Abstract
Routine childhood immunizations against infectious diseases are an integral part of our public health infrastructure. They provide direct protection to the immunized individual and indirect protection to children and adults unable to be immunized by reducing spread of vaccine-preventable diseases in the community. All 50 states, the District of Columbia, and Puerto Rico have regulations requiring proof of immunization as a condition for child care and school attendance as a public health strategy to protect children in these settings and to secondarily serve as a mechanism to promote timely immunization of children by their caregivers. Although all states and the District of Columbia have mechanisms to exempt school attendees from specific immunizations for medical reasons, the majority also have a heterogeneous collection of regulations and laws that allow nonmedical reasons for exemption. The American Academy of Pediatrics (AAP) supports certification of immunization to attend child care and school as a sound means of providing a safe environment for attendees and employees of these settings. The AAP also supports medically indicated exemptions to specific immunizations as determined for each individual child. The AAP advocates for the elimination of nonmedical exemptions from immunizations as contrary to optimal individual and public health.