Article

Implications of philosophical and personal belief exemptions on re-emergence of vaccine-preventable disease The role of spatial clustering in under-vaccination

Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
Human Vaccines & Immunotherapeutics (Impact Factor: 2.37). 06/2012; 8(6):838-41. DOI: 10.4161/hv.19743
Source: PubMed

ABSTRACT

Vaccine exemption policies vary by state, and it has been demonstrated that easier protocols for personal/philosophical belief exemptions are associated with lower vaccine coverage at the state level. However, this does not lead to ubiquitously lower immunization rates across the state, as shown by variability in county-level exemption rates. Rather, there is geographical clustering of areas which are then more vulnerable to outbreaks of vaccine-preventable diseases. Understanding both state and local patterns of vaccine exemptions and developing policies and public health interventions to increase coverage in high-risk areas is critical. At all levels of healthcare, efforts must be made to encourage vaccination education and legislation to protect the public's health.

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    • "As one of the most trusted sources for vaccinerelated information, clinicians play an important role in parental decisions about school-entry immunization exemptions [11]. Furthermore , the ease of exemption protocols has been positively correlated with exemption rates [12] [13] [14]. To reduce the ease by which exemptions are obtained, physicians have been included in the exemption process. "
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    ABSTRACT: Background As exemptions to school-entry requirements rise, vaccination rates in Arizona school children are approaching levels that may threaten public health. Understanding the interactions physicians have with vaccine-hesitant parents, as well as the opinions physicians hold regarding vaccination, exemption, and exemption policies, are critical to our understanding of, and ability to affect, vaccination exemption rates among children. Methods Survey responses were elicited from practitioners listed in The Arizona Partnership for Immunization and the Arizona Medical Association databases using a multi-pronged recruitment approach. Respondents provided data regarding their practice, comfort with parental refusal of individual vaccines, opinions about the beliefs held by parents that seek exemptions, parent education strategies, issues regarding providing care to unvaccinated children, and potential changes to Arizona policy. Results A total of 152 practitioners providing care to a wide geographic and economic population of Arizona responded to the survey. Respondents were generally strong advocates of all immunizations but were more accepting of parents’ desires to refuse hepatitis B and rotavirus vaccines. Almost all providers indicated that they see patients whose parents request to refuse or delay from vaccinations at least occasionally (88% and 97%, respectively). Only 37% of respondents indicated that they would be supportive of a policy requiring them to sign off on a parent's decision to refuse vaccination. Conclusions Vaccination providers in Arizona are generally very supportive of childhood immunizations but have varying comfort with exemption from individual vaccines. Responding providers tended to not support a requirement for a physician's signature for vaccine exemptions due to varying concerns regarding the implementation of such a practice.
    Full-text · Article · Jun 2014
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    • "As one of the most trusted sources for vaccinerelated information, clinicians play an important role in parental decisions about school-entry immunization exemptions [11]. Furthermore , the ease of exemption protocols has been positively correlated with exemption rates [12] [13] [14]. To reduce the ease by which exemptions are obtained, physicians have been included in the exemption process. "
    [Show abstract] [Hide abstract]
    ABSTRACT: As exemptions to school-entry requirements rise, vaccination rates in Arizona school children are approaching levels that may threaten public health. Understanding the interactions physicians have with vaccine-hesitant parents, as well as the opinions physicians hold regarding vaccination, exemption, and exemption policies, are critical to our understanding of, and ability to affect, vaccination exemption rates among children. Survey responses were elicited from practitioners listed in The Arizona Partnership for Immunization and the Arizona Medical Association databases using a multi-pronged recruitment approach. Respondents provided data regarding their practice, comfort with parental refusal of individual vaccines, opinions about the beliefs held by parents that seek exemptions, parent education strategies, issues regarding providing care to unvaccinated children, and potential changes to Arizona policy. A total of 152 practitioners providing care to a wide geographic and economic population of Arizona responded to the survey. Respondents were generally strong advocates of all immunizations but were more accepting of parents' desires to refuse hepatitis B and rotavirus vaccines. Almost all providers indicated that they see patients whose parents request to refuse or delay from vaccinations at least occasionally (88% and 97%, respectively). Only 37% of respondents indicated that they would be supportive of a policy requiring them to sign off on a parent's decision to refuse vaccination. Vaccination providers in Arizona are generally very supportive of childhood immunizations but have varying comfort with exemption from individual vaccines. Responding providers tended to not support a requirement for a physician's signature for vaccine exemptions due to varying concerns regarding the implementation of such a practice.
    Full-text · Article · May 2014 · Vaccine
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    ABSTRACT: Objectives: The present study was designed to characterize Arizona schools with high rates of permanent PBE among kindergartners, and to determine the degree to which they aggregate across the state. Methods: Data for permanent personal belief exemptions (PBE) were accessed through the 2010-2011 kindergarten Immunization Data Report (IDR) from the Arizona Department of Health Services (AZDHS), and were linked to the 2009-2010 data from the National Center of Education Statistics (NCES). Incidence rate ratios (IRR) were calculated using negative binomial regression, and hotspots were identified using Getis-Ord Gi*. Results: Schools with highest proportion of white students compared to the lowest had the highest exemption rates (IRR=14.11; 95% confidence interval [CI], 9.47-21.03); furthermore charter schools and those with low prevalence of free and reduced lunches had significantly higher rates of PBE. Statewide analyses of PBE identified higher rates of permanent PBE in northern vs. southern Arizona, while a more focused examination of the central Arizona region demonstrated a pattern of increased PBE from west to east. Conclusion: In Arizona, the profile of a high PBE school is that of a charter school attended by predominantly white, higher-income students. The local and statewide hotspots serve as a challenge that requires a multi-faceted approach that calls upon all healthcare professionals. It is important that both local and statewide pockets be targeted by local and state officials either to improve vaccination uptake or to employ careful monitoring to identify outbreaks at their onset.
    No preview · Article · Dec 2012 · Vaccine
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