A Targeted Assessment of Childhood Immunizations in Nevada County

Transcription

1 A Targeted Assessment of Childhood Immunizations in Nevada County Salina Zomat, Krystal Scott, and Nicole Fink April 12, 2016 Source:

2 Outline Nevada County Immunization Crisis Importance Complications Rationale Contagious Childhood Diseases County Infection Rates Potential Solutions Source:

3 Nevada County Childhood Immunization Crisis Nevada County had some of the lowest rates of kindergarteners are are vaccinated Personal Belief Exemptions (BPE) are very common Source:

4 90.3% 90% 72.6% Source: %20CA%20Kindergarten%20Immunization%20Assessment.pdf

5 Why is This Important? Childhood immunizations have countless benefits When vaccination rates fall, the incidence of serious illnesses can increase

6 Benefits of Childhood Immunization Vaccines: o Life saving o Safe & effective Eradicated Diseases Polio, Haemophilus Influenza Type B (HIB) o Herd immunity o Saves families time & money o Protects future generations Source:

7 Contagious Childhood Disease in Nevada County Pertussis (Whooping Cough) o Diphtheria, Tetanus, and Pertussis (DtaP) Vaccine Measles o Measles, Mumps, Rubella (MMR) Vaccine Varicella Varicella o Chickenpox Vaccine Measles Source: Pertussis

8 Pertussis aka Whooping Cough Early symptoms (1-2 weeks) Runny nose Low-grade fever Mild, occasional cough Apnea a pause in breathing (in babies) Sources:

9 Later symptoms Pertussis aka Whooping Cough o High-pitched, rapid "whooping" coughing fits o Vomiting & exhaustion during or after coughing fits Image Source:

10 Incidence Rates of Pertussis 74 Source:

11 Measles Common Symptoms Fever Rash Runny Nose Red eyes Highly Contagious for 9 days o 21 day incubation period o Contagious 4 day before - 4 days after appearance of rash o 9 / 10 unvaccinated people will contract measles if exposed Sources: immunization/infographic/measles.htm

12 Measles in the United States In 2000, measles was declared eliminated due to: o High population immunity o Highly effective vaccine Measles in California o 2014: Disneyland o 2016: Nevada County (!) Source:

13 Disneyland: The Happiest Place on Earth December February measles cases confirmed! o 110 were California residents 39 visited Disneyland in December, where they were exposed to measles. 49 were unvaccinated Source:

14 Measles at Nevada County School (2016) Yuba River Charter School o 57% of school s kindergarteners not in compliance with required vaccinations. o School closed to unvaccinated students until April 4th. Source:

15 Varicella aka Chicken Pox Transmission o Contact / airborne o Contagious 1-2 days before rash, until all blisters have scabs o Shingles can spread chickenpox to unvaccinated persons Signs & Symptoms o high fever o tiredness o loss of appetite o headache Source:

16 Complications of Infection Pertussis (Whooping Cough) o 23%: Pneumonia o 61%: Apnea Varicella (Chicken Pox) o Shingles o Pneumonia Measles o 1 in 20: Pneumonia o 2 in 1000: Death Sources: & about/complications.html

17 Community Health Diagnosis #1 Potential risk of contagious or infectious diseases among school-aged children related to decreased immunization rates in Nevada County as demonstrated in statistics from the California Department of Public Health and the Nevada County Status Report.

18 Community Health Diagnosis #2 Increased risk of declining immunization rates in Nevada County among kindergarteners related to Personal Belief Exemptions (PBEs) as demonstrated in reports from the California Department of Public Health.

19 Why is this Happening? Population / culture of Nevada County o Personal Belief Exemptions (PBE) o Socioeconomic status Lack of understanding Protective parents o Painful experience injections o Belief that vaccine is worse than the disease it prevents Image Source: Source: Source:

20 % 7.6% 2.5% Source: %20CA%20Kindergarten%20Immunization%20Assessment.pdf

21 Population/Culture of Nevada County Holistic Parenting o Natural, non-toxic approach to parenting Vaccine Conspiracy Theories o Big Pharma, Mercury/Thimerosal, Peanut Allergies Critical of Governmental Authority o Less likely to vaccinate Selective Vaccination o Spacing out or eliminating certain vaccinations Sources: Cynthia Wilson, Director of Public Health Nursing, Nevada County Childhood Immunzation Survey refusers-newsroom/parents-opting-for-natural-healthy-practices-and-no-vaccines-pressenterprise/#.vwgslwqrk2w,

22 Percentage of Respondents Nevada County Childhood Vaccine Survey Question: Which vaccines are you opting out of or delaying? Source: Nevada County Public Health Department: Childhood Vaccine Survey

23 Lack of Understanding Regarding Vaccines Doubts About Vaccine Importance o Rarity of disease o Over reliance on herd immunity Adverse Reactions to Vaccines o o o o Additive & Preservatives Multiple Vaccinations Autism Sudden Infant Death Syndrome (SIDS) Complex Immunization Schedule Vaccines During Pregnancy Sources: vaccinesafety/concerns/

24 Socioeconomic Status & Childhood Immunizations Observational Study of 300 cases done in January-July 2012 Assessed the vaccination status of children <5 yrs o Complete vaccination was 240 (80%) o Partial vaccination was 17 (5.7%) o Incomplete vaccination was 43 out of 300 (14.3%) o Reason for non-vaccination due to either low socioeconomic condition or low level of education of parents/guardians Source:

