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TABLE 1

Association of Mandatory Vaccination, the Availability of a Nonmedical Exemption Option, and the Penalty of Noncompliance With Rates of Vaccination Against Measles (2006–2015) and Pertussis (2006–2016)

No. Country-YearsDifference in Vaccination Rate, % (95% CI)P
Measles    
 Mandatory vaccination, yes or no 287 3.71 (1.68 to 5.74) .0003 
 Mandatory vaccination without nonmedical exemption, yes or no 267 3.80 (1.23 to 6.37) .0037 
 Financial penalty for noncompliance per €500 59 0.80 (0.5 to 1.15) <.0001 
Pertussis    
 Mandatory vaccination, yes or no 316 2.14 (0.13 to 4.15) .04 
 Mandatory vaccination without nonmedical exemption, yes or no 294 2.07 (−1.74 to 5.89) .28 
 Financial penalty for noncompliance per €500 65 1.1 (0.95 to 1.30) <.0001 
No. Country-YearsDifference in Vaccination Rate, % (95% CI)P
Measles    
 Mandatory vaccination, yes or no 287 3.71 (1.68 to 5.74) .0003 
 Mandatory vaccination without nonmedical exemption, yes or no 267 3.80 (1.23 to 6.37) .0037 
 Financial penalty for noncompliance per €500 59 0.80 (0.5 to 1.15) <.0001 
Pertussis    
 Mandatory vaccination, yes or no 316 2.14 (0.13 to 4.15) .04 
 Mandatory vaccination without nonmedical exemption, yes or no 294 2.07 (−1.74 to 5.89) .28 
 Financial penalty for noncompliance per €500 65 1.1 (0.95 to 1.30) <.0001 

All models are adjusted for GDP per capita, GINI, urban population, universal health care coverage, median age, percentage of the population <14 years of age, and education level.

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