scholarly journals Getting Personal: How Childhood Vaccination Policies Shape the Landscape of Vaccine Exemptions

2020 ◽  
Vol 7 (3) ◽  
Author(s):  
Romain Garnier ◽  
Emma R Nedell ◽  
Saad B Omer ◽  
Shweta Bansal
Keyword(s):  
Clustering Analysis ◽  
Vaccine Coverage ◽  
Herd Immunity ◽  
State Level ◽  
The United States ◽  
Childhood Vaccination ◽  
Policy Changes ◽  
Vaccination Rates ◽  
Exemption Policy ◽  
Epidemiological Effects

Abstract Background State-mandated school entry immunization requirements in the United States play an important role in achieving high vaccine coverage, but variations in vaccine exemption policies result in a patchwork of vaccine coverage across the country. Methods In this study, we evaluate epidemiological effects and spatial variations in nonmedical exemption (NME) rates in the context of vaccine policies. We first analyze the correlation between NME rates and vaccine coverage for 3 significant childhood vaccinations. Furthermore, we assess the effects of policy changes in a subset of states, using a correlative approach at the state level and performing a clustering analysis at the county level. Results We find that higher rates of exemptions are associated with lower vaccination rates of school-aged children in all cases. In a subset of states where exemption policy has recently changed, we show that the effects on statewide NME rates vary widely and that decreases in NMEs can lead to an increase in other types of exemptions. Finally, our clustering analysis in California, Illinois, and Connecticut shows that policy changes affect the spatial distribution of NMEs. Conclusions Our work suggests that vaccination policies have significant impacts on patterns of herd immunity. Our findings can be used to develop evidence-based vaccine legislation.

scholarly journals Getting personal: how vaccination exemptions shape herd immunity

2018 ◽  
Author(s):  
Emma R Nedell ◽  
Romain Garnier ◽  
Saad B Omer ◽  
Shweta Bansal
Keyword(s):  
Policy Change ◽  
Spatial Clustering ◽  
Vaccine Coverage ◽  
Herd Immunity ◽  
The United States ◽  
Vaccine Preventable Diseases ◽  
Vaccination Rates ◽  
Before And After ◽  
Exemption Policy ◽  
Epidemiological Effects

Background: State-mandated school entry immunization requirements in the United States play an important role in achieving high vaccine coverage and preventing outbreaks of vaccine-preventable diseases. Most states allow non-medical exemptions that let children remain unvaccinated on the basis of personal beliefs. However, the ease of obtaining such exemptions varies, resulting in a patchwork of state vaccination exemption laws, contributing to heterogeneity in vaccine coverage across the country. In this study, we evaluate epidemiological effects and spatial variations in non-medical exemption rates in the context of vaccine policies. Methods and Findings: We first analyzed the correlation between non-medical exemption rates and vaccine coverage for three significant childhood vaccinations and found that higher rates of non-medical exemptions were associated with lower vaccination rates of school-aged children in all cases. We then identified a subset of states where exemption policy has recently changed and found that the effects on statewide non-medical exemption rates varied widely. Focusing further on Vermont and California, we illustrated how the decrease in non-medical exemptions due to policy change was concurrent to an increase in medical exemptions (in CA) or religious exemptions (in VT). Finally, a spatial clustering analysis was performed for Connecticut, Illinois, and California, identifying clusters of high non-medical exemption rates in these states before and after a policy change occurred. The clustering analyses show that policy changes affect spatial distribution of non-medical exemptions within a state. Conclusions: Our work suggests that vaccination policies have significant impacts on patterns of herd immunity. Our findings can be used to develop evidence-based vaccine legislation.

scholarly journals The Effect of Vaccination Rates on the Infection of COVID-19 under the Vaccination Rate below the Herd Immunity Threshold

2021 ◽  
Vol 18 (14) ◽  
pp. 7491
Author(s):  
Yi-Tui Chen
Keyword(s):  
Infection Rate ◽  
Herd Immunity ◽  
The United States ◽  
Vaccination Rate ◽  
Infection Rates ◽  
Vaccination Rates ◽  
The United Kingdom ◽  
The World ◽  
Almost All ◽  
The Impact

