Parental refusal and delay of childhood vaccination has increased in recent years in the United States. This phenomenon challenges maintenance of herd immunity and increases the risk of outbreaks of vaccine-preventable diseases. We examine US county-level vaccine refusal for patients under five years of age collected during the period 2012--2015 from an administrative healthcare dataset. We model these data with a Bayesian zero-inflated negative binomial regression model to capture social and political processes that are associated with vaccine refusal, as well as factors that affect our measurement of vaccine refusal.Our work highlights fine-scale socio-demographic characteristics associated with vaccine refusal nationally, finds that spatial clustering in refusal can be explained by such factors, and has the potential to aid in the development of targeted public health strategies for optimizing vaccine uptake.

翻译：近年来，美国父母拒绝或延迟儿童疫苗接种的现象有所增加。这一现象挑战了群体免疫的维持，并增加了疫苗可预防疾病暴发的风险。我们利用2012—2015年间行政医疗数据集，研究了美国县级五岁以下患者疫苗拒绝情况。我们采用贝叶斯零膨胀负二项回归模型对这些数据进行建模，以捕捉与疫苗拒绝相关的社会和政治过程，以及影响我们测量疫苗拒绝的因素。我们的研究凸显了全国范围内与疫苗拒绝相关的精细社会人口学特征，发现空间聚集性可由这些因素解释，并有助于制定针对性的公共卫生策略以优化疫苗接种率。