How strong are the country’s defenses against vaccine-preventable diseases and how well are U.S. citizens protected? What we can do to make our “ImmUnion” stronger and more resilient in the face of emerging health threats?
Every Child By Two (ECBT) has shared a special report on the State of Our Nation’s “ImmUnion” with members of congress to highlight the power of vaccines and suggest areas of action to fortify the health of our nation. While the medical community has the ability to protect Americans of all ages from deadly infectious diseases, public health workers continue to battle disease outbreaks across the nation that threaten the health and wellbeing of our citizens. Many Americans continue to lack access to life-saving vaccines that can protect themselves, their families and their communities from preventable diseases, while others fail to realize that vaccines are available to protect them from many different life-threatening diseases.
This comprehensive 2017 State of the ImmUnion Report highlights the successes of vaccines, the economic and societal savings incurred from vaccines, challenges facing the public health system, and key areas we must focus on to achieve optimal protection for all Americans.
ECBT is hopeful that this report will not only help congressional leaders learn more about the vaccination rates in their home states, but that it will also help public health advocates prioritizing the benefits of immunizations in the years ahead.
ECBT is committed to working with all stakeholders to ensure this message reaches every level of state and federal government – from the local public health department, to the President of the United States. But we need your help!
You are an important part of the equation. Join us in helping to make sure that immunizations remain a public health priority by taking these simple steps:
1. Support critical public health funding.
Having an adequate public health budget ensures that the Centers for Disease Control and Prevention (CDC), the states and the territories are all prepared to:
- respond to existing and emerging vaccine-preventable disease outbreaks,
- conduct community outreach,
- educate providers and the public
- maintain immunization registries, and
- provide vaccine services to the community.
The report highlights the success of vaccines and discusses the economic and societal saving that occur as a result of a well-vaccinated population.
Unfortunately, federal vaccine appropriations have not met the levels requested in annual justification reports from the CDC, and state appropriations are nearly non-existent. This has resulted in a loss of personnel and the disbanding of several highly effective statewide coalitions which had supported immunization efforts for decades.
Additionally, if and when the Affordable Care Act is repealed, nearly $600 million in funds that currently support the CDC and state immunization activities may be eliminated. You can learn more about the critical funding issues here, and if you want to ensure legislators reallocate these funds, take a moment to add your name to Every Child By Two’s Vaccine Funding Support Statement here.
2. Support the science behind vaccines and the CDC’s recommended immunization schedule.
The public must be continually reassured that the timing of vaccines is carefully considered prior to CDC recommendation, and that vaccine safety is heavily monitored with pre and post licensure procedures. There are many disproven myths about the safety of vaccines and we need immunization champions who are well-informed and ready to respond to concerns with evidence-based responses. This report includes specific resources that can be helpful in addressing vaccine safety and policy concerns and even provides links to state specific immunization rates.
3. Join your local immunization coalition to see how you can work to advance the State of the ImmUnion in your local area.
Learn more about the vaccination rates in your state, and the impact vaccine-preventable diseases are having there, by accessing the resources cited in the State of the ImmUnion report, such as the American Academy of Pediatrics’ interactive map and the CDC’s VaxView. If you want to connect with other immunization advocates in your state, simply send an email to us at email@example.com and we can help connect you with your local immunization coalition.
4. Communicate directly with your state and federal legislators to encourage them to support a strong State of the ImmUnion.
Whether you call, email or Tweet your state and federal legislators, grab their attention by including any of the informative graphics from this special report. Simply include a link to the PDF report of the 2017 State of the ImmUnion along with some of the images we’ve compiled in our State of the ImmUnion social media toolkit and you’ll be helping to get the message out. (And don’t forget to tag @ShotofPrev in your tweets so we can help amplify your message.)
Every Child By Two’s Vaccinate Your Family campaign is an initiative aimed at raising awareness of the critical importance of vaccines across the lifespan. We are encouraged by the actions of so many devoted immunization champions all across the nation, and we hope you will join our efforts to ensure a strong “State of the ImmUnion”. Be sure to subscribe to our Shot of Prevention blog, like our Vaccinate Your Family Facebook page, and follow us on Twitter at @ShotofPrev to continue to receive updates on how you can join us as a voice for positive change!
