Individual and Community Risks of Measles and Pertussis Associated With Personal Exemptions to Immunization

CONTEXT The risk of vaccine-preventable diseases among children who have philosophical and religious exemptions from immunization has been understudied. OBJECTIVES To evaluate whether personal exemption from immunization is associated with risk of measles and pertussis at individual and community le...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2000-12, Vol.284 (24), p.3145-3150
Main Authors: Feikin, Daniel R, Lezotte, Dennis C, Hamman, Richard F, Salmon, Daniel A, Chen, Robert T, Hoffman, Richard E
Format: Article
Language:English
Subjects:
Adolescent
Bacterial diseases
Bacterial diseases of the respiratory system
Bioethics
Biological and medical sciences
Bordetella pertussis
Child
Child, Preschool
Colorado - epidemiology
Disease Outbreaks
Dissent and Disputes
Health risk assessment
Human bacterial diseases
Human viral diseases
Humans
Immunization
Incidence
Infectious diseases
Measles
Measles - epidemiology
Measles - prevention & control
Measles virus
Medical sciences
Philosophy, Medical
Public health
Religion and Medicine
Retrospective Studies
Risk
Schools
Vaccination - psychology
Vaccination - statistics & numerical data
Vaccines
Viral diseases
Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye
Whooping Cough - epidemiology
Whooping Cough - prevention & control
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Summary:CONTEXT The risk of vaccine-preventable diseases among children who have philosophical and religious exemptions from immunization has been understudied. OBJECTIVES To evaluate whether personal exemption from immunization is associated with risk of measles and pertussis at individual and community levels. DESIGN, SETTING, AND PARTICIPANTS Population-based, retrospective cohort study using data collected on standardized forms regarding all reported measles and pertussis cases among children aged 3 to 18 years in Colorado during 1987-1998. MAIN OUTCOME MEASURES Relative risk of measles and pertussis among exemptors and vaccinated children; association between incidence rates among vaccinated children and frequency of exemptors in Colorado counties; association between school outbreaks and frequency of exemptors in schools; and risk associated with exposure to an exemptor in measles outbreaks. RESULTS Exemptors were 22.2 times (95% confidence interval [CI], 15.9-31.1) more likely to acquire measles and 5.9 times (95% CI, 4.2-8.2) more likely to acquire pertussis than vaccinated children. After adjusting for confounders, the frequency of exemptors in a county was associated with the incidence rate of measles (relative risk [RR], 1.6; 95% CI, 1.0-2.4) and pertussis (RR, 1.9; 95% CI, 1.7-2.1) in vaccinated children. Schools with pertussis outbreaks had more exemptors (mean, 4.3% of students) than schools without outbreaks (1.5% of students; P = .001). At least 11% of vaccinated children in measles outbreaks acquired infection through contact with an exemptor. CONCLUSIONS The risk of measles and pertussis is elevated in personal exemptors. Public health personnel should recognize the potential effect of exemptors in outbreaks in their communities, and parents should be made aware of the risks involved in not vaccinating their children.
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.284.24.3145