One of the most significant public health achievements has been a reduction in the incidence of vaccine-preventable diseases. However, because immunization rates are at an all-time high, and disease rates are low, many parents have not seen the deadly diseases that once took the lives of so many children, or left them with debilitating after-effects. Consequently, parents have begun to focus on concerns about vaccine side effects and safety issues. Some parents are choosing not to vaccinate their children, depending on herd immunity for protection. Unfortunately, when vaccination rates decrease, disease incidence begins to climb. Unvaccinated children become susceptible hosts and herd immunity can be lost. An example of this is the decline in MMR vaccination in Great Britain , due to a much publicized and flawed study, which linked the vaccine to autism. Although the majority of the authors of this study have partially retracted their interpretation of this link, the damage has been done, and many parents have refused to vaccinate their children for measles. Great Britain has been experiencing outbreaks of measles and is in danger of losing their herd immunity. This points out a new focus in our immunization program. Public health nurses must be aware of resources to educate parents and providers, and must be able to spend time on addressing parental concerns. As a result, public health nurses in our districts have been attending immunization updates and the annual four-part “Epidemiology and Prevention of Vaccine-preventable Disease Course provided by the CDC.
The Alleghany Health District is an active participants in the local immunization coalition CBIP – Community Based Immunization Project. This is a public/private partnership, consisting of local health-related groups and service agencies, which works to improve the immunization status of children, adolescents and adults. CBIP , initiated in 1994, has sponsored free clinics, developed and promoted educational materials, assisted in immunization assessments in private provider offices, and participated in many immunization awareness activities. This local coalition is a member of the statewide coalition, ( PIV ) Project Immunize Virginia . CBIP members have in the past and are currently serving in leadership positions in the statewide coalition. One of the recent CBIP activities included providing educational presentations with CNE credits to seven local immunization providers. This PowerPoint presentation called “Vaccines: What’s New…What’s News” was well received. CBIP also supplied the providers with resource manuals, “pink books,” schedule posters and schedule bookmarks.
CBIP also sponsored “Vaccinate and Vote.” This campaign was a PIV sponsored/funded initiative designed to promote flu and pneumonia vaccination in the older adult population in the Roanoke and Salem localities. These areas were targeted because their influenza rates exceeded the state averages for the previous season. Election Day provided a unique link for vaccine promotion. CBIP collaborated with community volunteers to staff 27 polling sites in the targeted zip code areas. These volunteers distributed flu and pneumonia educational materials, and mini flyers with maps and information about the planned free flu clinic. Over one thousand educational brochures were distributed at polling sites. Over 500 hundred free flu vaccinations were administered. Over half of the recipients were in the highest risk group. This collaborative effort of community volunteers, students, health departments and immunization coalition members served an important role in increasing awareness of a significant health problem in our region. Site selection helped us to reach an under vaccinated population and our agency was able to consolidate staff to efficiently distribute a large portion of our influenza vaccine supply. A mass clinic such as this was also a valuable operational exercise for emergency preparedness.
For National Infant Immunization Awareness Week, 2004, CBIP designed and distributed schedule posters and immunization schedule bookmarks to licensed daycares and immunization providers in both Alleghany and Roanoke Health Districts.
CBIP is also addressing the need of adolescent immunization awareness by a PIV initiative called TRIP (Teen Report Card Immunization Project). School administration will be solicited to participate in this effort to communicate immunization messages to high school students and their parents through report card distribution. Volunteers will affix an informational sticker on the back of the report card envelope. The goal is to improve immunization coverage among Virginia ’s adolescents by increasing awareness at the local level.
When new information about vaccine preventable diseases emerges, public health staff is usually in the forefront with providing education. This was the case with meningococcal meningitis and the increased risk in college freshmen. The Alleghany Health Department sent educational brochures and letters about new legislation to the high schools for report card distribution to high school seniors.
Hepatitis B vaccination catch-up for middle school children and subsequent new legislation was anticipated, and our health district was preemptive in our actions by initiating in-school vaccination and educational programs. Since 1998, Roanoke City Health Department completed the series of hepatitis B vaccination in planned school clinics for over 2,600 children. Public health nurses in both Roanoke City and Alleghany health districts have spent many hours collaborating with School Nurses to ensure that all children entering sixth grade are appropriately immunized for Hepatitis B.
Immunization clinics are an integral part of our immunization services and our health district strives to meet our customer needs for expert delivery, varied cultural and language requirements and after hours vaccination opportunities. Customer surveys and patient flow analyses assist staff to improve our practices. In order to assess the success of our interventions, we collect data using a tool called CASA (Clinic Assessment Software Application). This is a menu-driven relational database developed by the National Immunization Program, CDC. The data assists us to plan activities to increase immunization rates in our localities. The 2010 national goal is 90 percent coverage, at 24 months of age, for each of the following vaccines: DTP4 , Polio3 , MMR1 , HIB3 , HepB3 , and VZV1 . Rates for both districts range from 46-91 percent for this series, compared with 67.9-73.6 percent statewide. Included in our assessment activities is compliance with state requirements for school and daycare entry. Assistance is provided to daycares that wish to set up “tickler files” for reminder and recall. Data gathered locally is also used for state and national statistics and “Vaccines for Children” funding.
Many travelers in our area are referred to our clinics for travel advice and vaccinations. Itineraries can be very complex and require extensive consultation time. Salem and Roanoke City are Yellow Fever Vaccination Centers.
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