Founded in 1991 by Former First Lady Rosalynn Carter and Former First Lady of Arkansas Betty Bumpers, Every Child By Two works to protect families and individuals from vaccine-preventable diseases by raising awareness of the critical need for timely immunizations for people of all ages, increasing the public’s understanding of the bene ts of vaccines, increasing con dence in the safety of vaccines, ensuring that all families have access to life-saving vaccines, and advocating for policies that support timely vaccination. Learn more at ecbt.org.
The Trust For America’s Health (TFAH) recently examined the nation’s ability to respond to public health emergencies. They tracked progress and vulnerabilities, and included a review of state and federal public health preparedness policies. In their report titled Ready or Not? Protecting the Public from Diseases, Disasters and Bioterrorism, they found that 26 states and Washington, D.C. scored a six or lower on 10 key indicators of public health preparedness.
As Every Child By Two continues to report on the State of the ImmUnion, we’ve asked Trust for America’s Health to elaborate on the vaccine section of their report in the following guest post co-authored by Dara Alpert Lieberman, MPP, Senior Government Relations Manager and Albert Lang, Senior Communications Manager.
The Importance of Vaccines Can Never be Overstated
“Some of the greatest public health successes of the past century — including the worldwide eradication of smallpox and the elimination of polio, measles and rubella in the United States — are the result of successful vaccination programs.”
Yet, somewhere along the way we lost our wonder in the awe-inspiring results vaccines produce.
A recent model estimated that, from 1994-2013, the Vaccines for Children program prevented as many as 322 million illnesses, 21 million hospitalizations and 732,000 deaths at a net savings of $1.38 trillion in societal costs. And, each year, we know that three million lives are saved because vaccines exist and are administered. According to the CDC:
- Nearly everyone in the U.S. got measles before there was a vaccine, and hundreds died from it each year. Today, most doctors have never seen a case of measles.
- More than 15,000 Americans died from diphtheria in 1921, before there was a vaccine. Only one case of diphtheria has been reported to CDC since 2004.
- An epidemic of rubella (German measles) in 1964-65 infected 12.5 million Americans, killed 2,000 babies, and caused 11,000 miscarriages. In 2012, 9 cases of rubella were reported to CDC.
If you think this is hyperbole, remember that we effectively eliminated measles in the United States in 2000, yet, since 2014, we have experienced a resurgent number of measles cases, largely among people who were unvaccinated.
In our recent report, Ready or Not? Protecting the Public from Diseases, Disasters and Bioterrorism, we found that just 10 states vaccinated at least half of their population against the seasonal flu.
We like to use this as a bit of a proxy indicator. Basically, if we can’t vaccine a large portion of the population for something that is more or less the norm, what are the odds we could quickly vaccinate a majority of the population during a pandemic. For example, if there was a vaccine for Zika, would the nation been able to dispense it?
Another lesson we can draw from vaccination rates: when we become complacent, our preparedness suffers. We can’t let vaccine complacency continue. To improve vaccination rates, TFAH’s report included policy recommendations such as: Read more…
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.
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.
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?
The timing could not have been worse.
It was the holiday season and many family members were traveling great distances to converge on “Mom’s House”. To complicate matters even more, one family member was temporarily living with her mom as a result of being on bed rest for the duration of her high risk pregnancy.
Her mother, who was a fairly active woman in her mid-70 without any health problems, was complaining about back pain. She believed she had strained a muscle but couldn’t seem to get relief. When the rash appeared a few days later, it became clear that she had shingles.
It really shouldn’t have come as much of a surprise.
About one of every three people in the U.S. will get shingles during their lifetime, and the risk increases with age. For immune compromised individuals, the risk of shingles increases by as much as 50 fold. In fact, every year in the U.S. approximately one million people are affected by shingles.
If you’ve ever known someone who has suffered with this disease, you’ll know why you would want to prevent it.
