During the last six months of this year, measles cases in the United States rose to their highest level in over a decade. The Centers for Disease Control and Prevention (CDC) reported this finding in the August 22, 2008 edition of the MMWR. CDC researchers trace the rise in measles to transmission within the country, rather than an increase of overseas cases arriving in the U.S. Pockets of unvaccinated populations are most affected and risk spreading the highly contagious virus. A full copy of the report can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5733a1.htm.
Has your coalition seen a measles increase in your area? How is your group addressing the rising number of unvaccinated children?
Wednesday, August 27, 2008
Monday, August 27, 2007
Posted by: Sean Hubert, Project LOVE
Back-to-School….Back to the drawing board
In recent days I have seen some discussion on how to release the tension of back to school lines in public health clinics. Immunization coalitions create and execute plans for back to school outreach, but how effective are they? For some communities these outreach activities are very effective. But for some high VFC*-qualified communities, not as much.
Last year, Project LOVE partnered with several organizations to hold satellite clinics in areas where data has shown elevated school exclusion rates year after year. It also happened to coincide with high qualified free or reduced lunch programs which equate VFC-eligibility. It made sense to us to have these clinics in those identified areas for the family’s convenience and to hold them around and during exclusion day (for Ohio schools it’s two weeks after school starts). Information about these clinics were distributed to the parents through the school nurses on several occasions, including the letter stating your child will be excluded without the required immunizations. We were geared up and ready to take on the flow. But nothing happened. In all the clinics (8 areas in total) we had a handful of families show up.
Where did the rest go? You bet…our local health department. Apparently our families preferred to take the longer bus or car trip and spend the hours in wait rather than to go to the clinics set up in their neighborhoods. We know procrastination is habitual, but maybe so is going to the main health department. It doesn’t help that they are so darn friendly too (honestly!).
So the lesson learned was that we not hold convenient localized clinics but rather staff more personnel to help the main health department out. It’s not my first choice obviously, but it was our community’s choice. Throughout the summer using the media, we strongly encourage families to contact their medical provider early for an appointment, but with school starting next week (for us), that’s no longer an option. Most offices I have contacted are booked at least two weeks out.
I strongly support working closely with your school systems. They can help you identify many aspects as you plan back to school events such as school exclusion rates and assist you on getting the word out to the parents. If you are in a state where it is allowable to give immunizations at the school, holding clinics on site is a very effective option.
*VFC-Vaccine For Children federal program
Back-to-School….Back to the drawing board
In recent days I have seen some discussion on how to release the tension of back to school lines in public health clinics. Immunization coalitions create and execute plans for back to school outreach, but how effective are they? For some communities these outreach activities are very effective. But for some high VFC*-qualified communities, not as much.
Last year, Project LOVE partnered with several organizations to hold satellite clinics in areas where data has shown elevated school exclusion rates year after year. It also happened to coincide with high qualified free or reduced lunch programs which equate VFC-eligibility. It made sense to us to have these clinics in those identified areas for the family’s convenience and to hold them around and during exclusion day (for Ohio schools it’s two weeks after school starts). Information about these clinics were distributed to the parents through the school nurses on several occasions, including the letter stating your child will be excluded without the required immunizations. We were geared up and ready to take on the flow. But nothing happened. In all the clinics (8 areas in total) we had a handful of families show up.
Where did the rest go? You bet…our local health department. Apparently our families preferred to take the longer bus or car trip and spend the hours in wait rather than to go to the clinics set up in their neighborhoods. We know procrastination is habitual, but maybe so is going to the main health department. It doesn’t help that they are so darn friendly too (honestly!).
So the lesson learned was that we not hold convenient localized clinics but rather staff more personnel to help the main health department out. It’s not my first choice obviously, but it was our community’s choice. Throughout the summer using the media, we strongly encourage families to contact their medical provider early for an appointment, but with school starting next week (for us), that’s no longer an option. Most offices I have contacted are booked at least two weeks out.
