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Regan T, Wills WB, Barbera AR, Reyes PE, Jacklin K, Crowder D, Henderson K, Montes B, Bugajski A. Association of Type of Vaccination Center With Time to Emergency Department Presentation for Acute COVID-19 Infection: An Exploratory Analysis. Cureus 2023; 15:e51229. [PMID: 38283444 PMCID: PMC10821755 DOI: 10.7759/cureus.51229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Objective The objective of this study was to identify potential associations between coronavirus disease 2019 (COVID-19) vaccination center reception location and time to presentation to the emergency department for acute COVID-19 infection. The a priori hypothesis was that there are significant differences in the outcome based on vaccination administration center type. Methods This was a cross-sectional, observational study conducted within a hospital in Lakeland, Florida, between October 2021 and May 2022. Participants were at least 18 years old with confirmed severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection and at least two COVID-19 symptoms at enrollment. Patients with prior confirmed COVID-19 diagnosis and hospitalization within 10 days of screening were excluded. Participants were sampled from within the emergency department of the institution. The primary outcome was time to presentation to the emergency department for acute COVID-19 infection since the last vaccination dose from each sampled COVID-19 vaccination center location. Results A total of 93 participants were analyzed. Of these, 48 (52%) participants received COVID-19 vaccination. Participants vaccinated at vaccine clinics demonstrated a significantly longer mean survival time (288.2 (29.9)) compared to other sites. Significant predictors of hospitalization were age (aOR, 1.09, 95%CI 1.02-1.16, p < 0.01), sex (aOR: 10.05, 95%CI 1.52-66.54, p < 0.05), physical function (aOR, 0.90, 95%CI 0.83-0.97, p < 0.01) and number of medications (aOR, 1.34, 95%CI 1.14-1.58, p < 0.001). Conclusions This exploratory analysis highlights the need for further investigation into both characteristics of healthcare institutions and individual-level factors that may play a role in the prolonged prevention of emergency department presentations due to COVID-19 infection. Increased transparency of data regarding practices related to the administration of COVID-19 vaccines across various institutions may be beneficial in further understanding the role of COVID-19 vaccinations in preventing symptomatic disease across local and global communities.
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Affiliation(s)
- Timothy Regan
- Department of Emergency Medicine, Lakeland Regional Health, Lakeland, USA
| | - Walter B Wills
- Department of Research and Sponsored Studies, Lakeland Regional Health, Lakeland, USA
| | - Andrew R Barbera
- Department of Emergency Medicine, Lakeland Regional Health, Lakeland, USA
| | - Pedro E Reyes
- Department of Research and Sponsored Studies, Lakeland Regional Health, Lakeland, USA
| | - Kellcee Jacklin
- Department of Research and Sponsored Studies, Lakeland Regional Health, Lakeland, USA
| | - Dana Crowder
- Department of Research and Sponsored Studies, Lakeland Regional Health, Lakeland, USA
| | - Kathryn Henderson
- Department of Research and Sponsored Studies, Lakeland Regional Health, Lakeland, USA
| | - Brandon Montes
- Department of Research and Sponsored Studies, Lakeland Regional Health, Lakeland, USA
| | - Andrew Bugajski
- Department of Research and Sponsored Studies, Lakeland Regional Health, Lakeland, USA
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2
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Correira JW, Pettigrew SM, Kamstra R, Megyeri PR, Silverstein GJ, Kambrich S, Ma J, Doll MK. Exploring the impact of the New York State repeal of nonmedical vaccination exemptions on student enrollment, absenteeism, and school workload: Perspectives from a survey of school administrators. Hum Vaccin Immunother 2023; 19:2261176. [PMID: 37750393 PMCID: PMC10524776 DOI: 10.1080/21645515.2023.2261176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023] Open
Abstract
In June 2019, New York State (NYS) adopted Senate Bill 2994A eliminating nonmedical vaccine exemptions from school entry laws. Since student noncompliance with the law required school exclusion, we sought to evaluate the law's effects on student enrollment and absenteeism, and school workloads related to its implementation. In November 2019, we sent an electronic survey to NYS (excluding New York City) schools. Due to the COVID-19 pandemic, outreach was curtailed in March 2020 with 525 (14%) of 3,759 eligible schools responding. To account for non-response, results were analyzed using inverse probability weighting. After weighting, 39% (95% CI: 34%, 44%) of schools reported enrollment changes and 31% (95% CI: 26%, 36%) of schools reported absenteeism related to the law. In addition, 95% (95% CI: 93%, 98%) of schools reported holding meetings and/or preparing correspondence about the law, spending a mean of 14 (95% CI: 11, 18) hours on these communication efforts. Schools in the highest pre-mandate nonmedical exemption tertile (vs. lowest) were more likely to report enrollment and absenteeism changes, and higher workloads. While our results should be interpreted with caution, changes in student enrollment, absenteeism, and school workloads may represent important considerations for policymakers planning similar legislation.
