From April 22-29, 2017, 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. Throughout this week, NACCHO will focus attention on the benefits of maintaining high immunization rates at the community level. We sat down with Carolyn Cook, RN, MSN, Public Health Nurse at Tacoma-Pierce County Health Department, to discuss the importance of infant immunization and the critical role of LHDs in promoting and providing infant vaccinations.
In 2011, the Centers for Disease Control and Prevention named vaccine-preventable diseases as one of ten great public health achievements of the preceding decade. Yet in the last few years, the nation has seen a re-emergence of VPDs (e.g., measles, mumps, pertussis, diphtheria). In your experience, what factors are contributing to this resurgence?
For one, our nation has increased access to a wide variety of opinions, information, and stories – some of which have connected vaccines to negative health outcomes – and a decreased ability to filter through that information to determine its validity and credibility. The proliferation of stories that aim to discredit vaccines has shifted the perception of danger and risk from the vaccine-preventable disease to the vaccine itself. Plus, there aren’t many recent examples of the damage VPD outbreaks can cause, fostering the perception that these diseases aren’t that dangerous and parents don’t need to be concerned about children contracting them. What people are failing to realize is that the lack of large-scale outbreaks is a direct result of the diseases not being spread due to a well-immunized population.
As VPDs re-emerge, what risks might unvaccinated infants and toddlers face?
Depending on the disease, the risks of failing to vaccinate can range from serious health complications to death. While it’s true that we can minimize VPD outbreaks if there are enough people in a community who are fully immunized, we cannot prevent individuals within that community from contracting a VPD. This means that infants and toddlers who are not vaccinated remain vulnerable to dangerous and potentially life-threatening health outcomes, and that vulnerability only increases with age. An unvaccinated infant could, theoretically, remain in good health due to community immunity. But as that child grows older and begins interacting with more people, there are unforeseen long-term risks for his or her health, especially if the child travels internationally.
For these reasons, when we encounter parents who are opposed to vaccination despite vaccine-positive recommendations from providers, our health department, as recommended by the CDC, encourages the parents to take certain precautions. For example, we recommend evaluating the risks of all travel, particularly international; informing all of the child’s healthcare providers that they are unvaccinated; practicing diligence in keeping the unvaccinated child away from others who may be sick; and, communicating with the LHD to stay apprised of any current or emerging communicable disease outbreaks.
How is Tacoma-Pierce County Health Department working to promote infant immunization and mitigate the risks of failing to vaccinate?
As a Department we partner with our community to assure that people have access to immunizations rather than provide them directly. Our Department nurses meet regularly with community providers to support evidence-based interventions to increase vaccination coverage. We also partner with a local health system to conduct walk-in immunization clinics and work with our local Medical Reserve Corps to conduct school based flu clinics. These clinics also help protect infants, who can’t receive the flu vaccine until six months of age, by making sure their siblings are vaccinated. We also focus on effective communication planning to make best use of various media to promote immunizations to the community. Finally, our “Positive Parents Group” is an initiative that enlists pro-vaccine parents to champion immunization in the community, to the media, and to legislators.
We are a member of the Pierce County Immunization Coalition (PCIC), whose other members include local pediatricians and family medicine physicians, community pharmacies, schools, the state health department, and large medical organizations. Through community education for providers, nurses and the general public, the PCIC raises awareness of VPDs and equips community members to identify and voice vaccine-related concerns to local legislators.
Beyond education, PCIC is working to develop sustainable ways to ensure all children are well-immunized. For example, we have an initiative that connects community members with healthcare providers who will serve uninsured, underinsured, or families who do not have a provider. All children can receive vaccines at no charge to parents.
Which of those efforts have been most effective in influencing parents vaccinate their infants?
In many cases, a positive recommendation from the child’s physician or provider is the most critical determinant in infants getting fully immunized. That means provider education is critical because it equips them with the most accurate information and helps communicate effectively with parents about vaccines. Being fully educated about vaccines as a means of preventing illness is just as important as being fully educated and equipped to administer care to sick patients.
In promoting infant immunizations, where do considerations around social determinants of health and cultural competency become relevant?
Social determinants of health are very relevant to the context of vaccinations. In the same way public health is engaged in issues such as green space and stable housing, we must be working to address access to vaccinations. Right now, our health department is kicking off a program that assesses whether changing some aspects in a community can improve health outcomes in that community. One aspect of that is preventing influenza in at-risk communities. We will be providing in school flu vaccination at no charge to parents.
With the uncertainties surrounding public health funding under the current Administration, how can LHDs prepare to continue providing critical preventive services such as childhood immunizations?
Our focus has to shift to sustainability. Partnerships are going to be key so we can continue connecting children who don’t have stable healthcare access to private providers. There are so many people who don’t have access to care, for a variety of reasons, and local public health is well-positioned to make connections between the community and healthcare providers who can fill gaps. Further, we need to help build and strengthen relationships between schools and private healthcare providers, so that in the case of large-scale outbreaks where we need to immunize large numbers of children at once (e.g., H1N1), the pathways and connections already exist and we can more easily mobilize immunization for all children in our community.
NACCHO is pleased to support LHDs like Tacoma-Pierce County as they work to increase vaccination coverage across the lifespan. We’d also like to congratulate two local public health professionals, JoAnn Rupiper, MPH, BSN, Employee Health Nurse, Southern Nevada Health District and Cynthia Modie, MEd, RN, Director of Community Health, Lorain County General Health District, for being named 2017 CDC Childhood Immunization Champions! Their 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.