School of Nursing and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19130, USA.
Am J Public Health. 2012 Aug;102(8):e59-67. doi: 10.2105/AJPH.2012.300821. Epub 2012 Jun 14.
Personal belief exemptions (PBEs) from mandated school entry vaccinations have increased in California over the past decade. Infectious disease outbreaks in the state may be associated with the aggregation of intentionally unvaccinated children within schools. We sought to quantify the exposure of California kindergartners to children with PBEs at school.
We used cross-sectional California Department of Public Health data on 3 kindergarten cohorts to define and calculate multiple measures of exposure to children with exemptions, including interaction and aggregation indices, for the state as a whole (2008-2010) and by county (2010).
In 2010, the PBE rate in California was 2.3 per 100 students, and the school PBE rate for the average kindergartner with a PBE was 15.6 per 100. More than 7000 kindergartners in California attend schools with PBE rates greater than 20 per 100, including 2700 kindergartners with PBEs. Exposure measures vary considerably across counties.
Our results suggest increasing levels of exposure among kindergarten students in California to other kindergartners with PBEs. Our data provide a concrete set of metrics through which public health and education officials can identify high-risk areas as targets for policy and programmatic interventions.
在过去十年中，加利福尼亚州的强制性学校入学疫苗接种个人信仰豁免（PBE）有所增加。该州的传染病暴发可能与学校内故意未接种疫苗的儿童聚集有关。我们试图量化加利福尼亚幼儿园儿童在学校接触 PBE 儿童的情况。
我们使用加利福尼亚州公共卫生部关于 3 个幼儿园队列的横断面数据，定义并计算了多种接触有豁免权儿童的暴露指标，包括全州（2008-2010 年）和各县（2010 年）的相互作用和聚集指数。
2010 年，加利福尼亚州的 PBE 率为每 100 名学生 2.3 例，平均有 PBE 的幼儿园儿童的学校 PBE 率为每 100 名 15.6 例。加利福尼亚州有 7000 多名幼儿园儿童就读于 PBE 率超过 20/100 的学校，其中包括 2700 名有 PBE 的幼儿园儿童。暴露指标在各县之间差异很大。
我们的研究结果表明，加利福尼亚州幼儿园学生接触其他有 PBE 的幼儿园学生的水平在不断提高。我们的数据提供了一套具体的指标，公共卫生和教育官员可以通过这些指标来确定高风险地区作为政策和项目干预的目标。
