Getting Personal: How Childhood Vaccination Policies Shape the Landscape of Vaccine Exemptions
Getting Personal: How Childhood Vaccination Policies Shape the Landscape of Vaccine Exemptions
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DOI：
10.1093/ofid/ofaa088
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发表时间：
2020-03-01
影响因子：
4.2
通讯作者：
Bansal, Shweta
中科院分区：
文献类型：
--
作者：
Garnier, Romain;Nedell, Emma R.;Bansal, Shweta
背景资料。美国国家强制入学免疫要求在实现高疫苗覆盖率方面发挥了重要作用，但疫苗豁免政策的变化导致全国疫苗覆盖率参差不齐。在这项研究中，我们在疫苗政策的背景下评估流行病学效应和非医疗豁免(NME)率的空间差异。我们首先分析了3种重要的儿童疫苗接种的NME率和疫苗覆盖率之间的相关性。此外，我们使用州一级的相关方法和县一级的聚类分析来评估政策变化在州的子集中的影响。我们发现，在所有情况下，较高的豁免率与较低的学龄儿童疫苗接种率有关。在豁免政策最近发生变化的一个州的子集中，我们表明，对全州非市场经济税率的影响差异很大，非市场经济的减少可能会导致其他类型的豁免增加。最后，我们对加利福尼亚州、伊利诺伊州和康涅狄格州的聚类分析表明，政策变化影响了非制造业企业的空间分布。我们的工作表明，疫苗接种政策对群体免疫模式有重大影响。我们的发现可以用来制定基于证据的疫苗立法。
Background. State-mandated school entry immunization requirements in the United States play an important role in achieving high vaccine coverage, but variations in vaccine exemption policies result in a patchwork of vaccine coverage across the country.Methods. In this study, we evaluate epidemiological effects and spatial variations in nonmedical exemption (NME) rates in the context of vaccine policies. We first analyze the correlation between NME rates and vaccine coverage for 3 significant childhood vaccinations. Furthermore, we assess the effects of policy changes in a subset of states, using a correlative approach at the state level and performing a clustering analysis at the county level.Results. We find that higher rates of exemptions are associated with lower vaccination rates of school-aged children in all cases. In a subset of states where exemption policy has recently changed, we show that the effects on statewide NME rates vary widely and that decreases in NMEs can lead to an increase in other types of exemptions. Finally, our clustering analysis in California, Illinois, and Connecticut shows that policy changes affect the spatial distribution of NMEs.Conclusions. Our work suggests that vaccination policies have significant impacts on patterns of herd immunity. Our findings can be used to develop evidence-based vaccine legislation.