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Comment & Response |

Vaccination Compliance and the US Measles Epidemic—Reply

Maimuna S. Majumder, MPH1,2; Jane E. Huston, MPH1; John S. Brownstein, PhD1,3
[+] Author Affiliations
1Computational Epidemiology Group, Children’s Hospital Informatics Program, Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
2Engineering Systems Division, Massachusetts Institute of Technology, Cambridge
3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
JAMA Pediatr. 2015;169(9):877-878. doi:10.1001/jamapediatrics.2015.1527.
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In Reply We were interested to read the responses to our Research Letter regarding substandard vaccine compliance and the 2015 Disneyland measles outbreak. The authors raise several questions regarding our modeling method and resulting vaccination rate estimates.

As cited by Blumberg et al,1 the incidence decay and exponential adjustment (IDEA) model does not consider transmission heterogeneity; in this way, it is a simplification of reality, as all models are. We agree that this is an important consideration and we were pleased to see that Blumberg et al1 incorporated heterogeneity in their own analysis of the Disneyland measles outbreak. However, we believe that the results obtained from the IDEA model are valuable in that they effectively highlight the pervasiveness of vaccine hesitancy clusters in the United States, a phenomenon that directly contributes to increased risk of disease transmission.

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September 1, 2015
Tomás Bogardus, PhD
1Department of Philosophy, Pepperdine University, Malibu, California
JAMA Pediatr. 2015;169(9):876. doi:10.1001/jamapediatrics.2015.1524.
September 1, 2015
Raymond Leung, MBBS; Maya Munoz, DO
1Meadville Pediatrics, Meadville, Pennsylvania
JAMA Pediatr. 2015;169(9):876-877. doi:10.1001/jamapediatrics.2015.1530.
September 1, 2015
Seth Blumberg, MD, PhD; Wayne T. A. Enanoria, PhD; Travis C. Porco, PhD, MPH
1St Mary’s Medical Center, San Francisco, California
2Francis I Proctor Foundation for Research in Ophthalmology, University of California–San Francisco, San Francisco3Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco
2Francis I Proctor Foundation for Research in Ophthalmology, University of California–San Francisco, San Francisco3Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco4Department of Ophthalmology, University of California–San Francisco, San Francisco
JAMA Pediatr. 2015;169(9):877. doi:10.1001/jamapediatrics.2015.1534.
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