OEREP Journal Club: December 12, 2012 Safety and Effectiveness of Childhood Vaccinations Rebecca Trocki, MSHAI and Edwin Lomotan, MD.

Slides:



Advertisements
Similar presentations
PARTISAN CONTROL AND STATE DECISIONS ABOUT OBAMACARE FULL GO STATES (n = 22) Arkansas Michigan CALIFORNIA MINNESOTA COLORADO NEVADA CONNECTICUT New Hampshire.
Advertisements

The West` Washington Idaho 1 Montana Oregon California 3 4 Nevada Utah
Division of Students with Disabilities and English Language Learners May 2012 Developing High Quality IEPs Ensuring each student has access to their least.
TOTAL CASES FILED IN MAINE PER 1,000 POPULATION CALENDAR YEARS FILINGS PER 1,000 POPULATION This chart shows bankruptcy filings relative to.
Birth Defects Tracking and Prevention: Too Many States Are Not Making the Grade Presentation by The Trust for America’s Health February 20, 2002.
Self-Reported Obesity Among U.S. Adults in 2012 Definitions  Obesity: Body Mass Index (BMI) of 30 or higher.  Body Mass Index (BMI): A measure of an.
Q Homeowner Confidence Survey Results Feb. 18, 2009.
IMMUNIZATIONS HEALTHROOM ASSISTANT TRAINING Cheri Dotson, RN, BSN, MA
A Child 2 years or older entering Preschool or Head Start 4 Diphtheria/Tetanus/Pertussis (DTaP) 3 Polio 1 Varicella (chickenpox) – if no history of disease.
BINARY CODING. Alabama Arizona California Connecticut Florida Hawaii Illinois Iowa Kentucky Maine Massachusetts Minnesota Missouri 0 Nebraska New Hampshire.
Child Care Provider Parents Siblings GrandparentsHealthcare Worker.
Chart 6. 12: Impact of Community Hospitals on U. S
Toronto North Local Immigration Partnership Immunization Toronto Public Health November 2013.
Selected Data for West Virginia Higher Education J. Michael Mullen WVFAA November 6, 2003.
A-38 Table 5.1: Total Number of Active Physicians (1) per 1,000 Persons by State, 2010 and 2011 Source: National Center for Health Statistics. (2014).
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 68 Childhood Immunization.
This chart compares the percentage of cases filed in Maine under chapter 13 with the national average between 1999 and As a percent of total filings,
Map Review. California Kentucky Alabama.
September 9, 2005 Washington, D.C. My.Medicare.gov - The Medicare Beneficiary Portal The Future of Beneficiary Self-Service.
1. AFL-CIO What percentage of the funds received by Alabama K-12 public schools in school year was provided by the state of Alabama? a)44% b)53%
Better Health. No Hassles. Get Immunized! National Immunization Month.
Figure 1. Growth of HSA/HDHP Enrollment from March 2005 to January Source: 2010 AHIP HSA/HDHP Census.
Medicare Advantage Enrollment: State Summary Five Slide Series, Volume 2 July 2013.
A-38 Table 5.1: Total Number of Active Physicians (1) per 1,000 Persons by State, 2007 and 2008 Source: National Center for Health Statistics. (2011).
Directions: Label Texas, Arkansas, Louisiana, Mississippi, Tennessee, Alabama, Georgia, Florida, South Carolina, North Carolina, Virginia--- then color.
Prevalence of Self-Reported Obesity Among U.S. Adults by State and Territory Definitions  Obesity: Body Mass Index (BMI) of 30 or higher.  Body Mass.
