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With School Vaccine Exemptions on the Rise, What Can Be Done to Protect Our Students?

June 12, 2018 1 comment

Today, PloS Medicine published a study that examined the increase we are seeing across the country in philosophical exemptions to school vaccine requirements, also known as personal belief exemptions.

According to the authors, 12 of the 18 states that allow philosophical exemptions have seen an increase in parents choosing to exempt their children from one or more vaccines. As a result, several metropolitan areas are at risk of an outbreak of disease, such as measles, similar to the one we saw originate at Disneyland in Anaheim, California three years ago.

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The Washington Post notes that the study “characterized many rural counties, as well as urban areas, as ‘hotspots’ because their high exemption rates put them at risk for epidemics of measles, whooping cough and other pediatric infectious diseases.

Amy Pisani, Executive Director of Every Child By Two/Vaccinate Your Family, expressed concern about what is known as the “community protection threshold” by stating, 

“It’s alarming to see the rise in exemption rates across this country, putting communities at greater risk. Parents need to understand that timely vaccines are critical to protecting children’s health and should be at the top of the family’s to-do list.”

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While the study reveals some interesting data points, there’s little information as to why it appears that parents are increasingly claiming exemptions for their children.

In most states, the school vaccine exemptions tend to be elevated in a handful of communities, as opposed to a general rise in exemptions throughout the state.  It appears that more research needs to be done to better inform public health policymakers regarding the underlying reasons parents are exempting their children from school required vaccines.

In the meantime, some of the states with the highest levels of exemptions have passed legislation to make nonmedical exemptions more difficult to obtain. For example:

  • In Washington state, a law was passed that required parents to have their exemption form signed by a health care provider.
  • In Oregon, parents have the option of watching an online module on the dangers of not vaccinating or getting a form signed by a health care provider.

While both states saw an immediate and encouraging reduction in the number of exemptions claimed, it appears that these policies have not been effective over time and exemptions are once again on the rise.

Tightening laws and policies clearly does not keep those parents who are intent on seeking exemptions from obtaining them. But how about eliminating nonmedical exemptions?

After the 2014-2015 measles outbreak in California, the state legislature decided to eliminate all nonmedical exemptions. Again, one year after the law was passed exemption rates fell dramatically and, most importantly, vaccination rates rose well above community immunity thresholds, thus better protecting communities against disease outbreaks.

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But what will the future hold?  Will parents who have philosophical reasons to avoid vaccines for their children find ways to obtain medical exemptions?

Initial data suggests that may be the case. According to an article in JAMA, the California medical exemption rate reflected a three-fold increase following the introduction of the law, from 0.17% to 0.51%. According to the article’s authors,

“Some vaccine-hesitant parents may have successfully located physicians willing to exercise the broader discretion provided by SB 277 for granting [medical exemptions]…If true, this practice would be inconsistent with the recommendation from the American Academy of Pediatrics to reserve [medical exemptions] for children having contraindications.”

In the coming years, public health partners may have a better sense of whether eliminating nonmedical exemptions can sustainably increase vaccination rates and protect our communities against dangerous vaccine-preventable diseases. We will also be looking to additional studies to learn how many parents are choosing exemptions because they have true personal objections to vaccinations, or because they don’t view vaccination as a priority among their long back-to-school lists.

In the meantime, it’s important to help state legislators and the public understand what has been tried to-date and what are the most promising policy paths forward. 

Here are some ways that you can be informed and help to inform others:

  • Consider sharing Vaccinate Your Family’s fact sheet on the impacts of exemption legislation with your local lawmakers to remind them of their role in strengthening our defenses against vaccine-preventable disease.
  • Check out Vaccinate Your Family’s 2018 State of the ImmUnion report to learn more about federal policies that aim to protect our families and communities from dangerous diseases.
  • Help ensure children are better informed about how diseases develop and how vaccines work with the immune system by sharing specially designed science curricula from The Vaccine Maker’s Project with school nurses and science teachers at your local elementary, middle or high schools.
  • Find out more about the vaccination rates in your state and community by contacting your local schools, public health department or reviewing the latest CDC vaccination coverage reports.
  • Stay informed about the latest immunization news and research by following Vaccinate Your Family’s Facebook, Twitter and Instagram accounts, subscribing to this Shot of Prevention blog and sharing the information we discuss on these channels with your social contacts.