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Affiliation(s)
- John W. Correira
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
| | - Stacy M. Pettigrew
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
| | | | - Perrie Rose Megyeri
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
| | - Gabriel J. Silverstein
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
| | | | - Julia Ma
- Precision Analytics, Montreal, Quebec, Canada
| | - Margaret K. Doll
- Department of Allied Health Sciences, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
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3
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Moore TP, Bennett JC, Graff K, Rao M, Augusto O, Chu HY, Wagenaar BH, Bell TR. State Policy Removing the Personal Belief Exemption for Measles, Mumps, and Rubella (MMR) School Immunization Requirement, Washington State, 2014-2022. Am J Public Health 2023; 113:795-804. [PMID: 37200605 PMCID: PMC10262239 DOI: 10.2105/ajph.2023.307285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 05/20/2023]
Abstract
Objectives. To assess the impact of Washington State's 2019 Engrossed House Bill (EHB) 1638-which removed measles, mumps, and rubella (MMR) personal belief exemptions-on MMR vaccine series completion and exemption rates in K-12 students. Methods. We used interrupted time-series analyses to examine changes in MMR vaccine series completion rates before and after EHB 1638 was passed and the χ2 test for differences in exemption rates. Results. EHB 1638 implementation was associated with a 5.4% relative increase in kindergarten MMR vaccine series completion rates (95% confidence interval = 3.8%, 7.1%; P ≤ .001), and results were similar with Oregon as a control state (no change observed in Oregon; P = .68). MMR exemptions overall decreased 41% (from 3.1% in 2018-2019 to 1.8% in 2019-2020; P ≤ .001), and religious exemptions increased 367% (from 0.3% to 1.4%; P ≤ .001). Conclusions. EHB 1638 was associated with an increase in MMR vaccine series completion rates and a decrease in any MMR exemption. However, effects were partially offset by an increase in religious exemption rates. Public Health Implications. Removal of personal belief exemptions for the MMR immunization requirement only may be an effective approach to increase MMR vaccine coverage rates statewide and among underimmunized communities. (Am J Public Health. 2023;113(7):795-804. https://doi.org/10.2105/AJPH.2023.307285).