Infant and Adolescent Hepatitis B Vaccination and Use of Combination Vaccines United States.
2005 National Immunization Survey Stephen L. Cochi, M.D., M.P.H. Acting Director National Immunization Program, CDC National Press Club July 27, 2005 Department.
CHAPTER 7 FILINGS IN MAINE CALENDAR YEARS 1999 – 2009 CALENDAR YEAR CHAPTER 7 FILINGS This chart shows total case filings in Maine for calendar years 1999.
Office of Head Start Update Disabilities Services Information and Activities Jim O’Brien Office of Head Start
Thomas Weiser, MD, MPH Medical Epidemiologist Portland Area Indian Health Service Northwest Portland Area Indian Health Board.
Study Cards The East (12) Study Cards The East (12) New Hampshire New York Massachusetts Delaware Connecticut New Jersey Rhode Island Rhode Island Maryland.
MANDATORY CHILDHOOD IMMUNIZATIONS AND ADOLESCENT HUMAN PAPILLOMAVIRUS (HPV): NO SHOTS – NO SCHOOL AUDREY MUNN AMY ROELSE.
Hawaii Alaska (not to scale) Alaska GeoCurrents Customizable Base Map text.
US MAP TEST Practice
Education Level. STD RATE Teen Pregnancy Rates Pre-teen Pregnancy Rate.
TOTAL CASE FILINGS - MAINE CALENDAR YEARS 1999 – 2009 CALENDAR YEAR Total Filings This chart shows total case filings in Maine for calendar years 1999.
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.
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Childhood Immunization.
Table 2.1: Number of Community Hospitals,(1) 1994 – 2014
Expanded State Agency Use of NMLS
Supplementary Data Tables, Utilization and Volume
Physicians per 1,000 Persons
JON S. ABRAMSON, M.D. DEPARTMENT OF PEDIATRICS
USAGE OF THE – GHz BAND IN THE USA
Table 3.1: Trends in Inpatient Utilization in Community Hospitals, 1992 – 2012
Percentage of Fully Electronic* Death Records Filed
Name the State Flags Your group are to identify which state the flag belongs to and sign correctly to earn a point.
HIV Surveillance in Urban and Nonurban Areas
Table 2.1: Number of Community Hospitals,(1) 1981 – 2005
Table 3.1: Trends in Inpatient Utilization in Community Hospitals, 1987 – 2007
The States How many states are in the United States?
State Adoption of NMLS ESB
HIV Surveillance in Women
HIV Surveillance in Adolescents and Young Adults
Supplementary Data Tables, Trends in Overall Health Care Market
HIV Surveillance by Race/Ethnicity.
Table 2.3: Beds per 1,000 Persons by State, 2013 and 2014
Pediatric HIV Surveillance
Self-Reported Obesity Among U.S. Adults in 2012
HIV Surveillance by Race/Ethnicity
Supplementary Data Tables, Utilization and Volume
Epidemiology of HIV Infection through 2009
WASHINGTON MAINE MONTANA VERMONT NORTH DAKOTA MINNESOTA MICHIGAN
This slide presents the distribution of diagnoses of HIV infection among adults and adolescents diagnosed from 2006 through 2009, by transmission category.
Expanded State Agency Use of NMLS
NCIRD 2018 Vaccination Coverage Awards
The estimated number of adults and adolescents living with AIDS in each region of the 50 states and the District of Columbia increased from 1993 through.
Percent of adults aged 18 years and older who have obesity †
USAGE OF THE 4.4 – 4.99 GHz BAND IN THE USA
Presentation transcript:

OEREP Journal Club: December 12, 2012 Safety and Effectiveness of Childhood Vaccinations Rebecca Trocki, MSHAI and Edwin Lomotan, MD

OEREP Journal Club: December 12, 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) to cause birth defects and mental retardation in 20,000 newborns Rubella (German Measles) to cause birth defects and mental retardation in 20,000 newborns Measles to infect 4 million children and kill 3000 Measles to infect 4 million children and kill 3000 Diptheria to be one of the common causes of death in school children Diptheria to be one of the common causes of death in school children Pertussis (Whooping Cough) to kill 8000 children Pertussis (Whooping Cough) to kill 8000 children

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

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

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

Selected Childhood Vaccine Statistics 2009 Disease20 th Century2009%Decrease Diphtheria 21, % Measles530, % Mumps162,3442,61298% Pertussis200,75227,53886%

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

Exemption Definitions * All estimates of percentages of children with exemptions are weighted to the number of enrolled children unless otherwise noted. Number of exemptions are unweighted counts. * All estimates of percentages of children with exemptions are weighted to the number of enrolled children unless otherwise noted. Number of exemptions are unweighted counts. † Medical and nonmedical exemptions might not be mutually exclusive. Some children might have both medical and nonmedical exemptions. † Medical and nonmedical exemptions might not be mutually exclusive. Some children might have both medical and nonmedical exemptions. § Exemptions because of philosophic reasons are not allowed. § Exemptions because of philosophic reasons are not allowed. ¶ Exemptions because of religious reasons are not allowed. ¶ Exemptions because of religious reasons are not allowed. ** Rate differences between 2009–10 school year and 2010–11 school year are greater than 1.5 percentage points. ** Rate differences between 2009–10 school year and 2010–11 school year are greater than 1.5 percentage points. †† Exemptions because of medical reasons are allowed but are not reported separately from other exemptions. †† Exemptions because of medical reasons are allowed but are not reported separately from other exemptions. §§ Exemptions because of religious reasons are allowed but are not reported separately from other exemptions. §§ Exemptions because of religious reasons are allowed but are not reported separately from other exemptions. ¶¶ Exemption because of philosophic reasons are allowed but are not reported separately from other exemptions. ¶¶ Exemption because of philosophic reasons are allowed but are not reported separately from other exemptions. *** Did not report exemptions to CDC. *** Did not report exemptions to CDC. ††† Estimates are based on total children surveyed because total children enrolled is unknown. ††† Estimates are based on total children surveyed because total children enrolled is unknown. §§§ The median is based on estimates for 49 states and District of Columbia. §§§ The median is based on estimates for 49 states and District of Columbia. ¶¶¶ Exemptions are allowed but not tracked. ¶¶¶ Exemptions are allowed but not tracked.

State Snapshots of Exemptions 2010 StateMedical # % Religious # Philosophical # Non-medical (R+P) (%) Total # % Maryland § Virginia150.3—¶ DC § California8710.2—¶12, , Washington , , Oregon800.22,648-§5.82, Illinois1, ,270 —§ 4.59, Michigan , , Pennsylvania , , Oklahoma North Dakota West Virginia440—¶-§ Colorado & Wyoming No information available

Exemption Analysis Rates for exemptions vary widely (more than a factor of 10) Rates for exemptions vary widely (more than a factor of 10) Rates for exemptions may reflect different rules for what is allowable… Rates for exemptions may reflect different rules for what is allowable… – Medical exemptions only – Medical and religious exemptions only – Medical, religious, and philosophical exemptions..but not entirely..but not entirely – The highest rate of exemptions appear in states that allow for medical, religious, and philosophical exemptions – Some states with all three allowable types of exemptions still have low rates of exemptions

Pertussis Epidemic in Washington State Published every Tuesday afternoon. Data through 11/10/2012 Pertussis cases in Washington, 2012 Pertussis cases reported in 20124,501 Cases reported for the same period in New cases reported November 4-10, Age groups with highest rate Children under age 1 Children ages 10 to 13 Cases in babies under age one in County with highest rateSkagit Counties with reported pertussis cases38 Counties with no reported pertussis cases1

