Individual and community risks of measles and pertussis associated with personal exemptions to immunization
Individual and community risks of measles and pertussis associated with personal exemptions to immunization
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DOI：
10.1001/jama.284.24.3145
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发表时间：
2000-12-27
影响因子：
120.7
通讯作者：
Hoffman, RE
中科院分区：
文献类型：
--
作者：
Feikin, DR;Lezotte, DC;Hoffman, RE
在哲学和宗教上有免疫豁免的儿童中，疫苗可预防疾病的风险一直未得到充分研究，目的是评估个人免疫豁免是否与个人和社区一级麻疹和百日咳的风险有关。设计、设置和参与者基于人群的回溯性队列研究，使用1987-1998年间科罗拉多州3至18岁儿童中所有报告的麻疹和百日咳病例的标准化表格收集的数据，主要结果衡量免种者和接种儿童中麻疹和百日咳的相对风险；接种疫苗儿童发病率与免免者频率之间的关联；学校暴发与学校免免者频率之间的关联；结果与接种疫苗的儿童相比，免疫儿童患麻疹和百日咳的风险分别高22.2倍(95%可信区间，15.9~31.1)和5.9倍(95%可信区间，4.2~8.2)。调整混杂因素后，免疫儿童的麻疹发病率(相对危险度为1.6，95%CI为1.0-2.4)和百日咳发病率(相对危险度为1.9；95%CI为1.7-2.1)与一个县的免疫者频率相关。有百日咳暴发的学校比未暴发的学校有更多的免疫者(平均4.3%的学生；P=.001)，至少有11%的麻疹暴发儿童通过接触免疫者获得感染。结论个人免疫者患麻疹和百日咳的风险增加。公共卫生人员应认识到豁免者在其社区暴发疫情中的潜在影响，并应让父母意识到不为孩子接种疫苗所涉及的风险。
Context The risk of vaccine-preventable diseases among children who have philosophical and religious exemptions from immunization has been understudied,Objectives To evaluate whether personal exemption from immunization is associated with risk of measles and pertussis at individual and community levels.Design, Setting, and Participants Population-based, retrospective cohort study using data collected on standardized forms regarding all reported measles and pertussis cases among children aged 3 to 18 years in Colorado during 1987-1998,Main Outcome Measures Relative risk of measles and pertussis among exemptors and vaccinated children; association between incidence rates among vaccinated children and frequency of exemptors in Colorado counties; association between school outbreaks and frequency of exemptors in schools; and risk associated with exposure to an exemptor in measles outbreaks.Results Exemptors were 22.2 times (95% confidence interval [CI], 15.9-31.1) more likely to acquire measles and 5.9 times (95% CI, 4.2-8.2) more likely to acquire pertussis than Vaccinated children. After adjusting for confounders, the frequency of exemptors in a county was associated with the incidence rate of measles (relative risk [RR], 1.6, 95% CI, 1.0-2.4) and pertussis (RR, 1.9; 95 % CI, 1.7-2.1) in vaccinated children. Schools with pertussis outbreaks had more exemptors (mean, 4.3% of students) than schools without outbreaks (1.5% of students; P=.001), At least 11% of vaccinated children in measles outbreaks acquired infection through contact with an exemptor,Conclusions The risk of measles and pertussis is elevated in personal exemptors. Public health personnel should recognize the potential effect of exemptors in outbreaks in their communities, and parents should be made aware of the risks involved in not vaccinating their children.