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Affiliation(s)
- Tyler P Moore
- Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle
| | - Julia C Bennett
- Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle
| | - Katherine Graff
- Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle
| | - Mayuree Rao
- Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle
| | - Orvalho Augusto
- Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle
| | - Helen Y Chu
- Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle
| | - Bradley H Wagenaar
- Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle
| | - Teal R Bell
- Tyler P. Moore, Katherine Graff, and Teal R. Bell are with the Washington State Department of Health, Tumwater. Julia C. Bennett, Mayuree Rao, Orvalho Augusto, and Bradley H. Wagenaar are with the School of Public Health, University of Washington, Seattle. Helen Y. Chu is with the Department of Medicine, University of Washington, Seattle
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Pruitt SL, Tiro JA, Kepka D, Henry K. Missed Vaccination Opportunities Among U.S. Adolescents by Area Characteristics. Am J Prev Med 2022; 62:538-547. [PMID: 35125272 DOI: 10.1016/j.amepre.2021.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/16/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A total of 3 vaccines are recommended for U.S. adolescents: tetanus, diphtheria, and acellular pertussis; meningococcal conjugate; and human papillomavirus. To understand the disparities in vaccine availability and hesitancy, adolescent-, household-, and area-level characteristics associated with patterns of vaccine coverage are described. METHODS In 2020-2021, the authors generated national estimates among 8 possible combinations of vaccine coverage and identified the associated characteristics using 2015-2017 National Immunization Survey-Teen for male and female adolescents aged 13-17 years (N=63,299) linked to area (ZIP code) characteristics. Next, the factors associated with a missed opportunity for human papillomavirus vaccine (i.e., receipt of tetanus, diphtheria, and acellular pertussis and meningococcal conjugate only compared with coverage of all the 3 vaccines) were identified using logistic regression. RESULTS Most U.S. adolescents received all the 3 vaccines (42.9%) or tetanus, diphtheria, and acellular pertussis and meningococcal conjugate only (32.1%); fewer received no vaccines (7.7%) or tetanus, diphtheria, and acellular pertussis only (6.6%); and the remainder received some combination of 1-2 vaccines. Missed opportunities for human papillomavirus vaccination were more likely among adolescents who were male, were of White race, were uninsured, were in middle-income households, and were living in rural areas and were less likely among adolescents who were older, who were Medicaid insured, whose parents completed surveys in Spanish, who were in poverty-level households, and who were living in high-poverty areas. CONCLUSIONS A substantial number of U.S. adolescents are not fully vaccinated, and coverage varies by vaccine type, population, and place. Providers should routinely stock all the 3 vaccines and promote simultaneous, same-day vaccination to avoid missed vaccine opportunities. More research and interventions are needed to understand and modify patient, provider, payer, vaccine supply/storage, or other reasons for suboptimal coverage of all the recommended vaccines.
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Affiliation(s)
- Sandi L Pruitt
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Jasmin A Tiro
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Deanna Kepka
- College of Nursing, The University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kevin Henry
- Department of Geography and Urban Studies, Temple University, Philadelphia, Pennsylvania; Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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5
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Reindl D, Catma S. A pre-vaccine analysis using the Health Belief Model to explain parents' willingness to vaccinate (WTV) their children in the United States: implications for vaccination programs. Expert Rev Pharmacoecon Outcomes Res 2022; 22:753-761. [PMID: 35192425 DOI: 10.1080/14737167.2022.2045957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study uses the Health Belief Model (HBM) to explain parents' willingness-to-vaccinate (WTV) their children with COVID-19 vaccine in the United States (US). Analysis included determining if vaccination choice among parents statistically varied based on geography among the sample collected. METHODS A cross-sectional survey was administered November 2020. Multiple regression analysis was completed determining which HBM constructs to be most relevant to parents' WTV their children with COVID-19 vaccine. To determine "hot" and "cold" geographic spots for WTV, a hot spot analysis based on Getis-Ord Gi* statistics was executed. RESULTS Primary data collection included a convenience sample of US parents. Approximately 66% of parents surveyed were "likely/extremely likely" to vaccinate their children if the COVID-19 vaccine was provided free by the government. Results highlight HBM connections to WTV. CONCLUSIONS The relationship between parents' WTV their children with a COVID-19 vaccine and constructs within the theoretical framework of the HBM represents a necessary point in the development of efficacious COVID-19 vaccination programs among parents in the US. Interpreting differences in location and health beliefs toward vaccines merit in-depth investigation for local, state and federal level vaccination programs to be effective.