Shingles can cause severe and long-lasting pain. While the shingles rash typically resolves in about a month for most people, the pain is very difficult to treat. Other symptoms include fever, headache, chills, upset stomach, muscle weakness, skin infection, scarring. Shingles can also develop in the eyes and cause vision loss. Additionally, in about 10-18% of cases, patients will suffer with postherpetic neuralgia (PHN) which is a condition best described as a lingering, burning, stabbing, throbbing, or shooting pain that can last weeks, months or even years.
So with one mom down with shingles, her daughter grew concerned over the arrival of her new baby. Would it be possible for her newborn to contract the virus?
Fortunately, people don’t catch shingles from other people. Rather, shingles (also called herpes zoster) is caused by a reawakening of the varicella zoster virus (VZV) that causes chickenpox. After contracting chickenpox, the virus lives in the nervous system for years – even decades – until something causing it to reawaken. Sometimes it’s reawakened by a waking of the immune system from advancing age or immune-suppressive drugs used to treat cancers. But what’s hardest to accept is that most cases of shingles occur among adults who are otherwise healthy. Even having suffered with shingles doesn’t prevent someone from having it again. In fact, a reoccurrence of shingles happens in about 6% of people.
In the case of the mother and pregnant daughter sharing a home, the possibility existed that the newborn baby, too young for varicella vaccine, could potentially be at risk of contracting chickenpox if she were to come into contact with the rash of the infected grandmother. This is why the family was advised by their doctors to be extra diligent in washing hands after touching any of the open sores.
While there are verified cases of shingles in people of all ages – even adolescents – the risk of shingles appears to peak in those age 65 and older (as seen in the chart at left).
So, while scientist have been observing an increase in the incidence of zoster since 1993, they attribute the rise in cases to an aging population as well as a population who is increasingly immune compromised.
To complicate matters further, experts explain that the epidemiology of zoster has been changing and it’s unclear exactly why. The current vaccine, which we know to have poor efficacy in the high risk elderly, also does not provide long-lasting protection. However, it can reduce the risk of shingles by half (51%) and reduces the risk of prolonged pain at the rash site by 67%.
When shingles vaccine was first licensed in 2006, it was approved for use in people age 50 and over. In fact, the research at that time determined that the shingles vaccine had a 70% efficacy among people ages 50-59. However, the efficacy was reduced when administered to older individuals, and protection continued to decline significantly at 5-10 years post vaccination.
So, when the Advisory Committee on Immunization Practices (ACIP) announced their adult vaccine recommendations in 2008, they recommended one dose of shingles vaccine be administered to adults at age 60 and older. Their decision was based on the belief that vaccine administrations should be timed to achieve the greatest reduction in burden of disease and the related complications. Since there was insufficient evidence of long-term protection offered by the zoster vaccine, it was believed that vaccinating persons under 60 years of age may not help protect people when the incidence of herpes zoster and it’s complications were at their highest.
While it appears that there has been a downward trend in childhood cases of shingles since 2005, most likely as a result of increased varicella vaccination among children, current shingles vaccine uptake among adults 60 and over is lower than most other adult recommended vaccines at just 27.9%. If uptake were greater it is suspected that we would be seeing fewer cases.
In looking ahead, we are hopeful that two new shingles vaccines will prove to be more effective.
Every Child By Two’s State of the ImmUnion campaign is honoring National Immunization Awareness Month (#NIAM16) with a Blog Relay highlighting the importance of vaccines across the lifespan and across the nation.
In this guest post, we hear from Heidi Parker, MA, Executive Director of Immunize Nevada. She reminds us that promoting health and preventing disease is not just a cause to recognize during the month of August; instead, it is something we need to do each and every day.
By Heidi Parker, MA, Executive Director of Immunize Nevada
Dr. Donald A. Henderson passed away recently, with little media attention or fanfare. This is alarming, considering “saving millions of lives” was listed as one of his life accomplishments.
In case you’re wondering who he is, Dr. Henderson led the global effort to eradicate smallpox — a disease that, in the 20th century and before it was extinguished, was blamed for at least 300 million deaths. Clearly, his triumph over smallpox proved the power of vaccines.
During National Immunization Awareness Month, we are reminded that promoting health and preventing disease is not just a cause to recognize during the month of August; instead, it is something we need to do each and every day.
