Measuring Immunization Coverage among Preschool Children: Past, Present, and Future Opportunities

Salmon, Daniel A.

doi:10.1093/epirev/mxj001

Cited by 36 publications

(23 citation statements)

References 59 publications

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“…NMEs to immunization have been on the rise in many states in recent years, including California. [13][14][15][16][17] Correlations between the ease of obtaining NMEs and the rates of NMEs have been demonstrated. 13,14,18,19 From 2000 to 2010, California' s NME rates more than tripled from 0.77% to 2.33%, with some schools reporting NME rates as high as 84% in 2010.…”

mentioning

confidence: 95%

Nonmedical Vaccine Exemptions and Pertussis in California, 2010

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Previous studies have shown that nonmedical exemptions (NMEs) to immunization cluster geographically and contribute to outbreaks of vaccinepreventable diseases such as pertussis. The 2010 pertussis resurgence in California has been widely attributed to waning immunity from acellular pertussis vaccines. WHAT THIS STUDY ADDS:This study provides evidence of spatial and temporal clustering of NMEs and clustering of pertussis cases and suggests that geographic areas with high NME rates were also associated with high rates of pertussis in California in 2010.abstract BACKGROUND: In 2010, 9120 cases of pertussis were reported in California, more than any year since 1947. Although this resurgence has been widely attributed to waning immunity of the acellular vaccine, the role of vaccine refusal has not been explored in the published literature. Many factors likely contributed to the outbreak, including the cyclical nature of pertussis, improved diagnosis, and waning immunity; however, it is important to understand if clustering of unvaccinated individuals also played a role. METHODS:We analyzed nonmedical exemptions (NMEs) for children entering kindergarten from 2005 through 2010 and pertussis cases with onset in 2010 in California to determine if NMEs increased in that period, if children obtaining NMEs clustered spatially, if pertussis cases clustered spatially and temporally, and if there was statistically significant overlap between clusters of NMEs and cases.RESULTS: Kulldorff' s scan statistics identified 39 statistically significant clusters of high NME rates and 2 statistically significant clusters of pertussis cases in this time period. Census tracts within an exemptions cluster were 2.5 times more likely to be in a pertussis cluster (odds ratio = 2.47, 95% confidence interval: 2.22-2.75). More cases occurred within as compared with outside exemptions clusters (incident rate ratios = 1.20, 95% confidence interval: 1.10-1.30). The association remained significant after adjustment for demographic factors. NMEs clustered spatially and were associated with clusters of pertussis cases. CONCLUSIONS:

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confidence: 95%

Nonmedical Vaccine Exemptions and Pertussis in California, 2010

et al. 2013

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“…First, Washington is 1 of a few states that permit school data to be entered by families themselves, which can result in inaccuracies. 20 Second, reporting of school data often occurs before final immunization statuses are complete (thus leading to potential underestimates of coverage). Third, most states do not include homeschooled children in their school exemption data 21 ; yet, vaccine refusal can be particularly pronounced among families that homeschool, 22,23 and VPDs are known to occur in these settings.…”

Section: School Exemption Datamentioning

confidence: 99%

“…The Childhood Immunization Initiative Act of 1993 was originally introduced to Congress with language to do just this, but this language was later changed to instead allocate funding for states to establish their own registries. 20,33 The main benefit of a national registry is that it can help medical and public health officials more easily gauge local trends in immunization and detect clusters of unimmunized individuals. 34 This is evident from the experience of countries with national immunization registries, including Australia and many countries in Western Europe.…”

Section: Establishment Of a National Immunization Registrymentioning

confidence: 99%

The Challenges in Measuring Local Immunization Coverage: A Statewide Case Study

et al. 2016

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There are many forms of existing immunization surveillance in the United States and Washington state, but all are limited in their ability to provide timely identification of clusters of unimmunized individuals and assess the risk of vaccine-preventable diseases. This article aims to: (1) describe challenges to measuring immunization coverage at a local level in the United States using Washington State as a case study; and (2) propose improvements to existing surveillance systems that address the challenges identified.

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“…The National Immunization Survey (NIS) -the gold standard tool for monitoring vaccine uptake among children aged 19-35 months -is typically constrained to producing coarse state-level estimates. 1 In recent years, vaccine hesitancy (i.e., a desire to delay or refuse vaccination, despite availability of vaccination services) 2 has resurged in the United States, challenging the maintenance of herd immunity. In December 2014, foreign importation of the measles virus to Disney theme parks in Orange County, California resulted in an outbreak of 111 measles cases, 45% of which were among unvaccinated individuals.…”

Section: Introductionmentioning

confidence: 99%