Although vaccination is carried out worldwide, the vaccination rate varies greatly. As of 24 May 2021, in some countries, the proportion of the population fully vaccinated against COVID-19 has exceeded 50%, but in many countries, this proportion is still very low, less than 1%. This article aims to explore the impact of vaccination on the spread of the COVID-19 pandemic. As the herd immunity of almost all countries in the world has not been reached, several countries were selected as sample cases by employing the following criteria: more than 60 vaccine doses per 100 people and a population of more than one million people. In the end, a total of eight countries/regions were selected, including Israel, the UAE, Chile, the United Kingdom, the United States, Hungary, and Qatar. The results find that vaccination has a major impact on reducing infection rates in all countries. However, the infection rate after vaccination showed two trends. One is an inverted U-shaped trend, and the other is an L-shaped trend. For those countries with an inverted U-shaped trend, the infection rate begins to decline when the vaccination rate reaches 1.46–50.91 doses per 100 people.

scholarly journals Modeling the COVID-19 Vaccination Dynamics in the United States: An Estimation of Coverage Velocity and Carrying Capacity Based on Socio-demographic Vulnerability Indices in California

2021 ◽  
Author(s):  
Alexander Bruckhaus ◽  
Aidin Abedi ◽  
Sana Salehi ◽  
Trevor A Pickering ◽  
Yujia Zhang ◽  
...  
Keyword(s):  
Vaccine Coverage ◽  
Vulnerability Index ◽  
The United States ◽  
Household Composition ◽  
Social Vulnerability Index ◽  
Vaccination Rates ◽  
Group Methods ◽  
The Social ◽  
Data Points ◽  
Maximum Proportion

Introduction: Coronavirus disease 2019 (COVID-19) disparities among vulnerable populations are a paramount concern that extends to COVID-19 vaccine administration. We aim to better characterize the scope of vaccine inequity in California by comparing the Social Vulnerability Index (SVI) of California counties and respective vaccination rates, modeling the growth rate and anticipated maximum proportion of individuals vaccinated by SVI group. Methods: Overall SVI, its four themes, and 9228 data points of daily vaccination numbers across all 58 California counties were used to model, overall and by theme, growth velocity of proportion of population vaccinated and the expected maximum proportion of individuals (at least 1 dose of Pfizer-BioNTech, Moderna, or Johnson & Johnson/Janssen) that will be vaccinated for each theme. Results: Overall high vulnerability counties in California have lower vaccine coverage velocity compared to low and moderate vulnerability counties. The largest disparity in coverage velocity between low and highly vulnerable counties was observed in Theme 3 (minority status & language). However, our model showed that highly vulnerable counties based on Theme 3 are expected to eventually achieve a higher proportion of vaccinated individuals compared to low vulnerable counterparts if current trajectories continue. Counties in the overall low vulnerability category are estimated to achieve a higher proportion of vaccinated individuals when compared to high and moderate vulnerable counties, assuming current trajectories. The largest disparity in asymptotic proportion vaccinated between high and low vulnerable counties was observed in Theme 2 (household composition & disability). Conclusion: This study provides insight into the problem of COVID-19 vaccine disparity across California which can be used to help promote equity during the current pandemic as well as guide the allocation of future vaccines such as COVID-19 booster shots.

scholarly journals Demographics, perceptions, and socioeconomic factors affecting influenza vaccination among adults in the United States

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5171 ◽  
Author(s):  
Kaja M. Abbas ◽  
Gloria J. Kang ◽  
Daniel Chen ◽  
Stephen R. Werre ◽  
Achla Marathe
Keyword(s):  
United States ◽  
Health Insurance ◽  
Influenza Vaccination ◽  
Vaccine Efficacy ◽  
Herd Immunity ◽  
The United States ◽  
Vaccine Cost ◽  
Factors Affecting ◽  
Vaccination Rates ◽  
Healthy People 2020

