Health in the United States

Chlamydia remains the most commonly reported infectious disease in the United States. There were more than 1.2 million cases of chlamydia (1,244,180) reported to CDC in 2009, the largest number of cases ever reported to CDC for any condition.[1]

There were 301,174 reported cases of gonorrhea in 2009 (10 percent less than in 2008), making gonorrhea the second most commonly reported infectious disease in the U.S. In 2009, the gonorrhea rate for women was slightly higher than for men.[1]

In 2009, there were 13,997 reported cases of primary and secondary syphilis — the most infectious stages of the disease — the highest number of cases since 1995 and an increase over 2007 (11,466 cases).[1]

The United States has a long history of school vaccination requirements. The first school vaccination requirement was enacted in the 1850s in Massachusetts to prevent the spread of smallpox.[11] The school vaccination requirement was put in place after the compulsory school attendance law caused a rapid increase in the number of children in public schools, increasing the risk of smallpox outbreaks. The early movement towards school vaccination laws began at the local level including counties, cities, and boards of education. By 1827, Boston had become the first city to mandate that all children entering public schools show proof of vaccination.[12] In addition, in 1855 the Commonwealth of Massachusetts had established its own statewide vaccination requirements for all students entering school; this influenced other states to implement similar statewide vaccination laws in schools as seen in New York in 1862, Connecticut in 1872, Pennsylvania in 1895, and later the Midwest, South and Western US. By 1963, 20 states had school vaccination laws.[12]

These school vaccination resulted in political debates throughout the United States, as those opposed to vaccination sought to overturn local policies and state laws.[13] An example of this political controversy occurred in 1893 in Chicago, where less than 10 percent of the children were vaccinated despite the twelve-year-old state law.[12] Resistance was seen at the local level of the school district as some local school boards and superintendents opposed the state vaccination laws, leading the state board health inspectors to examine vaccination policies in schools. Resistance proceeded during the mid-1900s and in 1977 a nationwide Childhood Immunization Initiative was developed with the goal of increasing vaccination rates among children to 90% by 1979.[14] During the two-year period of observation, the initiative reviewed the immunization records of more than 28 million children and vaccinated children who had not received the recommended vaccines.

In 1922 the constitutionality of childhood vaccination was examined in the Supreme Court case Zucht v. King. The court decided that a school could deny admission to children who failed to provide a certification of vaccination for the protection of the public health.[14] In 1987, a measles epidemic occurred in Maricopa County, Arizona, and another court case, Maricopa County Health Department vs. Harmon, examined the arguments of an individual's right to education over the state's need to protect against the spread of disease. The court decided that it is prudent to take action to combat the spread of disease by denying un-vaccinated children a place in school until the risk for the spread of measles has passed.[14]

Schools in the United States require an updated immunization record for all incoming and returning students. While all states require an immunization record, this does not mean that all students must get vaccinated. Opt-out criteria are determined at a state level. In the United States, opt-outs take one of three forms: medical, in which a vaccine is contraindicated due to a component ingredient allergy or existing medical condition; religious; and personal philosophical opposition. As of 2019, 46 states allow religious exemptions, with some states requiring proof of religious membership. Only Mississippi, West Virginia, California and New York do not permit religious exemptions.[2][15] 18 states allow personal or philosophical opposition to vaccination.[3]

Over the last decade vaccination rates have been declining in the United States. Although the rate is fairly limited on a larger scale, vaccine-preventable disease outbreaks are occurring in pockets across the U.S. “In 2012, exemption rates ranged from a low of approximately 0.45 percent in New Mexico, to a high of 6.5 percent in Oregon.[16] The outbreaks have significant correlations with unvaccinated children, and state policy exemption processes. California, which is currently in the process of changing its state exemption policies, dealt with a 2015 measles outbreak stemming from the popular Disneyland park. Significantly, most of the afflicted were unvaccinated, which eventually spread to over 17 separate states across the U.S.[17] If the federal government works to provide an equal vaccination regulation nationally, immunization rates should begin to rise, while preventable outbreaks should diminish.