Posts Tagged ‘vaccination’

Studying Vaccine Choice

January 25th, 2013

As I mentioned in a blog post a few weeks ago, more AZ parents are choosing not to vaccinate their kids- and using “personal exemptions” when they enroll their kids in school.  If the trend continues, we could jeopardize our immunization rates enough so that we’d see long gone diseases like measles and mumps return in AZ.  In order to figure out why more parents are making this choice, we asked Dr.’s Ernst & Jacobs at the UA’s College of Public Health to look into the “who, what, when, where and why” of this trend toward more personal belief exemptions.  I talked about the where exemptions are more common in my earlier blog, but now we have a better idea of why those rates have been growing – convenience, fear and recordkeeping.

One of the key tasks we asked the UA to look into is why more and more parents are choosing not to vaccinate their kids.  During town hall sessions with parents whose kids attended schools with high exemption rates… 62% of exempting parents said they had heard of someone who had a reaction to a vaccine. Parents who chose exemptions were concerned with the possible side-effects of immunizations and didn’t always trust information provided by the government and pharmaceutical companies.  A statewide survey of 131 clinicians found the main reasons parents refuse or delay immunizations is the unfounded fear their child will suffer long-term consequences from vaccine side-effects. The doctors cited personal conversations with parents as the most effective tool in educating parents about vaccines.

The studies done by the UA include recommendations about how to overcome some of the issues…  but much of it boils down to better education about vaccinations. Our Immunization Program website includes the findings and recommendations from the UA study.  I’ve also asked our immunization and maternal and child health teams to examine this new data and provide me with some intervention recommendations moving forward.

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Influenza Still Increasing in AZ

January 25th, 2013

Yesterday afternoon’s weekly flu report shows that influenza is still circulating widely in AZ…  with a steep increase in the last couple of weeks.  The strain that’s circulating is mostly Type A - H3N2 which can be more severe than the 2009 H1N1, especially for seniors. There are plenty of B strains going around too.  But you can still find a vaccine through Stop the Spread AZ – just be sure to call the place first to make sure they still have it and if you need an appointment.  By the way- this year’s vaccine is still a perfect match for the circulating strains.  The best prevention besides getting vaccinated is to wash your hands and make sure you cough or sneeze into your sleeve instead of your hand.  Most importantly…  don’t send your kids to school sick and don’t go to work sick either.

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We Nailed Smallpox- Why Not Polio?

October 24th, 2012

Today is World Polio Day so I thought I’d throw together this post to give you an update on where we are in the global eradication effort.  2012 has been a good year so far- as the global public health system has made some real progress.  This year we’re down to only 3 countries with cases (Afghanistan, Nigeria and Pakistan) and only 200 cases.  We’re closer than ever to global eradication of this nasty disease.  The world was about this close to eliminating polio in the 2000′s, but political strife and other issues in West Africa turned the tide and set the eradication clock back.  

A couple billion kids around the world have been vaccinated against polio in the last decades - resulting in a 99% decrease in global polio cases.  The Bill and Melinda Gates Foundation has been adding support to the new push to eradicate by working with the Global Polio Eradication Initiative.  

You might wonder why public health was able to get rid of Smallpox but not Polio (yet).  It’s basically because Polio is spread through via the “fecal-oral” route.  That means that folks shed the virus in feces…  and other people catch the disease through contaminated water (or food).  That means that we need to use mass vaccination efforts to prevent more cases rather than the more cost effective and efficient “ring vaccination”  approach that we used to eradicate Smallpox.  With Smallpox…  we could track down cases quickly and vaccinate contacts and villages to prevent the spread- since it went person to person. 

Looking for a book to read about one of public health’s biggest achievements?  You’ll enjoy a new book written by Dr. Bill Foege called House on Fire: The Fight to Eradicate Smallpox.

