The state of the antivaccine movement in the United States: A focused examination of nonmedical exemptions in states and counties
The state of the antivaccine movement in the United States: A focused examination of nonmedical exemptions in states and counties
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DOI：
10.1371/journal.pmed.1002578
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发表时间：
2018-06-01
期刊：
影响因子：
15.8
通讯作者：
Nolan, Melissa S.
中科院分区：
文献类型：
--
作者：
Olive, Jacqueline K.;Hotez, Peter J.;Nolan, Melissa S.
近年来，美国出现了反对接种公共卫生疫苗的社会运动，麻疹疫情也随之增加。自2009年以来，美国18个州中有12个州的“哲学信仰”疫苗非医疗豁免（NME）数量有所增加。阿肯色州（AR）、亚利桑那州（AZ）、爱达荷州（ID）、缅因州（ME）、明尼苏达州（MN）、北达科他州（ND）、俄亥俄州（OH）、俄克拉荷马州（OK）、俄勒冈州（OR）、宾夕法尼亚州（PA）、德克萨斯州（TX）、和犹他州（UT）。美国的几个“热点”大都市区因其非常大量的非ME而脱颖而出。它们包括西北部的华盛顿州西雅图、华盛顿州斯波坎和俄勒冈州波特兰;西南部的亚利桑那州凤凰城、犹他州盐湖、犹他州普罗沃、德克萨斯州休斯顿、德克萨斯州沃斯堡、德克萨斯州普莱诺和德克萨斯州奥斯汀;中西部的密歇根州特洛伊、密歇根州沃伦、密歇根州底特律和密苏里州堪萨斯城;东北部的宾夕法尼亚州匹兹堡。我们分析了非ME率与实际疫苗接种率之间的关系，发现这些州的非ME率与麻疹、腮腺炎和风疹（MMR）疫苗接种率之间呈负相关，（通过斯皮尔曼相关性，P = 0.03），这表明，总体NME率较高的州实际上MMR疫苗覆盖率较低我们的研究结果表明，在主要的大都市地区正在建立新的抗疫苗接种活动的焦点，使选定的城市容易受到疫苗接种可预防疾病的影响。正如最近在加州的阿纳海姆的经验所指出的那样，低疫苗接种率导致了麻疹的爆发。相比之下，国家关闭非市场经济体导致了孕产妇和新生儿死亡率的增加。
A social movement of public health vaccine opposition has been growing in the United States in recent years; subsequently, measles outbreaks have also increased.Since 2009, the number of "philosophical-belief" vaccine nonmedical exemptions (NMEs) has risen in 12 of the 18 states that currently allow this policy: Arkansas (AR), Arizona (AZ), Idaho (ID), Maine (ME), Minnesota (MN), North Dakota (ND), Ohio (OH), Oklahoma (OK), Oregon (OR), Pennsylvania (PA), Texas (TX), and Utah (UT).Several US "hotspot" metropolitan areas stand out for their very large numbers of NMEs. They include Seattle, WA, Spokane, WA, and Portland, OR in the Northwest; Phoenix, AZ, Salt Lake City, UT, Provo, UT, Houston, TX, Fort Worth, TX, Plano, TX, and Austin, TX in the Southwest; Troy, MI, Warren, MI, Detroit, MI, and Kansas City, MO in the Midwest; and Pittsburgh, PA in the Northeast. Additional smaller counties D especially in ID, WI, and UT D also stand out for their high exemption rates.We analyzed the relationship between NME rates and actual vaccine coverage, and found an inverse association between NME rate and measles, mumps, and rubella (MMR) vaccine coverage of kindergarteners in these states (P = 0.03 by Spearman correlation), indicating that states with higher overall NME rates do in fact have lower MMR vaccine coverage (P = 0.007 by beta regression).Our findings indicate that new foci of antivaccine activities are being established in major metropolitan areas, rendering select cities vulnerable for vaccination-preventable diseases. As noted by the recent experience in Anaheim, California, low vaccination rates resulted in a measles outbreak. In contrast, state closure of NMEs has resulted in an increase of MMR coverage.