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Affiliation(s)
- Diana Reindl
- Public Health University of South Carolina Beaufort Bluffton, SC
| | - Serkan Catma
- Economics University of South Carolina Beaufort Bluffton, SC
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6
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Gromis A, Liu KY. Spatial Clustering of Vaccine Exemptions on the Risk of a Measles Outbreak. Pediatrics 2022; 149:183781. [PMID: 34866158 PMCID: PMC9037455 DOI: 10.1542/peds.2021-050971] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Areas of increased school-entry vaccination exemptions play a key role in epidemics of vaccine-preventable diseases in the United States. California eliminated nonmedical exemptions in 2016, which increased overall vaccine coverage but also rates of medical exemptions. We examine how spatial clustering of exemptions contributed to measles outbreak potential pre- and postpolicy change. METHODS We modeled measles transmission in an empirically calibrated hypothetical population of youth aged 0 to 17 years in California and compared outbreak sizes under the observed spatial clustering of exemptions in schools pre- and postpolicy change with counterfactual scenarios of no postpolicy change increase in medical exemptions, no clustering of exemptions, and lower population immunization levels. RESULTS The elimination of nonmedical exemptions significantly reduced both average and maximal outbreak sizes, although increases in medical exemptions resulted in more than twice as many infections, on average, than if medical exemptions were maintained at prepolicy change levels. Spatial clustering of nonmedical exemptions provided some initial protection against random introduction of measles infections; however, it ultimately allowed outbreaks with thousands more infections than when exemptions were randomly distributed. The large-scale outbreaks produced by exemption clusters could not be reproduced when exemptions were distributed randomly until population vaccination was lowered by >6 percentage points. CONCLUSIONS Despite the high overall vaccinate rate, the spatial clustering of exemptions in schools was sufficient to threaten local herd immunity and reduce protection from measles outbreaks. Policies strengthening vaccine requirements may be less effective if alternative forms of exemptions (eg, medical) are concentrated in existing low-immunization areas.
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Affiliation(s)
- Ashley Gromis
- Departments of Health Policy and Management,Address correspondence to Ashley Gromis, PhD, Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health, 650 Charles Young Dr S, 31-269 CHS Box 951772, Los Angeles, CA 90095. E-mail:
| | - Ka-Yuet Liu
- Sociology,California Center for Population Research, University of California, Los Angeles, California,Center for Brain Science, Riken Institute, Wako, Japan
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7
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Doll MK, Correira JW. Revisiting the 2014-15 Disneyland measles outbreak and its influence on pediatric vaccinations. Hum Vaccin Immunother 2021; 17:4210-4215. [PMID: 34495822 DOI: 10.1080/21645515.2021.1972707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The 2014-15 Disneyland measles outbreak that began at the California theme park in December 2014 sparked an international conversation regarding measles, vaccine hesitancy, and vaccine policies. The outbreak capped a year with the highest number of measles cases reported in two decades and came amidst increasing trends in nonmedical vaccine exemptions in California and elsewhere. Because of its sensational story line and spread among unvaccinated populations, the outbreak received a high level of media coverage that focused on vaccine hesitancy as a primary driver of the outbreak. This media coverage and the ostensible public support for vaccines that followed led some to hypothesize that the outbreak might have a "Disneyland effect," or a positive influence on the uptake of pediatric measles vaccine. This article reviews the facts of the outbreak and its context, and explores the evidence for the Disneyland outbreak causing an influence on U.S. pediatric vaccine-related beliefs and behaviors.
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Affiliation(s)
- Margaret K Doll
- Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, Albany, NY, USA
| | - John W Correira
- Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, Albany, NY, USA
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8
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Masters NB, Zelner J, Delamater PL, Hutton D, Kay M, Eisenberg MC, Boulton ML. Evaluating Michigan's Administrative Rule Change on Nonmedical Vaccine Exemptions. Pediatrics 2021; 148:peds.2021-049942. [PMID: 34404742 DOI: 10.1542/peds.2021-049942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Vaccine hesitancy is a growing threat to health in the United States. Facing the fourth highest vaccine exemption rate in the United States in 2014, Michigan changed its state Administrative Rules, effective January 1, 2015, requiring parents to attend an in-person vaccine education session at their local health department before obtaining a nonmedical exemption (NME). In this article, we evaluate the longer-term impact of this policy change on the rate, spatial distribution, and sociodemographic predictors of NMEs in Michigan. METHODS Using school-level kindergarten vaccination data from Michigan from 2011 to 2018, we evaluated sociodemographic predictors of NMEs before and after this Administrative Rule change using Bayesian binomial regression. We measured the persistence and location of school district-level geographic clustering using local indicators of spatial association. RESULTS Immediately after the rule change, rates of NMEs fell by 32%. However, NME rates rebounded in subsequent years, increasing by 26% by 2018, although income disparities in NME rates decreased after the rule change. Philosophical, religious, and medical vaccine exemptions exhibited distinct geographic patterns across the state, which largely persisted after 2015, illustrating that NME clusters remain a concern despite this rule change. CONCLUSIONS Although Michigan's Administrative Rule change caused a short-term decline in NME rates, NME rates have risen dramatically in the following 4 years since the policy was implemented. Michigan's administrative effort to require parental education at the local health department before receiving an exemption did not cause a sustained reduction in the rate or spatial distribution of NMEs.
