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TABLE 2

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

Mandatory VaccinationNo. CountriesPertussisa Incidence Rate Ratio (95% CI)Measles Incidence Rate Ratio (95% CI)
No mandatory vaccination 22 Reference Reference 
Mandatory vaccination 0.30 (0.07 to 1.30) 0.38 (0.13 to 1.16) 
Mandatory vaccination without nonmedical exemptions 1.04 (0.18 to 6.32) 0.14 (0.05 to 0.36) 
Monetary fine    
 No mandatory vaccination 22 Reference Reference 
 Mandatory vaccination and monetary penalty for noncompliance 0.42 (0.18 to 0.98) 0.14 (0.05 to 0.39) 
Mandatory VaccinationNo. CountriesPertussisa Incidence Rate Ratio (95% CI)Measles Incidence Rate Ratio (95% CI)
No mandatory vaccination 22 Reference Reference 
Mandatory vaccination 0.30 (0.07 to 1.30) 0.38 (0.13 to 1.16) 
Mandatory vaccination without nonmedical exemptions 1.04 (0.18 to 6.32) 0.14 (0.05 to 0.36) 
Monetary fine    
 No mandatory vaccination 22 Reference Reference 
 Mandatory vaccination and monetary penalty for noncompliance 0.42 (0.18 to 0.98) 0.14 (0.05 to 0.39) 
a

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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