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 vaccination22ReferenceReference
Mandatory vaccination70.30 (0.07 to 1.30)0.38 (0.13 to 1.16)
Mandatory vaccination without nonmedical exemptions51.04 (0.18 to 6.32)0.14 (0.05 to 0.36)
Monetary fine
 No mandatory vaccination22ReferenceReference
 Mandatory vaccination and monetary penalty for noncompliance60.42 (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.