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Affiliation(s)
| | - Jon Zelner
- Departments of Epidemiology.,Center for Social Epidemiology and Population Health
| | - Paul L Delamater
- Department of Geography.,Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - David Hutton
- Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Matthew Kay
- Department of Computer Science, McCormick School of Engineering.,Department of Communication Studies, School of Communication, Northwestern University, Evanston, Illinois
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9
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Marek L, Hobbs M, Wiki J, McCarthy J, Tomintz M, Campbell M, Kingham S. Spatial-temporal patterns of childhood immunization in New Zealand (2006-2017): an improving pattern but not for all? Eur J Public Health 2021; 31:561-566. [PMID: 33624065 DOI: 10.1093/eurpub/ckaa225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Declining childhood immunization represents a serious public health problem globally and in New Zealand. To guide efforts to increase immunization coverage, this study monitors nationwide change in immunization coverage since the introduction of the National Immunisation Register (NIR) in 2005 and spatiotemporal patterns of immunization coverage from 2006 to 2017. METHODS The study population consisted of 4 482 499 individual immunization records that were obtained from the NIR (2005-2017). Data on yearly and average immunization coverage in census area units (CAUs) in New Zealand were calculated by milestone age (6/8/12/18/24/60/144 months). Data for 2005 were excluded due to missing records in the introductory period of the NIR. We analyzed spatial and spatiotemporal patterns using Gi* and SaTScan methods. RESULTS Immunization coverage improved since the introduction of the NIR in 2005, reaching a peak in 2014 and 2015 with a slight decrease in 2016 and 2017. Well and insufficiently immunized areas were identified with spatial autocorrelation analyses highlighting several hot- and cold-spots. Comparison of CAUs with neighbouring CAUs allowed for the identification of places where immunization coverage was significantly higher or lower than expected, over both time and space. CONCLUSION We provide the first spatiotemporal analysis of childhood immunization in New Zealand that utilizes a large sample of over 4.4 million individual immunization records. Our spatial analyses enable policymakers to understand the development of childhood immunization coverage and make more effective prevention strategies in New Zealand.
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Affiliation(s)
- Lukas Marek
- GeoHealth Laboratory, Geospatial Research Institute, University of Canterbury, Christchurch, New Zealand
| | - Matthew Hobbs
- GeoHealth Laboratory, Geospatial Research Institute, University of Canterbury, Christchurch, New Zealand.,School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Jesse Wiki
- GeoHealth Laboratory, Geospatial Research Institute, University of Canterbury, Christchurch, New Zealand
| | | | - Melanie Tomintz
- GeoHealth Laboratory, Geospatial Research Institute, University of Canterbury, Christchurch, New Zealand
| | - Malcolm Campbell
- GeoHealth Laboratory, Geospatial Research Institute, University of Canterbury, Christchurch, New Zealand.,School of Earth and Environment, University of Canterbury, Christchurch, New Zealand
| | - Simon Kingham
- GeoHealth Laboratory, Geospatial Research Institute, University of Canterbury, Christchurch, New Zealand.,School of Earth and Environment, University of Canterbury, Christchurch, New Zealand
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Fliss MD, Gartner DR, McClure ES, Ward JB, Rennie S. Public health, private names: ethical considerations of branding schools of public health in the United States. CRITICAL PUBLIC HEALTH 2021. [DOI: 10.1080/09581596.2020.1736270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mike D. Fliss
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Danielle R. Gartner
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Elizabeth S. McClure
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Stuart Rennie
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
- UNC Bioethics Center, University of North Carolina, Chapel Hill, NC, USA
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11
