Impact of eliminating nonmedical exemptions in California

项目总结/摘要 疫苗是公共卫生领域最成功的干预措施之一，可以预防各种传染性疾病。 疾病和提供大量的医疗保健成本节省。即便如此，许多家长还是成为 关注疫苗，并通过非医疗途径选择不为子女接种疫苗。 豁免。这种疫苗拒绝率的增加促成了最近的传染病爆发 在全国范围内，导致许多州限制免疫豁免。事实上，加州颁布了免疫法 SB 277法案将取消所有非医疗豁免。由于加州是第一个超过 三十年来消除所有非医疗豁免，我们目前没有证据基础的影响， 这样的政策变化将在人口层面产生影响。 SB 277的实施提供了一个机会，以评估消除非医疗 豁免。由于加州在政策格局中的规模和重要性，SB 277的实施 具有指导其他国家修改免疫政策的潜力。因此，评价 加州最近的免疫立法可能会产生全国性的影响。 我们的研究小组先前已经评估了疫苗犹豫和拒绝以及免疫豁免的影响 关于疾病控制此外，我们还对获得非医疗豁免的难易程度进行了分析。 通过这项工作，我们确定了要求不那么严格的州有更高的非医疗比率， 豁免比国家更严格的要求。我们还进行了研究，记录了 非医疗免疫豁免与疾病发病率增加之间的关联。因此，我们的团队 以前的评估和分析可以扩展到研究完全消除非医疗保健的影响。 豁免。 拟议的研究将为实施免疫豁免建立证据基础 通过1）分析免疫豁免前后的比率，聚类和差异来立法 SB 277的实施，2）评估动机，态度，信念和医疗保健实践负担 与SB 277背景下的疫苗接种有关，3）评估 在学校一级实施和执行立法，以及4）确定SB 277的影响， 家庭教育的比率。最后，我们将为以下措施的实施和效果建立证据基础： 有可能指导州和国家一级决策的免疫立法。

PROJECT SUMMARY/ABSTRACT Vaccines are one of the most successful interventions in public health, preventing a variety of infectious diseases and providing a substantial health care cost savings. Even so, many parents have become concerned with vaccines and are opting out of required vaccination for their children through nonmedical exemptions. This increase in vaccine refusal rates has contributed to recent infectious disease outbreaks nationwide, causing many states to restrict immunization exemptions. In fact, California enacted immunization legislation SB277, which will remove all nonmedical exemptions. As California is the first state in more than three decades to eliminate all nonmedical exemptions we do not currently have an evidence base of the effect policy changes such as this will have at the population level. The implementation of SB277 provides an opportunity to evaluate the impact of elimination of nonmedical exemptions. Due to the size and importance of California in the policy landscape, the implementation of SB277 has the potential to guide other states immunization policy modifications. Therefore, the evaluation of California's recent immunization legislation could have national implications. Our team has previously evaluated vaccine hesitancy and refusal and the impact of immunization exemptions on disease control. Additionally, we have conducted analyses of the ease of obtaining nonmedical exemptions. Through this work, we determined states with less stringent requirements have higher rates nonmedical exemptions than the states with stricter requirements. We also conducted studies that documented the association between nonmedical immunization exemptions and increased disease incidence. Thus, our team's previous evaluation and analysis can be extended to study the effect of total elimination of nonmedical exemptions. The proposed study will develop an evidence base for the implementation of immunization exemption legislation through 1) analyzing rates, clustering, and variances of immunization exemptions before and after SB277 implementation, 2) evaluating the motivations, attitudes, beliefs, and health care practice burden relating to vaccinations in the context of SB277, 3) assessing the determinants and implications of variability in implementation and enforcement of legislation at the school level, and 4) ascertaining the impact of SB277 on the rates of home schooling. Ultimately, we will develop an evidence base for the implementation and effect of immunization legislation that has the potential to guide decision-making at the state and national levels.