2. Niccole Colthorp Ashley Cruz Christie Kleinert Melinda Turner Rebecca Williams

3.  The unvaccinated population is at risk to contract life threatening and highly contagious diseases due to declining routine vaccinations.

4.  “Childhood vaccines have the potential to prevent 42,000 early deaths and 20 million cases of disease among Americans born in a given year, according to a new analysis” (Gordon 2014).  This means we can prevent disease outbreak and exposure by vaccination. This is measurable by the CDC and the health departments that report the diseases each year. We can look at their data and determine that immunizations are effective.

5.  "Some of the vaccine preventable diseases that still circulate in the US include whooping cough, chicken pox, HIB ( cause of meningitis), and influenza. These diseases as well as the other vaccine preventable diseases, can range from mild to severe and life threatening. In most cases, there is no way to know beforehand if a child will get a mild or serious case" (CDC, 2012).  If everyone is deciding not to immunize their children this puts the entire population at risk because now everyone is compromised.

6.  The CDC recommends most vaccine series to begin before the child is 15 months of age.  After the initial vaccines are given to a child, they will need boosters around 4-6 years and then again at 11-12 years depending on the vaccine.  Adults who were not initially vaccinated as a child can choose to have some vaccines later in life. They are generally given in a series and require boosters for optimum coverage (CDC, 2014).

7.  35,564 doses of vaccine administered  99% compliance in 280 schools  100% reporting compliance in 230 childcare sites  40.4% flu vaccination rate for ages 6 months-18 years; highest in state  27.6% flu vaccination rate for ages 6 months and up; highest in state (Kent County Health Department, 2012)

8.  Kent County has high compliance rates, but with the increased number of parents opting out of immunizations there continues to be the need to educate the public.

9.  In the late 90’s there was an article published in the Lancet by Dr. Wakefield about a case study which he claimed linked the MMR vaccine to autism. It was later found he altered much of the data to make his case. He published his works with other credible sources that had not actually looked into the data. Brian Deer investigated the children used in the case study and discovered many of them had behavioral issues documented well before receiving the vaccine (Deer, 2011). There was another investigation of the case study and the original article was retracted (Eggertson, 2011). Unfortunately, the damage was already done. The media took a hold of the article and began blaming autism on the vaccine, which lead many parents to avoid vaccinating their children.

10.  Parents thought that not immunizing their children provided them with “herd immunity”. Which means they are protected from the disease because everyone else is vaccinated.  Parents refused because of the number of vaccines their child received in 1 visit  Refusal because of potential side effects, fear, bad personal experience, pre-existing allergies or rashes

11.  Pediatrician offices generally give the vaccines, but if a child is seen by a general physician they may not carry the vaccine in the office. The parent may have a hard time finding a local health department or facility they can take their child to as well (Chicago, 1999).  Sometimes vaccine shortages can prevent willing parents from vaccinating. “Fortunately, parents do not have to worry about the cost of vaccines in the United States; free vaccines are available to all uninsured and underinsured children through the Vaccines for Children program” (Bronfin, 2008, pg 153). Many parents do not know what vaccines are covered by insurance and where they can get them.

12.  Many people believe if you receive a vaccine, you will develop the disease (50, n.d.). People allow this fear to take over and do not realize they are subjecting themselves to developing the disease.  “Scientific evidence has refuted many of the misconceptions regarding vaccine safety; however, parental refusal of vaccines is increasing” (Chatterjee & O’Keefe, 2010, pg 497). If parents trust their healthcare provider’s recommendations, vaccination rates at the community level could increase. Another reason for denying vaccines is lack of education.

13.  Children are at risk for developing once almost nonexistent diseases because parents do not feel safe vaccinating their children.  Healthcare professionals need to listen to these fears and explain the facts to parents, preferably before the child is due.  Nurses need to be educated and informed on vaccine safety issues to effectively educate parents on the risks and benefits of the vaccinations.

14. Nurses need to stay up-to-date on their immunizations as well to help decrease the spread of infection.  Changes would be seen rapidly if the proper education is there. Once parents are educated and have their fears re-assured then they can educate others about the importance of immunizations as well.  Nurses need to reiterate the pros and cons of immunizing your child and be sure to answer all questions parents have.

15.  Anthrax, Diphtheria, Haemophilus Influenza type b (Hib), Hepatitis A, Hepatitis B, Human Papillomavirus (HPV), Influenza, Japanese Encephalitis, Lyme Disease, Measles, Meningococcal, Mumps, Pertussis, Pneumococcal Disease Polio, Rabies, Rotavirus, Rubella, Shingles, Smallpox, Tetanus, Tuberculosis, Typhoid Fever, Chickenpox, and Yellow Fever.