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Masters NB, Delamater PL, Boulton ML, Zelner J. Measuring Multiple Dimensions and Indices of Nonvaccination Clustering in Michigan, 2008-2018. Am J Epidemiol 2021; 190:1113-1121. [PMID: 33305789 DOI: 10.1093/aje/kwaa264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/23/2020] [Accepted: 12/07/2020] [Indexed: 11/15/2022] Open
Abstract
Michigan experienced a significant measles outbreak in 2019 amidst rising rates of nonmedical vaccine exemptions (NMEs) and low vaccination coverage compared with the rest of the United States. There is a critical need to better understand the landscape of nonvaccination in Michigan to assess the risk of vaccine-preventable disease outbreaks in the state, yet there is no agreed-upon best practice for characterizing spatial clustering of nonvaccination, and numerous clustering metrics are available in the statistical, geographical, and epidemiologic literature. We used school-level data to characterize the spatiotemporal landscape of vaccine exemptions in Michigan for the period 2008-2018 using Moran's I, the isolation index, the modified aggregation index, and the Theil index at 4 spatial scales. We also used nonvaccination thresholds of 5%, 10%, and 20% to assess the bias incurred when aggregating vaccination data. We found that aggregating school-level data to levels commonly used for public reporting can lead to large biases in identifying the number and location of at-risk students and that different clustering metrics yielded variable interpretations of the nonvaccination landscape in Michigan. This study shows the importance of choosing clustering metrics with their mechanistic interpretations in mind, be it large- or fine-scale heterogeneity or between- and within-group contributions to spatial variation.
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12
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Völker S, Hammerschmidt R, Spura A. [Geographic analyses as a foundation for evidence-based public health interventions: the example identification and typology of risk clusters for mumps, measles, and rubella]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:600-609. [PMID: 33891131 PMCID: PMC8087606 DOI: 10.1007/s00103-021-03318-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/17/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ideally, health services and interventions to improve immunization rates should be tailored to local target populations, such as spatial clusters. However, to date, little attention has been paid to spatial clusters of underimmunization and have instead been typified based on small-scale data. AIM Using the example of vaccination against measles, mumps, and rubella (MMR) in children, the present study aims to (1) identify the spatial distribution of insufficient MMR vaccination in Westphalia-Lippe on a small scale, (2) identify specific, spatial risk clusters with insufficient vaccination protection, and (3) describe spatial-neighborhood influencing factors of the different risk clusters as starting points for public health interventions. MATERIAL AND METHODS Account data from the Kassenärztliche Vereinigung Westfalen-Lippe (KVWL) were used as a basis. Birth cohorts 2013-2016 of children with statutory health insurance were formed and aggregated at postcode level (n = 410). Statistically significant, spatially compact clusters and relative risks (RRs) of underimmunization were identified. Local risk models were estimated in binary logistic regressions based on spatial-neighborhood variables. RESULTS AND DISCUSSION Two significant clusters of underimmunization were identified for each of the vaccination rates "at least one MMR vaccination" and "both MMR vaccinations." Significant risk factors for low immunization rates included age structure, socioeconomic variables, population density, medical coverage, and value attitude. The proposed methodology is suitable for describing spatial variations in vaccination behavior based on identified typologies for targeted evidence-based interventions.
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Affiliation(s)
- Sebastian Völker
- Stabsbereich Unternehmensentwicklung, Kassenärztliche Vereinigung Westfalen-Lippe (KVWL), Robert-Schimrigk-Str. 4-6, 44141, Dortmund, Deutschland.
- Zentrum für Public Health und Versorgungsforschung, Masterstudiengang Public Health, Paracelsus Medical University, Salzburg, Österreich.
