{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T12:37:35Z","timestamp":1782391055632,"version":"3.54.5"},"reference-count":23,"publisher":"American Public Health Association","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:p> Objectives. To assess the impact of Washington State\u2019s 2019 Engrossed House Bill (EHB) 1638\u2014which removed measles, mumps, and rubella (MMR) personal belief exemptions\u2014on MMR vaccine series completion and exemption rates in K\u201312 students. <\/jats:p><jats:p> Methods. We used interrupted time-series analyses to examine changes in MMR vaccine series completion rates before and after EHB 1638 was passed and the \u03c7<jats:sup>2<\/jats:sup> test for differences in exemption rates. <\/jats:p><jats:p> Results. EHB 1638 implementation was associated with a 5.4% relative increase in kindergarten MMR vaccine series completion rates (95% confidence interval\u2009=\u20093.8%, 7.1%; P\u2009\u2264\u2009.001), and results were similar with Oregon as a control state (no change observed in Oregon; P\u2009=\u2009.68). MMR exemptions overall decreased 41% (from 3.1% in 2018\u20132019 to 1.8% in 2019\u20132020; P\u2009\u2264\u2009.001), and religious exemptions increased 367% (from 0.3% to 1.4%; P\u2009\u2264\u2009.001). <\/jats:p><jats:p> Conclusions. EHB 1638 was associated with an increase in MMR vaccine series completion rates and a decrease in any MMR exemption. However, effects were partially offset by an increase in religious exemption rates. <\/jats:p><jats:p> Public Health Implications. Removal of personal belief exemptions for the MMR immunization requirement only may be an effective approach to increase MMR vaccine coverage rates statewide and among underimmunized communities. (Am J Public Health. 2023;113(7):795\u2013804. https:\/\/doi.org\/10.2105\/AJPH.2023.307285 ) <\/jats:p>","DOI":"10.2105\/ajph.2023.307285","type":"journal-article","created":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T21:36:11Z","timestamp":1694036171000},"page":"795-804","source":"Crossref","is-referenced-by-count":6,"title":["State Policy Removing the Personal Belief Exemption for Measles, Mumps, and Rubella (MMR) School Immunization Requirement, Washington State, 2014\u20132022"],"prefix":"10.2105","volume":"113","author":[{"given":"Tyler P.","family":"Moore","sequence":"first","affiliation":[{"name":"Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia C.","family":"Bennett","sequence":"additional","affiliation":[{"name":"Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Graff","sequence":"additional","affiliation":[{"name":"Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayuree","family":"Rao","sequence":"additional","affiliation":[{"name":"Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orvalho","family":"Augusto","sequence":"additional","affiliation":[{"name":"Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen Y.","family":"Chu","sequence":"additional","affiliation":[{"name":"Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley H.","family":"Wagenaar","sequence":"additional","affiliation":[{"name":"Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. 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