1. Conscientious Exemptions in Texas Amy Schlabach, Immunization Compliance Coordinator Immunization Branch November 1, 2010

2. Conscientious Exemption Legislation 78 th Legislature 2003 Regular Session House Bill 2292 Effective September 1, 2003

3. Summarizing Legislation Key Provisions of HB 2292 Allows exemption for reasons of conscience, including a religious belief Applies to child-care facilities, elementary or secondary schools and institutions of higher education May be excluded from school in times of emergency or epidemic Requires affidavit Prohibits maintaining a record of names of individuals requesting the form

4. Summarizing Legislation Key Provisions of HB 2292 The affidavit form: Must contain a seal or other security device to prevent reproduction. Must contain a statement indicating the person “understands the benefits and risks of immunizations and the benefits and risks of not being immunized.” Must be obtained by submitting a written request to the department. Must be signed by the person claiming the exemption or, if a minor, signed by the parent. Must be submitted within 90 days from date notarized.

5. Changes to Rules 2003 Texas began allowing exemptions from immunizations based on reasons of conscience, including religious beliefs. Exemptions requested from September 2003 through April 2004, were valid for five years. In April 2004, the former Texas Board of Health ruled exemptions to be valid for two years. The approved rules allowed parents to fax their requests for the affidavit form In December 2007, the Executive Commissioner of the Health & Human Services Commission approved changes to the exemption rule allowing parents or guardians to request via the Internet that an affidavit form be mailed to them.

6. Conscientious Exemption Requires written requests for affidavit, incl. facsimiles and internet Requires full name and date of birth of child Allows request for up to five forms per child Allows exemption for one or more vaccines Affidavit form is valid for two years

7. Conscientious Exemption Original requests are returned with forms Affidavit forms are pre-printed with child’s name and date of birth Benefits and Risks of Vaccination fact sheet is included with forms.

8. Sources for Conscientious Exemption Data Number of affidavit forms requested Number of requests Number of children for whom exemptions are requested Number of affidavit forms per child Number of exemptions reported via school surveys & child-care audits

9. Yearly Comparison of the Number of Individuals Requesting Conscientious Exemptions, 2004 - 2010

10. 2009-10 Annual Report of Immunization Status: Kindergarten Conscientious Exemptions Kindergarten Conscientious Exemptions Vaccine Category(%) DTP/DTaP0.53 Hepatitis B0.47 MMR 20.54 Polio0.53 Varicella0.58 Hepatitis A0.53

11. 2009-10 Annual Report of Immunization Status: 7 th Grade Conscientious Exemptions 7 th Grade Conscientious Exemptions Vaccine Category(%) Tdap0.35 Hepatitis B0.24 MMR0.24 Polio0.25 Varicella0.35 Meningococcal0.37

12. Annual Report of Immunization Status: Total Number of Conscientious Exemptions Reported, School Year 2003- 2010 School Year Number of Students Enrolled with a Conscientious Exemption Percent of Students Enrolled with a Conscientious Exemption 2003-042,3140.08% 2004-052,7220.09% 2005-066,9910.15% 2006-079,6060.21% 2007-0810,4040.23% 2008-0912,6330.28% 2009-1019,0500.39%

13. Annual School Report: Total Number of Conscientious Exemptions Reported, School Year 2003-2010

15. Questions? Amy Schlabach Immunization Compliance Coordinator Immunization Branch 800-252-9152 512-458-7111 ext 6470 Amy.schlabach@dshs.state.tx.us www.ImmunizeTexas.com

16. Vaccine Coverage Sources Texas Immunization Branch – Coverage Levels http://www.dshs.state.tx.us/immunize/coverage/default.shtm National Immunization Survey – Child, 19-35 months http://www.cdc.gov/vaccines/stats-surv/imz-coverage.htm#nis National Immunization Survey – Teen http://www.cdc.gov/vaccines/stats-surv/imz-coverage.htm#nisteen Texas County Retrospective Immunization School Survey (TCRISS) http://www.dshs.state.tx.us/immunize/coverage/tcriss.shtm Texas School Immunization Validation Survey http://www.dshs.state.tx.us/immunize/coverage/validation.shtm Texas Childcare Immunization Assessment http://www.dshs.state.tx.us/immunize/coverage/childcare.shtm The Annual Survey of Immunization Status http://www.dshs.state.tx.us/immunize/coverage/schools.shtm The Behavioral Risk Factor Surveillance System (BRFSS) http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm