OEREP Journal Club: December 5, 2012 “Vaccines are medicine’s bright and shining star, before, parents in the United States could expect each year “Vaccines are medicine’s bright and shining star, before, parents in the United States could expect each year Polio to paralyze 10,000 children Polio to paralyze 10,000 children Rubella (German Measles) could cause birth defects and mental retardation in 20,000 newborns Rubella (German Measles) could cause birth defects and mental retardation in 20,000 newborns Measles to infect 4 million children killing 3,000 Measles to infect 4 million children killing 3,000 Diptheria was the common causes in school children Diptheria was the common causes in school children Pertussis (Whooping Cough) would kill 8,000 children Pertussis (Whooping Cough) would kill 8,000 children

OEREP Journal Club: December 5, 2012 Safety and Effectiveness of Childhood Vaccinations Rebecca Trocki, MSHAI and Edwin Lomatan, MD

How are Vaccines Made  Vaccines are made by taking viruses of bacteria and weakening them so they cannot replicate themselves  When children are exposed enough to the vaccine, they develop an immunity but not enough to make them sick

4 ways that viruses and be are weakened to create a vaccine  Change the blueprint or genetics of virus so it replicated poorly  Destroy the blue print of the virus  Utilize part of the virus  Remove the toxin or poison in the bacteria so it cannot do any harm

Some Vaccine Myths  Vaccines Do Not Work  Vaccines are not necessary  Vaccines are not safe  Infants are too young to get vaccinated  Better to have a natural immunity than vaccination  Vaccines use up the immune system

Vaccine Preventable Diseases Diphtheria Diphtheria Diphtheria Haemophilus influenzae type b (Hib) Haemophilus influenzae type b (Hib) Haemophilus influenzae type b Haemophilus influenzae type b Hepatitis A Hepatitis A Hepatitis A Hepatitis A Hepatitis B Hepatitis B Hepatitis B Hepatitis B Influenza Influenza Influenza Measles Measles Measles Meningococcal Meningococcal Meningococcal Mumps Mumps Mumps Pertussis (whooping cough) Pertussis (whooping cough) Pertussis Pneumococcal disease Pneumococcal disease Pneumococcal disease Pneumococcal disease Polio Polio Polio Rotavirus (severe diarrhea) Rotavirus (severe diarrhea) Rotavirus Rubella (German measles) Rubella (German measles) Rubella Tetanus (lockjaw) Tetanus (lockjaw) Tetanus Varicella (chickenpox) Varicella (chickenpox) Varicella For print-friendly fact sheets, flyers, and posters about vaccines and the diseases they prevent in preteens and teens, consult the Print Materials for Preteens and Teens page. For print-friendly fact sheets, flyers, and posters about vaccines and the diseases they prevent in preteens and teens, consult the Print Materials for Preteens and Teens page.Print Materials for Preteens and Teens pagePrint Materials for Preteens and Teens page

Vaccine Statistics DiseasePre-Vaccine Era 2006%Decrease Diphtheria 175, % Measles503, % Mumps152,2096, % Purtussis %

Vaccine Statistics DiseasePre-Vaccine Era 2006%Decrease Diphtheria 175, % Measles503, % Mumps152,2096, % Purtussis %

AHRQ Innovation Snapshot Snapshot Summary Summary The El Rio Health Center developed a comprehensive program to increase pediatric immunization rates consisting of the following key elements: ongoing immunization training for pediatricians and nurses, a computerized data system to track immunizations, reminders for both patients and providers, and nurse-run immunization clinics offered at the center and in the community. The program has more than tripled immunization rates since its inception, achieving levels that exceed Federal standards for childhood immunizations. Evidence Rating (What is this?) The El Rio Health Center developed a comprehensive program to increase pediatric immunization rates consisting of the following key elements: ongoing immunization training for pediatricians and nurses, a computerized data system to track immunizations, reminders for both patients and providers, and nurse-run immunization clinics offered at the center and in the community. The program has more than tripled immunization rates since its inception, achieving levels that exceed Federal standards for childhood immunizations. Evidence Rating (What is this?)What is this?What is this? Moderate: The evidence consists of pre- and post-implementation comparisons of immunization rates, along with informal feedback from providers and parents.begin do Developing Organizations Moderate: The evidence consists of pre- and post-implementation comparisons of immunization rates, along with informal feedback from providers and parents.begin do Developing Organizations El Rio Health Center, Tucson AZ end do Date First Implemented El Rio Health Center, Tucson AZ end do Date First Implemented 1992 begin pp Patient Population 1992 begin pp Patient Population Age > Adolescent (13-18 years); Child (6-12 years); Vulnerable Populations > Children; Age > Infant (1-23 months); Insurance Status > Medicaid; Vulnerable Populations > Medically uninsured; Age > Preschooler (2-5 years); Vulnerable Populations > Urban populationsend pp Age > Adolescent (13-18 years); Child (6-12 years); Vulnerable Populations > Children; Age > Infant (1-23 months); Insurance Status > Medicaid; Vulnerable Populations > Medically uninsured; Age > Preschooler (2-5 years); Vulnerable Populations > Urban populationsend pp

Laws and Regulations for Vaccinations State Mandatory Vaccination Laws School Vaccination Requirements Every state and the District of Columbia has a law requiring children entering school to provide documentation that they have met the state immunization requirements. 15 In 1827, Boston was the first city to require vaccination against smallpox for public school students. 16 Other cities and states adopted the policy, and state statutes were amended as new vaccines were introduced. 17 Many modern school vaccination laws are the result of measles outbreaks in the 1960s and 1970s. 18

Example requirements from different states and/or acceptable exclusions Example requirements from different states and/or acceptable exclusions

Pertussis outbreak Pertussis outbreak

For discussion Why are there outbreaks Why are there outbreaks Why are there myths Why are there myths Vaccine refusal Vaccine refusal Are there appropriate research questions for AHRQ? Are there appropriate research questions for AHRQ?