COMMUNITY IMMUNITY: UNDERSTANDING SCHOOL IMMUNIZATION DATA AND BUILDING VACCINE CONFIDENCE IN YOUR PRACTICE

Transcription

1 COMMUNITY IMMUNITY: UNDERSTANDING SCHOOL IMMUNIZATION DATA AND BUILDING VACCINE CONFIDENCE IN YOUR PRACTICE MCAAP Webinar August 18, 2016 Presented by: Kathleen Shattuck, Assessment Coordinator and Rebecca Vanucci, Immunization Outreach Coordinator MDPH Immunization Program 1

2 OBJECTIVES Describe how Massachusetts school immunization data is collected and how to access the data; Explain the definition of vaccine confidence; Review programs to enhance vaccine confidence, including communication strategies. 2

3 SCHOOL REQUIREMENTS AND PROVIDERS If they don t meet school requirements families/children may Contact you for immunizations to meet requirements Plan the schedule at your office with school requirements in mind. Contact you for a medical exemption Be denied entry or excluded from childcare or school if they aren t up-to-date Be excluded from school if unvaccinated (even with an exemption) if there is an exposure to a vaccine preventable disease 3

4 IMMUNIZATION REQUIREMENTS FOR ENTRY TO SCHOOL 4

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6 PHASE-IN SCHEDULE FOR MMR, TDAP, AND VARICELLA VACCINES MMR and 2 Varicella Tdap K-5 and 7-12 College: full-time freshmen-graduates; all health science Grades 7-12 College: full-time freshmen-graduates; all health science K 12 College: full-time freshmen-graduates; all health science Grades 7-12 College: full-time freshmen-graduates; all health science 6

7 CERTIFICATE OF IMMUNIZATION DEFINITION A form or letter signed and dated by a physician, nurse practitioner, physician assistant or designee which specifies the month and year of administration and the type/name of the vaccine(s) administered to the student A report from the Massachusetts Immunization Information System (MIIS) which specifies the month and year of administration and the type/name of the vaccine(s) administered to the student. MDPH Regulation 105 CMR found at 7

8 CHILDREN WHO ARE NOT APPROPRIATELY IMMUNIZED Three situations when children not appropriately immunized may be admitted to school: Medical exemptions allowed with physician documentation attesting that an immunization is medically contraindicated. (Must renew each year.) Religious exemptions allowed with a parent or guardian written statement that immunizations conflict with their sincere religious beliefs. (Recommend to renew each year.) Homeless children cannot be excluded from school due to lack of an immunization record. 8

9 CHILDREN WHO ARE NOT APPROPRIATELY IMMUNIZED Philosophical exemptions are not allowed in MA, even if signed by a physician. Exemptions must be kept in the student s file at school. Policies on exclusion are developed and enforced at the local level. Exclusions during disease outbreaks: When one or more cases of a vaccinepreventable disease is present in a school, susceptible students with medical or religious exemptions may be subject to exclusions. 9

10 Percent Exemptions IMMUNIZATION EXEMPTIONS AMONG KINDERGARTEN STUDENTS, Total Exemptions Medical Exemptions Religious Exemptions N=976 N=760 N=216 Year Source: Massachusetts School Immunization Surveys

11 Suffolk Norfolk Plymouth Middlesex Essex Hampden Worcester Bristol Percent Exemptions Berkshire Franklin Nantucket Barnstable Hampshire Dukes RATES OF KINDERGARTEN STUDENTS WITH AN EXEMPTION, BY COUNTY, Source: Massachusetts School Immunization Surveys 2015 Religious and medical exemptions combined MA Total Rate = 1.3%

12 RATES OF KINDERGARTEN STUDENTS WITH AN EXEMPTION, BY COUNTY, % 3.1% 1.2% 2.7% 0.5% 4.1% 1.3% State Total: 1.3% 1.6% 0.9% 1.4% 1.1% Source: Massachusetts School Immunization Surveys 2015 religious and medical exemptions combined 3.5% 8.2% %

