Immunization and Vaccination Laws in the US Text Size:

In 1809, Massachusetts became the first state to pass a law requiring immunization against smallpox. Since then, immunization laws have been a controversial topic that, to this day, continues to be fought over in state legislatures and the courts.

On one side of the argument are advocates of immunization, who argue that vaccines are a safe, necessary way to protect the public health. On the other side of the argument are people who object on religious grounds or who question the safety and effectiveness of immunizations.

Immunization Laws Effecting Adults

The federal and state governments do not require adult citizens to be vaccinated, although the National Immunization Program recommends certain vaccinations for adults. However, many adults are required to be vaccinated as a condition of employment in the public and private sector. For example, the US military requires that everyone entering military service be vaccinated against certain diseases. In addition, the government imposes vaccination requirements on non-US citizens who want to reside in this country. Foreign citizens who are seeking permanent residency in the United States, as well as foreign-born children who are entering the country to be adopted, must be vaccinated against all vaccine-preventable diseases before being allowed to enter the country.

Immunization Laws for Children

The government does require children to be vaccinated. For example, every state has immunization requirements that must be fulfilled before a child may enter school. These school immunization laws are often based on the recommendations of the infectious disease committees of the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians.

Most states require that children entering school be vaccinated against:

• Diphtheria
• Haemophilus influenza type b
• Hepatitis B
• Pertussis (whooping cough)
• Polio
• Measles
• Mumps
• Rubella
• Tetanus (lockjaw)

Some states also require the varicella (chicken pox) vaccine.

Although many adults may have received the smallpox vaccine when they were young, this vaccine is not required nowadays because the disease is no longer a threat.

Most states require the parents or guardian of a child entering school to provide written proof signed by a healthcare provider of each child's compliance with the vaccine requirements. Unless there is a religious objection to vaccination or a health condition that precludes vaccination, children who have not met the state requirements will not be permitted to attend school.

Religious, Philosophical and Medical Objections to Immunizations

Every state except West Virginia and Mississippi allow parents with religious objections to immunization to apply for an exemption for their child from the state's immunization requirements.

Twenty states allow parents who have a philosophical objection to immunization to apply for an exemption. These states are:

• Arizona
• Arkansas
• California
• Colorado
• Idaho
• Louisiana
• Maine
• Michigan
• Minnesota
• Missouri (applies only to daycare, preschool and nursery school)
• New Mexico
• North Dakota
• Ohio
• Oklahoma
• Pennsylvania
• Texas
• Utah
• Vermont
• Washington
• Wisconsin

All states allow for medical exemptions to immunization. Medical exemptions are usually granted to children with compromised immune systems, allergies to vaccine ingredients, and other chronic or severe illnesses.

If you have a religious or philosophical objection to immunizing your child, you'll need to supply an affidavit to the school testifying to that fact. If the school refuses to honor your objection, in most cases a letter from your lawyer that explains your legal right to object should solve the problem. In extreme situations, parents have fought their local school districts in court to gain or uphold their right to keep their child from being vaccinated.

Information About Risks and Benefits of Vaccines

Federal law requires that parents, guardians or patients be given written information about the risks and benefits of vaccination before administering the vaccine. In addition, the National Childhood Vaccine Injury Act requires all healthcare providers in the United States to provide copies of a Vaccine Information Statement before administering any vaccines for diphtheria, Haemophilus influenza type b, hepatitis A, hepatitis B, influenza, measles, mumps, rubella, pertussis, pneumococcal conjugate, polio, tetanus or varicella.

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