Pertussis Epidemic in the United States 2012 STATES WITH INCIDENCE OF PERTUSSIS THE SAME OR HIGHER THAN THE NATIONAL INCIDENCE (AS OF SEPTEMBER 20, 2012), WHICH IS 9.3/100,000 PERSONS STATES WITH INCIDENCE OF PERTUSSIS THE SAME OR HIGHER THAN THE NATIONAL INCIDENCE (AS OF SEPTEMBER 20, 2012), WHICH IS 9.3/100,000 PERSONS WISCONSIN 87.6 ALASKA 23.5 WISCONSIN 87.6 ALASKA 23.5 UTAH 33.6 PENNSYLVANIA 11.7 UTAH 33.6 PENNSYLVANIA 11.7 ARIZONA 12.2 VERMONT 51.9 ARIZONA 12.2 VERMONT 51.9 MINNESOTA 72.6* OREGON 21.9 MINNESOTA 72.6* OREGON 21.9 MISSOURI 11.6MONTANA 44.7 MISSOURI 11.6MONTANA 44.7 NEW MEXICO 27.0 KANSAS 17.2 NEW MEXICO 27.0 KANSAS 17.2 IDAHO 12.0COLORADO 11.0 IDAHO 12.0COLORADO 11.0 WASHINGTON 62.3 MAINE 42.6 WASHINGTON 62.3 MAINE 42.6 NEW HAMPSHIRE 14.9 KENTUCKY 10.7 NEW HAMPSHIRE 14.9 KENTUCKY 10.7 IOWA 42.1 NEW YORK 13.8 IOWA 42.1 NEW YORK 13.8 WYOMING 10.3 NORTH DAKOTA 41.9 WYOMING 10.3 NORTH DAKOTA 41.9 ILLINOIS 12.3 NEBRASKA 8.8 ILLINOIS 12.3 NEBRASKA 8.8

Current Pertussis Epidemic

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

AHRQ Innovation Results Results Pre- and post-implementation comparisons show that the program has more than tripled immunization rates since its inception, achieving levels that exceed Federal standards for childhood immunizations. Anecdotal reports from providers and parents suggest that the program has improved the quality of care. Tripling of immunization rates: During the first 3 to 5 years of the program, immunization rates for 2-year-old children increased from approximately 30 to 94 percent. By 2006, rates reached 97 percent. The program has maintained these high rates each year that adequate supplies of vaccines are available. As of 2012, all El Rio Pediatric Clinics have achieved immunization rates of 90 percent for the combo-3 vaccines for two-year-old patients who remain in the clinic's care. Pre- and post-implementation comparisons show that the program has more than tripled immunization rates since its inception, achieving levels that exceed Federal standards for childhood immunizations. Anecdotal reports from providers and parents suggest that the program has improved the quality of care. Tripling of immunization rates: During the first 3 to 5 years of the program, immunization rates for 2-year-old children increased from approximately 30 to 94 percent. By 2006, rates reached 97 percent. The program has maintained these high rates each year that adequate supplies of vaccines are available. As of 2012, all El Rio Pediatric Clinics have achieved immunization rates of 90 percent for the combo-3 vaccines for two-year-old patients who remain in the clinic's care. Exceeding standards: The program won the Daniel T. Cloud Outstanding Practice Award from The Arizona Partnership for Immunization for exceeding Federal standards and achieving immunization rates of 90 percent or more for children turning 2 years old. Exceeding standards: The program won the Daniel T. Cloud Outstanding Practice Award from The Arizona Partnership for Immunization for exceeding Federal standards and achieving immunization rates of 90 percent or more for children turning 2 years old. Anecdotal reports of better quality: Anecdotal reports from providers suggest that the training sessions have allowed for a more collaborative approach to monitoring whether immunizations are up-to-date and administered correctly. Parents view the immunization clinics as an added benefit, and providers have not noticed changes in compliance with well-child visits. Anecdotal reports of better quality: Anecdotal reports from providers suggest that the training sessions have allowed for a more collaborative approach to monitoring whether immunizations are up-to-date and administered correctly. Parents view the immunization clinics as an added benefit, and providers have not noticed changes in compliance with well-child visits. Evidence Rating (What is this?) 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. Moderate: The evidence consists of pre- and post-implementation comparisons of immunization rates, along with informal feedback from providers and parents.

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 natural immunity than vaccination  Vaccines use up the immune system

For discussion Why are there outbreaks Why are there outbreaks – Vaccination rates are decreasing – Vaccine effectiveness is decreasing? Why do parents refuse vaccines? Why do parents refuse vaccines? – Autism controversy – Vaccine myths (from previous slide) Are there appropriate research questions for AHRQ? Are there appropriate research questions for AHRQ?