13 RATES OF K STUDENTS WITH EXEMPTION AND NO VACCINES, BY COUNTY, % 0.6% 0.4% 1.2% 0.2% 1.3% 0.5% State Total: 0.5% 0.6% 0.3% 0.3% 0.3% Source: Massachusetts School Immunization Surveys 2015 religious and medical exemptions combined 3.3% 1.4% %

14 SCHOOL VACCINATION AND EXEMPTION RATES POSTED Rates posted for , and school years for Childcare/preschools Kindergarten 7 th grade Rates for colleges should be posted soon Schools with <30 children do not have rates posted Schools that did not respond to the survey are indicated 14

15 SCHOOL VACCINATION AND EXEMPTION RATES POSTED click on School Immunizations 15

16 IMMUNIZATIONS AND INTERNATIONAL STUDENTS School immunization requirements apply to any individual from another country attending or visiting classes or educational programs as part of a formal academic visitation or exchange program. 16

17 RESOURCES: IMMUNIZATIONS AND INTERNATIONAL STUDENTS Resources for interpreting foreign vaccine records: CDC s Pink Book Appendix B: Foreign Language Terms inkbook/downloads/appendices/b/fo reign-products-tables.pdf ACIP General Recommendations Section titled Persons Vaccinated Outside the United States (pg. 27) rr6002.pdf Immunization Program

18 VACCINE CONFIDENCE AND WAYS TO ENHANCE VACCINE CONFIDENCE IN YOUR PRACTICE 18

19 VACCINE CONFIDENCE Choice of term vaccine confidence instead of vaccine hesitancy Confidence amount/level of trust In the recommended immunizations In the provider(s) who administer vaccines In the process that leads to vaccine licensure and the recommended vaccination schedule More confident = less hesitant National Vaccine Advisory Committee, Assessing the State of Vaccine Confidence in the United States: Recommendations from the National Vaccine Advisory Committee, December Report found at: 19

20 Vaccine Confidence used to look a lot like this 20

21 But recently, we have seen some shifting 21

22 SO, WHAT S HAPPENING? Disease outbreaks Pertussis Measles Mumps Meningococcal disease outbreaks at college campuses EV-D68 Ebola More, different vaccine voices Parent advocacy groups in favor of vaccines Social Media platform Andrew Wakefield 1998 MMR-Autism Study discredited Fully retracted Only looked at kids displaying signs of autism More than 20 studies after looked at the connection and showed no link between MMR and autism 22

23 RECENT MEDSCAPE ARTICLE ON VACCINE ACCEPTANCE Medscape Vaccine Acceptance Report 2016, Susan B. Yox, RN, EdD; Laura A. Stokowski, RN, MS July 27,

24 WHY MORE ACCEPTANCE? Last year was 33% Medscape Vaccine Acceptance Report 2016, Susan B. Yox, RN, EdD; Laura A. Stokowski, RN, MS July 27,

25 MAJORITY OF PEOPLE VACCINATE ON RECOMMENDED SCHEDULE 25

26 VACCINATION COVERAGE IN THE US Proportion of kids nationally with no vaccine doses is 0.8% (this has been consistent over time). Indication of generally high vaccine acceptance NIS data showed 26% in 2009 delayed 1 or more vaccines, which went up from 22% in Indication of lacking vaccine confidence 1) MMWR, August 28, 2015, Vol. 64, No. 33, ) NVAC, Assessing the State of Vaccine Confidence in the United State: Recommendations from NVAC, November-December 2015,

27 VERY FEW US TODDLERS HAVE RECEIVED NO VACCINES AT ALL Source: National Immunization Survey 27

28 USING SCHOOL DATA TO INCREASE VACCINE CONFIDENCE Look up your school s immunization rates Fortunate to live in an area of high imm. rates However, there can still be pockets of un or underimmunized children Need to keep high rates to protect kids Be an advocate! Our area may be susceptible to VPD and outbreaks Important to vaccinate your child on rec d immunization schedule Please tell your friends Be an advocate! 28

