Estimating childhood infectious disease outbreak risk in the context of heterogeneous vaccine coverage

摘要 自愿拒绝推荐的儿童疫苗正变得越来越普遍。此外，大学毕业生的空间聚集性-- 看电影的儿童可能会带来疫情暴发的风险，远远超出人口平均水平的范围。怎么- 一直以来，疫苗拒绝接种集群对传染病暴发风险的影响程度在很大程度上是未知的。迪- 导致疫苗拒绝聚集的动态过程也没有得到足够的研究，限制了我们针对干预措施的能力 明确针对疫苗拒绝集聚的高危现象。许多疫情风险管理战略都基于 在政策中(例如，入学疫苗强制要求)。这样的政策应该考虑到群集性疫苗拒绝接种的现实。 这份K01职业发展奖提案包含了关于这一主题的高级培训和研究目标。糖果- Date的职业目标是成为传染病预防领域的领导者，通过在 传染病、社会流行病学、地理空间科学和复杂系统建模。培训目标主要集中在 三个领域：1)基于代理的传染病建模，2)卫生政策，3)职业发展。一份临时文件- 由威斯康星大学麦迪逊分校和埃默里大学的四名资深教师组成的纪律团队将监督候选人的培训。 并包括临床儿科传染病、疫苗宣传、疫苗拒绝分类、卫生政策、 以及基于代理的健康行为建模。该项目有两个研究目标。目标1是量化超额风险 麻疹和百日咳暴发源于成群的未接种疫苗的儿童。基于代理的模型将被用来模拟- 并测试集团内的动态进程以及对这些进程的潜在政策影响。目标2是 描述疫苗犹豫不决的想法的属性，这些想法促进了对迟疑和拒绝的吸收，就扩散而言 创新理论。一种混合的方法将包括结构化访谈，对疫苗犹豫不决的网络调查 家长(目标n=600)，并开发基于代理的模型，以帮助针对未来的干预努力。协会- 将估计疫苗迟疑中创新结构的扩散与疫苗结果之间的关系。研究一下-- 它包括：a)对因拒绝接种疫苗而聚集的暴发风险的估计；b)一个决策工具，以 指导政策制定；以及c)利用创新框架的扩散来表征疫苗的迟疑性。这些 结果将通过告知如何最有效地预防疫苗来填补疫苗犹豫不决的关键经验和理论空白 拒绝接种疫苗的父母群体的形成(以及如何应对)。为了最大限度地取得成功和后续 拟议研究的传播和公共卫生影响，拟议K01的合作者包括 社会网络、创新扩散、基于代理的建模和基于社区的儿童早期干预试验。 有了这个合作者网络，指导的K01研究结果将被用来证实未来的R01干预- 使用预防健康框架修改导致疫苗拒绝群组的动态群体过程的临床试验 和传染病暴发。

Abstract Voluntary refusal of recommended childhood vaccines is becoming more common. Moreover, spatial clustering of unvac- cinated children likely introduces epidemic outbreak risk that extends far beyond what population averages suggest. How- ever, the degree to which clustering of vaccine refusal affects risk of infectious disease outbreak is largely unknown. Dy- namic processes leading to clustering of vaccine refusal are also understudied, limiting our ability to target interventions explicitly at the high-risk phenomenon of vaccine refusal clustering. Many outbreak risk management strategies are based in policy (e.g., school-entry vaccine mandates). Such policies should consider the realities of clustered vaccine refusals. This K01 Career Development Award proposal consists of advanced training and research aims on this topic. The candi- date's career objective is to become a leader in infectious disease prevention by conducting research at the intersection of infectious disease, social epidemiology, geospatial science, and complex systems modeling. The training aims focus on three areas: 1) agent-based modeling of infectious disease, 2) health policy, and 3) professional development. An interdis- ciplinary team of four senior faculty mentors at UW-Madison and Emory University will oversee the candidate's training, and includes experts in clinical pediatric infectious disease, vaccine advocacy, vaccine refusal clustering, health policy, and agent-based modeling of health behaviors. The project has two research aims. Aim 1 is to quantify the excess risk of measles and pertussis outbreak stemming from clusters of unvaccinated children. Agent-based models will be used to sim- ulate populations and test dynamic within-group processes and potential policy effects on those processes. Aim 2 is to characterize the attributes of vaccine-hesitant ideas that promote uptake of hesitancy and refusals in terms of diffusion of innovation theory. A mixed methods approach will include structured interviews, a web-based survey of vaccine-hesitant parents (target n=600), and development of an agent-based model to aid in targeting future intervention efforts. Associa- tions between diffusion of innovation constructs in vaccine hesitancy and vaccine outcomes will be estimated. Study out- comes include: a) an estimate of outbreak risk stemming from clustering in vaccine refusal; b) a decision making tool to guide policy development; and c) characterization of vaccine hesitancy using a diffusion of innovation framework. These results will fill critical empirical and theoretical gaps in vaccine hesitancy by informing how to most effectively prevent the formation of (and how to respond to) clusters of parents who refuse vaccines. To maximize success and subsequent dissemination and public health impact of the proposed research, collaborators for the proposed K01 include experts in social networks, diffusion of innovation, agent-based modeling, and community-based early childhood intervention trials. With this network of collaborators, results of the mentored K01 research will be used to substantiate future R01 interven- tion trials using a preventive health framework to modify the dynamic group processes leading to vaccine refusal clusters and infectious disease outbreak.