Saad B. Omer, Disease Prevention and Control Program , International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room 5507, Baltimore, MD, USA, Neal Halsey, Disease Prevention and Control Program , International Health, Johns Hopkins School of Public Health, 615 N. Wolfe Street, Suite 5041, Baltimore, MD, USA, Larry Moulton, Disease Prevention and Control Program, International Health, Johns Hopkins School of Public Health, 615 N. Wolfe Street, Suite 5519, Baltimore, MD, USA, Shannon Stokley, National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-52, Atlanta, GA, USA, Mathew Pierce, William K. Y. Pan, Disease Prevention and Control Program , International Health, The Johns Hopkins University, Baltimore, MD, USA, and Daniel A. Salmon, College of Medicine, University of Florida, 1329 SW 16th Street, Room 5239, PO BOX 100177, Gainesville, FL, USA.
Learning Objectives for this Presentation:
By the end of the presentation participants will be able to a) appreciate the impact of state immunization policies on pertussis incidence b) use data to advocate for more effective state immunization laws.
Background:
School immunization requirements have played a major role in controlling rates of vaccine preventable diseases. State immunization laws allow certain exemptions to these requirements. Children with non-medical immunization exemptions are at a higher risk of acquiring and transmitting vaccine preventable diseases. Moreover, state policies have been associated with exemption rates. There has been an increase in the number of pertussis cases identified and there is some evidence of an increase in non-medical exemptions.
Objectives:
To evaluate associations between state-level incidence of pertussis and: ease of obtaining non-medical exemptions; policy of granting philosophical exemptions; and, acceptance of parental signature as sufficient proof of compliance with school immunization requirements.
Methods:
We used negative binomial regression to analyze state-level data on the incidence of pertussis and on state immunization policies.
Results:
On unadjusted analysis, ease of exemptions was associated with a 43% higher incidence of pertussis (Incidence Rate Ratio [IRR]: 1.43; 95%CI 1.10-1.85). For states where the option of philosophical exemptions was available, the incidence rate was almost twice as high as the states where this option was not available (IRR: 1.99; 95%CI 1.26-3.14). The point estimate of IRR was >1 for states allowing parental signature as sufficient proof of immunization, although the 95% confidence interval included 1 (IRR: 1.26; 95%CI 0.62-2.57). Exemption ease (IRR: 1.34; 95%CI 1.03-1.73) and availability of philosophical exemptions (IRR: 1.98; 95%CI 1.26-3.12) remained associated with pertussis incidence on multivariate analysis –adjusting for state-level proportions of minorities and inside urban area.
Conclusions:
Our findings demonstrate an association of pertussis incidence with ease of obtaining exemptions and availability of philosophical exemptions and support effective administrative controls over granting non-medical exemptions.
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