29 IMMUNIZATION A COMPLEX COMMUNICATION ENVIRONMENT Low disease awareness = increased focus on vaccine risks Low tolerance for vaccine risks Full and complicated immunization schedule Time is often limited Many places to find and get information 29

30 BACKGROUND Delay and/or refusal of vaccines can put individuals and communities at risk of vaccine-preventable diseases. The health care provider is parents most commonly cited source of vaccine information.1,2 Many parents also often report obtaining vaccine information from sources other than health care providers, such as family, friends, and online sources.1 1 Brunson EK. The impact of social networks on parents' vaccination decisions. Pediatrics. 2013;131(5):e Smith PJ, Kennedy AM, Wooten K, Gust DA, Pickering LK. Association between health care providers' influence on parents who have concerns about vaccine safety and vaccination coverage. Pediatrics. 2006;118(5):e

31 QUANTITATIVE AND QUALITATIVE RESEARCH SHOW Most parents are generally confident in: The safety of vaccines The effectiveness of vaccines The benefits of vaccines The number of vaccines their child gets in the first 2 years of life But, they may still be anxious about shot visits About 25% of parents report having at least a little anxiety And, they may still have questions Questions may not be the same as concerns Questions and concerns may vary by disease and vaccine Just because they have questions does NOT mean they won t vaccinate.

32 INCREASED REQUESTS FOR CHANGES IN RECOMMENDED IMMUNIZATION SCHEDULE In one national study conducted in 2012, 93% of pediatricians and family physicians received a request to alter the ACIP immunization schedule. While most people are accepting the recommended immunization schedule, providers spend more time discussing the benefits of immunizations. Kempe, Allison et al., Physician Response to Parental Requests to Spread Out the Recommended Vaccine Schedule, Pediatrics Volume 135, Number 4, April 2015:

33 FIRST TIME MOTHERS ARTICLE Article focused on how first time mothers decide or intend to decide to vaccinate their child 75% planned to have their child receive all vaccinations at recommended time. BUT: 63.5% of first time expectant mothers said they had not received any information on childhood vaccines from their obstetrician/gynecologist (OB/GYN) or midwife. Those who were planning to delay or who were undecided relied primarily on socially available information sources (such as the Internet) rather than a healthcare professional. Possible outreach: Improved access to vaccine information from birth health professionals could foster better vaccine - related knowledge 33

34 In the past month, what were your 3 most important sources of information about childhood vaccines? Internet search engine (Google, Yahoo) % In the past month, what were your 3 most important sources of information about childhood vaccines? 36.0 Internet social media (e.g., Facebook, Twitter, message boards) % Acceptors (Mothers who said their child would receive all vaccines as recommended) 4.5 #1 32.7% Family 27.0 Internet news sites 3.5 My healthcare professional (such as a primary care professional or OB/GYN) Online pregnancy or parenting site (e.g., BabyCenter or The Bump) 22.5 Parenting blogs Apps (for smartphones or tablets) 3.0 #2 26.7% Friends 17.0 Other source(s) (not Internet) 2.5 Internet health site 13.5 Traditional media (such as television, newspapers, radio, magazines, and books) 1.5 My child s doctor 9.5 Other Internet sources 1.5 My child s other parent 7.5 My child s nurse 1.0 Complementary healthcare professional (such as chiropractor or homeopath) #3 26.0%

35 In the past month, what were your 3 most important sources of information about childhood vaccines? Internet search engine (Google, Yahoo) % In the past month, what were your 3 most important sources of information about childhood vaccines? 36.0 Internet social media (e.g., Facebook, Twitter, message boards) % Delayers/Decliners (Mothers who said they would space out or delay or get some but not all vaccines) 4.5 #1 58.6% Family 27.0 Internet news sites 3.5 My healthcare professional (such as a primary care professional or OB/GYN) Online pregnancy or parenting site (e.g., BabyCenter or The Bump) 22.5 Parenting blogs Apps (for smartphones or tablets) 3.0 #2 34.5% Friends 17.0 Other source(s) (not Internet) 2.5 Internet health site 13.5 Traditional media (such as television, newspapers, radio, magazines, and books) 1.5 My child s doctor 9.5 Other Internet sources 1.5 My child s other parent 7.5 My child s nurse 1.0 Complementary healthcare professional (such as chiropractor or homeopath) #3 31.0%

