These pockets of susceptibles put everyone at risk, especially those who are too young to be vaccinated, too young to be fully vaccinated, and those with true medical exemptions who can’t be vaccinated.
Looking at the state and county level rates of MMR vaccination by kindergarten, you can see that a lot more kids haven’t been getting vaccinated since 1990. In fact, while 97.6% of kindergarteners during the 1998-99 school year had their MMR vaccination, it quickly fell to about 90%, where it remains today. In Clark County, where we are currently seeing a large outbreak of measles, the drop was even worse.
“What’s so important about all this data is that it destroys the false narrative. Vaccination rates haven’t gone down lately. Period. Ask any epidemiologist you know to run these numbers.”
JB Handley on CDC, Check YOUR Data: MMR Vaccination Rates are NOT Declining
Speaking of false narratives, many states now publish school and county level immunization rates, so it is easy to see past anti-vaccine propaganda and see that vaccination rates truly have gone down lately in areas that are dealing with outbreaks.
“I wanted to make sure and corroborate that data with data from the Oregon Health Authority, which they conveniently don’t publish very often, but someone sent me their data from 2014, showing that 97.1% of 7th graders in Oregon have received an MMR vaccine! Where’s the decline?”
JB Handley on CDC, Check YOUR Data: MMR Vaccination Rates are NOT Declining
In 2017, 95.5% of teens in Oregon had received one dose of the MMR vaccine. Only 90% had received the recommended two doses. Rates in Multonah County, near the current outbreak in Washington, were actually a little better, at 96.7% (one dose) and 92% (2 doses).
Still, there are plenty of schools with much lower rates, creating the pockets of susceptibles that are causing these outbreaks.
And chicken pox parties, while not as common as some folks imagine, were definitely a thing, because you didn’t want your child to become an adult and get chicken pox, when it was more dangerous. But since most kids got chicken pox so easily, most got it when they were kids, even without a chicken pox parties, and tragically, many learned that it wasn’t only dangerous to adults.
These days, most cases and outbreaks of chicken pox are in unvaccinated children and adults.
7 new cases in the outbreak associated with the Asheville Waldorf School in West Asheville, North Carolina, bringing the case count to 41 in that outbreak, including 4 cases in the community as the outbreak continues to spread (Nov 2018)
6 new cases at the Asheville Waldorf School in West Asheville, North Carolina, bringing the case count to 34 in that outbreak (Nov 2018)
at least 5 cases at Daybreak Primary School in Battle Ground in Clark County, Washington, leading to quarantine of at least 38 unvaccinated students who will be kept out of class for at least 21 days (Oct 2018)
at least 5 cases at two schools in Ottawa County, Michigan, including Waukazoo Elementary and Kids First – Early Childhood Center in Jenison, leading to the quarantine of at least 34 children (Oct 2018)
a cluster of chicken pox cases in Grant County, Washington at Park Orchard Elementary, North Elementary and Longview Elementary schools (Sept 2018)
at least 5 cases at the The Little Red School House Too daycare in Westbrook, Maine (May 2016)
These cases are just the tip of the iceberg though, as there are still about 7,000 to 10,000 chickenpox cases reported in the United States each year. And that’s with some states, like Oregon and Washington, not reporting cases of this Nationally Notifiable Condition to the CDC.
Still, since chicken pox caused a few hundred deaths and at least 10,000 hospitalizations each year less than twenty-five years ago, that’s a lot of progress.
Getting Chicken Pox
How do you get chicken pox?
Since it is very contagious, if your child is exposed to someone with chicken pox or shingles, then they might develop chicken pox in about 10 to 21 days (incubation period).
are unvaccinated, either intentionally, because they have a true medical exemption, or because they are too young for the vaccine, which is first given when kids are 12-months-old
are partially vaccinated, with only one dose of the chicken pox vaccine
have a problem with their immune system, including kids getting chemotherapy
In addition to being at risk for chicken pox, non-immune pregnant women, newborns born to women who develop chicken pox at around the time of delivery, premature babies, and those are immunocompromised can be at risk for severe disease.
Avoiding Chicken Pox
Want to avoid chicken pox and the chance of ending up in a chicken pox quarantine and having to stay out of school for 3 weeks or more?
That’s not an option for some kids with true medical exemptions though, including most kids who are immunocompromised. When they get caught up in one of these outbreaks and get exposed to chicken pox, it becomes a matter of life and death to work to try and prevent their getting chicken pox.
These CDC reports should even take away any last idea that they are.
If there was any association with vaccines, then why are autism rates so widely different in the 11 states that are tracked by ADDM?
Are immunization rates different in those states?
Autism and Developmental Disabilities Monitoring (ADDM) Network
Anyone who has read the latest report on autism rates understands that it “is not a representation of autism in the United States as a whole, but is instead an in-depth look at the 11 communities in the ADDM Network.”
Those communities have changed for each report, but this time they were in Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin.
Even then, the ADDM Network doesn’t look at all of the children in those states. They are mostly looking at children near large institutions that are hosts for the ADDM Network, such as the University of Arkansas for Medical Sciences, Johns Hopkins University, and Rutgers University, etc.
