Harvard University Extension School, Cambridge, MA 02138.
Division of Pharmacoepidemiology & Pharmacoeconomics, Department of Medicine, Harvard University Medical School and Brigham and Women's Hospital, Boston, MA 02120.
Proc Natl Acad Sci U S A. 2017 Jul 3;114(27):7101-7105. doi: 10.1073/pnas.1700240114. Epub 2017 Jun 20.
Because of increased numbers of recorded pertussis cases in the United States, this study sought to understand the role of nonmedical vaccine exemptions and waning immunity may have had on the resurgence of pertussis in the United States at the community level. We used geospatial scan statistics, SaTScan, version 9.4, to analyze nonmedical vaccine exemptions of children entering kindergarten in 2011 and 2012 and reported pertussis cases in 2012 for children in age groups 5 years and younger and 10 to 14 years. Eight statistically significant clusters of nonmedical vaccine exemptions in kindergarteners and 11 statistically significant clusters of pertussis cases in children and adolescents were identified and geospatially linked. Forty-five percent of the counties in the study had high rates of nonmedical vaccine exemptions. The proportion of kindergarteners with nonmedical vaccine exemptions was 2.8 times larger in the identified exemption clusters. In addition, 31 counties had geographic clusters of high rates of pertussis in children ages 10 to 14 years old, consistent with waning immunity. Our findings are consistent with the view that geographic clusters of nonmedical vaccine exemptions and waning immunity may have been factors contributing to community-level pertussis outbreaks.
由于美国记录的百日咳病例数量增加，这项研究旨在了解非医学疫苗豁免和免疫力下降在社区层面可能对百日咳在美国的死灰复燃所起的作用。我们使用地理空间扫描统计，SaTScan 版本 9.4，分析了 2011 年和 2012 年进入幼儿园的儿童的非医学疫苗豁免情况以及 2012 年 5 岁以下和 10 至 14 岁儿童的百日咳报告病例。在幼儿园儿童中确定了 8 个具有统计学意义的非医学疫苗豁免集群，在儿童和青少年中确定了 11 个具有统计学意义的百日咳病例集群，并进行了地理空间联系。研究中 45%的县有高比例的非医学疫苗豁免。在确定的豁免集群中，有非医学疫苗豁免的幼儿园儿童比例高出 2.8 倍。此外，31 个县有 10 至 14 岁儿童百日咳发病率高的地理集群，这与免疫力下降相一致。我们的研究结果与以下观点一致，即非医学疫苗豁免和免疫力下降的地理集群可能是导致社区层面百日咳爆发的因素之一。
