title: Variation in exemptions to school immunization requirements among New York State private and public schools.
abstract: OBJECTIVE
  School immunization requirements have ensured high vaccination rates and have helped to control vaccine-preventable diseases. However, vaccine exemptions have increased in the last decade. This study compared New York State private versus public schools with respect to medical and religious exemption rates.
  
  
  METHODS
  This retrospective study utilizes New York State Department of Health Immunization Survey data from the 2003 through 2012 academic years. Schools were categorized as private or public, the former further categorized by religious affiliation. Rates of medical and religious vaccine exemptions were compared by school category.
  
  
  RESULTS
  From 2003 to 2012, religious exemptions increased in private and public schools from 0.63% to 1.35% and 0.17% to 0.29% (Spearman's R: 0.89 and 0.81), respectively. Among private schools, increases in religious exemption rates during the study period were observed in Catholic/Eastern Orthodox, Protestant/Other Christian, Jewish, and secular schools (Spearman's R=0.66, 0.99, 0.89, and 0.93), respectively. Exemption rate ratios in private schools compared to public schools were 1.39 (95% CI 1.15-1.68) for medical and 3.94 (95% CI: 3.20-4.86) for religious exemptions. Among private school students, all school types except for Catholic/Eastern Orthodox and Episcopal affiliates were more likely to report religious exemptions compared to children in public schools.
  
  
  CONCLUSIONS
  Medical and religious exemption rates increased over time and higher rates were observed among New York State private schools compared to public schools. Low exemption rates are critical to minimize disease outbreaks in the schools and their community.
authors.affiliation: Albany School of Public Health, State University of New York, University at Albany, Albany, NY, United States.
authors.forename: Yun-Kuang
authors.initials: YK
authors.lastname: Lai
authors.affiliation: Institute for Health and the Environment, University at Albany, State University of New York, Albany, NY, United States.
authors.forename: Jessica
authors.initials: J
authors.lastname: Nadeau
authors.affiliation: Institute for Health and the Environment, University at Albany, State University of New York, Albany, NY, United States.
authors.forename: Louise-Anne
authors.initials: LA
authors.lastname: McNutt
authors.affiliation: Upstate Golisano Children's Hospital, State University of New York, Syracuse, NY, United States. Electronic address: shawja@upstate.edu.
authors.forename: Jana
authors.initials: J
authors.lastname: Shaw
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D055118:Medication Adherence; D009518:New York; D012189:Retrospective Studies; D012574:Schools
keywords: Children; Exemption; Immunization; Religion; School; Vaccine