The 325,483 8-year-olds in the latest ADDM Network report were born in 2006 and live in:
part of Maricopa County in metropolitan Phoenix, Arizona
75 counties in Arkansas
Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, and Jefferson counties in Colorado
Clayton, Cobb, DeKalb, Fulton, and Gwinnett counties in Georgia
Baltimore County, Maryland
parts of two counties (Hennepin and Ramsey) including the large metropolitan cities of Minneapolis and St. Paul, Minnesota
Franklin, Jefferson, St. Charles, St. Louis, and St. Louis City counties in Missouri
Essex, Hudson, Union, and Ocean counties in New Jersey
Alamance, Chatham, Forsyth, Guilford, Orange, and Wake counties in North Carolina
Bedford, Cheatham, Davidson, Dickson, Marshall, Maury, Montgomery, Rutherford, Robertson, Williamson, and Wilson counties in Tennessee
Dane, Green, Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Rock, Walworth, and Waukesha counties in Wisconsin
“Autism prevalence among black and Hispanic children is approaching that of white children,” said Dr. Stuart Shapira, associate director for science at the CDC’s National Center on Birth Defects and Developmental Disabilities. “The higher number of black and Hispanic children now being identified with autism could be due to more effective outreach in minority communities and increased efforts to have all children screened for autism so they can get the services they need.”
It shows that “there continue to be many children living with ASD who need services and support, now and as they grow into adolescence and adulthood.”
Immunization Rates and the Autism and Developmental Disabilities Monitoring Network
It also helps to dispell any last ideas that vaccines are associated with autism…
Just look at the immunization rates in the ADDM Network counties (4 doses of DTaP, 3 doses of IPV, one dose of MMR, 3 doses of Hib, 3 doses of HepB, 1 dose of Varicella, 4 doses of Prevnar, flu shot, and 1 dose of HepA by age 36 months) and compare them to the autism rates in those same counties.
If vaccines were associated with autism, what should you see? Higher rates of autism in the areas with the highest immunization rates. You don’t see that in any of this data though, do you?
The counties in New Jersey, with the highest rates of autism, have good immunization rates, but they aren’t much different from the immunization rates in Colorado counties or Arizona counties with much lower autism rates.
Some other things we know about vaccines and the latest autism report?
in 2006, when those kids were born, New Jersey had one of the lowest rates for getting newborns a hepatitis B shot on their first day, as recommended, at just 23%. Arizona, with a much lower rate of autism, did much better, getting 65% of newborns their birth dose of hepatitis B vaccine on time. In fact, Maricopa County had one of the highest rates, at 71%.
fewer than half of their mothers likely received a flu shot during their pregnancy, even though they had been recommended since the 1990s
extremely few of their mothers received a Tdap vaccine during their pregnancy, as this didn’t become a routine recommendation until 2011
Does any of this surprise you?
How can vaccines be associated with autism, when counties that have higher immunization rates have lower rates of autism?
What to Know About Vaccines and the Latest Autism Prevalence Report
The latest Autism and Developmental Disabilities Monitoring (ADDM) Network report on autism prevalence from the CDC shows a rate that has increased to 1 in 59 children. And as county level trends in vaccination coverage show no correlation to those autism prevalence rates, folks will hopefully stop trying to associate vaccines with autism.
More on Vaccines and the Latest Autism Prevalence Report
reminding parents to bring their immunization records with them to each appointment, especially if they are new patients
keeping accurate immunization records on each patient
carefully recording vaccines that have been given outside your office
using an immunization information system or immunization registry to make it easier to keep track of immunization records
generating lists of patients who’s vaccines are past due
using reminder and recall messages, either phone calls, text messages, or postcards, etc., so that parents are notified when vaccines are due soon or past due
using an electronic health record system to automatically generate prompts when vaccines are due at well visits and sick visits
manually reviewing your patient’s vaccination status at each visit, whether it is a sick visit, well visit, or just a nurse visit, to see if they need any immunizations. Remember, a mild illness is not usually a contraindication to getting vaccinated.
reducing missed opportunities to vaccinate kids by using standing orders and “nurse only” or “shots only” visits for vaccinations
having extended hours for some scheduled or walk-in vaccination clinics
“Pediatricians in the sample often provided parents with inconsistent, mixed messages and sometimes offered information about HPV or HPV vaccination that was inaccurate. Pediatricians used presumptive language in only 11 of 75 encounters; when used, presumptive language was associated with higher odds of accepting HPV vaccine.”
Sturm et al, on Pediatrician-Parent Conversations About Human Papillomavirus Vaccination: An Analysis of Audio Recordings
Pediatricians who are getting frustrated talking to parents who have been refusing vaccines might also learn a few new things, including how to use presumptive language.
What is presumptive language?
In the HPV vaccination study quoted above, it was defined as “a matter-of-fact statement that the child was due for or would receive HPV vaccine that day or at a future date, conveying a positive stance toward vaccination.” This is in contrast to a nonpresumptive style that “involved questions or uncertainty,” such as “do you want to get a shot today?”
“High-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them.”
Gilkey et al, on Provider communication and HPV vaccination: The impact of recommendation quality
In addition to using presumptive language, another study has found that “By endorsing HPV vaccine highly, recommending same-day vaccination, and emphasizing cancer prevention, providers may be able to promote HPV vaccine initiation and completion while discouraging vaccine refusal and delay.”
Can these strategies work for your office?
What to Know About Increasing Childhood Vaccination Rates
From using reminder systems and standing orders to changing how you talk to parents, there are a lot of things that can be done to increase childhood vaccination rates.