National Infant Immunization Week: Q&A with Houston Health Department

From April 21-28, 2018, local health departments (LHDs) across the nation will celebrate National Infant Immunization Week (NIIW). Established in 1994, NIIW is an opportunity to highlight the importance of protecting infants from vaccine-preventable diseases (VPDs) and celebrate the achievements of immunization programs in promoting healthy communities. To celebrate this important awareness event, NACCHO sat down with LaTasha Hinckson Callis, Administration Manager in the Immunization Bureau of Houston Health Department, to discuss the importance of infant immunization and the critical role of LHDs in promoting and providing infant vaccinations.

How is Houston Health Department working to promote infant immunization and mitigate the risks of failing to vaccinate? The Houston Health Department (HHD) works to promote infant immunizations in a variety of ways to ensure we protect the communities we serve. We partner with local community organizations, churches, birthing hospitals and businesses to promote vaccine-preventable disease awareness among staff and clients. We spend a substantial amount of time providing detailed information about vaccine-preventable diseases—signs, symptoms, causes, transmission and prevention—through the distribution of printed materials at health fairs and participating in community presentations. We also use personal stories to promote infant immunizations in a way that brings awareness to the real risks a family may face for failing to vaccinate. A partnership through the Women, Infants and Children (WIC) program allows even more reach where we conduct activities throughout the year to engage parents and bring about awareness to the importance of childhood vaccination.

What challenges do you face in doing this work? Limited resources is one, but I’m sure I’m not alone on that front. I am constantly amazed by what we’re able to accomplish with our limited resources, but that speaks to the passion and dedication of our staff.  Aside from that, Texas has seen an increase in anti-vaccine sentiments with efforts to pass anti-vaccine legislation and elect anti-vaccine advocates—Andrew Wakefield himself resides in Texas. Despite those efforts, most of the population understand the benefits of vaccines and we work closely with our partners, remaining diligent in promoting infant immunizations.

Despite those challenges, where have you found successes in increasing rates of infant and childhood immunization? The citizens of Houston and Harris County depend on us to provide immunization services like vaccination and education so we find creative ways to increase our reach. One example of that is our partnership with non-traditional organizations to promote flu vaccination. We provided educational materials to car dealerships, gyms, coffee shops and other high-traffic businesses to increase visibility of positive immunization messaging. Houston is the fourth largest city in the nation so there is a limited number of people our staff can realistically reach, but by leveraging our partners and community, we accomplish so much more.

We also assess the immunization records at childcare facilities and share coverage rates with their staff, while educating them on vaccine-preventable diseases and techniques for record screening. The training encourages and empowers them to share information with parents to increase infant immunization rates within their facilities. Childcare facilities in our area have high overall infant immunization rates—this intervention allows HHD to monitor coverage rates across our area to work in preventing vaccine-preventable disease outbreaks.

How have you used partnerships to increase the number of infant vaccinations provided in your community? We are only as strong as our partnerships and we appreciate each one of them! While we always promote medical homes, we understand access to care issues persist and therefore partner with immunization mobile units. There are six large mobile units that provide immunizations to the citizens of Houston and Harris County—you can find them on any given day at local WIC sites, libraries, schools, churches and community organizations. We even spearheaded a project a few years ago in partnership with the mobile units to identify the zip codes in which they were providing services. We then analyzed the data and used it to direct them to the communities that had been overlook or were underserved.

Aside from mobile units we partner continuously with Vaccines for Children (VFC) providers to promote vaccine inventory management and proper storage and handling to ensure that the community have access to viable and potent vaccines through education, training, unannounced and compliance visits.

How and why does the Houston Health Department encourage parents and healthcare providers to enter all vaccinations into the immunization registry, ImmTrac2, starting as early as infancy? As the entire world now knows, Houston floods. As a result of Hurricane Harvey, many families experienced flooded homes and lost important documents including immunization records. Individuals who were starting school, a new job, or who had concerns about their potential exposure to vaccine-preventable diseases were in a panic—they lost that piece of paper and their peace of mind. ImmTrac2 helps to mitigate those risks, but Texas is one of a handful of states that has an opt-in Registry, so making it relatable is important. By connecting the dots and explaining how ImmTrac2 helps families keep track of important immunization records is one way we make parents aware of the benefits and encourage them to provide consent for their children to be included in the system.