16.  Best practice includes:  Primary community prevention-educate parents and administer vaccines according to recommended schedule.  Secondary community prevention-Routine well-child checks and school screenings

17.  Disciplines that would be involved in addressing the problem could be:  Pediatricians in the community  Leaders in the community  Health department including public health nurse.  Local church groups  Schools  Local television stations  Websites with vaccine schedules

18.  Mass media campaign  Immunization reminder campaign  Addressing parents concerns about vaccines  Phone reminders for children, teens, and adult for flu and pneumonia vaccines, etc.  A curriculum in schools about immunizations  To help increase the number of local children vaccinated, communities should offer services at convenient times and places and make sure parents can access those services.

19.  Kent County provides immunization clinics, schedules, travel immunizations and affordable immunizations to those who are not insured.

20.  Outcomes we could track include compliance with immunizations in a community.  The CDC and health departments locally have an estimate of how many people are receiving the immunizations.  We could also track how effective an immunization is in an area. For example, see how many people received the flu vaccine and compare that to how many cases were reported in an area.  Other outcomes measure progress towards achievement of short-term outcomes:  Choose areas that need improvement  Choose how to plan and implement the change  Provide evidence to support improvements (Public Health of Canada, 2009).

21.  Desired outcome is “to achieve the highest possible degree of community protection against vaccine- preventable diseases” (National Vaccine Advisory Committee, 2003).  The local health department keeps track of the trends of disease outbreaks so they would be involved in tracking if there was a change in trends

22.  Childhood immunization is pertinent in preventing contagious, sometimes deadly, diseases. By immunizing your child, they create antibodies to build immunity. Children 5 or less are more at risk for potential diseases because they do not have the immune system to fight the infection. By immunizing your child by the age of 2 you protect your child from diseases that they can pick up from day care or school.

23. 50 Reasons to Not Vaccinate your ChildrenEndAllDisease.com. (n.d.). Retrieved from http://www.endalldisease.com/50- reasons-to-not-vaccinate-your-children Bronfin, D. (2008). Childhood immunization controversies: What are parents asking? The Ochsner Journal, 8(3), 151- 156. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096324/ Centers for Disease Control and Prevention (2014). CDC - Vaccines - Adult Immunization Schedule, by Vaccine and Age Group. Retrieved from http://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html Centers for Disease Control and Prevention. (2014, May 19). Vaccines: Vac-Gen/10 Things You Need to Know. Retrieved from http://www.cdc.gov/vaccines/vac-gen/10-shouldknow.htm Chatterjee, A., & O’Keefe, C. (2010). Current controversies in the USA regarding vaccine safety. Expert Reviews, 9(5), 497- 502. doi: 10.1586/erv.10.36 Chicago Department of Public Health (1999). Parental Barriers to Childhood Immunizations. Retrieved from http://www.orau.gov/cdcynergy/web/IM/Content/activeinformation/resources/IM_ParentFG.pdf

24. County of Kent. (2014). AccessKent | Kent County, Michigan Retrieved from https://www.accesskent.com/Health/Immunizations Deer, B. (2011). How the case against the MMR vaccine was fixed. British Medical Journal, 342, 77-82. doi:10.1136/bmj.c5347 Eggertson, L. (2010). Lancet retracts 12-year-old article linking autism to MMR vaccines. CMAJ: Canadian Medical Association journal = journal de l’Association medicale canadienne, 182(4), E199–200. doi:10.1503/cmaj.109-3179 (PMID: 20142376) Gordon, S. (2014). Vaccines Prevent Millions of Infections, Save Billions in Costs: CDC. Retrieved from http://consumer.healthday.com/public-health-information-30/centers-for-disease-control-news-120/vaccines- prevent-millions-of-infections-save-billions-of-dollars-finds-study-685357.html Infection Control Today. (2011). What Factors Contribute to Suboptimal Childhood Immunization Rates. Retrieved from http://www.infectioncontroltoday.com/news/2011/07/what-factors-contribute-to-suboptimal-childhood- immunization-rates.aspx

25. Kent County Health Department. (2012). 2012 Annual Report. Retrieved from http://www.accesskent.com/Health/Publications/pdfs/2012_annual_report.pdf Muecke, M. A. (1984). Community Health Diagnosis in Nursing. Public Health Nursing, 1(1), 23-35. National Network for Immunization Information. (2010). Demographics of Unvaccinated Children - Immunization Science. Retrieved from http://www.immunizationinfo.org/science/demographics-unvaccinated-children National Vaccine Advisory Committee. (2003). Standards for child and adolescent immunization practices. Official Journal of the American Academy of Pediatrics, 112(4), 958-963. Retrieved from http://www.immunize.nc.gov/PDFs/2014%20PDF/Standards%20for%20Child%20and%20Adolescent%20Immunization %20Practices%2003.pdf Public Health Agency of Canada. (2009). Interim Evaluation of the National Immunization Strategy - Public Health Agency of Canada. Retrieved from http://www.atlantique.phac.gc.ca/im/nis-sni/nis-sni-07-eng.php University of Pennsylvania School of Nursing. (2012, August 22). Intentionally Unvaccinated Students Putting Other Children at Risk. ScienceDaily. Retrieved July 20, 2014 from www.sciencedaily.com/releases/2012/08/120822181234.htm