title: Religious exemptions for immunization and risk of pertussis in New York State, 2000-2011.
abstract: OBJECTIVE
  The objective of this study was to describe rates of religious vaccination exemptions over time and the association with pertussis in New York State (NYS).
  
  
  METHODS
  Religious vaccination exemptions reported via school surveys of the NYS Department of Health from 2000 through 2011 were reviewed by county, and the changes were assessed against incidence rates of pertussis among children reported to the NYS Department of Health Communicable Disease Electronic Surveillance System.
  
  
  RESULTS
  The overall annual state mean prevalence (± SD) of religious exemptions for ≥1 vaccines in 2000-2011 was 0.4% ± 0.08% and increased significantly from 0.23% in 2000 to 0.45% in 2011 (P = .001). The prevalence of religious exemptions varied greatly among counties and increased by >100% in 34 counties during the study period. Counties with mean exemption prevalence rates of ≥1% reported a higher incidence of pertussis, 33 per 100 000 than counties with lower exemption rates, 20 per 100 000, P < .001. In addition, the risk of pertussis among vaccinated children living in counties with high exemption rate increased with increase of exemption rate among exempted children (P = .008).
  
  
  CONCLUSIONS
  The prevalence of religious exemptions varies among NYS counties and increased during the past decade. Counties with higher exemption rates had higher rates of reported pertussis among exempted and vaccinated children when compared with the low-exemption counties. More studies are needed to characterize differences in the process of obtaining exemptions among NYS schools, and education is needed regarding the risks to the community of individuals opting out from recommended vaccinations.
authors.affiliation: SUNY Upstate Medical University, Syracuse, NY 13210, USA.
authors.forename: Aamer
authors.initials: A
authors.lastname: Imdad
authors.forename: Boldtsetseg
authors.initials: B
authors.lastname: Tserenpuntsag
authors.forename: Debra S
authors.initials: DS
authors.lastname: Blog
authors.forename: Neal A
authors.initials: NA
authors.lastname: Halsey
authors.forename: Delia E
authors.initials: DE
authors.lastname: Easton
authors.forename: Jana
authors.initials: J
authors.lastname: Shaw
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000639:trends; D003430:Cross-Sectional Studies; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage*; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D032541:Mass Vaccination / Q000639:trends*; D009518:New York; D011159:Population Surveillance; D012068:Religion and Medicine; D013334:Students / Q000706:statistics & numerical data; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014917:Whooping Cough / Q000453:epidemiology* / Q000635:transmission
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine
keywords: children; exemptions; immunization; pertussis