Does the CDC Determine Medical Exemptions for Vaccines?

California’s new vaccine law has some folks arguing about medical exemptions again.

Some want very broad guidelines and are confused about how doctors determine who should get a medical exemption.

Does the CDC Determine Medical Exemptions for Vaccines?

Bob Sears even thinks he has a bombshell revelation that clears everything up.

An email from the CDC!

The thing is, no one has ever said that ACIP contraindications and precautions to vaccination are the one and only factor that should determine whether or not a child should get a medical exemption.

“If a child has a medical exemption to immunization, a physician licensed to practice medicine in New York State must certify that the immunization is detrimental to the child’s health. The medical exemption should specify which immunization is detrimental to the child’s health, provide information as to why the immunization is contraindicated based on current accepted medical practice, and specify the length of time the immunization is medically contraindicated, if known.”

Dear Colleague letter regarding guidelines for use of immunization exemptions

So no one should really be surprised by an email that says the CDC does not determine medical exemptions.

What Qualifies as a Vaccine Medical Exemption?

What are the other big factors, in addition to ACIP contraindications and precautions?

“A medical exemption is allowed when a child has a medical condition that prevents them from receiving a vaccine.”

What is an Exemption and What Does it Mean?

Medical exemptions for vaccines should be based on AAP and ACIP guidelines, current accepted medical practice, and evidence based medicine.

“Medical exemptions are intended to prevent adverse events in children who are at increased risk of adverse events because of underlying conditions. Many of these underlying conditions also place children at increased risk of complications from infectious diseases. Children with valid medical exemptions need to be protected from exposure to vaccine-preventable diseases by insuring high coverage rates among the rest of the population. Granting medical exemptions for invalid medical contraindications may promote unfounded vaccine safety concerns. Although states may wish to allow parents who make decisions based on poor science or perceptions to withhold vaccines from their children, these exemptions should be distinguished from valid medical exemptions.”

Salmon et al on Keeping the M in Medical Exemptions: Protecting Our Most Vulnerable Children

For example, in addition to kids who may have had a severe allergic reaction to a vaccine, there are often children with immune system problems or who have a moderate or severe illness who can’t get one or more vaccines, at least temporarily.

Medical exemptions for vaccines should not be based on anecdotes or simply because a vaccine-friendly doctor has scared a parent away from vaccinating and protecting their kids.

They should rarely be done based on family history of reactions or what some people think are vaccine reactions.

In general, they should rarely be given, as the AAP states in their policy statement, Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance, “only a very small proportion of children have medical conditions prohibiting specific immunizations…”

That’s why rates of medical exemptions should be low.

“Between the 2009-2010 and 2016-2017 school years, the national median prevalence of medical exemptions has remained constant, between 0.2% to 0.3%, with state-level ranges showing little heterogeneity over time, never exceeding the range of 0.1% to 1.6% over this period.”

Bednarczyk et al on Current landscape of nonmedical vaccination exemptions in the United States: impact of policy changes

And why you shouldn’t have schools with high rates of medical exemptions or doctors writing a lot of medical exemptions.

More on Vaccine Medical Exemption Guidelines

• How to Claim a Vaccine Exemption
• Abuse of Vaccine Exemptions
• Why Should Medical Exemptions Be Based on CDC Contraindications?
• The History of Vaccine Exemptions
• Who Is Kenneth Stoller?
• Who Should Write Your Child’s Medical Exemption for Vaccines?
• Update on Vaccine Exemption Rates in California
• ACIP – Contraindications and Precautions
• AAP – Vaccine Contraindications And Precautions
• AAP – Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance
• CDC – Who Should NOT Get Vaccinated with these Vaccines
• CDC – What is an Exemption and What Does it Mean?
• School Exemption Laws by State
• Study – Experiences With Medical Exemptions After a Change in Vaccine Exemption Policy in California
• Study – Medical exemptions to school immunization requirements in the United States–association of state policies with medical exemption rates (2004-2011)
• Study – Current landscape of nonmedical vaccination exemptions in the United States: impact of policy changes
• Keeping the M in Medical Exemptions: Protecting Our Most Vulnerable Children
• Study – Rising rates of vaccine exemptions: problems with current policy and more promising remedies
• Vaccine Medical Exemptions Are a Delegated Public Health Authority
• Dear Colleague letter regarding guidelines for use of immunization exemptions
• Frequently Asked Questions About Legislation Removing Non-Medical Exemptions from School Vaccination Requirements
• SB277 New School Rules: What Providers and Parents Need to Know
• California SB276 – legislation to reduce vaccine medical exemption abuse
• ‘Dr. Bob’ Sears Accused Of Issuing Invalid Vaccine Medical Exemptions–Again
• After SB 277, medical exemptions to vaccine mandates for sale, courtesy of Dr. Bob Sears
• Exemptions Surge As Parents And Doctors Do ‘Hail Mary’ Around Vaccine Laws