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Global Polio Eradication- The Ongoing Push

December 30th, 2011

Public health efforts eradicated smallpox from the globe in the late 1970s.  The last naturally occurring case was in Somalia in 1977 (followed by a couple of lab accident cases in 1978).  Public health’s sites have been set on Polio eradication for the last couple of decades.  We got close a couple of times, but a series of naturally occurring and man-made setbacks slowed progress.  

A couple of billion kids around the globe have been vaccinated against polio in the last decades - resulting in a 99% decrease in global polio cases.  The world was on the verge of eliminating polio in the 2000′s, but political strife and other issues in West Africa turned the tide and set the eradication clock back.  The good news is that the world is making progress again.  The list of countries where polio cases is shrinking, as are the number of cases.  Parts of Nigeria, India, Tajikistan, and parts of Afghanistan and Pakistan account for more than 75% of global cases.  The Bill and Melinda Gates Foundation has been adding support to the new push to eradicate by working with the Global Polio Eradication Initiative.  The goal is to eradicate polio by 2015. 

Polio is more challenging to eradicate than smallpox was because it’s spread through what public health calls the “fecal-oral” route (i.e. sewage) rather than person to person, which means that public health needs to use mass vaccination efforts in areas with cases rather than the more focused (and less labor intensive)  “ring vaccination”  approach used to eradicate smallpox.

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Run with the Herd

September 30th, 2011

Pretty much everybody knows that getting an annual influenza vaccine protects them from getting influenza- but fewer people realize that getting vaccinated saves other people’s lives as well.  That’s because if a large percentage of the population takes advantage of the vaccine (called herd immunity) we can reduce the overall spread of the disease- and save the lives of vulnerable folks that don’t benefit as much from getting the vaccine (because their immune system isn’t as robust). 

This year we have a unique opportunity to pull off very high vaccination rates.  That’s because there will be gobs of vaccine available this season (166,000,000 doses nationally) and the logistics have never been easier.  This is the first flu season that certified AZ pharmacists can give shots to everybody over 6 years old (even without a prescription)- meaning that everybody in the family over 6 can get vaccinated at local pharmacies this year- avoiding inconvenient doctor’s appointments for families. 

There’s also a wider variety of vaccines to choose from this season.  Of course, there’s the classic influenza vaccine with the needles which is approved for everyone 6 months and above.  There’s also a nasal spray for healthy non-pregnant people aged 2-49, and a new “micro-needle array” vaccine (that looks kind of like a band-aid) for people 18-64.  Plus, this is the first year we’ve had a new “high dose” influenza vaccine for seniors (65 and up) that provides for a better immune response and protection.  This year’s vaccine is a perfect match for the circulating strains in the Southern Hemisphere (at least so far), meaning that it should provide good protection.

In years past- we spent a lot of time helping folks find flu shot locations- but that’s not as necessary these days because so many pharmacies are providing vaccine now.  Check out location information and other public health stuff about the flu at www.stopthespreadaz.org. 

State employees can get a free flu shot through the Benefit Options vaccine program again this fall.  Influenza vaccination clinics will be held throughout October and November- and you can find times and locations on the new ADOA influenza vaccine website.  For flu clinic schedules or information regarding the status of the 2011 flu vaccine program throughout the flu season visit: www.benefitoptions.az.gov/wellness.

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Who Is Ed Jenner?

May 17th, 2011

He’s a guy that may have saved more lives than any other single person in history. In the 1790′s, he noticed that “milkmaids” seldom came down with smallpox.  He developed a theory that the blisters which “milkmaids” commonly had as part of their work (from a disease called cowpox) somehow protected them from smallpox. In 1796, he tested his theory by inoculating the 8 year old son of his gardener with cowpox blisters.

Later, he conducted what at the time was an accepted practice called “variolation”, meaning he purposely infected the boy with a small amount of smallpox in a controlled manner that was commonly practiced at the time to “immunize” people against further infection with smallpox.  “Variolation” produced lasting immunity to smallpox because the person was infected with the smallpox virus.  But, because variolation had a much lower mortality rate (about 1%) than the disease itself (20–30%), it was considered an acceptable practice at the time.  Since the boy never got sick from repeated exposures, Jenner concluded that cowpox could be made into an effective smallpox vaccine.

