Childhood Vaccine Exemptions: A Broader Perspective Is Required.

Abstract

* Abbreviation: LRA — : least-restrictive alternative A selective view of childhood vaccine exemption policy is presented by Opel et al in Pediatrics .1 Their primary premise is that recent attempts to restrict nonmedical vaccine exemptions are scientifically and ethically problematic.1 The authors suggest that rather than working to eliminate all nonmedical exemptions for vaccines, the focus should be on exemptions related to measles, which they see as a unique vaccine-preventable disease. The authors provide information on the highly contagious nature of the measles virus, provide accurate safety and efficacy data about the measles vaccine, and discuss the ethics of the least-restrictive alternative (LRA). They use this information to argue that only measles should be restricted from nonmedical vaccine exemptions. However, we disagree with their interpretations and seek to provide an alternative approach. First, the authors point to the contagiousness of measles as distinctive among infectious diseases. They refer to the high R0 of measles in comparison with other vaccine-preventable infectious diseases. The R0 is defined as the average number of secondary cases produced by a typical infected person in a fully susceptible population.2 The R0 has implications for the spread and control of an infection within a population and provides a basis for understanding the proportion of the population that must be immunized to provide herd or community immunity. Opel et al1 point to the fact that other vaccine-preventable infections have lower R0 than measles, ranging from 4 to 7 as opposed to 12 to 18, although their estimates may be low for some … Address correspondence to Carrie L. Byington, MD, University of Utah Health Sciences Center, 26 South 2000 East, HSEB Suite 5515, Salt Lake City, UT. E-mail: carrie.byington{at}hsc.utah.edu