The process starts at birth, which is why HHD works with birthing hospitals promoting Hepatitis B vaccination, education on receiving ImmTrac2 consent from patients, and proper documentation of the birth dose in the registry. ImmTrac2 is a great resource for healthcare providers as well, but it is only as good as the data that is entered. For this reason, HHD promotes ImmTrac2 usage by conducting outreach and educational trainings to providers. ImmTrac2 outreach specialists stress the importance of entering not only doses administered, but any historical doses that may be missing from the system. We walk providers through the steps on how to access the system and make it work for them through use of the Vaccine Forecaster tool and reminder/recall letters, for example.

In promoting infant immunizations, where do considerations around social determinants of health and cultural competency become relevant? In our city we face a variety of issues. Vaccine hesitancy, religious, cultural and personal beliefs, access to care, financial factors and more. Understanding the effects cultural competency and social determinants of health have on infant immunization is essential to increasing overall coverage rates. We tailor our messaging to fit our audience while keeping the underlying message constant: vaccines are safe and effective and the best protection for a child is vaccinating on time, every time.

Project Milestone participants

Project Milestone, an HHD program created in the early 2000s, was initiated in response to low infant immunization rates after determining high disparities of coverage among low-income populations in Houston. Still in existence today, HHD’s immunization program works in partnership with HHD WIC and Health Centers to increase infant immunization coverage rates. An immunization navigator, placed at each site, provides client referrals to human service needs to remove barriers to immunization. Following referral, the navigator screens client immunization records to identify vaccines past due/coming due, conducts reminder and recall activities, promotes the use of immunization information systems, and educates parents on the importance of timely vaccination. Social determinants of health and cultural competency are relevant every day while implementing this project and our staff keep that top of mind to protect infants against 14 vaccine-preventable diseases by age 24 months.

Many people underestimate the seriousness of vaccine-preventable diseases, which can have serious health consequences. Why do you think that is? Vaccines are a victim of their own success and that has unfortunately caused some people to become complacent. Smallpox has been eradicated, polio eliminated from the U.S., and the incidence of many vaccine-preventable diseases has decreased by more than 90%. Many people have never known anyone who contracted a vaccine-preventable disease or even heard a story of a family member or otherwise that lost a loved one because of it – they don’t see a risk so their perception is that the risk does not exist. But that’s where we come in as healthcare providers and public health workers—we must find ways to take those messages to the public so they are aware. By and large, people see the benefits of vaccination, but without a strong recommendation or access to the information many families remain at risk.

What would you say to those parents/guardians who are not confident in the safety of vaccines or are hesitant to vaccinate their infants? It is so important to keep the lines of communication open with vaccine hesitant parents. Most times they are simply seeking support and honest dialogue. A great way to do this is by using Allison Singer’s CASE Method (Corroborate, About Me, Science and Explain/Advise) to help them understand the importance of vaccination:

  • First, corroborate and acknowledge their concern in a respectful way—”I understand as a parent/guardian you want to do what’s best for your child, like wanting them to be free from preventable diseases—that’s why it’s so important to vaccinate.”
  • Second, talk about your knowledge and expertise—”I have dedicated over 10 years of my career to immunizations and I’m committed to improving the health of children through vaccination.”
  • Third, share the science with them by either handing them a Vaccine Information Statement to review, resources from the CDC website describing vaccine safety, or links to reliable web sites.
  • Fourth, explain/advise—“I myself am fully vaccinated and ensure the same for everyone in my family to protect against these potentially deadly diseases; that’s why I recommend these vaccines for your child.”

NACCHO is pleased to support LHDs like Houston Health Department as they work to increase vaccination coverage across the lifespan. We’d also like to congratulate Bethany Bjorklund, RN, Immunization Nurse at Cerro Gordo County Department of Public Health in Mason City, IA, for being named a 2018 CDC Childhood Immunization Champion! Bethany’s excellent work is a reflection of local public health’s commitment to advancing childhood immunization. Learn more about NIIW and how your LHD can get involved.

About Kim Rodgers

Kim Rodgers serves as a Communications Specialist at NACCHO. Her work includes promoting local health departments' best practices, as well as partner tools and resources, in infectious disease and preparedness through NACCHO's communications channels, storytelling, and outreach to various audiences.

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