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Geographic clusters in underimmunization and vaccine refusal.

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Geographic clusters of childhood underimmunization and vaccine refusal exist. Identifying these areas with spatial scan statistics can help target public health interventions for better immunization rates.

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Area of Science:

  • Epidemiology
  • Public Health
  • Spatial Analysis

Background:

  • Parental refusal and delayed childhood vaccinations are increasing.
  • These trends may cluster geographically, posing public health risks.
  • Clusters can hinder achieving optimal immunization coverage benchmarks.

Purpose of the Study:

  • To identify geographic clusters of underimmunization and vaccine refusal.
  • To compare underimmunization patterns across different vaccines.
  • To assess if vaccine refusal clusters impede high immunization rates.

Main Methods:

  • Analysis of electronic health records for 154,424 children (born 2000-2011) in Northern California.
  • Utilized spatial scan statistics to detect clusters of underimmunization and vaccine refusal.
  • Study population had continuous membership from birth to 36 months of age.

Main Results:

  • Identified 5 significant underimmunization clusters (18-23% rate vs. 11% outside).
  • Underimmunization with measles, mumps, rubella, and varicella vaccines showed similar geographic clustering.
  • Vaccine refusal also clustered (5.5-13.5% rate vs. 2.6% outside).

Conclusions:

  • Underimmunization and vaccine refusal exhibit geographic clustering.
  • Spatial scan statistics are effective for identifying areas with immunization challenges.
  • Targeted interventions are needed in identified high-risk geographic locations.