Evaluating Michigan's Administrative Rule Change on Nonmedical Vaccine Exemptions
Evaluating Michigan's Administrative Rule Change on Nonmedical Vaccine Exemptions
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DOI：
10.1542/peds.2021-049942
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发表时间：
2021-09-01
期刊：
影响因子：
8
通讯作者：
Boulton, Matthew L.
中科院分区：
文献类型：
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作者：
Masters, Nina B.;Zelner, Jon;Boulton, Matthew L.
疫苗犹豫是对美国健康的日益严重的威胁。面对2014年美国第四高的疫苗豁免率，密歇根州改变了其州行政规则，从2015年1月1日起生效，要求父母在获得非医疗豁免（NME）之前参加当地卫生部门的面对面疫苗教育会议。在这篇文章中，我们评估了这一政策变化对Michigan. MEs的发病率、空间分布和社会人口学预测因素的长期影响：使用密歇根州2011年至2018年的学校幼儿园疫苗接种数据，我们使用贝叶斯二项式回归评估了这一管理规则变化前后NME的社会人口学预测因素。我们测量的持久性和位置的学区一级的地理聚类使用当地的空间association.RESULTS指标：规则改变后，立即NME率下降了32%。然而，NME利率在随后几年反弹，到2018年增加了26%，尽管规则改变后NME利率的收入差距有所减少。哲学，宗教和医疗疫苗豁免表现出不同的地理模式，在整个国家，这在很大程度上持续到2015年后，说明NME集群仍然是一个问题，尽管这一规则的变化。结论：虽然密歇根州的行政规则的变化造成了短期的NME率下降，NME率大幅上升，在接下来的4年，因为该政策的实施。密歇根州的行政努力，要求父母在当地卫生部门接受教育，然后才获得豁免，并没有造成持续减少的速度或空间分布的NME。
OBJECTIVES: Vaccine hesitancy is a growing threat to health in the United States. Facing the fourth highest vaccine exemption rate in the United States in 2014, Michigan changed its state Administrative Rules, effective January 1, 2015, requiring parents to attend an in-person vaccine education session at their local health department before obtaining a nonmedical exemption (NME). In this article, we evaluate the longer-term impact of this policy change on the rate, spatial distribution, and sociodemographic predictors of NMEs in Michigan.METHODS: Using school-level kindergarten vaccination data from Michigan from 2011 to 2018, we evaluated sociodemographic predictors of NMEs before and after this Administrative Rule change using Bayesian binomial regression. We measured the persistence and location of school district-level geographic clustering using local indicators of spatial association.RESULTS: Immediately after the rule change, rates of NMEs fell by 32%. However, NME rates rebounded in subsequent years, increasing by 26% by 2018, although income disparities in NME rates decreased after the rule change. Philosophical, religious, and medical vaccine exemptions exhibited distinct geographic patterns across the state, which largely persisted after 2015, illustrating that NME clusters remain a concern despite this rule change.CONCLUSIONS: Although Michigan's Administrative Rule change caused a short-term decline in NME rates, NME rates have risen dramatically in the following 4 years since the policy was implemented. Michigan's administrative effort to require parental education at the local health department before receiving an exemption did not cause a sustained reduction in the rate or spatial distribution of NMEs.