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Together we can work to ensure that students get the protections they deserve in their schools and communities.

Educating Legislators About Preventative Health and Vaccination

October 30, 2017 Leave a comment

Every Child By Two will be making a special presentation on Capitol Hill on Tuesday, October 31st, alongside experts from the American Public Health Association, the American Diabetes Association and the National Council on Aging.

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The panel, which will be moderated by the National Coalition on Health Care, will discuss the vital role of Health and Human Services initiatives to drive down health costs and improve health outcomes at each stage of life.

Every Child By Two’s Executive Director, Amy Pisani, will explain the ability of vaccines to save both lives and money – and the impact federal funding cuts will have on our efforts to combat vaccine-preventable diseases in the U.S.

Please contact your legislators and suggest they attend this special presentation on Prevention Across the Lifespan.  

It will be held at the U.S. Capitol Visitor Center from 10-11:30 am on October 31st in room SVC-203.  If you are unable to attend, we encourage you to watch Every Child By Two’s portion of the presentation via Facebook Live on the Vaccinate Your Family Facebook page.

You may also want to review and share our 2017 State of the ImmUnion report with your legislators.

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This report examines what we can do, as public health advocates and legislators, to make our ImmUnion stronger and more resilient in the face of emerging health threats. The report highlights the successes of vaccines, the economic and societal savings incurred from vaccines, challenges facing the public health system and key areas of focus to achieve optimal protection against vaccine-preventable diseases.  There are even resources within the report that help individuals learn more about the vaccination rates in their state and what can be done to ensure the health of families throughout the nation.  To access the report, click here.

How Are People in the U.S. Impacted By Polio Around the World?

October 18, 2016 1 comment

On October 24th, Rotary International will host the fourth annual World Polio Day event to raise awareness, funds and support to #EndPolioNow.

Since Rotary and its partners launched the Global Polio Eradication Initiative nearly 30 years ago, the incidence of polio has plummeted by more than 99.9 percent, from about 350,000 cases a year to 26 confirmed as of Sept. 19, 2016. Today, polio remains endemic in three countries – Afghanistan, Nigeria and Pakistan.

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Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially vulnerable countries with weak public health and immunization services and travel or trade links to endemic countries. Without full funding and political commitment, this paralyzing disease could return to previously polio-free countries, putting children everywhere at risk.

Before we engage in the global discussion on polio eradication next week, we’ve asked Every Child By Two Board Member and infectious disease specialist, Paul A. Offit, MD, to elaborate on the “State of the ImmUnion” for polio here in the United States.  

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This is what he had to say:

What is the most striking fact about polio that you wish people knew?

That once people are affected, there isn’t much you can do to make them better. The only real weapon against polio is the vaccine. Everything else—iron lungs, braces, hot packs, and occupational therapy—are far too little far too late.

How would you describe the current “State of the ImmUnion” for polio? Are there still cases of polio in the U.S.? Are enough people protected? How could people in the U.S. get polio?

Read more…

Everything is bigger in Texas — except when it’s not: A Texan reflects on #NIAM

August 4, 2016 1 comment

In recognition of National Immunization Awareness Month (#NIAM16), Every Child By Two’s #StateofTheImmUnion campaign will highlight the importance of vaccines throughout the lifespan.  We are excited to present the first in a series of guest posts from colleagues throughout the nation who will provide their perspective on the topic of the week for #NIAM16.

The following post focusing on adult vaccines was written by Anna Dragsbaek, President and CEO of The Immunization Partnership, a Texas-based non-profit organization dedicated to the eradication of vaccine-preventable diseases through education, advocacy for science-based immunization policy and the support of immunization best practices.

