Immunity Requirements and Exemptions Allowed for Health Professional Students, United States, 2008

Immunity Requirements and Exemptions Allowed for Health Professional Students, United States, 2008

Background: Since health professional students have potential for exposure to infectious materials, they are included in the Advisory Committee on Immunization Practices (ACIP) definition of healthcare personnel (HCP).  The number of U.S. health professional schools with student immunity requirements for ACIP-recommended vaccines for HCP has risen substantially during the past 20 years. 

Objective:   Describe immunity requirements for U.S. health professional students, including exemptions allowed, for ACIP-recommended vaccines for HCP.

Methods:   Self-administered electronic survey was fielded November 2008-March 2009, and distributed to deans of all entry-level baccalaureate nursing programs (n=603), and accredited MD-granting (n=130) and DO-granting (n=26) medical schools in the U.S. and Puerto Rico.  An immunity requirement was defined as requiring students to produce 1) documentation of a previous vaccination or 2) other evidence of immunity to a vaccine-preventable disease (e.g., laboratory evidence).

Results:   Survey response rates, by school type, were as follows: nursing, 74% (n=442); MD-granting medical, 76% (n=98); DO-granting medical, 88% (n=23).  Survey estimates were weighted to account for non-respondents.  The percentage of schools with immunity requirements ranged from 98.0% for rubella to 18.4% for influenza, and except for varicella, did not differ significantly by school type.  Among those with an immunity requirement, schools that accepted only documented vaccine administration and all other ACIP-recommended evidence of immunity (if applicable) ranged from 8.7% for mumps, to 71.1% for influenza.  For example, among schools with an immunity requirement to mumps, only 29.2% accepted birth before 1957, despite this being considered as presumptive evidence of immunity by ACIP at the time of the survey.  Additionally, 12.6% of schools with an immunity requirement to mumps accepted non-verified disease history, despite this not being ACIP-recommended.  Schools with immunity requirements were least likely to allow nonmedical exemptions for Tdap vaccine (25.0%), and most likely to allow nonmedical exemptions for influenza vaccine (37.7%).  Among schools allowing exemptions, a note written by the student was often sufficient documentation to obtain medical (32%), religious (68%) and personal belief (82%) exemptions.    

Conclusions:   U.S. health professional schools that choose to require immunity to specific vaccine-preventable diseases should accept only documented vaccine administration, or other ACIP-recommended evidence of immunity, if applicable.  For schools that choose to allow exemptions, the ease of obtaining exemptions may not be consistent with the intended purpose of the immunity requirement.