I strongly support working closely with your school systems. They can help you identify many aspects as you plan back to school events such as school exclusion rates and assist you on getting the word out to the parents. If you are in a state where it is allowable to give immunizations at the school, holding clinics on site is a very effective option.
*VFC-Vaccine For Children federal program
Thursday, July 5, 2007
Immunization Registries…More than just a database
IZTA is pleased to welcome a new guest blogger – Sean Hubert, the Director of Project L.O.V.E. – An immunization coalition serving Franklin County, Ohio. His first posting follows:
Project L.O.V.E. and its partners recently conducted a retrospective survey where we reviewed kindergarten immunization records in our public school system. We looked back to when these children were two to see how many were up-to-date on the recommended immunization schedule. The process was cumbersome and took many partner members and countless hours to complete the study. What we found was exactly what we expected; that our children were not well protected in our urban areas against vaccine preventable diseases. It was excellent we finally had data to back up what we have been saying for some time, but there had to be a better way of getting this data.
Of course there is and it’s by using immunization registries. Not only would it be a quick query search to pinpoint areas in need for additional immunization outreach, we could focus our partners in using their valuable time for actual outreach rather than research. Not to mention, the data that we would collect from the registry would be real-time compared to the 3 year old data we collected from the retrospective study.
So why didn’t we do that? Quite simply…our registry is filled with gaps since many immunization providers still aren’t using it. It really astonished me when first taking over Project L.O.V.E. that providers wouldn’t be using a free web-based system to track their immunizations. With so many perks for using the system such as free reminder/recall notices to patients, easy access in ordering and tracking vaccines as well as easily printable reports for daycare, school and camp forms, why wouldn’t they? Although we have made some stride in provider participation, it hasn’t been an easy sale. I hate to think that it will take legislation as some states have done to get all providers to use the system but it may be our only hope.
Registries make sense in so many ways and levels. Parents never need to worry again about a paper record that can be easily lost or destroyed. Providers could track their patients much better and make fewer calls to past providers as well as never worrying that they are over immunizing a child. And Public Health could structure their limited resources and funding to those families that really need the outreach as opposed to blanketed outreach. It just makes sense…but I’m preaching to the choir.
Project L.O.V.E. and its partners recently conducted a retrospective survey where we reviewed kindergarten immunization records in our public school system. We looked back to when these children were two to see how many were up-to-date on the recommended immunization schedule. The process was cumbersome and took many partner members and countless hours to complete the study. What we found was exactly what we expected; that our children were not well protected in our urban areas against vaccine preventable diseases. It was excellent we finally had data to back up what we have been saying for some time, but there had to be a better way of getting this data.
Of course there is and it’s by using immunization registries. Not only would it be a quick query search to pinpoint areas in need for additional immunization outreach, we could focus our partners in using their valuable time for actual outreach rather than research. Not to mention, the data that we would collect from the registry would be real-time compared to the 3 year old data we collected from the retrospective study.
So why didn’t we do that? Quite simply…our registry is filled with gaps since many immunization providers still aren’t using it. It really astonished me when first taking over Project L.O.V.E. that providers wouldn’t be using a free web-based system to track their immunizations. With so many perks for using the system such as free reminder/recall notices to patients, easy access in ordering and tracking vaccines as well as easily printable reports for daycare, school and camp forms, why wouldn’t they? Although we have made some stride in provider participation, it hasn’t been an easy sale. I hate to think that it will take legislation as some states have done to get all providers to use the system but it may be our only hope.
Registries make sense in so many ways and levels. Parents never need to worry again about a paper record that can be easily lost or destroyed. Providers could track their patients much better and make fewer calls to past providers as well as never worrying that they are over immunizing a child. And Public Health could structure their limited resources and funding to those families that really need the outreach as opposed to blanketed outreach. It just makes sense…but I’m preaching to the choir.
Tuesday, May 29, 2007
Maximizing Protection vs. Increasing Rates
It has been about four years now since I have told anyone that our Coalition works to 'increase immunization rates'. In my presentations, on our websites, in our marketing materials, in our meetings and campaigns we talk about maximizing immunization or disease protection not necessarily increasing rates. There are two very important reasons for this.
