Melanie D Whittington1, Allison Kempe2, Amanda Dempsey3, Rachel Herlihy4, Jonathan D Campbell5. 1. Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora. Electronic address: Melanie.Whittington@ucdenver.edu. 2. Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora; Children's Hospital Colorado, Aurora. 3. Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora; Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora. 4. Disease Control and Environmental Epidemiology Division, Colorado Department of Public Health and the Environment, Denver. 5. Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora.
Abstract
OBJECTIVE: Despite relatively high national vaccination coverage for measles, geographic vaccination variation exists resulting in clusters of susceptibility. A portion of this geographic variation can be explained by differences in state policies related to nonmedical vaccine exemptions. The objective of this analysis was to determine the magnitude, likelihood, and cost of a measles outbreak under different nonmedical vaccine exemption policies. METHODS: An agent-based transmission model simulated the likelihood and magnitude of a measles outbreak under different nonmedical vaccine exemption policies, previously categorized as easy, medium, or difficult. The model accounted for measles herd immunity, infectiousness of the pathogen, vaccine efficacy, duration of incubation and communicable periods, acquired natural immunity, and the rate of recovery. Public health contact tracing was also modeled. Model outcomes, including the number of secondary cases, hospitalizations, and deaths, were monetized to determine the economic burden of the simulated outbreaks. RESULTS: A state with easy nonmedical vaccine exemption policies is 140% and 190% more likely to experience a measles outbreak compared with states with medium or difficult policies, respectively. The magnitude of these outbreaks can be reduced by half by strengthening exemption policies. These declines are associated with significant cost reductions to public health, the health care system, and the individual. CONCLUSIONS: Strengthening nonmedical vaccine exemption policies is 1 mechanism to increase vaccination coverage to reduce the health and economic effect of a measles outbreak. States exploring options for decreasing their vulnerability to outbreaks of vaccine-preventable diseases should consider more stringent requirements for nonmedical vaccine exemptions.
OBJECTIVE: Despite relatively high national vaccination coverage for measles, geographic vaccination variation exists resulting in clusters of susceptibility. A portion of this geographic variation can be explained by differences in state policies related to nonmedical vaccine exemptions. The objective of this analysis was to determine the magnitude, likelihood, and cost of a measles outbreak under different nonmedical vaccine exemption policies. METHODS: An agent-based transmission model simulated the likelihood and magnitude of a measles outbreak under different nonmedical vaccine exemption policies, previously categorized as easy, medium, or difficult. The model accounted for measles herd immunity, infectiousness of the pathogen, vaccine efficacy, duration of incubation and communicable periods, acquired natural immunity, and the rate of recovery. Public health contact tracing was also modeled. Model outcomes, including the number of secondary cases, hospitalizations, and deaths, were monetized to determine the economic burden of the simulated outbreaks. RESULTS: A state with easy nonmedical vaccine exemption policies is 140% and 190% more likely to experience a measles outbreak compared with states with medium or difficult policies, respectively. The magnitude of these outbreaks can be reduced by half by strengthening exemption policies. These declines are associated with significant cost reductions to public health, the health care system, and the individual. CONCLUSIONS: Strengthening nonmedical vaccine exemption policies is 1 mechanism to increase vaccination coverage to reduce the health and economic effect of a measles outbreak. States exploring options for decreasing their vulnerability to outbreaks of vaccine-preventable diseases should consider more stringent requirements for nonmedical vaccine exemptions.
Authors: Emily P Hyle; Naomi F Fields; Amy Parker Fiebelkorn; Allison Taylor Walker; Paul Gastañaduy; Sowmya R Rao; Edward T Ryan; Regina C LaRocque; Rochelle P Walensky Journal: Clin Infect Dis Date: 2019-07-02 Impact factor: 9.079
Authors: Audrey C Bangs; Paul Gastañaduy; Anne M Neilan; Amy Parker Fiebelkorn; Allison Taylor Walker; Sowmya R Rao; Edward T Ryan; Regina C LaRocque; Rochelle P Walensky; Emily P Hyle Journal: J Pediatric Infect Dis Soc Date: 2022-06-22 Impact factor: 5.235