title: Vaccine policy and Arkansas childhood immunization exemptions: a multi-year review.
abstract: BACKGROUND
  An increase in total vaccine exemptions (medical, philosophic, and religious) occurred in Arkansas after a 2003 legislation added a philosophic category and used a new process for vaccine exemptions. By legislative requirement, the Arkansas Department of Health monitored exemptions through the 2009-2010 school year.
  
  
  OBJECTIVE
  The goal of the study was to determine the prevalence of vaccine exemption in 2003-2010 compared to the number of requests prior to the legislation enacted in 2003.
  
  
  METHODS
  Exemptions were calculated by school-age category using raw numbers of exemptions, total estimates of the population by age level, enrollment numbers for students in public and private schools, and in enrolled college students born after 1957. Exemptions also were analyzed by school district, grade level, type of exemption, and particular vaccine exemption requested.
  
  
  RESULTS
  Overall exemptions continued to rise each year, with an average increase of 23.1% annually. Medical exemptions declined from an average of 21.3% of all exemptions before to an average of 4.8% thereafter. The greatest increase in number of exemptions was observed among college students. The highest total rate of exemptions per precollegiate student population was <1.3%. When exemption requests were categorized, most (79%) were for exemptions from "all vaccines." The most common single exempted vaccine was MMR (measles, mumps, rubella).
  
  
  CONCLUSIONS
  Since philosophic exemptions were codified in 2003 in Arkansas, the number and rate of vaccine exemptions continue to progressively increase. However, vaccine-preventable disease clusters have not yet been linked to or identified in any population with a high rate of vaccine exemptions.
authors.affiliation: Arkansas Department of Health, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA.
authors.forename: Haytham
authors.initials: H
authors.lastname: Safi
authors.forename: J Gary
authors.initials: JG
authors.lastname: Wheeler
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Reeve
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ochoa
authors.forename: José R
authors.initials: JR
authors.lastname: Romero
authors.forename: Robert
authors.initials: R
authors.lastname: Hopkins
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Ryan
authors.forename: Richard F
authors.initials: RF
authors.lastname: Jacobs
mesh_terms: D001131:Arkansas; D002675:Child, Preschool; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D017589:Immunization Programs / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D007223:Infant; D037141:Mandatory Programs / Q000331:legislation & jurisprudence; D012042:Registries