Trends in Kindergarten Rates of Vaccine Exemption and State-Level Policy, 2011–2016

Omer, Saad B.; Porter, Rachael M.; Allen, Kristen; Salmon, Daniel A.; Bednarczyk, Robert A.

doi:10.1093/ofid/ofx244

Cited by 32 publications

(26 citation statements)

References 15 publications

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“…2 However, vaccine hesitancy among parents has emerged in recent decades as a threat to this high coverage, 3,4 leading to the clustering of vaccine refusal and associated outbreaks of vaccine-preventable diseases (VPDs). [5][6][7] This includes the most recent outbreak of measles in the United States, in which more cases have been reported so far in 2019 than in any year since 1994. 8 Vaccine coverage for maternal vaccines is suboptimal, with only about half of pregnant women receiving influenza and tetanus, diphtheria and acellular pertussis (Tdap) vaccines in 2018.…”

Section: Introductionmentioning

confidence: 99%

Characterizing the vaccine knowledge, attitudes, beliefs, and intentions of pregnant women in Georgia and Colorado

Dudley

Limaye

Omer

et al. 2020

Human Vaccines & Immunotherapeutics

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Vaccine coverage for maternal vaccines is suboptimal; only about half of pregnant women received influenza and Tdap vaccines in 2018. We explored knowledge, attitudes, beliefs, intentions, and trust regarding maternal and infant vaccines among pregnant women. Between June 2017 and July 2018, we surveyed 2196 pregnant women recruited from geographically and socio-demographically diverse prenatal care practices in Georgia and Colorado (56% response rate). Fifty-six percent of pregnant women intended to receive both influenza and Tdap vaccines during pregnancy and 68% intended to vaccinate their baby with all recommended vaccines on time. Attitudinal constructs associated with intention to vaccinate include confidence in vaccine safety (ORs: 16-38) and efficacy (ORs: 4-19), perceived risk of vaccine-preventable diseases (ORs: 2-6), social norms (ORs: 4-10), and trust in sources of vaccine information. Women pregnant with their first child were less likely than women who had prior children to intend to vaccinate themselves and their children, more likely to be unsure about their intentions to receive both maternal and infant vaccines, and less likely to report feeling they had enough knowledge or information about vaccines and vaccine safety (p < .01). This demonstrates an opportunity for vaccine education to increase vaccine confidence and informed decision-making, especially among first-time pregnant women. ARTICLE HISTORY

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Section: Introductionmentioning

confidence: 99%

Characterizing the vaccine knowledge, attitudes, beliefs, and intentions of pregnant women in Georgia and Colorado

Dudley

Limaye

Omer

et al. 2020

Human Vaccines & Immunotherapeutics

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“…We identified a subset of states in which public health policies regarding non-medical exemptions have recently changed. Six states have made it harder to obtain non-medical exemptions between 2012 and 2016 [5]: Alaska (2013), Oregon (2014), Illinois (2015), Connecticut (2015), Missouri (2015), and Michigan (2015). In addition, in 2016, Vermont disallowed philosophical exemptions to only allow religious exemptions [18].…”

Section: Methodsmentioning

confidence: 99%

“…The ease of obtaining non-medical exemptions varies widely depending on state public health policies, from requiring a simple signature from the parents to obtaining a notarized document [5]. Generally, higher rates of non-medical exemptions are found in states where policies are more permissive [1, 6, 7].…”

Section: Introductionmentioning

confidence: 99%

Getting personal: how vaccination exemptions shape herd immunity

Garnier

Sb³

et al. 2018

Preprint

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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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“…During the past two decades, immunization exemptions have steadily risen until the 2012À2013 school year, when the rate of immunization exemptions plateaued. Still, immunization exemptions corrode community immunity provided by population-based vaccination programs, and this warrants careful and continued monitoring to prevent vaccinepreventable disease outbreaks in the United States (Omer, Porter, Allen, Salmon, & Bednarczyk, 2018).…”

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confidence: 99%