Abstract
In a Policy Forum, Peter Hotez and colleagues discuss vaccination exemptions in US states and possible consequences for infectious disease outbreaks.
Highlights
We analyzed the relationship between nonmedical exemption (NME) rates and actual vaccine coverage, and found an inverse association between NME rate and measles, mumps, and rubella (MMR) vaccine coverage of kindergarteners in these states (P = 0.03 by Spearman correlation), indicating that states with higher overall NME rates do have lower MMR vaccine coverage (P = 0.007 by beta regression)
NME data were collected from all 18 states currently permitting philosophical-belief NMEs (Arkansas [AR], Arizona [AZ], Colorado [CO], Idaho [ID], Louisiana [LA], Maine [ME], Michigan [MI], Minnesota [MN], Missouri [MO], North Dakota [ND], Ohio [OH], Oklahoma [OK], Oregon [OR], Pennsylvania [PA], Texas [TX], Utah [UT], Washington [WA], and Wisconsin [WI])
From our 18 included states, state-level data were collected from state health departments and/or the US Centers for Disease Control and Prevention (CDC) [3] and analyzed by school year from 2009–2010 to 2016–2017
Summary
A detailed analysis of NMEs within each of the 18 states reveals that several counties, including those with large metropolitan areas, are at high risk for vaccine-preventable pediatric infection epidemics. NME data were collected from all 18 states currently permitting philosophical-belief NMEs (Arkansas [AR], Arizona [AZ], Colorado [CO], Idaho [ID], Louisiana [LA], Maine [ME], Michigan [MI], Minnesota [MN], Missouri [MO], North Dakota [ND], Ohio [OH], Oklahoma [OK], Oregon [OR], Pennsylvania [PA], Texas [TX], Utah [UT], Washington [WA], and Wisconsin [WI]). From our 18 included states, state-level data were collected from state health departments and/or the US Centers for Disease Control and Prevention (CDC) [3] and analyzed by school year from 2009–2010 to 2016–2017. Many county-level NME rates were publicly available from state health departments for the school year 2016 to 2017.
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