Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis
Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis
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DOI：
10.1093/aje/kwn263
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发表时间：
2008-12-15
影响因子：
5
通讯作者：
Salmon, Daniel A.
中科院分区：
文献类型：
--
作者：
Omer, Saad B.;Enger, Kyle S.;Salmon, Daniel A.
在美国，学校免疫要求对于控制疫苗可预防的疾病非常重要。48个州对学校免疫要求提供非医疗豁免。获得豁免的儿童感染和传播疫苗可预防疾病的风险增加。非医疗豁免的聚集会影响疫苗可预防疾病的社区风险。作者评估了密歇根州非医疗豁免的空间聚集性以及豁免集群和报告的百日咳病例集群之间的地理重叠。Kulldorf的扫描统计确定了1993年至2004年期间23个统计学上显著的豁免率普查区集群和6个显著的百日咳病例报告普查区集群。重要的百日咳时空集群的时间范围是1993年8月至1993年9月、1994年8月至1995年2月、1998年5月至1998年6月、2002年4月、2003年5月至2003年7月和2004年6月至2004年11月。豁免集群中的人口普查区更可能是百日咳集群（比值比= 3.0，95%置信区间：2.5，3.6）。在调整人口密度、少数民族比例、5岁或5岁以下儿童比例、贫困线以下人口比例和平均家庭规模后，豁免组群和百日咳组群的重叠仍然显著（比值比= 2.7，95%置信区间：2.2，3.3）。疫苗豁免者的地理区域对整个社区构成风险。除了监测州一级的豁免率外，卫生当局还应注意州内的异质性。
School immunization requirements are important in controlling vaccine-preventable diseases in the United States. Forty-eight states offer nonmedical exemptions to school immunization requirements. Children with exemptions are at increased risk of contracting and transmitting vaccine-preventable diseases. The clustering of nonmedical exemptions can affect community risk of vaccine-preventable diseases. The authors evaluated spatial clustering of nonmedical exemptions in Michigan and geographic overlap between exemptions clusters and clusters of reported pertussis cases. Kulldorf's scan statistic identified 23 statistically significant census tract clusters for exemption rates and 6 significant census tract clusters for reported pertussis cases between 1993 and 2004. The time frames for significant space-time pertussis clusters were August 1993-September 1993, August 1994-February 1995, May 1998-June 1998, April 2002, May 2003-July 2003, and June 2004-November 2004. Census tracts in exemptions clusters were more likely to be in pertussis clusters (odds ratio = 3.0, 95% confidence interval: 2.5, 3.6). The overlap of exemptions clusters and pertussis clusters remained significant after adjustment for population density, proportion of racial/ethnic minorities, proportion of children aged 5 years or younger, percentage of persons below the poverty level, and average family size (odds ratio = 2.7, 95% confidence interval: 2.2, 3.3). Geographic pockets of vaccine exemptors pose a risk to the whole community. In addition to monitoring state-level exemption rates, health authorities should be mindful of within-state heterogeneity.