Some State Vaccination Laws Contribute To Greater Exemption Rates And Disease Outbreaks In The United States
Some State Vaccination Laws Contribute To Greater Exemption Rates And Disease Outbreaks In The United States
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DOI：
10.1377/hlthaff.2014.1428
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发表时间：
2015-08-01
期刊：
影响因子：
9.7
通讯作者：
Mandich, Anne
中科院分区：
文献类型：
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作者：
Bradford, W. David;Mandich, Anne
卫生官员证实，免疫接种是公共卫生领域最成功的干预措施之一。然而，美国仍有大量未接种疫苗的人口。我们分析了州一级的疫苗接种豁免法律如何影响免疫接种率和可预防疾病的发病率。我们使用疾病控制和预防中心的年度学校评估报告，测量了2002年至2012年州幼儿园疫苗接种豁免法律的每个组成部分与州疫苗接种豁免率之间的关联。我们发现，要求卫生部门批准非医疗豁免，要求医生签署豁免申请，以及对不遵守免疫要求的行为进行刑事或民事处罚等政策对减少疫苗豁免有显著影响。我们的豁免法有效性指数确定了18个州的法律最有效，9个州的法律最无效。与其他州相比，最有效的州百日咳发病率较低。对于有兴趣减少该州疫苗豁免数量的政策制定者来说，我们的研究结果特别有趣。
Health officials attest that immunizations are among the most successful interventions in public health. However, there remains a substantial unvaccinated population in the United States. We analyzed how state-level vaccination exemption laws affect immunization rates and the incidence of preventable disease. We measured the association between each component of state kindergarten vaccination exemption laws and state vaccination exemption rates from 2002 to 2012, using the Centers for Disease Control and Prevention's annual school assessment reports. We found that policies such as requiring health department approval of nonmedical exemptions, requiring a physician to sign an exemption application, and having criminal or civil punishments for noncompliance with immunization requirements had a significant effect in reducing vaccine exemptions. Our exemption law effectiveness index identified eighteen states with the most effective laws and nine states with the least effective ones. The most effective states had lower incidences of pertussis, compared to other states. For policy makers interested in decreasing the number of vaccine exemptions in their state, our findings are of particular interest.