| | - Reinhard Hammerschmidt
- Stabsbereich Unternehmensentwicklung, Kassenärztliche Vereinigung Westfalen-Lippe (KVWL), Robert-Schimrigk-Str. 4-6, 44141, Dortmund, Deutschland
| | - Anke Spura
- Referat 2-24 Fortbildung, Qualifizierung, Hochschulkooperation, Bundeszentrale für gesundheitliche Aufklärung (BZgA), Köln, Deutschland
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13
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Paquette ET. In the Wake of a Pandemic: Revisiting School Approaches to Nonmedical Exemptions to Mandatory Vaccination in the US. J Pediatr 2021; 231:17-23. [PMID: 33484695 PMCID: PMC7816863 DOI: 10.1016/j.jpeds.2021.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/23/2020] [Accepted: 01/11/2021] [Indexed: 12/02/2022]
Abstract
Mandatory school vaccination policies with exclusion of unvaccinated students can be a powerful tool in ensuring high vaccination rates. Some parents may object to mandatory vaccination policies, claiming exemptions based on medical, religious, or philosophical reasons. Individual schools, school systems, or local or regional governments have different policies with respect to whether, and what kind of, exemptions may be allowed. In the setting of the current pandemic, questions regarding the acceptability of exemptions have resurfaced, as schools and local governments struggle with how to safely return children to school. Anticipating that school attendance will be facilitated by the development of a vaccine, school systems will face decisions about whether to mandate vaccination and whether to permit exemptions. The American Academy of Pediatrics promulgates policy favoring the elimination of nonmedical exemptions generally in schools. This discussion considers whether schools should eliminate nonmedical exemptions to vaccination as proposed in the American Academy of Pediatrics policy, ultimately concluding that broad elimination of exemptions is not justified and advocating a more nuanced approach that encourages school attendance while promoting vaccination and broader public health goals.
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Affiliation(s)
- Erin Talati Paquette
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Stanley Manne Children's Research Institute; and the Northwestern Pritzker School of Law,∗ Chicago, IL.
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14
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Wilson SE, Bunko A, Johnson S, Murray J, Wang Y, Deeks SL, Crowcroft NS, Friedman L, Loh LC, MacLeod M, Taylor C, Li Y. The geographic distribution of un-immunized children in Ontario, Canada: Hotspot detection using Bayesian spatial analysis. Vaccine 2021; 39:1349-1357. [PMID: 33518467 DOI: 10.1016/j.vaccine.2020.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND In Ontario, Canada, little is currently known about the extent to which un-immunized children may cluster geographically. Our objectives were to: describe the geographic distribution of fully un-immunized children; identify geographic clusters (hotspots) of un-immunized children; and to characterize the contribution of spatial effects and covariates on hotspots, where found. METHODS Our analytic cohort consisted of Ontario students aged 7-17 years in the 2016-2017 school year. We defined students as un-immunized if they had zero doses of any vaccine and a non-medical exemption recorded in Ontario's registry. We calculated unadjusted proportions of un-immunized students by Census Subdivision (CSD) and then used a sequential approach to identify hotspots starting first with hotspot identification at the CSD level and then probed identified hotspots further by Dissemination Area (DA) and including covariates. Hotspots were identified using the Besag-York-Mollie Bayesian spatial model and were defined as areas with >95% probability of having two times the proportion of un-immunized students, relative to the province overall. RESULTS We identified 15,208 (0.94%) un-immunized children within our cohort consisting of more than 1.61 million students. Unadjusted proportions of un-immunized students varied greatly by geography, ranging from 0% to 21.5% by CSD. We identified 16 hotspot CSDs which clustered in five distinct areas, all of which were located in southern Ontario. The contribution of covariates and spatial effects on the risk of having un-immunized students varied greatly across hotspot areas. CONCLUSIONS Although the provincial proportion (0.94%) of un-immunized students is small, geographical clustering of such students is evident in Ontario and in some areas presents an important risk for future outbreaks. Further qualitative work within these hotspot areas would be a helpful next step to better characterize the factors associated with vaccine refusal in these communities.
