Stay on Track Daycare Initiative | Vaccinate Before you Graduate | Vaccinate and Vote | Awards | Healthcare Workers
According to the CDC’s 2003 National Immunization Survey, Virginia's immunization rate for children up to 24 months of age is 84% for the 4:3:1:3:3 series. However, Virginia’s 2003 immunization rate for children up to 24 months enrolled in licensed daycare facilities is only 74% for the 4:3:1:3:3 series. The daycare data is collected annually using the CDC’s Clinical Assessment Software Application (CASA) at a random sample of daycare facilities throughout the state. CASA, a database developed by the CDC’s National Immunization Program, is a nationally used assessment tool for immunization clinics and providers. Keeping updated immunization records is a challenge for many daycare centers. Because of this, the annual CASA assessment data may not be an accurate reflection. Most likely, many of these children are up-to-date with their immunizations. However, the daycare provider may not have the most up-to-date immunization record, which makes the child’s daycare file appear that they are delinquent with immunizations.
The Stay on Track Daycare Initiative is designed to ensure that these children are not only immunized within an appropriate time but also report up-to-date immunization records to their daycare providers. This project was pilot tested by PIV in collaboration with Sentara Healthcare during the 2003-2004 academic year. During the Stay on Track pilot, 17 total daycare centers throughout Hampton Roads (from Virginia Beach, Norfolk, Portsmouth, Hampton and Newport News) were recruited to participate. PIV received consent for 200 children under 24 months to participate in the project. Each daycare center was supplied with a tickler file system, which generated reminders when each child was due for immunizations. The tickler file systems were updated monthly as updated immunization records were returned. Parents received a congratulatory letter and gift bag full of age-appropriate incentive items for compliance. The program results revealed that Stay on Track dramatically improved immunization rates in each center. Immunization rates among children enrolled in the project increased from 32.8% to 71.2% during the 6 months of intervention. However, the daycare staff reported difficulty using the tickler file systems independently. In result, the project has not been sustainable in any of the daycare centers. Currently, the Stay on Track methodology is being revised to conduct blanket education for the entire daycare center rather than attempt to track individual immunization deficiencies for individual children. This model will be retested in 2005.
Adolescents are a population at great risk for many vaccine-preventable diseases. However, the importance of adolescent immunization is often overshadowed by the tremendous concern surrounding childhood and adult immunization. Despite new Virginia legislation requiring certain immunizations, a statewide cohort of adolescents remains unprotected. To address this problem, PIV introduced a Rhode Island born campaign in Virginia called Vaccinate Before You Graduate. This campaign is focused on raising awareness about the importance of adolescent immunization to increase immunization coverage among Virginia’s adolescents through public awareness campaigns, media advocacy, provider education, and collaboration with local and national partners.
PIV initiated the Vaccinate Before You Graduate program during the summer of 2002. Coalition members designed and distributed 250 adolescent immunization resource kits with the goal of supplying immunization providers and immunization advocates with the tools to raise awareness and improve adolescent immunization coverage in their localities across the Commonwealth of Virginia. Kits included materials such as a list of strategies to promote the campaign, tips for using the media, sample letters and brochures, tools for providers, and a list of suggested partners. PIV launched the campaign by creating the first activity statewide, a scholastic partnership with Jostens and Herff Jones (the two largest suppliers of achievement products such as class rings, yearbooks, and graduation announcements) to distribute 40,000 adolescent immunization brochures to parents of Virginia’s high school seniors. In 2003, the Scholastic Partnership was expanded and 98,000 brochures were distributed to parents of high school freshmen, sophomores, juniors, and seniors, and in 2004, an additional 98,000 brochures were sent home.
In 2003, PIV established the first observance of National Adolescent Immunization Awareness Week (September 14-20, 2003). Nationally, immunization advocates observe Infant Immunization Awareness Week, Adult Immunization Awareness Week, and Immunization Awareness Month. Because adolescents are also at great risk for vaccine-preventable diseases, it is only appropriate that the immunization community distinguish a period to recognize the importance of adolescent immunization as well. PIV received a Governor’s Proclamation endorsing Adolescent Week in Virginia. During Adolescent Week, PIV hosted a National Satellite Conference that focused attention on immunization for adolescents. The conference featured national and state-level speakers who discussed the efficacy of updating immunization during adolescence, addressed barriers to adolescent immunization delivery, and provided methods to increase immunization coverage. Over 500 individuals from 43 states across the county participated in this broadcast.