During this week of National Immunization Awareness Month, it’s a good time to reflect on how we are doing as a state and as a nation with vaccinating our communities, including adults. And while Texas is the best state in the union for a number of reasons, when it comes to vaccinating our adults, we have some work to do.

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Fewer than half of Texas adults got the flu vaccine last season — far short of the Healthy People 2020 objective of 70 percent. Why is this? Some of it has to do with the things that are bigger — but that we wish weren’t. Take, for instance, the percentage of people whose access to vaccinations might be limited by their lack of health insurance. According to the Texas Medical Association, one in four adults in Texas don’t have medical insurance; nationwide, the number is one in six, the CDC reports.

The Adult Safety Net Program is designed to help uninsured adults gain access to vaccines by providing low-cost immunization — and it does help. Many adults are able to access to vaccines who otherwise wouldn’t be able to because of this program. But it can only do so much. And all too often adults live in areas where they don’t have access to an Adult Safety Net provider, don’t qualify for the program themselves, or area providers don’t offer all the vaccines recommended by the CDC.

texasAnd even those with insurance can find it difficult to gain access to vaccination for other reasons.

Texas has the largest rural population in the country — a fact that becomes abundantly apparent on the roughly 11-hour drive from Houston to El Paso. The entire state takes up more than 260,000 square miles. To put that into perspective, that’s nearly the square footage of neighboring states New Mexico, Oklahoma, Arkansas and Louisiana combined.  With so much ground to cover, many in the state have to travel long distances to see a healthcare provider. And because not all providers participate in the Adult Safety Net Program, the distance that uninsured Texans must drive can be significantly longer — even though these tend to be the people who can least afford the time and gas for a long drive.

But perhaps most importantly, many adults — especially young adults —simply don’t know that immunizations are recommended not just during childhood or when you’re in school, but also from age 19 on.

TEXASdreamstime_xl_4988317That could be, in part, due to the infrequency with which adults seek preventative care from their health home. Primary care providers (PCP) are often the chief health educators for families of all ages, and if adults aren’t seeing their PCPs (because of lack of insurance or access issues), they might not be getting information on what vaccines they might need and why.

But if anyone is up for a challenge, it’s Texans.

This spring we traveled across the state of Texas to talk with more than 700 healthcare providers, public health officials and vaccine advocates about what they experience on the ground as they work to protect our communities. And one thing is abundantly clear: Texans protect Texans. There are a lot of hard-working people throughout this great state who are committed to doing what they can to improve immunization rates across the lifespan and protect our communities from needless suffering as a result of vaccine-preventable diseases.

Community health workers are putting together health fairs to offer free flu vaccines for adults in Houston. Coalitions are working together in West Texas, the Panhandle and the Rio Grande Valley to educate and vaccinate adults in their communities. And stakeholders are working with the Texas state government in Austin to expand the vaccines available to uninsured adults and improve the statewide immunization registry to promote adult participation.

Things look like they’re getting better.

TEXASdreamstime_xl_29557210During the 2010-2011 flu season, about 40 percent of Texas adults were vaccinated against flu. In 2014-2015? That number was 45 percent. Sure, the progress is slow. And to move the needle even further, we’ll have to come together as a state to educate the adult population and push for laws and policies that could help improve access and uptake.

If there’s one thing we can be bigger — and better — at, it’s working together for better health for adults and families. But we’re Texans afterall. We don’t shy away from a challenge.

Find out more about the great works of Texas’ Immunization Partnership  by visiting www.immunizeUSA.org/blog

Join us next week as we present a guest blog from a physician colleague from California on the #NIAM16 topic of Pregnancy

Questioning Whether To Get Your Child the HPV Vaccine? Read This

January 21, 2016 7 comments

iStock_000039978628_Double.jpgIn June 2006, the first human papillomavirus (HPV) vaccine was licensed for use in the U.S.  Rather than celebrate the development of a vaccine to prevent a deadly form of cancer, many parents have instead been misguided by fear.  As a result of persistent internet stories and inaccurate myths that question the safety of HPV vaccines, parents continue to refuse or delay HPV vaccines for their children, and one of the most effective ways to prevent cancer is being grossly underutilized.