Objective The study objective is to analyze influenza vaccination status by demographic factors, perceived vaccine efficacy, social influence, herd immunity, vaccine cost, health insurance status, and barriers to influenza vaccination among adults 18 years and older in the United States. Background Influenza vaccination coverage among adults 18 years and older was 41% during 2010–2011 and has increased and plateaued at 43% during 2016–2017. This is below the target of 70% influenza vaccination coverage among adults, which is an objective of the Healthy People 2020 initiative. Methods We conducted a survey of a nationally representative sample of adults 18 years and older in the United States on factors affecting influenza vaccination. We conducted bivariate analysis using Rao-Scott chi-square test and multivariate analysis using weighted multinomial logistic regression of this survey data to determine the effect of demographics, perceived vaccine efficacy, social influence, herd immunity, vaccine cost, health insurance, and barriers associated with influenza vaccination uptake among adults in the United States. Results Influenza vaccination rates are relatively high among adults in older age groups (73.3% among 75 + year old), adults with education levels of bachelor’s degree or higher (45.1%), non-Hispanic Whites (41.8%), adults with higher incomes (52.8% among adults with income of over $150,000), partnered adults (43.2%), non-working adults (46.2%), and adults with internet access (39.9%). Influenza vaccine is taken every year by 76% of adults who perceive that the vaccine is very effective, 64.2% of adults who are socially influenced by others, and 41.8% of adults with health insurance, while 72.3% of adults without health insurance never get vaccinated. Facilitators for adults getting vaccinated every year in comparison to only some years include older age, perception of high vaccine effectiveness, higher income and no out-of-pocket payments. Barriers for adults never getting vaccinated in comparison to only some years include lack of health insurance, disliking of shots, perception of low vaccine effectiveness, low perception of risk for influenza infection, and perception of risky side effects. Conclusion Influenza vaccination rates among adults in the United States can be improved towards the Healthy People 2020 target of 70% by increasing awareness of the safety, efficacy and need for influenza vaccination, leveraging the practices and principles of commercial and social marketing to improve vaccine trust, confidence and acceptance, and lowering out-of-pocket expenses and covering influenza vaccination costs through health insurance.

scholarly journals Bayesian Inference of State-Level COVID-19 Basic Reproduction Numbers across the United States

2021 ◽  
Author(s):  
Abhishek Mallela ◽  
Jacob Neumann ◽  
Ely F Miller ◽  
Ye Chen ◽  
Richard G Posner ◽  
...  
Keyword(s):  
United States ◽  
Bayesian Inference ◽  
Disease Transmission ◽  
Case Reports ◽  
Herd Immunity ◽  
State Level ◽  
The United States ◽  
Expected Number ◽  
Reproduction Numbers ◽  
A Posteriori Estimates

Although many persons in the United States have acquired immunity to COVID-19, either through vaccination or infection with SARS-CoV-2, COVID-19 will pose an ongoing threat to non-immune persons so long as disease transmission continues. We can estimate when sustained disease transmission will end in a population by calculating the population-specific basic reproduction number R_0, the expected number of secondary cases generated by an infected person in the absence of any interventions. The value of R_0 relates to a herd immunity threshold (HIT), which is given by 1-1/R_0. When the immune fraction of a population exceeds this threshold, sustained disease transmission becomes exponentially unlikely (barring mutations allowing SARS-CoV-2 to escape immunity). Here, we report state-level R_0 estimates obtained using Bayesian inference. Maximum a posteriori estimates range from 7.1 for New Jersey to 2.3 for Wyoming, indicating that disease transmission varies considerably across states and that reaching herd immunity will be more difficult in some states than others. R_0 estimates were obtained from compartmental models via the next-generation matrix approach after each model was parameterized using regional daily confirmed case reports of COVID-19 from 21-January-2020 to 21-June-2020. Our R_0 estimates characterize infectiousness of ancestral strains, but they can be used to determine HITs for a distinct, currently dominant circulating strain, such as SARS-CoV-2 variant Delta (lineage B.1.617.2), if the relative infectiousness of the strain can be ascertained. On the basis of Delta-adjusted HITs, vaccination data, and seroprevalence survey data, we find that no state has achieved herd immunity as of 20-September-2021.

scholarly journals Impact of SARS-CoV-2 Vaccines on Covid-19 Incidence and Mortality in the United States

2021 ◽  
Author(s):  
Fang Fang ◽  
John David Clemens ◽  
Zuo-Feng Zhang ◽  
Timothy F. Brewer
Keyword(s):  
Negative Binomial ◽  
Herd Immunity ◽  
The United States ◽  
Vaccination Rate ◽  
Vaccine Hesitancy ◽  
Percentage Increase ◽  
Protective Effects ◽  
Vaccination Rates ◽  
Incidence And Mortality ◽  
Before And After

