Personal Belief Exemptions to Vaccination in California: A Spatial Analysis

Carrel, Margaret; Bitterman, Patrick

doi:10.1542/peds.2015-0831

Cited by 43 publications

(25 citation statements)

References 31 publications

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“…61 All states in the United States allow medical exemptions to vaccination, 3 states (California, Mississippi, and West Virginia) allow only medical exemptions, and the remainder allow religious and/or personal belief exemptions. Higher rates of nonmedical exemptions cluster geographically 62 and are associated with rural communities, private schools, and with sociodemographic factors that have also been associated with vaccine hesitancy. [63][64][65][66][67] Legal strategies to strengthen vaccination and counter vaccine hesitancy have focused on eliminating nonmedical exemptions or making exemptions more difficult to obtain.…”

Section: Where We Are Today and What Is Next? Immunization Laws And Smentioning

confidence: 99%

Vaccine Hesitancy: Where We Are and Where We Are Going

McClure

Cataldi

O’Leary

2017

Clinical Therapeutics

205

166

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At the community level, evidence-based communication strategies to address vaccine hesitancy are needed. The practice of dismissing families from pediatric practices who refuse to vaccinate is common, although widely criticized. Other controversial and rapidly evolving topics include statewide vaccination mandates and school exemption policies. Electronic interventions, such as text-messaging services and social media, have recently emerged as effective methods of communication and may become more important in coming years.

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Section: Where We Are Today and What Is Next? Immunization Laws And Smentioning

confidence: 99%

Vaccine Hesitancy: Where We Are and Where We Are Going

McClure

Cataldi

O’Leary

2017

Clinical Therapeutics

205

166

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“…We already know that state-level NME use increased in California from 2000 to 2013. Others have examined spatial clustering of NMEs in California over recent time periods in relation to pertussis outbreaks [ 14 ], school characteristics and medical exemptions [ 15 ], and policy changes [ 29 ]. This research is solely focused on the local spatial patterns of NME use and how they evolved over time.…”

Section: Introductionmentioning

confidence: 99%

“…By examining the spatiotemporal nature of the changes in NME use, we aim to uncover whether vaccine refusal acted as a spatially diffusive or contagious process over this time period, as suggested by others [ 15 , 29 ]. The first two research questions focus on the changing spatial patterns of vaccine-related behavior in an effort to unravel the role that “space” or “location” may play over time.…”

Section: Introductionmentioning

confidence: 99%

Examining the spatiotemporal evolution of vaccine refusal: nonmedical exemptions from vaccination in California, 2000–2013

2018

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BackgroundVaccine hesitancy continues to be an issue throughout the United States, as numerous vaccine hesitant parents are choosing to exempt their children from school-entry vaccination requirements for nonmedical reasons, despite the safety and effectiveness of vaccines. We conduct an analysis of how vaccine refusal, measured by the use of nonmedical exemptions (based on personal or religious beliefs) from vaccination (NMEs), evolved across space and over time in California.MethodsUsing school-entry data from the California Department of Public Health, we examined NMEs for students entering kindergarten in California from 2000 to 2013. We conduct global and local spatial autocorrelation analysis to determine whether NME use became more geographically clustered over the study period and whether the location of local clusters of high use were temporally stable. We conducted a grouping analysis that identified the general temporal trends in NME use over the time period.ResultsThe use of NMEs increased from 0.73% of all kindergarteners in 2000 to 3.09% in 2013 and became more geographically clustered over the study period. Local geographic clusters of high use were relatively isolated early in the study period, but expanded in size over time. The grouping analysis showed that regions with high NME use early in the study period were generally few (15% of all US Census tracts) and relatively isolated. Regions that had low initial NME use and moderate to large increases over the study period were located in close proximity to the initial high use regions. The grouping analysis also showed that roughly half of all tracts had 0% or very low NME use throughout the study period.ConclusionsWe found an observable spatial structure to vaccine refusal and NME use over time, which appeared to be a self-reinforcing process, as well as a spatially diffusive process. Importantly, we found evidence that use of NMEs in the initially isolated regions appeared to stimulate vaccine refusal in geographically proximal regions. Thus, our results suggest that efforts aimed at decreasing future NME use may be most effective if they target regions where NME use is already high, as well as the nearby regions.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5368-y) contains supplementary material, which is available to authorized users.

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“…in data collection methods and data quality. 29 A few states have published county-level exemption data, 64 which have been used to study child vaccination trends in California, [30][31][32] Michigan, 9 Washington, 8 65 Colorado, 33 ,and others. 34 Surveys have also been conducted to explore the drivers of vaccine hesitancy; 66 however, these studies are typically small-scale and insufficient in-depth exploration of the factors 67 associated with vaccination behavior.…”

Section: Introductionmentioning

confidence: 99%

Assessing the distribution and determinants of vaccine underutilization in the United States

Goldlust

Lee

Haran

et al. 2017

Preprint

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Despite advances in sanitation and immunization, vaccine-preventable diseases remain a significant cause of morbidity and mortality worldwide. In high-income countries such as the United States, coverage rates for vaccination against childhood infections remains high. However, the phenomenon of vaccine hesitancy makes maintenance of herd immunity difficult, impeding global disease eradication efforts.Reaching the 'last mile' will require early detection of vaccine hesitancy (driven by philosophical or religious choices), identifying pockets of susceptibility due to underimmunization (driven by vaccine unavailability, costs ineligibility), determining the factors associated with the behavior and developing targeted strategies to ameliorate the concerns. Towards this goal, we harness high-resolution medical claims data to geographically localize vaccine refusal and underimmunization (collectively, 'underutilization') in the United States and identify the socio-economic determinants of the behaviors.Our study represents the first large-scale effort for vaccination behavior surveillance and has the potential to aid in the development of targeted public health strategies for optimizing vaccine uptake.

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Personal Belief Exemptions to Vaccination in California: A Spatial Analysis

Cited by 43 publications

References 31 publications

Vaccine Hesitancy: Where We Are and Where We Are Going

Vaccine Hesitancy: Where We Are and Where We Are Going

Examining the spatiotemporal evolution of vaccine refusal: nonmedical exemptions from vaccination in California, 2000–2013

Assessing the distribution and determinants of vaccine underutilization in the United States

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