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North Carolina Immunization Branch


N.C. Studies on Immunization

Child Care Religious Exemptions


Based on annual kindergarten immunization reporting, the number of religious exemptions is increasing in North Carolina.  Buncombe County, in particular, has a much higher percentage than the other counties in the state.  Based on reports from the 2009-2010 school year, 0.68% of kindergarteners in the state have a religious exemption, while in Buncombe County, 3.81% of kindergarteners have an exemption.  Determining how to focus efforts on education is critical in reducing the number of exemptions.


  • To determine if the percentage of children having religious exemptions in child care is similar to the percentage of kindergarten students in Buncombe County. 
  • To assess why parents are choosing not to vaccinate their children.


In order to evaluate the childcares in Buncombe County, 20% of eligible childcares in the county will be visited for a review of the immunization records for children 19-59 months of age.  A survey will be distributed to childcare providers to collect their opinions on why parents have religious exemptions.


20% or 15 different childcares were chosen randomly and visited to evaluate the immunization records.  During the visits, 495 immunization records were reviewed with 54 children having a religious exemption, meaning 10.9% of the children have a religious exemption.  Seven childcare directors completed a survey asking why they believe parents are hesitant to vaccinate children.  Out of the choices provided on the survey (including an option about religious reasons), all directors chose the option that parents have concerns about vaccine safety.


Based on the record review, more children in childcare have a religious exemption to immunizations than those reported in kindergarten.  From the results of the survey, childcare operators believe parents are hesitant to vaccinate children because of vaccine safety concerns and not because they have a true religious exemption to vaccinating.

Intensive NCIR Training


The North Carolina Immunization Program (NCIP) began to roll out the statewide North Carolina Immunization Registry (NCIR) in 2006. Initial efforts focused on getting providers on the registry quickly. As a result, training focused on the data entry of client and immunization information and inventory management. Time constraints did not allow for training on the NCIR assessment tools. Although instructions on how to utilize these tools are available in the user manual, it became apparent that most providers were not utilizing these tools effectively. A primary goal of NCIP is to raise coverage rates among children throughout the state. In addition to guidance provided by NCIP it is up to providers to be aware of the immunization status of their patients and respond proactively to ensure all children achieve up-to-date (UTD) status. To help meet this goal NCIP developed training modules incorporating the NCIR with AFIX to help empower providers to obtain high coverage rates.


Fifty-nine private provider offices in North Carolina


Children ages 0-35 months receiving immunizations at participating providers

Project Description: New provider staff are provided with training enabling them to utilize the assessment tools within the NCIR to track the coverage rates and UTD status of children seen at their practice. A series on hands-on learning exercises teaches participants to: 1) learn to run NCIR assessment reports to obtain the real-time immunization coverage status of their patients; 2) learn to utilize the reminder/recall function to enable the providers to schedule necessary appointments with patients due for immunizations.

Results/Lessons Learned:

The intensive training showed positive results. Data show that providers began using the tools and overall coverage rates increased. The feedback from providers stated that the training was helpful and effective. The training module will be incorporated into future NCIR rollout efforts among new providers as well as provided during regional educational workshops and required AFIX visits.

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