Using this information, public health proceeded to develop what became the first smallpox vaccine using the cowpox virus (the word vaccine comes from the root latin word “vacca” which means cow).  Vaccination to prevent smallpox was soon practiced all over the world.  The cowpox virus was later replaced by a different version of the smallpox virus.  Public health efforts eradicated smallpox from the globe in the late 1970s.  The last naturally occurring case was in Somalia in 1977 (followed by a couple of lab accident cases in 1978).

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Global Polio Eradication Rounds the Bend

March 1st, 2011

Public health efforts eradicated smallpox from the globe in the late 1970s.  The last naturally occurring case was in Somalia in 1977 (followed by a couple of lab accident cases in 1978).  Public health set its sites on Polio next- with an expectation that it could be eradicated before the turn of the century.  A series of naturally occurring and man made setbacks slowed the progress.  The world has been struggling to eradicate polio for the last few decades.

Since 1988 about 2.5 billion children around the globe have been vaccinated against polio, and the number of polio cases per year has decreased by 99%.  The world was on the verge of eliminating polio in the 2000s, but political strife and other issues in West Africa turned the tide and set the eradication clock back.  The good news is that the world is making progress again.  The list of countries where polio cases is shrinking, as are the number of cases.  Parts of Nigeria, India, and parts of Afghanistan and Pakistan account for more than 75% of global cases.  A large scale vaccination effort is just finishing in India as part of an urgent response to confirmation of a new case in North India and more than 1.8 million children under 5 were immunized.  The Bill and Melinda Gates Foundation has been adding support to the new push to eradicate by working with the Global Polio Eradication Initiative.  The goal is to eradicate polio by 2015.

Polio is more challenging to eradicate than smallpox was because it’s spread through what public health calls the  “fecal-oral” route (i.e. sewage) rather than person to person, which means that public health needs to use mass vaccination efforts in areas with cases rather than the more focused (and less labor intensive)  “ring vaccination”  approach used to eradicate smallpox.

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ADHS Scores Electronic Medical Records Grant

September 23rd, 2010

ADHS just scored a $1.3M grant for “enhancing the interoperability of electronic health records and immunization information systems”. This grant allows us to accelerate work with public and private health care provider offices and Electronic Health Record vendors to develop interfaces for the automated vaccination data to the Arizona State Immunization Information System (ASIIS).  These electronic interfaces will minimize data entry and allow seamless, timely and efficient reporting of immunization data for our partners. Thanks to Patty Gast, Lisa Rassmussen, Madan Gopal, and Raghu Ramaswamy for their efforts in preparing this successful grant application.  Well done.

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Whooping Cough (aka Pertussis)

July 2nd, 2010

Whooping cough (pertussis) is a vaccine preventable disease that causes a severe and chronic cough.  It’s a nuisance for adults and adolescents, but it’s potentially lethal for infants.  California is having a serious outbreak right now with 4 times the normal number of cases this year.  Our numbers are up too, but nothing like in California.  So far this year, we’ve had 152 cases vs. 82 last year at this time, so while we’re up from last year, our epidemiologists haven’t called it an outbreak yet.

Infants should get their first pertussis shot at two months of age, but aren’t adequately protected until after their 3rd shot at 6 months old.  So it’s really important to make sure that the people around the infant aren’t sick with the whooping cough.  We had a pretty bad outbreak about 6 years ago and found that a lot of the infants were getting sick from parents, adolescent siblings and babysitters whose immunity had waned.  That’s why we added a pertussis booster shot for 6th – 8th graders.  California hasn’t added that requirement yet, so we’re better off than CA is in terms of that intervention.

We’re keeping a close eye on this (as are the counties)  and various counties are investigating additional public health interventions to slow the spread.  Most of the strategies are around the concept of “cocconing” which simply means doing things to make sure that everyone that takes care of infants gets a booster shot.

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