We must be relentless, much like Dr. Henderson was. Why? Because our news feeds continue to be filled with stories of vaccine-preventable diseases – a teen dies from meningococcal disease; a summer camp closes due to a whooping cough outbreak; college campuses battle mumps; measles spreads at music festivals; an infant too young to be vaccinated dies from pertussis; the list goes on.
In the United States, vaccines have reduced — and in some cases, eliminated — many of the diseases that killed or severely disabled people just a few generations ago. My great-grandfather died during the 1918 Influenza Flu Pandemic, along with millions of others; but decades later, our family is protected from this deadly virus when we get our annual flu shot. By vaccinating children against rubella (German measles), the risk that pregnant women will pass this virus on to their fetus or newborn has been dramatically decreased, and birth defects associated with that virus are now rarely seen. Countless examples like these demonstrate, day after day, vaccines are one of public health’s greatest achievements.
Unfortunately, tens of thousands of Americans still suffer serious health problems, are hospitalized, and even die from vaccine-preventable diseases. Read more…
As a mother and a nurse, I was vigilant in having both of my children up-to-date on all recommended vaccinations, including meningococcal vaccination. I was under the common misconception, as many parents are, that the meningococcal vaccine that my daughter received would fully protect her from meningococcal disease, when in fact, it didn’t protect her against meningitis B. The meningococcal vaccine (MCV4) only protects against four of the five common groups (ACWY), leaving adolescents and young adults vulnerable to meningitis B. Meningitis B is a type of bacterial meningitis, also known as meningococcal disease, which is a potentially fatal bacterial infection that can kill a healthy person within 24 hours.
When my daughter Kimberly Coffey died in 2012 from bacterial meningitis, a vaccine was not available to protect her. But since 2014, meningitis B vaccination has been available in the United States. Kimberly was a perfectly healthy 17-year-old high school senior, and I believe she would be alive today if meningitis B vaccination had been available to her.
I established The Kimberly Coffey Foundation in Kimberly’s honor to educate other parents and health care providers about meningitis B, also known as MenB.
It’s critical that parents know that MenB vaccination is now available, and that without requesting MenB vaccination in addition to the common meningococcal vaccine (MCV4), their child will not be fully protected against meningococcal disease and MenB.
The Kimberly Coffey Foundation has partnered with Pfizer on the National Meningococcal Disease Awareness Survey to gain a better understanding of parents’ knowledge of meningococcal disease and its available vaccines. This 2016 survey revealed that nearly 4 out of 5 parents didn’t know their child wasn’t fully immunized against the five common groups of meningococcal disease unless they had two meningococcal vaccines (MCV4 and MenB).
The bottom line is this – without adding MenB vaccination, we are going to lose more lives. There will continue to be more college outbreaks, especially since MenB has been responsible for several recent college outbreaks in the United States. According to data released by the CDC, MenB currently accounts for approximately 50% of meningococcal disease in the United States among persons aged 17-22 years old. MenB vaccination is available for individuals ages 10-25, and public health insurance and most private insurance plans provide coverage. However, your child’s provider may not mention it.
I want parents to have the knowledge to request MenB vaccination, in addition to the meningococcal vaccine, so that their children can potentially be fully protected against this devastating disease.
As a mother who lives every day with the heartache of not seeing my beautiful daughter live the full life she deserved, I know only too well how important MenB vaccination is. My daughter Kimberly’s life was one too many lost to this terrible disease.
I will be Kimberly’s voice as I continue to promote awareness of meningococcal disease, which includes MenB. I don’t ever want another parent to experience what I have. And more important, I don’t want another person to experience what Kimberly did when she battled for her life.
Kimberly contracted MenB two years too early—two years before the MenB vaccine was made available. She didn’t have the protection of the MenB vaccination, but your children can. Please protect your children – because YOU can.
For more information about meningitis B and the MenB vaccine, please visit the Kimberly Coffey Foundation at www.kimberlycoffeyfoundation.org.
Every Child By Two (host of the Shot of Prevention blog) welcomes guest blog posts on a variety of vaccine related issues. The views and opinions expressed in these guest posts do not necessarily represent the views of the Every Child By Two organization.