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Affiliation(s)
- Sarah E Wilson
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; ICES, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
| | - Andrean Bunko
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada
| | - Steven Johnson
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada
| | - Jillian Murray
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada
| | - Yue Wang
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
| | - Shelley L Deeks
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
| | - Natasha S Crowcroft
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; ICES, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Lindsay Friedman
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada
| | - Lawrence C Loh
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Peel Public Health, 7120 Hurontario Street, Mississauga, Ontario L5W 1N4, Canada
| | - Melissa MacLeod
- Southwestern Public Health, 410 Buller Street, Woodstock, Ontario N4S 6G9, Canada
| | - Christina Taylor
- Huron Perth Public Health, 77722B London Road R.R. 5, Clinton, Ontario N0M 1L0, Canada
| | - Ye Li
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
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15
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Fine-scale spatial clustering of measles nonvaccination that increases outbreak potential is obscured by aggregated reporting data. Proc Natl Acad Sci U S A 2020; 117:28506-28514. [PMID: 33106403 DOI: 10.1073/pnas.2011529117] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The United States experienced historically high numbers of measles cases in 2019, despite achieving national measles vaccination rates above the World Health Organization recommendation of 95% coverage with two doses. Since the COVID-19 pandemic began, resulting in suspension of many clinical preventive services, pediatric vaccination rates in the United States have fallen precipitously, dramatically increasing risk of measles resurgence. Previous research has shown that measles outbreaks in high-coverage contexts are driven by spatial clustering of nonvaccination, which decreases local immunity below the herd immunity threshold. However, little is known about how to best conduct surveillance and target interventions to detect and address these high-risk areas, and most vaccination data are reported at the state-level-a resolution too coarse to detect community-level clustering of nonvaccination characteristic of recent outbreaks. In this paper, we perform a series of computational experiments to assess the impact of clustered nonvaccination on outbreak potential and magnitude of bias in predicting disease risk posed by measuring vaccination rates at coarse spatial scales. We find that, when nonvaccination is locally clustered, reporting aggregate data at the state- or county-level can result in substantial underestimates of outbreak risk. The COVID-19 pandemic has shone a bright light on the weaknesses in US infectious disease surveillance and a broader gap in our understanding of how to best use detailed spatial data to interrupt and control infectious disease transmission. Our research clearly outlines that finer-scale vaccination data should be collected to prevent a return to endemic measles transmission in the United States.
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Bednarczyk RA, King AR, Lahijani A, Omer SB. Current landscape of nonmedical vaccination exemptions in the United States: impact of policy changes. Expert Rev Vaccines 2019; 18:175-190. [PMID: 30572729 DOI: 10.1080/14760584.2019.1562344] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION In the United States, high childhood vaccination coverage has reduced the morbidity and mortality due to vaccine-preventable diseases. The success of vaccination programs in achieving this high coverage is due, in part, to vaccination mandates for school entry. All states have such mandates, but there is heterogeneity across the states in the allowance of non-medical exemptions (e.g. religious or personal belief exemptions) to these mandates. AREAS COVERED We examine historical trends in non-medical exemption prevalence in the US, discuss recent state-level policy changes that may impact non-medical exemption prevalence, and review recent studies on the association between non-medical exemptions and infectious disease outbreaks. EXPERT COMMENTARY State-level implementation of mandates, and related allowances for medical and non-medical exemptions, varies greatly across the United States. Non-medical exemption rates have increased over the last two decades, with an increased risk of disease outbreaks in clusters of children with non-medical exemptions due to differences in state laws. Recent efforts to address non-medical exemption rates range from incorporating additional administrative requirements for exemptions and disallowance of any non-medical exemptions. Continued monitoring is needed to evaluate the impact of these changes on exemption rates, to develop optimal childhood vaccination policy across the United States.
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Affiliation(s)
- Robert A Bednarczyk
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,b Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,c Emory Vaccine Center , Emory University , Atlanta , GA , USA
| | - Adrian R King
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | - Ariana Lahijani
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | - Saad B Omer
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,b Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,c Emory Vaccine Center , Emory University , Atlanta , GA , USA.,d Department of Pediatrics , School of Medicine, Emory University , Atlanta , GA , USA
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17
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Scavone C, Sessa M, Clementi E, Rossi F, Capuano A. Italian Immunization Goals: A Political or Scientific Heated Debate? Front Pharmacol 2018; 9:574. [PMID: 29899702 PMCID: PMC5989663 DOI: 10.3389/fphar.2018.00574] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/14/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Cristina Scavone
- Department of Experimental Medicine - Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maurizio Sessa
- Department of Experimental Medicine - Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Emilio Clementi
- Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, L. Sacco University Hospital, Università di Milano, Milan, Italy.,Unit of Clinical Pharmacology, Scientific Institute, IRCCS E. Medea, Lecco, Italy
| | - Francesco Rossi
- Department of Experimental Medicine - Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine - Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
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