Background: Despite safe and effective vaccines to prevent Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infections and disease, a substantial minority of the US remains resistant to getting vaccinated. It is imperative to know if expanding vaccination rates could reduce community-wide Coronavirus 2019 (COVID-19) disease, not just among those vaccinated. Methods: Negative binomial models were used to estimate associations between U.S. county-level vaccination rates and county-wide COVID-19 incidence and mortality between April 23rd and September 30th, 2021. A two-week lag and a four-week lag were introduced to assess vaccination rate impact on incidence and mortality, respectively. Stratified analyses were performed for county vaccination rates >40%, and before and after Delta became the dominant variant. Findings: Among 3,070 counties, each percentage increase in population vaccination rates reduced county-wide COVID-19 incidence by 0.9% (relative risk (RR) 0.9910 (95% CI: 0.9869, 0.9952)) and mortality by 1.9% (RR 0.9807 (95% CI: 0.9745, 0.9823)). Among counties with vaccination coverage >40%, each percentage increase in vaccination rates reduced COVID-19 disease by 1.5%, RR 0.9850 (95% CI: 0.9793, 0.9952) and mortality by 2.7% (RR 0.9727 (95% CI: 0.9632, 0.9823)). These associations were not observed among counties with <40% vaccination rates. Increasing vaccination rates from 40% to 80% would have reduced COVID-19 cases by 45.4% (RR 0.5458 (95% CI: 0.4335, 0.6873)) and deaths by 67.0% (RR 0.3305 (95% CI: 0.2230, 0.4898)). An estimated 5,989,952 COVID-19 cases could have been prevented and 127,596 lives saved had US population vaccination rates increased from 40% to 80%. Interpretations: Increasing U.S. SARS-CoV-2 vaccination rates results in population-wide reductions in COVID-19 incidence and mortality. Furthermore, increasing vaccination rates above 40% has protective effects among non-vaccinated persons. Given ongoing vaccine hesitancy in the U.S., increasing vaccination rates could better protect the entire community and potentially reach herd immunity. Funding: National Cancer Institute

scholarly journals An Early Examination: Psychological, Health, and Economic Correlates and Determinants of Social Distancing Amidst COVID-19

2020 ◽  
Author(s):  
Hohjin Im ◽  
Christopher Ahn ◽  
Peiyi Wang ◽  
Chuansheng Chen
Keyword(s):  
Psychological Health ◽  
State Level ◽  
The United States ◽  
Relative Reduction ◽  
Future Directions ◽  
Social Distancing ◽  
Vaccination Rates ◽  
Political Partisanship ◽  
At Risk Populations ◽  
General Mobility

With the exponential spread of COVID-19 across the United States, federal and local government agencies have issued orders for residents to shelter-in-place. This study utilizes data collected from Unacast Inc. spanning observations of 3,142 counties across 50 states and the District of Columbia (N = 230,846) from March 8, 2020 to April 13, 2020 (n = 104,930) and from April 14, 2020 to May 24, 2020 (n = 131,912) in a 3-level multilevel model to examine the correlates of social distancing behavior, as measured by the relative reduction in 1) distance traveled and 2) non-essential visitations since baseline pre-COVID-19 times. Results indicate that educational attainment and political partisanship were the most consistent correlates of social distancing. State-level indicators of culture appeared to have differentiated effects depending on whether the model outcomes were reduction in general mobility or to non-essential venues. State-level neuroticism was generally positively related to social distancing, but states marked by high neuroticism were slower to engage in such behaviors. Counties and states characterized as already engaging in preventive health measures (e.g., vaccination rates, preparedness for at-risk populations) enjoyed quicker engagement in social distancing. Specific implications of findings and future directions are discussed.

scholarly journals National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States

2016 ◽  
Vol 113 (18) ◽  
pp. 5107-5112 ◽  
Author(s):  
David P. Durham ◽  
Martial L. Ndeffo-Mbah ◽  
Laura A. Skrip ◽  
Forrest K. Jones ◽  
Chris T. Bauch ◽  
...  
Keyword(s):  
United States ◽  
Cervical Cancer ◽  
Hpv Vaccination ◽  
National Level ◽  
Herd Immunity ◽  
State Level ◽  
Cost Effective ◽  
Health Impact ◽  
The United States ◽  
Cervical Cancers

