Public Health and Economic Consequences of Vaccine Hesitancy for Measles in the United States
Public Health and Economic Consequences of Vaccine Hesitancy for Measles in the United States
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DOI：
10.1001/jamapediatrics.2017.1695
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发表时间：
2017-09-01
期刊：
影响因子：
26.1
通讯作者：
Hotez, Peter J.
中科院分区：
文献类型：
--
作者：
Lo, Nathan C.;Hotez, Peter J.
在美国的一些地区，由于对疫苗的犹豫，常规儿童疫苗接种率正在下降，这有可能使许多传染病重新抬头，造成公共卫生和经济后果。在州和国家一级正在进行政策辩论，包括围绕儿童疫苗接种的非医疗（个人信仰）豁免的立法，以及可能成立的疫苗安全特别政府委员会，这可能影响疫苗覆盖率。目的以麻疹、腮腺炎和风疹（MMR）疫苗接种和麻疹为例，估计不同程度疫苗犹豫情况下美国儿童麻疹病例数和相关经济成本。设计、环境和参与者使用来自美国疾病控制和预防中心的公开数据来模拟美国县级儿童（2-11岁）的MMR疫苗接种覆盖率。对传染病传播采用了一个随机数学模型，该模型估计了与疫苗覆盖率相关的爆发规模分布。从文献中获得每个麻疹病例的经济成本。估计了增加疫苗犹豫流行率以及取消非医疗豁免的预测影响。该模型根据近年来美国儿童每年的麻疹病例进行了校准，并使用来自英格兰和威尔士的独立数据集验证了该模型的预测。主要结果和措施美国每年的麻疹病例和相关的公共部门成本。结果：美国MMR疫苗覆盖率下降5%，将导致全国每年2至11岁儿童麻疹病例增加3倍，公共部门费用增加210万美元。如果把未接种疫苗的婴儿、青少年和成年人也考虑在内，这个数字会高得多。由于麻疹输入的随机因素和一些模型输入的敏感性，这些估计值存在差异，尽管趋势是稳健的。结论和相关性该分析预测，由于疫苗犹豫（非医疗和个人信仰豁免），即使儿童疫苗接种的轻微减少，也会产生重大的公共卫生和经济后果。研究结果表明，迫切需要在州和国家一级的政策对话中解决疫苗犹豫问题，同时考虑取消儿童疫苗接种的个人信仰豁免。
IMPORTANCE Routine childhood vaccination is declining in some regions of the United States due to vaccine hesitancy, which risks the resurgence of many infectious diseases with public health and economic consequences. There are ongoing policy debates on the state and national level, including legislation around nonmedical (personal-belief) exemptions for childhood vaccination and possibly a special government commission on vaccine safety, which may affect vaccine coverage.OBJECTIVE To estimate the number of measles cases in US children and the associated economic costs under scenarios of different levels of vaccine hesitancy, using the case example of measles, mumps, and rubella (MMR) vaccination and measles.DESIGN, SETTING, AND PARTICIPANTS Publicly available data from the US Centers for Disease Control and Prevention were used to simulate county-level MMR vaccination coverage in children (age 2-11 years) in the United States. A stochastic mathematical model was adapted for infectious disease transmission that estimated a distribution for outbreak size as it relates to vaccine coverage. Economic costs per measles case were obtained from the literature. The predicted effects of increasing the prevalence of vaccine hesitancy as well as the removal of nonmedical exemptions were estimated. The model was calibrated to annual measles cases in US children over recent years, and the model prediction was validated using an independent data set from England andWales.MAIN OUTCOMES AND MEASURES Annual measles cases in the United States and the associated public sector costs.RESULTS A 5% decline in MMR vaccine coverage in the United States would result in an estimated 3-fold increase in measles cases for children aged 2 to 11 years nationally every year, with an additional $ 2.1 million in public sector costs. The numbers would be substantially higher if unvaccinated infants, adolescents, and adult populations were also considered. There was variation around these estimates due to the stochastic elements of measles importation and sensitivity of some model inputs, although the trend was robust.CONCLUSIONS AND RELEVANCE This analysis predicts that even minor reductions in childhood vaccination, driven by vaccine hesitancy (nonmedical and personal belief exemptions), will have substantial public health and economic consequences. The results support an urgent need to address vaccine hesitancy in policy dialogues at the state and national level, with consideration of removing personal belief exemptions of childhood vaccination.