"From 2001 through 2004, states that permitted personal belief exemptions [from vaccinations] had higher nonmedical exemption rates than states that offered only religious exemptions, and states that easily granted exemptions had higher nonmedical exemption rates in 2002 through 2003 compared with states with medium and difficult exemption processes. The mean exemption rate increased an average of 6% per year, from 0.99% in 1991 to 2.54% in 2004, among states that offered personal belief exemptions. In states that easily granted exemptions, the rate increased 5% per year, from 1.26% in 1991 to 2.51% in 2004. No statistically significant change was seen in states that offered only religious exemptions or that had medium and difficult exemption processes. In multivariate analyses adjusting for demographics, easier granting of exemptions (incidence rate ratio = 1.53; 95% confidence interval, 1.10-2.14) and availability of personal belief exemptions (incidence rate ratio = 1.48; 95% confidence interval, 1.03-2.13) were associated with increased pertussis incidence."

"...48 states that allow people to be exempted from required shots for various nonmedical reasons. All 48 of the states allow exemptions based on religious objections, but 19 of them also allow exemptions based on philosophical or other personal beliefs. Some states make it easy for parents to claim an exemption by simply signing a prewritten statement on the school immunization form. Others make it harder by requiring a signature from a local health official, a personally written letter, notarization or annual renewal.

The pendulum has swung too far toward letting parents opt out. States need to work harder at educating parents about the value of vaccination and should get tougher in granting exemptions."

For health officials responsible for seeing that young children receive their vaccinations on time, the upsurge in out-of-wedlock births cannot be good news.  Distinctively low vaccination rates among the children of unmarried mothers have, in fact, recently been documented in a study published in Public Health Reports.

Examining data collected during 1997-1998 from northern Manhattan, Detroit, San Diego, and rural Colorado, officials from the Centers for Disease Control and Prevention looked for social predictors that three-month-old infant children will not have received the recommended vaccinations (for diptheria-tetanus-pertussis, polio, haemophilus influenza type B and hepatitis B).  Among the factors statistically linked to particularly low vaccination rates were "having public or no insurance... and the adult respondent [i.e., the mother in almost all cases] being unmarried."  To be sure, the statistical linkage between maternal marital status and infant vaccination status reached the threshold of statistical significance for only two of the four data sources (Detroit and San Diego).  However, infant vaccination rates ran higher for the children of married mothers than for the children of unmarried mothers in all four sites. 

The authors of the new study stress that "ensuring that children are U[p]T[o]D[ate] with immunizations at three months is important in preventing vaccine-preventable diseases," and they express concerns about "vulnerable children" who have not been vaccinated "early in life, when the risk of complications for vaccine-preventable diseases is highest and the risk of exposure is significant from unimmunized or under immunized siblings." The researchers also warn that "a late start for the initial vaccination series [to be completed before an infant is three months old] has been found to be associated with underimmunization later in childhood."