Saad B Omer1,2,3,4, Kristen Allen5, D H Chang6, L Beryl Guterman5, Robert A Bednarczyk5,2,4, Alex Jordan5, Alison Buttenheim7,8, Malia Jones9, Claire Hannan10, M Patricia deHart11, Daniel A Salmon12. 1. Hubert Department of Global Health, somer@emory.edu. 2. Department of Epidemiology. 3. Department of Pediatrics, and. 4. Emory Vaccine Center, Emory University, Atlanta, Georgia. 5. Hubert Department of Global Health. 6. Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana. 7. Department of Family and Community Health, School of Nursing, and. 8. Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania. 9. Applied Population Laboratory, Department of Community and Environmental Sociology, University of Wisconsin-Madison, Madison, Wisconsin. 10. Association for Immunization Managers, Rockville, Maryland. 11. Office of Immunization and Child Profile, Washington State Department of Health, Olympia, Washington; and. 12. Department of International Health and Health Behavior Society, School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Abstract
BACKGROUND: The success of health care provider counseling-based interventions to address vaccine hesitancy is not clear. In 2011, Washington State implemented Senate Bill 5005 (SB5005), requiring counseling and a signed form from a licensed health care provider to obtain an exemption. Evaluating the impact of a counseling intervention can provide important insight into population-level interventions that focus on interpersonal communication by a health care provider. METHODS: We used segmented regression and interaction and aggregation indices to assess the impact of SB5005 on immunization coverage and exemption rates in Washington State from school years 1997-1998 through 2013-2014. RESULTS: After SB5005 was implemented, there was a significant relative decrease of 40.2% (95% confidence interval: -43.6% to -36.6%) in exemption rates. This translates to a significant absolute reduction of 2.9 percentage points (95% confidence interval: -4.2% to -1.7%) in exemption rates. There were increases in vaccine coverage for all vaccines required for school entrance, with the exception of the hepatitis B vaccine. The probability that kindergarteners without exemptions would encounter kindergarteners with exemptions (interaction index) decreased, and the probability that kindergarteners with exemptions would encounter other such kindergarteners (aggregation index) also decreased after SB5005. Moreover, SB5005 was associated with a decline in geographic clustering of vaccine exemptors. CONCLUSIONS: States in the United States and jurisdictions in other countries should consider adding parental counseling by health care provider as a requirement for obtaining exemptions to vaccination requirements.
BACKGROUND: The success of health care provider counseling-based interventions to address vaccine hesitancy is not clear. In 2011, Washington State implemented Senate Bill 5005 (SB5005), requiring counseling and a signed form from a licensed health care provider to obtain an exemption. Evaluating the impact of a counseling intervention can provide important insight into population-level interventions that focus on interpersonal communication by a health care provider. METHODS: We used segmented regression and interaction and aggregation indices to assess the impact of SB5005 on immunization coverage and exemption rates in Washington State from school years 1997-1998 through 2013-2014. RESULTS: After SB5005 was implemented, there was a significant relative decrease of 40.2% (95% confidence interval: -43.6% to -36.6%) in exemption rates. This translates to a significant absolute reduction of 2.9 percentage points (95% confidence interval: -4.2% to -1.7%) in exemption rates. There were increases in vaccine coverage for all vaccines required for school entrance, with the exception of the hepatitis B vaccine. The probability that kindergarteners without exemptions would encounter kindergarteners with exemptions (interaction index) decreased, and the probability that kindergarteners with exemptions would encounter other such kindergarteners (aggregation index) also decreased after SB5005. Moreover, SB5005 was associated with a decline in geographic clustering of vaccine exemptors. CONCLUSIONS: States in the United States and jurisdictions in other countries should consider adding parental counseling by health care provider as a requirement for obtaining exemptions to vaccination requirements.
Authors: Jessica E Atwell; Josh Van Otterloo; Jennifer Zipprich; Kathleen Winter; Kathleen Harriman; Daniel A Salmon; Neal A Halsey; Saad B Omer Journal: Pediatrics Date: 2013-09-30 Impact factor: 7.124
Authors: Daniel A Salmon; Lawrence H Moulton; Saad B Omer; M Patricia DeHart; Shannon Stokley; Neal A Halsey Journal: Arch Pediatr Adolesc Med Date: 2005-05
Authors: Saad B Omer; Kyle S Enger; Lawrence H Moulton; Neal A Halsey; Shannon Stokley; Daniel A Salmon Journal: Am J Epidemiol Date: 2008-10-15 Impact factor: 4.897
Authors: Paul L Delamater; S Cassandra Pingali; Alison M Buttenheim; Daniel A Salmon; Nicola P Klein; Saad B Omer Journal: Pediatrics Date: 2019-05-21 Impact factor: 7.124