Every year in the United States more than 12,000 women are diagnosed with cervical cancer, a disease principally caused by human papillomavirus (HPV). Bivalent and quadrivalent HPV vaccines protect against 66% of HPV-associated cervical cancers, and a new nonavalent vaccine protects against an additional 15% of cervical cancers. However, vaccination policy varies across states, and migration between states interdependently dilutes state-specific vaccination policies. To quantify the economic and epidemiological impacts of switching to the nonavalent vaccine both for individual states and for the nation as a whole, we developed a model of HPV transmission and cervical cancer incidence that incorporates state-specific demographic dynamics, sexual behavior, and migratory patterns. At the national level, the nonavalent vaccine was shown to be cost-effective compared with the bivalent and quadrivalent vaccines at any coverage despite the greater per-dose cost of the new vaccine. Furthermore, the nonavalent vaccine remains cost-effective with up to an additional 40% coverage of the adolescent population, representing 80% of girls and 62% of boys. We find that expansion of coverage would have the greatest health impact in states with the lowest coverage because of the decreasing marginal returns of herd immunity. Our results show that if policies promoting nonavalent vaccine implementation and expansion of coverage are coordinated across multiple states, all states benefit both in health and in economic terms.

scholarly journals Higher COVID-19 Vaccination Rates among Unemployed in the United States: State Level Study in the First 100 days of Vaccine Initiation

2021 ◽  
Author(s):  
Ali Roghani ◽  
Samin Panahi
Keyword(s):  
United States ◽  
Socioeconomic Factors ◽  
Educational Level ◽  
Vaccine Coverage ◽  
The Elderly ◽  
The United States ◽  
Poverty Level ◽  
Unemployment Rates ◽  
Vaccination Rates ◽  
Employment Rates

AbstractBackgroundSocioeconomic factors may impact the efficiency of COVID vaccine rollout; however, there are limited studies that examine how state socioeconomic status influences the speed of vaccine distribution. This study aimed to demonstrate how employment rates as one of the main socioeconomic factors affect vaccine coverage in 50 states of the United States.MethodsThis study has obtained vaccine data for the 50 states in the United States, available in the electronic online database ourworldindata.org. In addition to employment rates, other socioeconomic determinants including poverty level, uninsured rates, population density, homeownership, educational level, the percentage of the elderly population, and educational level were obtained from ourworldindata.org data platform. Data from these 50 states were used for regression analyses to examine the relationship between socioeconomic and vaccination rates.ResultsOur study revealed a positive linear association between unemployment and vaccine rates, and states with higher unemployment rates were more likely to have higher vaccination rates. However, other socioeconomic measures do not significantly associate with vaccine coverage.ConclusionDespite other studies showing that vulnerable populations had lower vaccine rates, this study shows that states with higher unemployment rates are more likely to be vaccinated. However, the finding suggests a need for more research for the states with higher than 5% unemployment rates, as they had a lower vaccine coverage than states with a range of 4% to 5% unemployment rates.

scholarly journals Measuring the Success of the US COVID-19 Vaccine Campaign—It’s Time to Invest in and Strengthen Immunization Information Systems

2021 ◽  
pp. e1-e3
Author(s):  
Jade Benjamin-Chung ◽  
Arthur Reingold
Keyword(s):  
Public Health ◽  
Information Systems ◽  
Vaccine Coverage ◽  
Herd Immunity ◽  
The United States ◽  
Time Estimates ◽  
The Us ◽  
Control And Prevention ◽  
Public Health Officials ◽  
State And Local

With the recent US Food and Drug Administration approval of the Pfizer-BioNTech and Moderna SARS-CoV-2 vaccines, the United States has begun COVID-19 vaccine dissemination. The vaccination program is historic in its massive scope and complexity. It requires accurate, real-time estimates of vaccine coverage to assess progress toward achieving herd immunity. Under Operation Warp Speed, the US Centers for Disease Control and Prevention (CDC) has constructed a federal database, or “data lake,” to monitor vaccine coverage nationwide and ensure that recipients receive both of the necessary doses. The data lake will be managed separately from existing state and local immunization information systems (IISs), which house vaccine data in all 50 states, five cities, the District of Columbia, and eight territories. In an open letter to the Director of the CDC in late 2020, four organizations representing immunization managers and public health officials expressed concerns about the plan to include vaccine recipients’ personal identifier information in the data lake.1 They also urged stronger coordination with IISs. (Am J Public Health. Published online ahead of print Feburary 18, 2021: e1–e3. https://doi.org/10.2105/AJPH.2021.306177 )

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