The Associations between Mandatory Vaccination and Incidence of Measles and Pertussis and Vaccination Rates in Europe Open Access
Vaz, Olivia (Spring 2018)
Abstract
Abstract
The Associations between Mandatory Vaccination and Incidence of Measles and Pertussis and Vaccination Rates in Europe
By Olivia Vaz
Background:
Vaccination legislation has played a major role in drastically decreasing the incidence of infectious diseases, including pertussis and measles, around the world. All countries in Europe recommend vaccination for their citizens but a subset of countries have mandatory vaccination requirements. These requirements may be important to the maintenance of high vaccination rates necessary to prevent disease outbreaks.
Objective: To determine if (1) the vaccination rates for pertussis-antigen vaccines and measles, mumps and rubella (MMR) vaccines are associated with mandatory vaccination and the availability of non-medical exemptions; (2) the incidence of pertussis and measles is associated with mandatory vaccination and the availability of non-medical exemptions; and (3) if the magnitude of the financial penalties faced by non-compliant parents is associated with the vaccination rates against pertussis and measles.
Methods:
We analyzed country-level vaccination rates and incidence rates from 2006 through 2015 for measles and 2006 through 2016 for pertussis, as well as the regulations for vaccination, non-medical exemptions, and penalties faced by parents who fail to comply with regulations, for 29 European countries.
Results:
Of the 29 countries studied, seven had mandatory vaccination, and of those seven, two allowed non-medical exemptions. There was no significant association between mandatory vaccination or non-medical exemption availability and vaccination rates or incidence or measles and pertussis. For every 100 € increase in the maximum possible penalty faced by non-compliant parents, rates for pertussis vaccinations were 0.15% higher (95% CI: 0.06, 0.23; p-value = 0.0007) and rates for measles vaccination were also 0.15% higher (95% CI: 0.06, 0.25; p-value = 0.0009).
Conclusions:
Neither mandatory vaccination nor non-medical exemption availability was statistically significantly associated with increased vaccination rates or decreased incidence rates, though the magnitude of the penalty face by parents was associated with an increase in vaccination coverage.
Table of Contents
Table of Contents
Chapter I
Background 1
Measles 1
Pertussis 3
Evolution of Vaccination Mandates in Europe 5
Impact of Mandatory Vaccination in the United States 6
Future Control and Elimination 7
Chapter II
Introduction 10
Methods 13
Data Collection Methods 13
Vaccination Rates and Associations with Vaccine Legislation 14
Disease Incidence and Associations with Policy 15
Results 17
Vaccination Rates and Associations with Vaccine Legislation 17
Disease Incidence and Associations with Policy 18
Discussion 20
Conclusions 22
References 23
Tables 27
Figures 29
Chapter III
Public Health Implications 32
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