36 In the past month, what were your 3 most important sources of information about childhood vaccines? Internet search engine (Google, Yahoo) % In the past month, what were your 3 most important sources of information about childhood vaccines? 36.0 Internet social media (e.g., Facebook, Twitter, message boards) % Undecideds (Mothers who said they were unsure about vaccinations) 4.5 #1 28.6% Family 27.0 Internet news sites 3.5 My healthcare professional (such as a primary care professional or OB/GYN) Online pregnancy or parenting site (e.g., BabyCenter or The Bump) 22.5 Parenting blogs Apps (for smartphones or tablets) 3.0 #2 23.8% Friends 17.0 Other source(s) (not Internet) 2.5 Internet health site 13.5 Traditional media (such as television, newspapers, radio, magazines, and books) 1.5 My child s doctor 9.5 Other Internet sources 1.5 #3 19.0% My child s other parent 7.5 My child s nurse 1.0 Complementary Internet health healthcare site tied 1.0 professional with Parenting (such blogs as chiropractor for #3 or homeopath) 36

37 LONGITUDINAL SURVEY: VACCINE INFORMATION SOURCE WH AT ARE THE THREE MOST I MPORTANT SOURCES OF INFORMATION THAT HAVE HELPED YO U MAKE A D EC IS I ON A B O U T YO U R YO U N G EST CHILD S VACC IN ATIO NS? Dr. Judith Weiner Presentation at National Immunization Coalition Conference: Influences on Immunization Decision- Making among U.S. Parents of Young Children: Results from Three Surveys 37

38 TYPES OF VACCINE-HESITANT PARENTS Uninformed but educable Want education to counter anti-vaccine information Misinformed but correctable Need information about vaccine benefits Well-read and open-minded Want to intelligently discuss pros and cons Strongly vaccine-hesitant Willing to listen but not likely to change their mind right away Strong-willed and committed against vaccines Want to sway you to their line of thinking Harrington JW. Consultant Ped. 2011;10(11):S17-S21. Halperin SA. Canadian J CME. 2000;12(1):62-74.

39 WHY VACCINATE? PREVENTS DISEASE In April 2014, CDC estimated that among children born during vaccination will prevent an estimated: 322 million illnesses 21 million hospitalizations 732,000 deaths over the course of their lifetimes Results in a net savings of $295 billion in direct costs and $1.38 trillion in total societal costs. MMWR, April 25, 2014, Vol. 63, No. 16,

40 Median Values MANY PROVIDERS UNDERESTIMATE THE VALUE PARENTS PLACE ON VACCINES Parent Provider's estimate Meningitis Hepatitis Pertussis Influenza HPV Adolescent vaccines Adapted from Healy et al. Vaccine. 2014;32:

41 A FEW TOOLS A strong, routine recommendation is the best indicator if someone will receive a vaccination Use the Presumptive Approach when discussing vaccines We have vaccines to give today to protect against pneumococcal disease, rotavirus, and whooping cough. Your child needs three shots today. We will do them at the end of the visit. 41

42 A FEW TOOLS CONTINUED List the benefits to the community By following the recommended childhood immunization schedule, your child will have protection against protects 14 serious her from vaccine- serious diseases, but protects those who are too young to be vaccinated or people with weakened immune systems and the elderly, who are at risk for serious complications and death. Show the risks of vaccine- Vaccinating your child not only disease preventable diseases by age 2. The success of vaccines means that Talk about individual we don t see benefit a lot of vaccinepreventable diseases anymore, but we have to remember they are very serious. For example, did you know that before the measles vaccine was introduced, there were 3-4 million cases a year, 48,000 people were hospitalized and people died? Measles is highly contagious and not just a little rash. 42