In 2004, PIV recruited 14 Virginia school districts to participate in an initiative to include adolescent immunization messages with report card distribution during the 2004-2005 academic year. Also in September, PIV co-hosted the 6th National Conference on Immunization Coalitions in Norfolk, which took place during Adolescent Week (Sept 19-25, 2004). At the conference, PIV hosted a 90-minute adolescent-focused, skills building workshop entitled “The Nuts & Bolts of Planning Adolescent Initiatives.” This workshop featured a panel of experts presenting information on adolescent recommendations, new vaccines, barriers and strategies to reach adolescents from the school’s perspective, and innovative strategies to engage adolescents as peer educators in the promotion of immunizations. PIV received a Governor’s Proclamation endorsing National Adolescent Immunization Awareness Week in Virginia that was presented during the workshop.
Most adults realize that immunization plays an important role in infant and child health. However, developing effective methods to educate adults about their need to be immunized has proven to be a challenge for many communities. PIV developed a model for empowering at–risk communities to develop strategies for adult immunization outreach services in conjunction with Election Day entitled Vaccinate and Vote. The purpose of this program is to involve the media, local immunization partners, community activists, and community agencies in advocacy and promotion of flu and pneumonia vaccinations for older adults. The project targets seniors ages 65+ who reside and vote in the selected communities.
In 2002, PIV pilot tested Vaccinate and Vote in the City of Hopewell. Hopewell was selected as a pilot sited based on Virginia Health Statistics from the year 2000. The report indicated that Hopewell pneumonia and influenza mortality was ten points higher than the overall state rate. PIV organized a six-week intervention that officially commenced with a Media/Community Forum during National Adult Immunization Awareness Week to engage community leaders and volunteers. On Election Day, Vaccinate and Vote partners and volunteers assembled at the seven polling sites in Hopewell to distribute adult immunization awareness materials and direct voters to a flu/pneumonia clinic at the Community Recreation Center. Collectively, 1500 brochures were distributed among Hopewell voters, and 354 total flu shots were administered during the five-hour flu clinic (70.8/hr). Results indicated that 82% of these individuals were age 50+.
In 2003, PIV expanded Vaccinate and Vote to 6 additional communities. PIV partnered with Virginia’s Quality Improvement Organization to identify zip codes indicating areas where large numbers of Medicare beneficiaries reside. Using this information, PIV then identified the priority zip codes based on flu and pneumonia mortality rates. The selected zip codes were in Roanoke, Roanoke City, Salem, Waynesboro, Staunton, and Richmond City. On Election Day 2003, Salem, Roanoke, and Roanoke City collectively administered 511 free flu shots during a five-hour period (102.2/hr). Survey data, indicated that 67% of individuals who received the influenza shot were age 55+; Staunton and Waynesboro collectively administered 842 total flu shots in a seven-hour period (120.2/hr), of these 66% were to individuals age 50+; and Richmond administered 140 total flu shots in a five-hour period (28/hr), of these, 90% were to individuals age 50+.
For the Presidential Election, PIV received funding from the Robert Wood Johnson Foundation to expand Vaccinate and Vote to 10 communities: Virginia Beach, Newport News, Petersburg, Staunton, Waynesboro, Salem, Roanoke, Fairfax, and two zip codes in Richmond. However, due to the unanticipated decrease in the U.S. flu supply, all Vaccinate and Vote activities will be postponed until the 2005-2006 season.
According to the Centers for Disease Control and Prevention (CDC), the influenza virus resulted in approximately 36,000 deaths and over 200,000 hospitalizations in the United States last year (CDC, Prevention and Control of Influenza, MMWR report July 28, 2006). Approximately 90 percent of these cases were among adults age 65 years and older (National Foundation for Infectious Diseases (NFID), Influenza Immunization Among Healthcare Workers: A Call To Action). Despite these statistics, the CDC reports that only 42% of healthcare professionals receive annual influenza immunizations, which is especially alarming for long term care (LTC) facilities because of the increased vulnerability of residents. Under-immunization of healthcare professionals against influenza poses a detrimental risk for residents, affects the quality of patient care, and causes an unnecessary financial burden. Immunizing your staff provides cost savings in terms of doctor visits, hospitalizations, and lost time at work.
Effective January 1, 2007, The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will require accredited institutions to implement an infection control standard that offers influenza vaccination to healthcare personnel with close patient contact. Project Immunize Virginia (PIV), the statewide immunization coalition is challenging all LTC facilities (even those not accredited by JCAHO) to increase the number of healthcare personnel who receive annual influenza immunizations. PIV would like you to be aware that increasing the rates within your facility is not only relatively simple, but also extremely cost-effective. While contracting influenza may be a mere inconvenience for some, it may be deadly for those at high-risk.
The following are a list of resources to help organizations increase influenza immunization rates in healthcare personnel:
For details:
Phone: (757) 668 6435
Email: CarltoCA@evms.edu
Project Immunize Virginia | Division of Community Health and Research, Eastern Virginia Medical School | 855 West Brambleton Avenue | Norfolk,VA 23510