A Longitudinal Analysis of the Effect of Nonmedical Exemption Law and Vaccine Uptake on Vaccine-Targeted Disease Rates

Y. Tony Yang · Vicky Debold

34 citations0/0 files storedAmerican Journal of Public Health

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Vaccine Coverage and Hesitancy Virology and Viral Diseases Immune responses and vaccinations

Abstract

OBJECTIVES: We assessed how nonmedical exemption (NME) laws and annual uptake of vaccines required for school or daycare entry affect annual incidence rates for 5 vaccine-targeted diseases: pertussis, measles, mumps, Haemophilus influenzae type B, and hepatitis B. METHODS: We employed longitudinal mixed-effects models to examine 2001-2008 vaccine-targeted disease data obtained from the National Notifiable Disease Surveillance System. Key explanatory variables were state-level vaccine-specific uptake rates from the National Immunization Survey and a state NME law restrictiveness level. RESULTS: NME law restrictiveness and vaccine uptake were not associated with disease incidence rate for hepatitis B, Haemophilus influenzae type B, measles, or mumps. Pertussis incidence rate, however, was negatively associated with NME law restrictiveness (b = -0.20; P = .03) and diphtheria-pertussis-tetanus vaccine uptake (b = -0.01; P = .05). CONCLUSIONS: State NME laws and vaccine uptake rates did not appear to influence lower-incidence diseases but may influence reported disease rates for higher-incidence diseases. If all states increased their NME law restrictiveness by 1 level and diphtheria-pertussis-tetanus uptake by 1%, national annual pertussis cases could decrease by 1.14% (171 cases) and 0.04% (5 cases), respectively.

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References

2005Understanding interobserver agreement: the kappa statistic.2007Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States 2005Factors Associated With Refusal of Childhood Vaccines Among Parents of School-aged Children 2000Individual and Community Risks of Measles and Pertussis Associated With Personal Exemptions to Immunization 2004Children Who Have Received No Vaccines: Who Are They and Where Do They Live?2010Factors underlying parental decisions about combination childhood vaccinations including MMR: A systematic review 2006Nonmedical Exemptions to School Immunization Requirements 1999Health Consequences of Religious and Philosophical Exemptions From Immunization Laws

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2018Legal approaches to promoting parental compliance with childhood immunization recommendations 2018Examining the spatiotemporal evolution of vaccine refusal: nonmedical exemptions from vaccination in California, 2000–2013 2024Inducing Immunity?2018Prioritizing Religion in Vaccine Exemption Policies 2016A spatiotemporal analysis of non-medical exemptions from vaccination: California schools before and after SB277

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