Although millions of doses of HPV vaccines have been administered in the past 10 years, some parents still fear what may happen if their child gets an HPV vaccine. 

What they should fear is what may happen if they don’t.

I offer the following information about HPV because everyone should understand where their fears ought to be directed: at the disease, not the vaccine designed to prevent it.

1)  It’s not about sex, it’s about cancer.

Regardless of what parents choose to teach (or not teach) their kids about sex, abstinence or contraception, the HPV vaccine is vital to the health of our children because it protects them from cancer.

By preventing people from contracting certain strains of a highly prevalent infection, we can then prevent the possibility of HPV infections turning into cancerous cells. An HPV infection is often contracted shortly after sexual debut, and can eventually lead to cancers of the cervix, vulva, vagina, penis, anus or throat. Since the majority of these cancers have no formal screening measures, they often go undetected until they are well advanced.

2)  Nearly all sexually-active individuals will contract HPV at some point in their lives. 

HPV is the most common sexually transmitted infection in the United States and is often referred to as the common cold of the genitals. HPV is not a new virus, but many people are unfamiliar with how dangerous and prevalent it is. Consider these staggering statistics:

Not only is HPV infection common, but most people rarely know they’re infected because it typically occurs without any symptoms.  Since it’s possible to develop symptoms years after first being infected, it’s especially difficult to diagnose exactly when a person first became infected.

In about 90% of cases, an HPV infection will eventually clear in about a year or two. However, during that time, those infected with HPV are often unknowingly spreading the infection to others.

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3)  As many as 10% of those infected will eventually develop cancer. 

While 90% of people may clear the infection, the other 10% end up developing cancerous cells years, or even decades, after initial exposure.  Since there is no way to determine which cases will clear and which will lead to cancer, universal vaccination is the most effective means of prevention.

The following data reveals just how many cancer cases are linked to HPV each year:

Cervical cancer: Almost all cervical cancer cases are caused by HPV and more than 11,000 women in the U.S. alone get cervical cancer each year.  When looking at the bigger picture, 528,000 new cases of cervical cancer were diagnosed worldwide in 2012.

Anal cancer: About 91% of anal cancers are caused by HPV and there are approximately 4,300 anal cancers diagnosed each year.

Oropharyngeal cancers(cancers of the head, neck, throat, mouth, tongue, and tonsils) About 72% are caused by HPV and an estimated 8,400 of these cancers are diagnosed each year.

Vaginal cancer: HPV causes about 75% of vaginal cancers and there are about 500 vaginal cancers diagnosed each year.

Vulvar Cancer: HPV causes about 50% of vulvar cancers and an estimated 2,100 vulvar cancers are diagnosed each year.

Penile Cancer: About 63% of penile cancers are linked to HPV and there are about 600 penile cancers diagnosed each year.

Genital Warts: There are more than 40 types of HPV that specifically affect the genital area. However, 90% of genital warts are caused by HPV types 6 or 11 and about 360,000 people in the U.S. get genital warts each year.

Since there is no test to check one’s overall HPV status, and no standard screening to detect HPV in the mouth or throat, getting an HPV vaccine is an effective way to prevent illness rather than leave people vulnerable to infections that can lead to cancer.

Some argue that since there is a test to screen for cervical cancer that this eliminates the need for vaccination among women.  While cervical cancer screenings are vitally important, they don’t prevent infection.  Instead, they help identify precancerous lesions. Once lesions are discovered, women may then need to endure various invasive and painful procedures.  These may include cone biopsies used to help diagnose precancerous or cancerous cells, and a loop electrosurgical excision procedure (LEEP) often used to burn off precancerous lesions.  Additionally, cervical cancer screenings don’t help identify other HPV related cancers or help screen of men or adolescents for HPV.  With the vaccine we can prevent cancers before they exist.

4)  Surprise…you don’t have to have sex to get HPV.

Read more…