title: A longitudinal analysis of the effect of nonmedical exemption law and vaccine uptake on vaccine-targeted disease rates.
abstract: OBJECTIVE
  We assessed how nonmedical exemption (NME) laws and annual uptake of vaccines required for school or daycare entry affect annual incidence rates for 5 vaccine-targeted diseases: pertussis, measles, mumps, Haemophilus influenzae type B, and hepatitis B.
  
  
  METHODS
  We employed longitudinal mixed-effects models to examine 2001-2008 vaccine-targeted disease data obtained from the National Notifiable Disease Surveillance System. Key explanatory variables were state-level vaccine-specific uptake rates from the National Immunization Survey and a state NME law restrictiveness level.
  
  
  RESULTS
  NME law restrictiveness and vaccine uptake were not associated with disease incidence rate for hepatitis B, Haemophilus influenzae type B, measles, or mumps. Pertussis incidence rate, however, was negatively associated with NME law restrictiveness (b = -0.20; P = .03) and diphtheria-pertussis-tetanus vaccine uptake (b = -0.01; P = .05).
  
  
  CONCLUSIONS
  State NME laws and vaccine uptake rates did not appear to influence lower-incidence diseases but may influence reported disease rates for higher-incidence diseases. If all states increased their NME law restrictiveness by 1 level and diphtheria-pertussis-tetanus uptake by 1%, national annual pertussis cases could decrease by 1.14% (171 cases) and 0.04% (5 cases), respectively.
authors: Y. Tony Yang and Vicky Debold are with the Department of Health Administration and Policy, George Mason University, Fairfax, VA.
authors: Y Tony
authors: YT
authors: Yang
authors: Vicky
authors: V
authors: Debold
mesh_terms: D033161:Government Regulation; D006192:Haemophilus Infections / Q000453:epidemiology* / Q000517:prevention & control; D018073:Haemophilus Vaccines / Q000008:administration & dosage*; D019741:Haemophilus influenzae type b; D006509:Hepatitis B / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008457:Measles / Q000453:epidemiology / Q000517:prevention & control; D009107:Mumps / Q000453:epidemiology / Q000517:prevention & control; D013219:State Government; D014765:Viral Vaccines / Q000008:administration & dosage*; D014777:Virus Diseases / Q000453:epidemiology* / Q000517:prevention & control; D014917:Whooping Cough / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D018073:Haemophilus Vaccines; D014765:Viral Vaccines