A Medical Exemption is an exception to compulsory school immunization laws, based upon a medical condition. According to the Centers for Disease Control and Prevention (CDC), all 50 states allow school children to be exempted from vaccination requirements for medical reasons.
West Virginia does not grant non-medical exemptions. Non-medical exemptions have been associated with increased occurrence of vaccine-preventable disease outbreaks originating in and spreading through schools.
To obtain a medical exemption a parent or guardian may use the form HERE to request the child’s physician submit a Request for Medical Exemption from Compulsory Immunization to the Bureau for Public Health’s Immunization Officer on behalf of the child.
The child’s physician can then submit the form which is available HERE or through the West Virginia Statewide Immunization Information System (WVSIIS). The Request for Medical Exemption from Compulsory Immunization must be completed and submitted by a physician licensed to practice medicine that has treated or examined the child to the State Immunization Officer, a physician licensed to practice medicine in West Virginia and employed by the State Bureau for Public Health.
The physician’s request for exemption from immunization(s) shall state specifically which vaccine or vaccines the child should be exempt from receiving, an explanation of the medical contraindication or precaution relied upon to make the request, and whether the reason for the exemption is permanent or temporary. The physician must provide medical evidence showing that an exemption is necessary. If the medical exemption is temporary, the request shall also provide the future date or time when the exemption should be reevaluated. Requests for temporary medical exemptions may not exceed 24 months from the time of the requested medical exemption.
Requests for a medical exemption from vaccine requirements shall be reviewed and approved or denied by the State Immunization Officer. The Immunization Officer will make reasonable efforts to notify the physician of any deficiencies in the request but it remains the responsibility of the physician to assure that the request is complete. It is the responsibility of the child’s physician to inform the child’s parent or guardian of the process for obtaining an exemption and the status of the request.
The Immunization Officer will review the evidence obtained from the child’s physician. If the evidence or information is incomplete, the Immunization Officer will make a request for additional evidence. If all of the evidence received by the Immunization Officer, including all medical opinion(s), is consistent and there is sufficient evidence for a determination of whether to grant an exemption, the Immunization Officer will make a determination or decision based on that evidence.
In some situations, the Immunization Officer may not be able to make these findings because the evidence in the case record is insufficient or inconsistent. If, after weighing the available evidence, the Immunization Officer determines that a conclusion cannot be reached about whether an exemption should be granted, the Immunization Officer will determine the best way to resolve the inconsistency or insufficiency.
The Immunization Officer will make the determination or decision based upon the most recent guidance from the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) with respect to medical contraindications or precautions for each vaccine.
A determination on an application for an exemption will be made within 20 days of receipt of a complete request for an exemption. A request that remains incomplete for 45 days will result in the denial of the request. The Immunization Officer will mail a written notice of the determination to the physician and the child’s parent or guardian, at their last known address. The written notice will explain in simple and clear language the Immunization Officer’s decision and the reasons for and the effect of the determination.
If the Immunization Officer’s determination is in whole or in part unfavorable, the written notice also will contain in understandable language a statement of the case setting forth the evidence on which the determination is based. The notice also will inform the child’s parent or guardian of the right to request a review of the Immunization Officer’s decision by the State Health Officer.
In order to request a review of the Immunization Officer’s determination, the child’s parent or guardian must file a written request to the State Health Officer. A request form is available at the West Virginia Division of Immunization Services (DIS) website by clicking HERE.
The request should include the name and age of the child for whom the exemption is requested, the name and address of the child’s parent or guardian, the reasons for disagreement with the previous determination or decision, and a statement of additional evidence to be submitted and the date it will submitted, if not included.
The request must be filed with the State Health Officer by U.S. Mail at 350 Capitol Street, Room 702, Charleston, West Virginia 25301; or email at VaccineExemption@wv.gov; or facsimile at (304) 558-1035, within 30 days after the date the child’s parent or guardian receives notice of the Immunization Officer’s decision.
If the child’s parent or guardian fails to request a review within 30 days after the date the child’s parent or guardian receives notice of the Immunization Officer’s determination or decision, the child’s parent or guardian may ask for more time to make their request.
The request for an extension of time must be in writing and it must give the reasons why the request for a review was not filed within the stated time period. A request for an extension may be filed by U.S. Mail, facsimile or email as provided in the paragraph above. If the child’s parent or guardian shows that there is good cause for missing the deadline, the time period will be extended to permit the filing of a request for a review.
If a request for a review is made, the child’s parent or guardian will be given an opportunity to present any additional written evidence to the State Health Officer. The State Health Officer will then make a decision based on all of this evidence.
After the child’s parent or guardian requests a review of the determination of the Immunization Officer, the State Health Officer will review the evidence that the Immunization Officer considered in making the initial determination and any other evidence the State Health Officer receives. The State Health Officer may request additional information of the child’s parent or guardian or the physician to complete the review and provide a decision. The State Health Officer will make a determination based on the preponderance of the evidence.
A determination on a request for a review of the Immunization Officer’s determination will be made within 30 days of receipt of the request for review or, in the event the State Health Officer requests additional information from the child’s parent or guardian or the physician, 30 days from the receipt of the requested information.
Failure of the child’s parent or guardian to submit requested information within 45 days of the receipt of the State Health Officer’s request will result in the State Health Officer making a determination based on the evidence available.
The State Health Officer's review is binding unless the child's parent or guardian requests a hearing within 45 days of the receipt of the State Health Officer's notice of review, as required by the Rules for Contested Case Hearings and Declaratory Rulings, 64 CSR 1.