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, 104 (2), 371-7

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

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

Y Tony Yang et al. Am J Public Health.

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.

Figures

FIGURE 1—
FIGURE 1—
State-level mean disease incidence rates: impact of nonmedical exemption law restrictiveness and vaccine uptake on vaccine-targeted disease incidence rates, United States, 2001–2008. Note. Hib = Haemophilus influenzae type B.
FIGURE 2—
FIGURE 2—
State-level trends in uptake for 4 vaccines: impact of nonmedical exemption law restrictiveness and vaccine uptake on vaccine-targeted disease incidence rates, United States, 2001–2008. Note. DTaP = diphtheria-pertussis-tetanus; Hib = Haemophilus influenzae type B; MMR = measles, mumps, rubella. In a box-and-whisker plot, the central box represents the values from the lower to upper quartile (25–75 percentiles). The middle line represents the median. The vertical line extends from the minimum to the maximum value, excluding outside values. An outside value is defined as a value that is larger than the upper quartile plus 1.5 times the interquartile range or smaller than the lower quartile minus 1.5 times the interquartile range.

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