Geospatial analysis of nonmedical vaccine exemptions and pertussis outbreaks in the United States
Open accessAbstract
Significance: Pertussis has been on the rise in the United States, and, in 2012, the United States had the highest number of reported pertussis (whooping cough) cases since 1955. This study provides evidence of spatial clustering of nonmedical vaccine exemptions in kindergarteners and spatial clustering of pertussis cases in children age groups 5 years and younger and 10 to 14 years at the community level. The results suggest that states should reconsider allowing nonmedical vaccine exemptions. The data also suggest a need for the creation of a longer-acting pertussis vaccine or improved regimen and a revised vaccination schedule for the current acellular pertussis vaccine.
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Reconstruction of appendage-bearing skin in cultures and in bioengineered grafts remains an unmet biomedical challenge.
“Reconstruction of appendage-bearing skin in cultures and in bioengineered grafts remains an unmet biomedical challenge3–9.”
From Hair-bearing human skin generated entirely from pluripotent stem cells (2020) · cites this paper as [7]
The Limitations and Waning Immunity passages discuss pertussis outbreaks, vaccine exemptions, and vaccine durability, not skin reconstruction. Searches for appendage-bearing skin, tissue-engineered grafts, hair follicles, and skin culture found no passage addressing the claim. (LLM, conf=0.78)
Experimental — accuracy not yet measuredCulture systems containing epidermal and dermal cells have been used to model human skin outside of the body for research or clinical uses for over 40 years.
“Culture systems containing epidermal and dermal cells have been used to model human skin outside of the body for research or clinical uses for over 40 years7,8,10; however, growing functional skin appendages in these systems has been persistently difficult.”
From Hair-bearing human skin generated entirely from pluripotent stem cells (2020) · cites this paper as [7]
The Discussion addresses pertussis vaccination and community immunity, not skin culture systems. Searches for epidermal and dermal cell cultures, skin models, and the claimed 40-year history found no relevant passage in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredGrowing functional skin appendages in culture systems containing epidermal and dermal cells has been persistently difficult.
“Culture systems containing epidermal and dermal cells have been used to model human skin outside of the body for research or clinical uses for over 40 years7,8,10; however, growing functional skin appendages in these systems has been persistently difficult.”
From Hair-bearing human skin generated entirely from pluripotent stem cells (2020) · cites this paper as [7]
The Discussion and Limitations sections address pertussis vaccination, outbreaks, and nonmedical vaccine exemptions, not skin culture systems. Searches for functional skin appendages, epidermal and dermal cells, and related terms found no passage addressing the claim. (LLM, conf=0.78)
Experimental — accuracy not yet measured
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Research works printed but not linked: 3
- [1]WangE, Clymer J, Davis-Hayes C, Buttenheim A (2014) Nonmedical exemptions from school immunization requirements: A systematic review. Am J Public Health 104:e62 -e84.
- [26]Phadke VK, Bednarczyk RA, Salmon DA, Omer SB (2016) Association between vaccine refusal and vaccine-preventable diseases in the United States: A review of measles and pertussis. JAMA 315:1149 -1158.
- [53]Pan S, Allen S (2015) California Legislative Senate Bill No. 227, Chapter 35. leginfo. legislature.ca.gov/faces/billNavClient.xhtml?bill\_id = 201520160SB277.
Cited by
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Hair-bearing human skin generated entirely from pluripotent stem cells
Lee, J., Rabbani, C. C., Gao, H., Steinhart, M. R., Woodruff, B. M., Pflum, Z. E., Kim, A., Heller, S., Liu, Y., Shipchandler, T. Z., et al. (2020) · Nature · doi:10.1038/s41586-020-2352-3 · Cited by 487 · see citing works
DeStefano, F., & Shimabukuro, T. T. (2019) · Annual Review of Virology · doi:10.1146/annurev-virology-092818-015515 · Cited by 128 · see citing works
- Authors
- Aloe, C., Kulldorff, M., & Bloom, B. R.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Venue
- Proceedings of the National Academy of Sciences
- Publisher
- National Academy of Sciences
- Published
- 2017-06-20
- Volume
- 114
- Issue
- 27
- Pages
- 7101-7105
- ISSN
- 0027-8424 (ISSN-L)
- 1091-6490
- PMC
- PMC5502604
- OpenAlex
- W2705321490
- Cited by
- 51
- References
- 0
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 7 · 2022: 4 · 2021: 8 · 2020: 9 · 2019: 6 · 2018: 6
- FWCI
- 6.39
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Proceedings of the National Academy of Sciences (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- HHS | NIH | National Institute of Allergy and Infectious Diseases (5R01AI107721)
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › Diphtheria, Corynebacterium, and Tetanus
- Keywords
- pertussis, waning immunity, vaccine hesitancy, pertussis resurgence, geographic clustering, kindergarten children, adolescents, SaTScan
- MeSH terms
- Vaccination Refusal, Adolescent, Child, Child, Preschool, Disease Outbreaks, Geography, Humans, Infant, Infant, Newborn, Pertussis Vaccine, United States, Vaccination, Whooping Cough, Cluster Analysis, Immunization Programs
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