Reason One: Increasing immunization rates does not sound all that appealing or important to most people. If anything it sounds to people quite robotic and inhuman. For most people with the exception of some public health geeks (no offense here – I have the highest regard for public health geeks as I am one myself) raising immunization rates doesn’t mean anything. It is simply bean counting. In some ways it actually feeds peoples stereotypes that all we want to do is push more vaccines. ‘What do your immunization rates have to do with my life or my children?’ Now if you say you are going to help maximize immunization protection or improve protection from disease that sounds better. If we have learned anything from politics recently it is that words are important. The phrases you use to describe what you do say a lot about you. And it is proven that people react very differently to different words. In a focus group asking people about which was more positive my money would be on protection over rates any day.
The second reason and most importantly for me - as I am a public health/science geek myself - is that raising immunization rates is inaccurate. That is not my job. That is not what I do. Now immunization rates may increase as a result of what I do, but I am not focused on that. My job is to help protect people from disease. If there was no disease I could care less about immunization. So the focus of what we do should be on the diseases and using immunization as a tool that works to protect people from those diseases. Also, simply raising rates is an unrealistic goal.
Why? Because we could spend trillions of dollars and never have 100% of people vaccinated – it’s impossible and a waste of resources. Some people have contraindications, some people are not the right ages for certain vaccines, and some people are not at risk for specific diseases, and some people simply refuse to be vaccinated. Now given that set of cards we can target immunizations to help protect the most people from the most disease.
We are the experts when it comes to what disease are really effecting or would be affecting people’s lives if they didn’t get immunized. And most diseases (not tetanus) have a herd immunity threshold that allow us to protect a group of people even if not everyone in that group is vaccinated. So we are more maximizers and optimizers rather than blind vaccinators.
The moral of this blog is to stop using the words 'increasing immunization rates' and start using the terms maximizing/ optimizing/ improving/ broadening immunization or disease protection. In the end it sounds better and is far more representative of what we do.
Reason One: Increasing immunization rates does not sound all that appealing or important to most people. If anything it sounds to people quite robotic and inhuman. For most people with the exception of some public health geeks (no offense here – I have the highest regard for public health geeks as I am one myself) raising immunization rates doesn’t mean anything. It is simply bean counting. In some ways it actually feeds peoples stereotypes that all we want to do is push more vaccines. ‘What do your immunization rates have to do with my life or my children?’ Now if you say you are going to help maximize immunization protection or improve protection from disease that sounds better. If we have learned anything from politics recently it is that words are important. The phrases you use to describe what you do say a lot about you. And it is proven that people react very differently to different words. In a focus group asking people about which was more positive my money would be on protection over rates any day.
The second reason and most importantly for me - as I am a public health/science geek myself - is that raising immunization rates is inaccurate. That is not my job. That is not what I do. Now immunization rates may increase as a result of what I do, but I am not focused on that. My job is to help protect people from disease. If there was no disease I could care less about immunization. So the focus of what we do should be on the diseases and using immunization as a tool that works to protect people from those diseases. Also, simply raising rates is an unrealistic goal.
Why? Because we could spend trillions of dollars and never have 100% of people vaccinated – it’s impossible and a waste of resources. Some people have contraindications, some people are not the right ages for certain vaccines, and some people are not at risk for specific diseases, and some people simply refuse to be vaccinated. Now given that set of cards we can target immunizations to help protect the most people from the most disease.
We are the experts when it comes to what disease are really effecting or would be affecting people’s lives if they didn’t get immunized. And most diseases (not tetanus) have a herd immunity threshold that allow us to protect a group of people even if not everyone in that group is vaccinated. So we are more maximizers and optimizers rather than blind vaccinators.
The moral of this blog is to stop using the words 'increasing immunization rates' and start using the terms maximizing/ optimizing/ improving/ broadening immunization or disease protection. In the end it sounds better and is far more representative of what we do.
