Immunization

About California’s New Vaccination Law

In 2015, California passed SB 277, one of the most comprehensive school immunization laws in the country. Starting July 1, 2016, all newly enrolled children in day care and school will need to be immunized, except those with medical exemptions.

What Has Changed?

Starting January 1, 2016, the following changes go into effect:

  • Parents can no longer use personal (including religious) belief exemptions to opt out of vaccinations required when enrolling in child care and public and private schools.
  • Children with serious health issues can opt out by providing the school a medical exemption written by a licensed physician.
  • Some children are exempt:
    • Students in home-based private schools; and
    • Students enrolled in an independent study program who do not receive classroom-based instruction.
    • Students who qualify for individualized education programs (IEPs) will be allowed to access any special education and related services required by the IEPs, regardless of whether the students are vaccinated.

What About Children Who Currently Have Personal Belief Exemptions?

Unvaccinated kids can stay unvaccinated and still remain in school until the next “grade span,” as long as their exemption is on file before January 1, 2016.

Grade spans are defined as (a) birth to preschool, (b) kindergarten to grade six, and (c) grades seven to twelve. Students cannot enroll in a new school, change schools, or enter kindergarten or seventh grade without the mandatory vaccinations.

For example, a parent can still use a current personal belief exemption for a child in second grade if they remain at the same school they attended last year. Under the new law, the child will be allowed to remain in the same school without vaccinations until they reach the seventh grade. However, the same child will not be able to enroll in a different school without getting vaccinated first.

What Are the Mandatory Vaccinations?

Children must be immunized against 10 diseases: polio, diphtheria, tetanus, pertussis (whooping cough), measles, mumps, rubella, chicken pox, and bacterial meningitis (required for child care and preschool settings). Hepatitis B vaccination is required for students aged 4-6 admitted to California schools, it is not required after 7 years of age. Students entering seventh grade are required to have a Tdap booster (Tetanus, reduced diphtheria, and pertussis).

Immunization Is a Public Health Priority

Despite years of effort, immunization rates have not reached desired levels. Nationwide, low-income children and adolescents are less likely than their wealthier peers to have been fully immunized.(1) In California, more than 8% of children arrive at kindergarten without all required vaccines, and only 42% of children and adolescents are immunized against the flu in any given year.(2) The rates of other essential vaccinations–including human papillomavirus, meningococcal meningitis, and pertussis/whooping cough–are also too low. As a result, children and adolescents catch, suffer from, and pass on dangerous preventable illnesses.

School-Located Vaccination Increases Immunization Rates

School-located vaccination (SLV) programs and school-based health centers (SBHCs) improve adolescent vaccination rates, while simultaneously saving health care dollars for society. More specifically, recent research shows that:

  • SLV is an effective way to increase immunization rates and prevent costly illness.(3,4,5,6)
  • More than 80% of SBHCs offer important adolescent vaccinations, with the vast majority providing vaccinations to Medicaid covered (96%) and uninsured (98%) students.(7)
  • Across a wide range of vaccinations—including Hep B, Tdap, MMR, and HPV—SBHCs can achieve significantly higher rates of full immunization than other types of providers.(8)

Resources for Practice

For tools to help you implement school-located vaccination, see Immunization Resources.

Citations
(1) Child Trends Data Bank: http://www.childtrendsdatabank.org/?q=node/71.
(2) http://www.kidsdata.org/
(2) California Health Interview Survey, 2009.
(3) Frieden, T. (2010). Memorandum Report: 2009 H1N1 School-Located Vaccination Program Implementation, OEI-04-10-00020.
(4) Gupta, R., Isaac, B., & Briscoe, J. (2010). A Local Health Department’s School-Located Vaccination Experience with H1N1 Pandemic Flu Vaccine. Journal of School Health. 80(7): 325.
(5) Lindley, M.C., Boyer-Chu, L., Fishbein, D.B., Kolasa, M., et al. (2008). The Role of Schools in Strengthening Delivery of New Adolescent Vaccines. Pediatrics. 121: S46-S55.
(6) Schmeir, J., Li, S., King, J.C., Nichol, K., et al.  (2008). Benefits and Costs of Immunizing Children against Influenza at School: An Economic Analysis based on a Large-Cluster Controlled Clinical Trial. Health Affairs. W96-W104.
(7) Federico, S.G., Abrams, L., Everhart, R.M., Melinkovich, P., et al. (2010). Addressing Adolescent Immunization Disparities: A Retrospective Analysis of School-Based Health Center Immunization Delivery. American Journal of Public Health. 100(9): 1630-1634.
(8) Daley, M.F., Curtis, C.R., Pyrzanowski, J., Barrow, J., et al. (2009). Adolescent Immunization Delivery in School-Based Health Centers: A National Survey. Journal of Adolescent Health. 45: 445-452.