43 HPV COMMUNICATION STRATEGIES Talk about HPV vaccination as cancer prevention! Cancer prevention is important to parents so remind them that HPV vaccination protects against not only cervical cancer but also anal, penile, vaginal, vulvar, and oropharyngeal cancers. Recommend the HPV vaccine the same way and on the same day as other vaccines. Example: Now that your child is 11, they are due for three shots that are really important for all kids their age: HPV, meningococcal, and Tdap. I recommend giving these at the end of the visit today. New MDPH resource found at 43

44 PARTNERSHIPS: IT TAKES A VILLAGE! MAPHN MA Chapter of ACNM Massachusetts Medical Society MA Chapter of ACOG MCAAP Immunization Initiative MDPH Immunization Program MA Adult Immunization Coalition (MAIC) HPV Coalition and Working Group Women, Infants, Children (WIC) MA Chapter of the AAFP School Nurses MA Chapter of the PTA 44

45 ADDRESSING VACCINE CONFIDENCE: PUBLIC/PARENTS Social media campaigns Cervical Health Awareness Month - January National Infant Immunization Week April 16-23, 2016 National Immunization Awareness Month in August National Influenza Vaccination Week one week in December Newsletters and s to partners for target populations Massachusetts Chapter of the PTSA Regional Meetings

46 RESOURCES 46

47 MATERIALS: PROVIDER RESOURCES Understanding Vaccines and Vaccine Safety How Vaccines Work The Recommended Childhood Immunization Schedule Ensuring the Safety of U.S. Vaccines Understanding the Vaccine Adverse Reaction Reporting System Understanding MMR Vaccine Safety Understanding Thimerosal, Mercury, and Vaccine Safety The Advisory Committee on Immunization Practices Diseases and the Vaccines that Prevent Them 14 vaccine-preventable disease sheets, each with 2 versions (one for high-information seeking parents and the other with basic information); Basic sheets are also available in Spanish If You Choose Not to Vaccinate, Understand the Risk and Your Responsibilities 47

48 PROVIDER RESOURCES FOR VACCINE CONVERSATIONS WITH PARENTS Developed with partners AAP and AAFP Targets healthcare professionals Based on formative research Uses risk communication principles Reviewed annually by subject matter experts 48

49 PROVIDER-TARGETED MATERIALS Topics of concern/interest to providers and parents Summary of key points Q&A format Date Co-branded with AAFP and AAP The science

50 PARENT-TARGETED MATERIALS Healthcare professionals requested more plain- language pieces for parents More basic overview of disease and vaccine Most have no story (or an abbreviated version) Clearly shows benefits and risks Available in Spanish and English 50

51 PARENT FRIENDLY RESOURCES

52 PARENT-TARGETED MATERIALS Date Quotes from healthcare professionals VPD risks Current stories from families affected by VPDs Co-branded with AAFP and AAP Vaccine risks and benefits References

53 INFORMATION AND RESOURCES FOR PARENTS AND PROVIDERS Links to CDC, Children s Hospital of Philadelphia (CHOP), American Academy of Pediatrics (AAP), Immunization Action Coalition (IAC) click on Vaccine Safety 53

54 PARENT ADVOCACY GROUPS Dr. Wendy Sue Swanson tlechildrens.org/ 54

55 TAKE AWAY MESSAGES Parents fall along a spectrum; this is not usually an either/or decision Questions and concerns do not always equal lack of confidence; vaccinating is still the norm Doctors and nurses are the most important source of information, but we can t ignore other social influences Reach parents where they are spending time including online Grassroots education and partnerships are key There is no quick fix message 55

56 QUESTIONS? Kathleen Shattuck Assessment Coordinator MDPH Immunization Program ma.us Rebecca Vanucci Immunization Outreach Coordinator MDPH Immunization Program ma.us