Yes, you can refuse vaccines for your newborn in California. At the hospital, parents can decline the hepatitis B birth dose, the vitamin K injection, and erythromycin eye ointment, and the state’s school immunization mandate does not apply until the child enters a classroom or licensed daycare. That later checkpoint is where California becomes strict: a 2015 law eliminated personal belief and religious exemptions, leaving a physician-issued medical exemption as the only way an unvaccinated child can attend school or licensed child care.
What You Can Decline at the Hospital
Hospitals routinely offer three preventive treatments to newborns: a hepatitis B vaccine, a vitamin K injection to prevent a rare but dangerous bleeding disorder, and erythromycin eye ointment to guard against infections. None of these are required for hospital discharge in California. Parents who decline are typically asked to sign a refusal form acknowledging the risks, and the hospital notes the decision in the medical record.
In December 2025, the CDC changed its hepatitis B guidance for newborns. Rather than recommending the birth dose for all infants, the CDC now advises “individual-based decision-making” for babies born to mothers who test negative for hepatitis B, meaning parents and their pediatrician weigh the benefits and risks together. For babies born to mothers who test positive or whose status is unknown, the birth-dose recommendation is unchanged.1Centers for Disease Control and Prevention. CDC Adopts Individual-Based Decision-Making for Hepatitis B Immunization
California also performs a newborn blood screening for genetic and metabolic disorders. Parents can refuse this test in writing on the state’s Newborn Screening Test Request Form.2Legal Information Institute. California Code of Regulations Title 17 6505 – Collection of Newborn Screening Specimens The screening catches conditions like sickle cell disease and PKU that cause serious harm if undetected, and most pediatricians strongly recommend it.
What Changes Once Your Child Enters School or Daycare
California’s immunization mandate applies to all children entering public or private schools, child care centers, nursery schools, and family day care homes. Senate Bill 277, signed in 2015, eliminated both personal belief and religious exemptions.3California Legislative Information. California Senate Bill 277 – Public Health Vaccinations
Proof of immunization is checked at two points: first admission (transitional kindergarten, kindergarten, or first enrollment in a California school) and advancement to seventh grade. The required vaccines cover:4California Department of Public Health. Shots Required for TK-12 and 7th Grade
- Diphtheria, tetanus, and pertussis (DTaP/Tdap): 5 doses for TK-12 entry; 1 Tdap booster for seventh grade
- Polio (IPV): 4 doses
- Measles, mumps, and rubella (MMR): 2 doses
- Hepatitis B: 3 doses (required at any grade except seventh)
- Varicella (chickenpox): 2 doses
The California Department of Public Health can add diseases to this list based on recommendations from the federal Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.5California Legislative Information. California Health and Safety Code 120325
Medical Exemptions Are the Only Exception
A medical exemption is the sole way an unvaccinated child can attend a California school or licensed daycare. A licensed physician (MD or DO) must examine the child and determine that one or more vaccinations would be medically unsafe based on the child’s specific health circumstances, such as a severe allergic reaction to a vaccine component, a compromised immune system, or a family medical history that makes vaccination risky.6California Legislative Information. California Health and Safety Code 120372
The exemption form must list each vaccine being exempted, explain the medical basis for each one, and state whether the exemption is temporary or permanent. Temporary exemptions expire after one year. All exemptions, temporary or permanent, cannot extend beyond the child’s current grade span: birth through preschool, kindergarten through sixth grade, or seventh through twelfth grade.7California Legislative Information. California Health and Safety Code 120370
Submitting Through CAIR-ME
Since January 1, 2021, all new medical exemptions must be submitted electronically through the California Immunization Registry – Medical Exemption (CAIR-ME) system. No other format is accepted.8California Department of Public Health. Obtaining a Medical Exemption – Guide for Parents and Physicians The physician registers for a CAIR-ME account, searches for the child, enters the required medical information, issues the exemption, and provides the parent with a printed copy of the two-page form for the school or daycare.9California Department of Public Health. California Immunization Registry – Medical Exemption Instructions
State Review of Exemptions
California does not accept medical exemptions at face value. Under Senate Bill 276 and Senate Bill 714, the California Department of Public Health reviews exemptions when a school’s overall immunization rate drops below 95% or when a physician issues five or more exemptions in a calendar year.10California Legislative Information. Senate Bill 276 – Immunizations Medical Exemptions A clinically trained CDPH staff member evaluates whether each exemption meets CDC, ACIP, or American Academy of Pediatrics guidelines. Exemptions that fall outside those standards can be revoked by the State Public Health Officer.
If an exemption is revoked, the child can stay in school but must start the required immunization schedule within 30 days unless the parent files an appeal. During the appeal, the child remains enrolled and is not required to begin immunizations until the appeal is resolved.11California Legislative Information. Senate Bill 714 – Immunizations
Homeschooling and Independent Study
California’s immunization requirements do not apply to children enrolled in a home-based private school or an independent study program with no classroom-based instruction.3California Legislative Information. California Senate Bill 277 – Public Health Vaccinations This is the primary path parents use when they want to avoid vaccinating without a medical exemption. The key distinction is that the child cannot participate in any classroom setting, including part-time programs at a brick-and-mortar school.
If a homeschooled child later enrolls in a traditional school or licensed daycare, the full immunization requirements apply at that point. There is no grandfathered status for previously homeschooled children.
Conditional Admission for Catching Up
A child who has not completed all required doses does not necessarily have to stay home. California allows conditional admission for children who have started their immunization series and are not currently due for any doses. The school must notify the parent of the dates by which the remaining doses need to be completed and must review the child’s records at least every 30 days until the series is finished.12Legal Information Institute. California Code of Regulations Title 17 6035 – Conditional Admission
Conditional admission is not a way to avoid vaccines indefinitely. Continued attendance depends on the child receiving each remaining dose on schedule, and a school can exclude a child who falls behind. For transfer students arriving from out of state whose records have not yet been received, schools can grant up to 30 school days of attendance before requiring documentation.
If Your Child Has Neither Vaccines Nor an Exemption
A child who lacks both proof of immunization and a valid medical exemption cannot be unconditionally admitted to any California school or licensed child care facility.5California Legislative Information. California Health and Safety Code 120325 There is no fine or criminal penalty for parents who refuse to vaccinate, but the practical consequence is that the child is shut out of both public and private classroom settings. If an unvaccinated child is exposed to one of the covered diseases, the local health officer can temporarily exclude the child from school until the risk of transmission passes.7California Legislative Information. California Health and Safety Code 120370
International Travel
Unvaccinated children face additional complications when traveling internationally. Some countries require proof of specific vaccinations for entry: yellow fever vaccination is mandatory for entry into certain African and South American nations, Saudi Arabia requires meningococcal vaccination for Hajj and Umrah pilgrims, and the World Health Organization periodically issues polio vaccination requirements for travelers leaving countries with active outbreaks.13Centers for Disease Control and Prevention. Travel Vaccine Recommendations for Infants and Children Country-specific requirements change, so check current entry rules before booking travel.