Background: To prevent the spread of Vaccine Preventable Diseases (VPD’s), school-aged children in the United States are required to receive vaccinations. In certain states, parents have the option to exempt their child from becoming vaccinated due to medical, religious, or personal reasons. The purpose of this research was to identify which states require mandatory vaccination education prior to granting vaccine exemptions and to identify the various types of required vaccination education.Methods: Immunization program managers from states requiring parents seeking exemptions to receive mandatory vaccination education were asked a series of open-ended questions. The interviews were conducted via telephone. The education-related questions identified: 1) which states require mandatory education prior to granting vaccine exemptions; 2) delivery methods for education; 3) standardization of materials; 4) renewal and evaluation of education; 5) the greatest obstacles to providing education; and 6) use of immunization registries to track vaccination education.Results: Ten states reported mandatory vaccination education requirements prior to granting vaccine exemptions. Three methods of vaccination education delivery were identified: printed material, face-to-face education, and/or online technology-driven education. Seven states have standardized vaccination education and use state exemption rates as a means to evaluate the education. Half of states required parents to renew vaccination education, but the time period for renewals varied from state-to-state. There were two general obstacles to delivering vaccination education, namely, lack of resources and lack of parent involvement.Conclusion: Parental education regarding vaccines impacts parents’ decisions to vaccinate their children. The method of delivering mandatory vaccination education varies greatly between states. Each method for vaccination education delivery has inherent advantages and disadvantages, indicating the need for further research to determine which method of education delivery is most effective. A combination of delivery methods may, in fact, be the best option. Identifying the most effective delivery method for vaccination education, as well as the most optimal time period for renewing the education, will assist other states developing mandatory vaccination education materials.



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vaccination, exemption, immunization, state requirements, education, mandate



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