Throughout the month of August, NACCHO’s National Immunization Awareness Month (NIAM) Blog Series will highlight the importance of immunizations across the lifespan. In this Q&A, Carrie Harter, MPH, Director of Disease Control at the Florida Department of Health in Manatee County (DOH-Manatee), discusses the importance of immunizations during pregnancy and the role of local health departments (LHDs) in improving immunization rates among this population.
Tell us a little bit about your local health department’s maternal immunization initiatives and why maternal vaccination is such an important public health priority.
Within the last few months, the Department of Health in Manatee County has begun to assemble an immunization coalition for our county called IMPACT: Immunizing Manatee’s Population against Communicable Transmissions. Our focus with IMPACT is immunizing across the lifespan. We want to touch on all aspects of a person’s health and well-being from childhood onto adulthood, while making sure that the residents of Manatee County, as well as our healthcare providers, really understand that pregnancy is a special time where there are opportunities for vaccination.
On a personal level, these public health initiatives are important to me because I have two children. Going through those pregnancies, I was fortunate to work in public health and understand the importance of immunization in protecting both the mom and baby. Providers don’t always talk about those things – I know mine didn’t – but having that knowledge empowered me to understand the importance of getting my flu shot during pregnancy and seeking out the Tdap vaccine during the third trimester. Through that experience, I recognized the opportunity for LHDs to play a key role in 1) educating pregnant women and empowering good public health choices, and 2) reminding providers that they are a trusted source of information for pregnant women. If providers give immunization recommendations, these women and families are going to listen, and LHDs are well-positioned to make that connection.
Under the framework of Public Health 3.0, local health departments are shifting to the role of the chief community health strategist and serving increasingly as conveners rather than service providers. How is your local health department working to create cross-sector partnerships to ensure immunization across the lifespan, including during pregnancy?
At DOH-Manatee, we take every opportunity available to build and continue partnerships throughout our community, whether it’s with healthcare providers or other organizations who may be working directly with the public. I had the opportunity to present at the local chapter of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), which brought together a variety of providers – nurses, obstetricians, residents, and pediatricians – from both Sarasota and Manatee counties. This gave me the platform to talk about what public health would recommend for vaccines during pregnancy. We had a good discussion and open dialogue around the importance of the flu shot during pregnancy and Tdap in the third trimester, as well as vaccines that aren’t recommended. Having that opportunity to liaise and network with our providers ensures that we have the opportunity to be proactive, instead of reactive, with these women and families.
Additionally, we had a representative from the FDOH state office in Tallahassee come to major birthing hospitals within the state, including one local hospital. They took the opportunity to look through charts to see if there was any documentation on Tdap in the third trimester for pregnant women, and of the 60+ charts that were reviewed, they didn’t find one mention of Tdap. We saw this as a great opportunity within the Department of Health to once again reach out to the obstetrician network. Manatee County is fairly small with a population of about 350,000, so we only have two hospitals that deliver babies. We strategized and decided to develop a brief brochure to bring to providers to let them know the recommendations, as well as let them know that these services are offered at the health department. The services are on a sliding scale, so many women would qualify to receive vaccines for free. The feedback that we hear from providers about immunization is that vaccines may be expensive for them to maintain and supply. We want everyone to know that at the health department, we offer those services and are welcoming women. We’ve seen this as an opportunity to identify that gap and fill the void with our services.
Our recent work focusing on immunizations in pregnant women through serving as a community health strategist is just a small portion of the work DOH-Manatee has been doing for several years through cross-sector partnerships. The health department is a member of the Manatee Healthcare Alliance (MHA), which is a coalition representing government, health care providers, social service organizations, and individuals committed to improving the health and well-being of all Manatee County residents. The MHA, with direct support from DOH-Manatee, facilitated the creation of Manatee County’s Community Health Assessment and the subsequent development of the Community Health Improvement Plan. Through a collaborative effort, our partners identified several health priority areas including teen pregnancy and infant mortality. The health department works closely with Manatee County’s Zero-to-Five Coalition, Healthy Start Coalition, and the Teen Pregnancy Prevention Committee to guide the action plans addressing these health priorities.
One of the ways that Manatee County is leveraging partnerships to increase immunization is through the newly-formed Immunization Coalition. What are the coalition’s objectives and what’s your health department’s role in achieving those?
