State Policy Removing the Personal Belief Exemption for Measles, Mumps, and Rubella (MMR) School Immunization Requirement, Washington State, 2014–2022

Bibliographic Data

ID11029653
AuthorsTyler P Moore (Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle.), Julia C Bennett (0000-0003-2559-2922, Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle.), Katherine Graff (Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle.), Mayuree Rao (0000-0002-0874-8238, Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle.), Orvalho Augusto (0000-0002-0005-3968, Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle.), Helen Y Chu (0000-0001-8502-9600, Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle.), Bradley H Wagenaar (0000-0002-3351-7175, Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle.), Teal R Bell (Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle.)
Year2023
Volume113
Issue7
Pages795-804
Publication date2023-07-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAmerican Journal of Public Health (JOURNAL)
Journal identifiersISSN: 0090-0036 • E-ISSN: 1541-0048
PublisherAmerican Public Health Association (PUBLISHER • US)
DOI10.2105/ajph.2023.307285
PMID37200605
OpenAlexW4377093896
LanguageEN
Citations received2
References cited22

Objectives. To assess the impact of Washington State’s 2019 Engrossed House Bill (EHB) 1638—which removed measles, mumps, and rubella (MMR) personal belief exemptions—on MMR vaccine series completion and exemption rates in K–12 students. Methods. We used interrupted time-series analyses to examine changes in MMR vaccine series completion rates before and after EHB 1638 was passed and the χ 2 test for differences in exemption rates. Results. EHB 1638 implementation was associated with a 5.4% relative increase in kindergarten MMR vaccine series completion rates (95% confidence interval = 3.8%, 7.1%; P ≤ .001), and results were similar with Oregon as a control state (no change observed in Oregon; P = .68). MMR exemptions overall decreased 41% (from 3.1% in 2018–2019 to 1.8% in 2019–2020; P ≤ .001), and religious exemptions increased 367% (from 0.3% to 1.4%; P ≤ .001). Conclusions. EHB 1638 was associated with an increase in MMR vaccine series completion rates and a decrease in any MMR exemption. However, effects were partially offset by an increase in religious exemption rates. Public Health Implications. Removal of personal belief exemptions for the MMR immunization requirement only may be an effective approach to increase MMR vaccine coverage rates statewide and among underimmunized communities. (Am J Public Health. 2023;113(7):795–804. https://doi.org/10.2105/AJPH.2023.307285 )

Confidence interval · Environmental health · Immunization · Measles · Measles-Mumps-Rubella Vaccine · MMR vaccine · Public health · Rubella · Rubella vaccine · Sociology · Vaccination · Adolescent Sexual and Reproductive Health · Demography · Immunology · Internal Medicine · Medicine · Vaccine Coverage and Hesitancy · Virology · Virology and Viral Diseases · Pediatrics

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