situations). Also, in some states, if an unvaccinated child is found to transmit a vaccine-preventable disease to someone else, the parents may be liable in a civil suit.

Because vaccines are considered medically necessary (except in the medical cases mentioned above), they are considered to be "best-care" practices. Therefore, if parents choose not to immunize their children, doctors will often have them sign a statement that they have discussed the risks and benefits of the vaccines and they understand that they are taking a risk in refusing vaccines for their children.

Risking disease

Many people incorrectly assume that a choice not to get a vaccine is a risk-free choice. But it isn't. The choice not to get a vaccine is a choice to risk the disease that the vaccine prevents. Studies have shown that unimmunized children are more likely to get vaccine-preventable diseases if there is an outbreak than those who have been immunized. Unimmunized children will be barred from school during an outbreak to protect them from the disease.

Here are some things to consider before making a decision not to immunize a child:

• Vaccines are considered the best way to protect your child against diseases that could cause liver damage, liver cancer, suffocation, meningitis, pneumonia, paralysis, lockjaw, seizures, brain damage, deafness, blindness, mental retardation, learning disabilities, birth defects, encephalitis or death.
• Vaccines are studied extensively for their safety before being recommended for children and continue to be monitored after recommendation (see How Are Vaccines Made?). Because vaccines are given to healthy children, they are held to the highest standards of safety.
• Vaccines are considered by some to be a civic duty because they create "herd immunity." This means that when most of the people in a community are immunized, there is less opportunity for a disease to enter the community and make people sick. Because there are members of our society that are too young, too weak, or otherwise unable to receive vaccines for medical reasons, they rely on "herd immunity" to keep them well.

Harm to others

There are four ways that others in the community may be harmed by a parent's decision not to immunize their child:

• If the unimmunized child gets a preventable disease, he or she may pass that disease to other unimmunized people in the community.
• Even when people are immunized, there is always a small percentage of them for whom the vaccine did not work or their immunity has waned; so these people will also be at increased risk if an unimmunized child gets a preventable disease.
• If a person cannot receive vaccines for medical reasons, they rely on those around them for protection from the diseases.
• Families that have received vaccines and contract a vaccine-preventable disease from an unimmunized person will need to pay the medical costs incurred by the disease. Treatment for the diseases cost much more than the vaccines, so the unimmunized child's family or society will bear these costs.

Those who choose not to immunize their child may be considered to be "free riders" by those who have immunized their children. For example, a mother whose son recently experienced a severe bout with pertussis was angry that other children in the classroom were not immunized. In discussing vaccine safety as the reason that many parents give for not wanting to immunize, she wondered why their children should be protected by herd immunity when her child and all of the other immunized children bore the small risk of side effects. In addition, she wondered why she wasn't made aware that so many of the children in the school weren't immunized due to personal beliefs. She concluded by saying, "Had I known . . .I would never have enrolled him in that school."

Updated: April 2008