The coalition started in May and is still in the growing and recruitment phase. Our vision is a bold one, but we aim to be able to eliminate preventable diseases through accessible immunizations for Manatee County residents. We are fortunate to be part of Florida’s integrated health system, and while we know that the health department certainly can’t do this alone, we want to lead the charge. Our mission is to establish a network of stakeholders to promote education of immunizations across the lifespan of Manatee County residents. With guidance from state, federal, and national partners (e.g., Bureau of Immunization in Tallahassee, the CDC, and NACCHO), our goals are to create and maintain community partnerships and develop a universal pro-vaccination message. There are a lot of different interpretations and messaging circulating, so we want to be that voice to get everyone on the same page of the importance and 
safety of vaccines. Hopefully, we can help eliminate vaccine hesitancies and educate residents of our county. Knowing that we’re trying to reach such a broad scope of stakeholders from pregnant women all the way up to the elderly, we also plan to establish workgroups with representation from daycares, after-school programs, all of our providers, and long-term care facilities. The health department aims to be the lead player in bringing these people together. One way we’ve reached out to key partners was through a presentation on IMPACT to the MHA. The presentation highlighted our vision and mission and also reviewed immunization data for the county. The MHA members were immediately engaged. We were able to increase our membership and started discussions on strategies to improve immunization rates in all age groups.
What recommendations do you have for building relationships and establishing sustainable partnerships with local chapters of public health and medical associations, such as the Association of Women’s Health, Obstetric and Neonatal Nurses?
Partnerships go both ways. It’s important to make yourself accessible when partners, or potential partners, are seeking out presentations or recommendations, and attend meetings when possible. Don’t only look for opportunities to come into their space to talk, but also touch base and try participating as a member, as well. For example, DOH-Manatee is a member of the local medical society. We have a page in their quarterly magazine devoted to public health messaging. It has been an effective way to maintain a partnership with medical providers while having a trusted platform to share our message. Additionally, staying engaged with AWHONN has afforded me the opportunity to be invited back just this year to talk to the same chapter about Zika in pregnancy. While there isn’t currently a vaccine, we’re hoping to move forward in that development, and it’s still an important topic for the group to understand where we’re at with Zika and pregnancy. Having that ongoing relationship can make your LHD a trusted source for multiple public health messages.
At NACCHO Annual 2017, much of the conversation focused on bridging the gap between public health and clinical medicine. How can LHDs and clinical providers work together to educate communities and increase vaccine confidence, especially among pregnant women?
I think it’s important to be that trusted voice. We want to make sure that, from the public health standpoint, our message is accurate and easy to understand. Working directly with our healthcare community, we know that we often speak the same language, but trying to turn that message into something the general public can understand takes some thought. Having frequent opportunities to convene leaders of healthcare organizations, public health, and other community stakeholders with a consistent, accurate voice builds trust and then lends itself to a partnership where everyone can work together. One way DOH-Manatee does this is by working closely with the nursing schools and local college for osteopathic medicine. We conduct presentations on public health priorities and even have the students shadow and work clinical rotations within the health department for exposure to community health. In addition to partnering directly with clinical providers, we also strive to work directly with Manatee County residents whenever possible. For example, I attended a hospital’s mommy-baby program to lead an informal conversation about immunizations for babies. The invitation to speak came from a nurse who I’d previously connected with for a presentation on immunizations for pregnant women. The moms had a lot of great questions about what they’ve heard about the flu shot, knowing that children under six months can’t get it and if it’s really important for the mom to now get it. These more casual interactions can stem from more formal presentations and are great opportunities to demonstrate the value of local health departments. Any opportunity that you’re provided is important to take. You might just be reaching a small subgroup, but hopefully, they’re sharing that information with their peers and it will lead to an entire network or community having the correct information and a strong public health message.
NACCHO is pleased to support local health departments in their participation of NIAM. Click here to find resources that can be utilized by your local health department, and be sure to check out our previous posts in the NIAM Blog Series:
- Breaking Down Barriers to Access to Increase Immunization Rates
- Increasing Adult Immunizations through Education and Outreach
- Turning the Tide on HPV Vaccination Rates
- Increasing Immunization through School-Located Clinics
For more information about vaccines for pregnant women, check out these resources from the Centers for Disease Control and Prevention:
