Impact of eliminating nonmedical exemptions in California

项目摘要/摘要 疫苗是公共卫生中最成功的干预措施之一，可以预防各种传染性疾病 并提供大量的医疗保健成本节约。即便如此，许多父母已经成为 关心疫苗，选择不通过非医疗方式为孩子接种必要的疫苗 免责条款。疫苗拒接率的上升是最近传染病暴发的原因之一。 全国范围内，导致许多州限制免疫豁免。事实上，加利福尼亚州颁布了免疫接种制度 立法SB277，将取消所有非医疗豁免。因为加州是第一个超过 30年来取消所有非医疗豁免，我们目前没有证据表明这一影响 这样的政策变化将在人口层面产生影响。 SB277的实施为评估消除非医疗疾病的影响提供了机会 免责条款。由于加州在政策版图中的规模和重要性，SB277的实施 有可能指导其他州修改免疫政策。因此，对其进行评价 加州最近的免疫立法可能会对全国产生影响。 我们的团队此前评估了疫苗的犹豫不决和拒绝接种以及免疫豁免的影响 在疾病控制方面。此外，我们还对获得非医疗豁免的容易程度进行了分析。 通过这项工作，我们确定要求不那么严格的州有更高的非医疗比率 豁免比要求更严格的州更高。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系。因此，我们团队的 以前的评价和分析可以扩展到研究完全消除非医疗保健的效果 免责条款。 拟议的研究将为实施免疫豁免提供证据基础。 立法通过1)分析免疫豁免前后的比率、聚类和差异 SB277实施，2)评估动机、态度、信念和卫生保健实践负担 与SB277中的疫苗接种有关，3)评估#年变异性的决定因素和影响 在学校一级实施和执行立法；以及4)确定SB277对 家庭教育的比率。最终，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两级决策的免疫立法。

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.