Every Child By Two’s State of the ImmUnion campaign is honoring National Immunization Awareness Month (#NIAM16) with a Blog Relay highlighting the importance of vaccines across the lifespan and across the nation.
In this fourth guest post, we learn how Maine has made great strides in stepping up the state’s vaccination rates for infants, babies and young children to at or above national levels. But when it comes to adolescents, Maine – like many other states – still has some catching up to do.
At Vax Maine Kids, they’re working hard to make sure parents know how to protect their childrenfrom several serious illnesses that can strike during the teen years.
This guest post by Franklin Health Pediatrics pediatrician, Dr. Gabe Civiello, highlights the importance of vaccines for preteens and teens and explains what Maine is doing to improve adolescent immunization rates.
By Gabriel Civiello, MD in collaboration with Vax Maine Kids
Healthcare providers all across Maine are celebrating the recent rebound in vaccination rates for our youngest children. In fact, our childhood immunization rates rank among the highest in the country. According to the 2014 National Immunization Survey, over 85% of Maine toddlers are up-to-date on their recommended vaccinations, and kindergarten non-medical exemption requests fell to 3.9% during the 2014-2015 school year.
The trends aren’t quite as positive for Maine’s preteens and teens, however. Nationwide, as children grow into their preteen and teen years, under immunization becomes much more common—and Maine is no exception. In fact, Maine’s vaccination rates for the meningococcal vaccine and the tetanus, diphtheria, and pertussis (Tdap) vaccine are below the national average and the lowest in New England. Following the national trend, human papillomavirus (HPV) vaccine rates in Maine are at least half of the rates of the other adolescent vaccines.
Why are immunization rates lower for Maine teens?
- Preteens and teens have lower attendance at well child visits. If they aren’t seeing their healthcare provider on a regular basis, they and their parents aren’t being reminded of the CDC-recommended vaccination schedule (and the importance of sticking to it). When teens see a provider solely for sick visits or emergencies, vaccinations may not come up in the discussion as often as they should.
- Critical vaccines for teens are not required for school attendance in Maine. Teens are allowed to attend school without getting the meningococcal vaccine and the HPV vaccine, and Maine is one of only three states that doesn’t require the Tdap vaccine. By leaving these vaccines out of school requirements, parents may get the impression that their children don’t need them.
- The HPV vaccine remains as poorly understood and under-utilized (by families and providers), in Maine as it is elsewhere in the country. We aren’t communicating the importance of safely vaccinating adolescents against the common cancers caused by the HPV virus before they become sexually active as well as we could.
There is good news for Maine teens in the NIS data, however. Our HPV vaccination rates are higher than the national average. This tells us that Maine parents and providers want to protect our children all the way into adulthood, and that HPV vaccine rates will likely improve with better communication about the vaccine.
Which diseases threaten Maine teens, and which vaccines can protect them?
There are four vaccines that are routinely recommended for all preteens between 11 and 12 years of age. Teens also need a booster dose of meningococcal vaccine at age 16, and teens may also need additional vaccines based on risk factors, travel, or if they missed previous doses. The vaccines routinely recommended for preteen and teen girls and boys are:
- Quadrivalent meningococcal conjugate vaccine, which protects against four types of meningococcal disease. Meningococcal disease is caused by bacteria and is a leading cause of bacterial meningitis – a serious infection around the brain and spinal cord – in teens and young adults. Two doses are needed for full protection.
- HPV vaccine, which protects against several types of HPV. HPV can cause cancers of the cervix, vulva and vagina in females and cancers of the penis in males. In both females and males, HPV infection can also lead to head/neck cancers, anal cancer and genital warts. Three doses are needed for full protection.
- Tdap vaccine, which is a booster shot against tetanus, diphtheria and pertussis. Pertussis (whooping cough) can keep kids out of school and activities for weeks. Infants, for whom pertussis can be deadly, are often infected by an older sibling or adult. A Tdap vaccine is recommended between the ages of 11-12 (with boosters for tetanus and diphtheria (Td) needed every 10 years throughout adulthood).
- Flu vaccine, because even healthy kids can get influenza, and it can be serious. All preteens and teens, should get the flu vaccine every year.