25 Median Household Income In 2014 US dollars Region Source:

26 Current Interventions in Nevada County Educational sessions held monthly for all home health visitors Quarantine infected children, or unvaccinated children during positive cases New Law SB277 - mandated vaccinations in CA Nevada County Public Health Immunization Program o Vaccines for Children Immunization Clinics Source:

27 Potential Solutions 1. Individual Solution 2. Community Solution 3. Systems Solution Image Source:

28 Individual Level Solution Harm Reduction - Education and Outreach: Engage with parents to establish trust enhance knowledge Urge to vaccinate from beginning of child s life, avoid falling behind Harm Reduction - Support Home Health Visitors and Nurses Educate, increase awareness Create flyers for parents what to do if their kids contract a communicable disease Source: Image Source: secure.static.tumblr.com/75f5da f5890adf0674bd1477/kivb4wi/jsrng2sku/ tumblr_static_tumblr_static_ers193tzmk0swsgwwcockkws8_640.jpg

29 Community Level Solution Create flyers on the benefits of handwashing post in school bathrooms. Vaccination by school RNs. Send flyers home with students on Vaccines For Children (VFC) program through the CDC (NCPH is a participant) Campaign for donations of hand sanitizers for school classrooms. Source:

30 Community Level Solution Disseminate Safety Information Sheets /Vaccine Information Statements o debunk myths (such as thimerosal in MMR causing Autism) o target grocery stores, schools, hospitals, churches, etc. Ensure vaccine administrators are aware of VAERS (Vaccine Adverse Event Reporting System) o Provide through mandatory CE classes o Safety program collects adverse events/se s that occur after administration o Reports analyzed and made available to the public Source:

31 Systems Level Solution Electronic Medical Records for MDs currently flag immunizations not completed Propose funding to EMRs that flag immunizations not completed to alert school RN s. Source:

32 Systems Level Solution Smartphone apps link parents to Immunizations Information Systems (IIS) Confidential computerized database Records immunizations administered by participating providers Reporting is confidential and capable of electronically exchanging data with EMR/EHR Immunization due date reminders Missed dose reminders based on the CA state schedule by the National Vaccine Information Center Source:

33 The End.Questions? Source:

34 References AAP Immunization Resources Adolescent Immunizations: Strategies for Increasing Coverage Rates. (2013). American Academy of Pediatrics. Retrieved from Ahmad, S., Zahid, S.B., Zeb, A. (2013). The impact of parental education and socioeconomic status on routine childhood vaccination: an observational study. Journal of Postgraduate Medical Institute. Retrieved from Anti-vaccination conspiracy theories. (2016). Very Well. Retrieved from Theories.htm California home to 39 cases of whooping cough. (2015). Data Points: The Kidsdata.org Blog. Retrieved from California State vaccine requirements. (2016). National Vaccine Information Center. Retrieved from Five important reasons to immunize your child. (n.d.). Centers for Disease Control and Prevention (CDC). Retrieved from matte/pdf/cdcfivereasonstovaccinateyourchild.pdf. Grass Valley and Nevada City selected as top retirement destinations. (2015). Coldwell Banker. Retrieved from blog.nevadacounty4sale.com/wp-content/uploads/2015/02/ NEVADACOUNTY.jpg&biw=1280&bih=705&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiYyof706zMAhVimoMKHbO_A20Q_AUICSgE#imgrc=7nXBL A1Cid2qxM%3A. Gregoire, C. (2015). Anti-vaccination advocates often don t trust the government, study finds. Huffpost Science. Retrieved from

35 References (cont d) Healthcare access in rural communities. (2014). Rural Health Information Hub. Retrieved from In Nevada County schools, impact of vaccination law remains to be seen. (2016). The Union. Retrived from Kindergarten immunization assessment results. (2015). California Department of Public Health, Immunization Branch. Retrieved from programs/immunize/documents/ %20ca%20kindergarten%20immunization%20assessment.pdf Lavin, E. (2015). In Nevada County schools, impact of vaccination law remains to be seen. The Union. Retrieved from News & important information. (2016). Yuba River Charter School. Retrieved from Parents opting for natural, healthy practices and no vaccines. (2012). The Refusers. Retrieved from Public Health Intervention Wheel image. (n.d.) Retrieved from Public health investigates confirmed measles case. (2016) California Department of Public Health. Retrieved from NR aspx. Quickfacts-California. (2015). United States Census Bureau. Retrieved from Recommended immunizations for children from birth through 6 years old. (2016). Centers for Disease Control. Retrieved from parents/downloads/parent-ver-sch-0-6yrs.pdf.

36 References (cont d) Reese, P. (2014). Vaccination rates up for California Kindergartners. The Sacramento Bee. Retrieved from Senate Bill No (2015). California Legislative Information. Retrieved from bill_id= sb277. Theme park adventure - latest news and features. (2016). Theme Park Adventure. Retrieved from /07/4_07_DL_1428A.jpg. Vaccine adverse event reporting system. (2016). Department of Health and Human Services. Retrieved from Vaccine-preventable disease surveillance. (2016). California Department of Public Health (CDPH). Retrieved from Pages/VaccinePreventableDiseaseSurveillance.aspx. Vaccine coverage percentage. (2013). Retrieved from Wick, J. (2011). Removing barriers to childhood immunization. Pharmacy Times. Retrieved from Wilson, C. Director of Public Health Nursing, Nevada County Public Health Department, personal communication, April 2016.