Renewed Focus on Immunizations at Children’s
from Caring For Our Future, Fall 2003
By Ann Doner, RN, Immunization Coordinator
In 1992, the Childhood Immunization Initiative (CII) Healthy Kids 2000 established a goal that by the year 2000, 90 percent of 2-year-olds would have received their primary vaccine series. The primary vaccine series accounts for approximately 80 percent of the vaccines required for school enrollment. Colorado law requires that children meet certain immunization standards for their age groups to enter and remain in school and preschool.
To estimate national vaccine compliance, surveys have been conducted annually since 1994. The U.S. Centers for Disease Control and Prevention and two of its agencies sponsor the National Immunization Survey. Information is obtained from immunization providers and patient households via quarterly telephone surveys and mail surveys.
The most recent survey (August 2003) reported that Colorado was ranked lowest of all 50 states for immunization rates in children 19 months to 36 months (62.7 percent). This dramatic failure demonstrates the continuing need to increase awareness of immunizations and to develop strategies to increase the number of fully immunized children.
Why Vaccinate?
There are several reasons to immunize our children. One reason is to prevent common infections that can disable or even result in death. Immunizations can protect children from at least 11 diseases. Children who are not immunized are susceptible to such preventable diseases as chicken pox. Vaccine-preventable illnesses also may be more severe in infants and young children who are most vulnerable, and complications may require hospitalization. When one child becomes infected, non-immunized family members and contacts throughout the community also are placed at risk for acquiring the disease.
Another reason to give vaccines is to prevent infection rates from rising in diseases that now occur infrequently. If immunization rates lag, previously rare infections can reappear in greater numbers. For example, between 1985 and 1991 an outbreak of measles occurred in the United States ; not because the vaccine failed, but because children were not receiving their vaccinations as recommended. During the outbreak it was noted that few children were fully immunized at the age of 2.
Some vaccines are given to prevent diseases that occur more frequently in other parts of the world. While polio and diphtheria are still found in other countries, most families who live in the United States have never seen people infected with these diseases. When an illness is absent from a community, it seems less significant and less threatening. It becomes easier to ignore the disease, and this may result in lower immunization rates. It is important to remember that these dangerous diseases are only a plane ride away.
Why is Colorado So Far Behind?
There are many factors that influence immunization rates. The immunization schedule is complicated, and intervals between the vaccines vary. Record-keeping becomes difficult with such a complex schedule. It can be difficult to keep track of the 20-plus shots required to fully immunize a child. Many families move around and may have multiple health-care providers. Immunization records are often incomplete or lost, and previous providers may be forgotten, making it difficult to track earlier vaccinations. If families arrive in a TCH clinic without documented immunization records, efforts are usually made to locate the immunization history from former health-care providers, schools or daycare providers. Often earlier records cannot be located.
If records cannot be found, immunizations may need to be restarted. At TCH, some clinics use a computer-based registry to record immunizations. Other health-care providers in Denver and throughout Colorado also are using the registry. A mandatory statewide registry would help eliminate some of the difficulties in maintaining accurate records and would decrease the need for repeated vaccinations because of poor record-keeping.
It can be costly to receive all the immunizations required. Some insurance providers do not fully cover the cost of vaccines. Under the federal Vaccine for Children (VFC) program, qualifying children may receive the vaccine itself at no cost, but providers are allowed to charge for the office visit. If families cannot pay the fee, it is waived. Individuals eligible for the VFC program include those with no insurance, those with Medicaid, Native Americans and Alaskan natives. Children who have health insurance that does not cover the cost of immunizations also are eligible for the VFC program if they go to a federally qualified health center. In general, there are inadequate financial resources in Colorado to support immunization activities.
In addition to their concern about the financial cost of vaccines, many parents are concerned with vaccine safety. Scientists are constantly working to improve vaccines by making them safer and easier to use. New combinations of vaccines are available, and different techniques for administering them are being tried. No vaccine is 100 percent safe and effective. Most adverse reactions are minor and temporary and include pain, redness and swelling at the site of the injection. Systemic adverse reactions are more generalized and may include fever, malaise, muscle aches, headache and loss of appetite. Serious allergic reactions may be life-threatening but are very rare. It is important for parents to weigh the benefits of preventing a disease against the risks of receiving the vaccine.
In addition to the above concerns, vaccine shortages in 2001 and 2002 also contributed to low immunization rates. The DTAP and pneumococcal vaccines were in short supply, causing children to miss or delay immunizations. Health-care providers are now working to bring these children up to date.
What Can We Do to Improve Immunization Rates in Colorado ?
In January 2000, a quality improvement project was initiated at The Children’s Hospital to evaluate immunization record-keeping and education. One goal of the project was to educate families, residents, students and clinical staff about the importance of immunizations. This was accomplished through lectures, development of an immunization website, and distribution of immunization screening and schedule cards. An immunization policy and procedure was developed for the inpatient population.
Another goal of the project was to develop systems to promote organization and maintenance of medical records needed by families for their children. A portfolio was developed for families to keep information on their children with sections containing medical information, medications, appointments, immunization information and information about The Children’s Hospital.
A final goal was to increase immunization rates for children. A position for an immunization coordinator for TCH was approved and an immunization coordinator began working in September to provide leadership throughout the hospital to increase awareness of vaccine-related issues and will provide information to both families and health-care providers.
The annual Safety and Immunization Fair was held at TCH in September, and more than 340 children received free immunizations. Other ideas to improve immunization rates include instituting a reminder system for families who receive vaccinations at TCH and expanding the use of the registry within the hospital. A poster presentation will be provided at the TCH annual Quality Fair in October focusing on the need to educate staff and families about the importance of childhood immunizations. The goal is to standardize the immunization process and to know patients’ immunization status within all TCH inpatient units and outpatient clinics.
References
Atkinson, W. & Wolfe, C. (Eds.). (2003). Epidemiology and Prevention of Vaccine-Preventable Diseases, (7th ed.). Atlanta, GA : Dept. of Health and Human Services, Centers For Disease Control and Prevention.
Internet resources
American Academy of Pediatrics, www.cispimmunize.org
Children’s Hospital of Philadelphia Vaccine Education Center, www.vaccine.chop.edu
National Immunization Program of the CDC, www.cdc.gov/nip