Friday, May 18, 2007
What is Immunization Infrastructure and What Does It Have To Do With
When I tell people about my job and I let them know that my Coalition works on improving immunization infrastructure. Soon after I mention this word I see that people’s eyes kind of glaze over with a mixed sense of confusion and boredom. I find the word infrastructure is one that has this effect on people.
However, I still continue to use it because building immunization infrastructure is one of the most important things our Coalition does. But what does it mean?
It means creating a system or a structure so that vaccines can be administered correctly, timely, and optimally to the appropriate individuals in order to maximize protection from communicable diseases.
Infrastructure involves education, awareness, relationships, legislation, networks, tools, money, and reality. This all sounds very obscure. Let me give you an example.
Right now in the U.S. pertussis is a disease that is very common. It is common because the immunity from the DtaP that children receive starts to wane as they become teens and adults. So the disease has found a large reservoir of people who are not immune to pertussis. We know this is true. Pertussis is no fun to get as an adult but it can be deadly for a newborn.
Since 2004 in California we have had 13 newborns die because they contracted pertussis from an adult who was infected. How do we stop this? Simple – a safe and effective booster shot called Tdap given to teens and adults which will most likely reduce the amount of cases of pertussis in the general population reducing the amount of cases transmitted to newborns and basically saving babies' lives.
Unfortunately there does not exist an infrastructure to immunize teens or even adults. This immunization infrastructure has to be built. This means making providers and the public aware that they need to get a Tdap booster to fully protect them from pertussis which is quite common. And it means creating places where they can get these vaccines.
Working with providers, school clinics, pharmacies, teen clinics, and emergency rooms to make sure they can get the vaccine, store it safely, administer it properly, and get paid for administering it. This means helping establish relationships between providers, the general public, vaccine makers, and State and local health departments. Immunization Coalitions can help do all this.
And this is what creating immunization infrastructure is all about. Immunization Coalitions identify barriers or gaps in the infrastructure and work on ways to fill them. Single entities like hospitals, health departments, or school districts can not build infrastructure alone – they need organizations that stretch across all of these sectors bringing diverse partners together for the common cause of protecting people from disease.
However, I still continue to use it because building immunization infrastructure is one of the most important things our Coalition does. But what does it mean?
It means creating a system or a structure so that vaccines can be administered correctly, timely, and optimally to the appropriate individuals in order to maximize protection from communicable diseases.
Infrastructure involves education, awareness, relationships, legislation, networks, tools, money, and reality. This all sounds very obscure. Let me give you an example.
Right now in the U.S. pertussis is a disease that is very common. It is common because the immunity from the DtaP that children receive starts to wane as they become teens and adults. So the disease has found a large reservoir of people who are not immune to pertussis. We know this is true. Pertussis is no fun to get as an adult but it can be deadly for a newborn.
Since 2004 in California we have had 13 newborns die because they contracted pertussis from an adult who was infected. How do we stop this? Simple – a safe and effective booster shot called Tdap given to teens and adults which will most likely reduce the amount of cases of pertussis in the general population reducing the amount of cases transmitted to newborns and basically saving babies' lives.
Unfortunately there does not exist an infrastructure to immunize teens or even adults. This immunization infrastructure has to be built. This means making providers and the public aware that they need to get a Tdap booster to fully protect them from pertussis which is quite common. And it means creating places where they can get these vaccines.
Working with providers, school clinics, pharmacies, teen clinics, and emergency rooms to make sure they can get the vaccine, store it safely, administer it properly, and get paid for administering it. This means helping establish relationships between providers, the general public, vaccine makers, and State and local health departments. Immunization Coalitions can help do all this.
And this is what creating immunization infrastructure is all about. Immunization Coalitions identify barriers or gaps in the infrastructure and work on ways to fill them. Single entities like hospitals, health departments, or school districts can not build infrastructure alone – they need organizations that stretch across all of these sectors bringing diverse partners together for the common cause of protecting people from disease.
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