The state of the antivaccine movement in the United States: A focused examination of nonmedical exemptions in states and counties

Olive, Jacqueline K.; Hotez, Peter J.; Damania, Ashish; Nolan, Melissa S.

doi:10.1371/journal.pmed.1002578

Cited by 167 publications

(148 citation statements)

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“…Folowing the analysis of Olive et al [10], we expected a negative association between nonmedical exemptions and school-aged children vaccination levels. We extended their analysis for 2016-2017 to all states (irrespective of the breadth of the non-medical exemptions they allow) and found that higher rates of non-medical exemptions are associated with lower vaccination rates for the MMR vaccine (Figure 1A; beta regression ; p < 0.001).…”

Section: Resultsmentioning

confidence: 88%

“…This association, along with the heterogeneous spatial distribution of non-medical exemptions, creates pockets of eroded herd immunity where outbreaks of vaccine preventable diseases would be more likely [30]. Furthermore, we illustrate that this is true not only for MMR [10] but for a wide range of childhood diseases. It is thus important to consider the compounded risk of all childhood diseases when evaluating the public health risk posed by non-medical exemptions.…”

Section: Discussionmentioning

confidence: 92%

“…The downstream impact of vaccination exemption policy on vaccination rates is also important to consider. Childhood vaccination rates tend to be lower in states with more permissive exemption policies [9], and a recent analysis has shown that in states allowing personal belief exemptions, higher levels of exemptions were associated with lower levels of measles, mumps, and rubella (MMR) vaccination in children attending kindergarten in the school year 20162017 [10]. Change in vaccination mandates increasing the difficulty for parents to obtain non-medical exemptions have had positive impacts on vaccination rates, including in Washington in 2011 [11] and California from the 2012-2013 school year [12].…”

Section: Introductionmentioning

confidence: 99%

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Getting personal: how vaccination exemptions shape herd immunity

Garnier

Sb³

et al. 2018

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Background: State-mandated school entry immunization requirements in the United States play an important role in achieving high vaccine coverage and preventing outbreaks of vaccine-preventable diseases. Most states allow non-medical exemptions that let children remain unvaccinated on the basis of personal beliefs. However, the ease of obtaining such exemptions varies, resulting in a patchwork of state vaccination exemption laws, contributing to heterogeneity in vaccine coverage across the country. In this study, we evaluate epidemiological effects and spatial variations in non-medical exemption rates in the context of vaccine 1 policies. Methods and Findings:We first analyzed the correlation between non-medical exemption rates and vaccine coverage for three significant childhood vaccinations and found that higher rates of non-medical exemptions were associated with lower vaccination rates of school-aged children in all cases. We then identified a subset of states where exemption policy has recently changed and found that the effects on statewide non-medical exemption rates varied widely.Focusing further on Vermont and California, we illustrated how the decrease in non-medical exemptions due to policy change was concurrent to an increase in medical exemptions (in CA) or religious exemptions (in VT). Finally, a spatial clustering analysis was performed for Connecticut, Illinois, and California, identifying clusters of high non-medical exemption rates in these states before and after a policy change occurred. The clustering analyses show that policy changes affect spatial distribution of non-medical exemptions within a state.Conclusions: Our work suggests that vaccination policies have significant impacts on patterns of herd immunity. Our findings can be used to develop evidence-based vaccine legislation.Immunization requirements for school-entry date back to 1922 and have played a key role in 1 achieving high levels of vaccine coverage against communicable diseases in the United States 2 [1]. This patchwork of childhood immune protection, however, is punctured by a hetero-3 geneous set of state-specific vaccination exemption rules. Medical exemptions to mandated 4 vaccinations are available in all 50 states, and 47 offer non-medical exemptions in some form. 5Namely, 18 states offer personal belief exemptions for those who object to vaccinations for 6 philosophical or moral reasons. In the remaining states offering non-medical exemptions, 7 they are limited to religious beliefs. In the remaining three states (California, Mississippi, 8 and West Virginia), only medical exemptions are available. While this has been the policy 9 in Mississippi and West Virginia for decades [2], the ban on non-medical exemptions in Cal-10 ifornia (enacted by CA Senate Bill 277 in January 2016) was motivated by the 2015 measles 11 outbreak in the state [3] in which suboptimal vaccination rates in school-aged children was 12 an important factor in the magnitude of the outbreak [4]. 13The ease of obtaining non-medical exemptions vari...

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Section: Resultsmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Getting personal: how vaccination exemptions shape herd immunity

Garnier

Sb³

et al. 2018

Preprint

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“…27 Several US metropolitan areas represent "hot spots" for these exemptions. 28 This may render such areas vulnerable to vaccine-preventable diseases, including infl uenza.…”

Section: How Effective Is It?mentioning

confidence: 99%

Influenza update 2018–2019: 100 years after the great pandemic

Mossad

2018

CCJM

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T his year marks the centennial of the 1918 infl uenza pandemic, which killed 50 million people worldwide. Three more infl uenza pandemics and annual epidemics have occurred since then, with other signifi cant interim events (Table 1). 1 The 2017-2018 epidemic was particularly severe and long. 2 This centennial year update focuses primarily on immunization, but also reviews epidemiology, transmission, and treatment. ■ EPIDEMIOLOGY 2017-2018 was a bad season The 2017-2018 infl uenza epidemic was memorable, dominated by infl uenza A(H3N2) viruses with morbidity and mortality rates approaching pandemic numbers. It lasted 19 weeks, killed more people than any other epidemic since 2010, particularly children, and was associated with 30,453 hospitalizationsalmost twice the previous season high in some parts of the United States. 2 Regrettably, 171 unvaccinated children died during 2017-2018, accounting for almost 80% of deaths. 2 The mean age of the children who died was 7.1 years; 51% had at least 1 underlying medical condition placing them at risk for infl uenza-related complications, and 57% died after hospitalization. 2 Recent estimates of the incidence of symptomatic infl uenza among all ages ranged from 3% to 11%, which is slightly lower than historical estimates. The rates were higher for children under age 18 than for adults. 3 Interestingly, infl uenza A(H3N2) accounted for 50% of cases of non-mumps viral parotitis during the 2014-2015 infl uenza season in the United States. 4

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“…I think I know most of it anyway." Oder auch die zunehmende Impfverweigerung aufgrund medizinisch nicht begründeter Vorbehalte [5]. Über ein Drittel der Laien nimmt an, mehr über Ursachen von Autismus zu wissen als Ärzte oder Wissenschaftler.…”

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Blind – ohne es zu bemerken

Kornhuber¹

2019

Fortschr Neurol Psychiatr

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The state of the antivaccine movement in the United States: A focused examination of nonmedical exemptions in states and counties

Abstract: In a Policy Forum, Peter Hotez and colleagues discuss vaccination exemptions in US states and possible consequences for infectious disease outbreaks.

Cited by 167 publications

References 9 publications

Getting personal: how vaccination exemptions shape herd immunity

Getting personal: how vaccination exemptions shape herd immunity

Influenza update 2018–2019: 100 years after the great pandemic

Blind – ohne es zu bemerken

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