PT  - JOURNAL ARTICLE
AU  - Sandra Goldlust
AU  - Elizabeth C. Lee
AU  - Murali Haran
AU  - Pejman Rohani
AU  - Shweta Bansal
TI  - Assessing the distribution and determinants of vaccine underutilization in the United States
AID  - 10.1101/113043
DP  - 2017 Jan 01
TA  - bioRxiv
PG  - 113043
4099  - http://biorxiv.org/content/early/2017/03/03/113043.short
4100  - http://biorxiv.org/content/early/2017/03/03/113043.full
AB  - Despite advances in sanitation and immunization, vaccine-preventable diseases remain a significant cause of morbidity and mortality worldwide. In high-income countries such as the United States, coverage rates for vaccination against childhood infections remains high. However, the phenomenon of vaccine hesitancy makes maintenance of herd immunity difficult, impeding global disease eradication efforts. Reaching the ‘last mile’ will require early detection of vaccine hesitancy (driven by philosophical or religious choices), identifying pockets of susceptibility due to underimmunization (driven by vaccine unavailability, costs ineligibility), determining the factors associated with the behavior and developing targeted strategies to ameliorate the concerns. Towards this goal, we harness high-resolution medical claims data to geographically localize vaccine refusal and underimmunization (collectively, ‘underutilization’) in the United States and identify the socio-economic determinants of the behaviors. Our study represents the first large-scale effort for vaccination behavior surveillance and has the potential to aid in the development of targeted public health strategies for optimizing vaccine uptake.