摘要

BACKGROUND:Vaccine hesitancy, the reluctance or refusal to receive vaccination, is a growing public health problem in the United States and globally. State policies that eliminate nonmedical ("personal belief") exemptions to childhood vaccination requirements are controversial, and their effectiveness to improve vaccination coverage remains unclear given limited rigorous policy analysis. In 2016, a California policy (Senate Bill 277) eliminated nonmedical exemptions from school entry requirements. The objective of this study was to estimate the association between California's 2016 policy and changes in vaccine coverage. METHODS AND FINDINGS:We used a quasi-experimental state-level synthetic control analysis and a county-level difference-in-differences analysis to estimate the impact of the 2016 California policy on vaccination coverage and prevalence of exemptions to vaccine requirements (nonmedical and medical). We used publicly available state-level data from the US Centers for Disease Control and Prevention on coverage of measles, mumps, and rubella (MMR) vaccination, nonmedical exemption, and medical exemption in children entering kindergarten. We used county-level data individually requested from state departments of public health on overall vaccine coverage and exemptions. Based on data availability, we included state-level data for 45 states, including California, from 2011 to 2017 and county-level data for 17 states from 2010 to 2017. The prespecified primary study outcome was MMR vaccination in the state analysis and overall vaccine coverage in the county analysis. In the state-level synthetic control analysis, MMR coverage in California increased by 3.3% relative to its synthetic control in the postpolicy period (top 2 of 43 states evaluated in the placebo tests, top 5%), nonmedical exemptions decreased by 2.4% (top 2 of 43 states evaluated in the placebo tests, top 5%), and medical exemptions increased by 0.4% (top 1 of 44 states evaluated in the placebo tests, top 2%). In the county-level analysis, overall vaccination coverage increased by 4.3% (95% confidence interval [CI] 2.9%-5.8%, p < 0.001), nonmedical exemptions decreased by 3.9% (95% CI 2.4%-5.4%, p < 0.001), and medical exemptions increased by 2.4% (95% CI 2.0%-2.9%, p < 0.001). Changes in vaccination coverage across counties after the policy implementation from 2015 to 2017 ranged from -6% to 26%, with larger increases in coverage in counties with lower prepolicy vaccine coverage. Results were robust to alternative model specifications. The limitations of the study were the exclusion of a subset of US states from the analysis and the use of only 2 years of postpolicy data based on data availability. CONCLUSIONS:In this study, implementation of the California policy that eliminated nonmedical childhood vaccine exemptions was associated with an estimated increase in vaccination coverage and a reduction in nonmedical exemptions at state and county levels. The observed increase in medical exemptions was offset by the larger reduction in nonmedical exemptions. The largest increases in vaccine coverage were observed in the most "high-risk" counties, meaning those with the lowest prepolicy vaccine coverage. Our findings suggest that government policies removing nonmedical exemptions can be effective at increasing vaccination coverage.

译文

背景: 疫苗的犹豫,即不愿或拒绝接受疫苗接种,是美国和全球日益严重的公共卫生问题。取消儿童疫苗接种要求的非医学 (“个人信仰”) 豁免的国家政策是有争议的,并且由于严格的政策分析有限,它们提高疫苗接种覆盖率的有效性仍然不清楚。2016,加州的一项政策 (参议院法案 277) 取消了入学要求中的非医疗豁免。这项研究的目的是估计加州 2016 政策和疫苗覆盖率变化之间的联系。方法和结果: 我们使用了一个准实验性的州级综合控制分析和县级差异分析来估计 2016 加州政策对疫苗接种覆盖率和豁免流行率的影响疫苗要求 (非医疗和医疗)。我们使用了来自美国疾病控制和预防中心的关于麻疹、腮腺炎和风疹 (MMR) 疫苗接种、非医疗豁免的公开可用的州级数据, 以及进入幼儿园的儿童的医疗豁免。我们使用了国家公共卫生部门单独要求的关于整体疫苗覆盖率和豁免的县级数据。基于数据可用性,我们包括了 45 个州的州级数据,包括 2011年至 2017年的加利福尼亚和 2010年至 2017年的 17 个州的县级数据。预先设定的主要研究结果是州分析中的 MMR 疫苗接种和县分析中的整体疫苗覆盖率。在州级综合控制分析中,在政策后时期,相对于其综合控制,加利福尼亚州 MMR 覆盖范围增加了 3.3% (在安慰剂测试中评估的 43 个州中排名前 2, 前 5%),非医疗豁免下降了 2.4% (前 2 个在安慰剂测试中评估的 43 个州,前 5%),医疗豁免增加了 0.4% (在安慰剂测试中评估的 44 个州中的前 1 个,前 2%)。在县级分析中,总体疫苗接种覆盖率增加了 4.3% (95% 置信区间 [CI] 2.9%-5.8%,p <0.001), 非医疗豁免下降了 3.9% (95% 置信区间 2.4%-5.4%,p & lt; 0.001),医疗豁免上升了 2.4% (95% 置信区间 2.0%-2.9%,p & lt; 0.001)。2015年至 2017年政策实施后,各县的疫苗接种覆盖率变化范围为-6% 至 26%,政策前疫苗覆盖率较低的县的疫苗接种覆盖率增加较大。结果对替代模型规范是稳健的。该研究的局限性是,从分析中排除了美国各州的一个子集,并且仅使用了 2 年基于数据可用性的政策后数据。结论: 在这项研究中,加州取消非医学儿童疫苗豁免政策的实施与疫苗接种覆盖率的估计增加和州和县级非医学豁免的减少有关。观察到的医疗豁免的增加被非医疗豁免的更大减少所抵消。在最 “高风险” 的县观察到疫苗覆盖率的最大增长,这意味着那些政策前疫苗覆盖率最低的县。我们的研究结果表明,政府取消非医疗豁免的政策可以有效地增加疫苗接种覆盖率。

Vaccine

免疫 疫苗 药物
概述  :  

疫苗是一种生物制品。是指为了预防、控制传染病的发生、流行,用各类病原微生物制作的用于人体接种的预防性生物制品。其中用细菌或螺旋体制作的疫苗称为菌苗。 分类 1.依据研发技术分类可分为传统疫苗及新型疫苗:传统疫苗是指疫苗成分是整个细菌病毒等病原微生物的某些亚单位成分,包括减毒活疫苗、灭活疫苗等;新型疫苗是指使用基因工程技术生产的疫苗等。 2.依据国家政策不同可分为第一类疫苗及第二类疫苗:第一类疫苗是指政府免费向公民提供,公民

vaccine 英 [’væksi:n] 美 [væksi:n]

释    义    n. 疫苗;牛痘苗

adj. 疫苗的;牛痘的

同根词    vaccinate vt. 给……接种疫苗;vi. 接种疫苗

vaccination n. 接种疫苗;种痘

例    句    Painful typhoid injections are a thing of the past, thanks to the introduction of an oral vaccine.自从发明了口服疫苗后,令人痛苦的伤寒疫苗注射就成为了过去。

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