IMMUNIZATION1

Immunization – Children Entering Kindergarten

Week 3 Assignment

Lindsay Ann Abrigo

March 17, 2014

MPH 584 – Community Health

Dr. Kimberly Brodie

Immunizations are essential to the health of society because it has contributed to the increase in life expectancy and reduction in infectious disease mortality. Deaths from infectious diseases have been vastly reduced because of widespread immunization programs. According to Healthy People 2020, vaccines are considered to be among the most cost-effective clinical preventive services (2013).Vaccines are among ten of the Centers for Disease Control and Prevention’s greatest success stories in public health (2011) and, according to Erin Walkinshaw, may be one of the safest, longest-lasting and most effective ways to prevent communicable diseases (2011). McKenzie et al. state “because many vaccine-preventable diseases are more common and more deadly among infants and children, the CDC recommends vaccinating children against more vaccine-preventable diseases early in life” (2012). Immunization among communities will contribute to safeguarding children against the potentially devastating effects of vaccine preventable diseases (McKenzie et al., 2012).

During the early years of life, children need vaccines to protect them from 14 diseases that can be serious, even life-threatening. The CDC asserts, “parents who choose not to vaccinate their own children increase the risk of disease not only for their children, but also for other children and adults throughout the entire community” (2013).Virtually all children, according to Schneider, “are vaccinated against diphtheria, tetanus, pertussis (whooping cough), polio, measles, rubella (German measles), mumps, and hepatitis B before they enter school” as the majority of these immunizations is required by law (2011). In addition, vaccinations for Haemophilus influenza type b (spinal meningitis), varicella (chicken pox), pneumococcal disease, and hepatitis A are recommended (Schneider, 2011). Laws requiring children to be vaccinated before school entry have helped to achieve high overall vaccination rates in the United States (Kennedy et al., 2005).In concurrence to the statement by Schneider (2011), McKenzie et al. cited the CDC’s recommended immunization schedule for children that include“four doses of the diphtheria, tetanus, and pertussis (DTP) vaccine, three or more doses of Haemophilus influenza type b (Hib) vaccine, and the varicella (chickenpox) vaccine” (2012). Flu vaccinations are also recommended for children to help keep them healthy (CDC, 2013).Although the CDC actively tracks immunization rates (Schneider, 2011), the CDC does not set immunization requirements for schools or childcare centers. Instead, each state decides which immunizations are required for a child's enrollment and attendance at a school or childcare facility in that respective state.

Healthy People 2020 cites that by adhering to a routine immunization schedule, society can: save 33,000 lives; prevent 14 million cases of disease; reduce direct health care costs by $9.9 billion; and save $33.4 billion in indirect costs (2013). Even so, “people in the United States continue to get diseases that are vaccine preventable” (Healthy People 2020, 2013). This may be due to parental decision not to immunize a child for fear of negative health outcomes as a result of being immunized. There are approximately 1 million children in the United States have not been fully vaccinated with the most critical vaccines and the “large number of unvaccinated children has been attributed to cost, lack of access to medical care, uneducated parents, and confusion on when to vaccinate children” (McKenzie et al., 2012).

As with any products regulated by the FDA, vaccines undergo rigorous reviews of laboratory and clinical data to ensure the safety, efficacy, purity and potency of these products (FDA, 2010). Immunizations that have been approved for marketing may require additional testing to further evaluate the vaccine and to address specific questions about the vaccine's safety, effectiveness, or possible side effects (FDA, 2010).The CDC acknowledges that any vaccine has the potential to cause side effects, but for the most part, these side effects are minor and go away after a few days (2014). Vaccines are monitored continuously to ensure their safety (CDC, 2014).

A study by Kennedy et al. showed that a greater proportion of opposed parents were likely to agree that the body can protect itself with vaccines and that vaccines were not or only somewhat important to a child’s health (2005). A greater proportion of opposed parents did not believe that vaccines were necessary to prevent certain diseases and were more likely than supportive parents to be concerned that vaccines were given to prevent diseases that were not serious and that children are not likely to get (Kennedy et al., 2005). In addition, a greater proportion of opposing parents versus supportive parents were more likely to view vaccines as unsafe or only somewhat safe, not be confident or only somewhat confident in the safety of childhood vaccines, and express concern that “children receive too many vaccines in their first two years of life,” and finally that their child would receive none or only some of the recommended childhood vaccines (Kennedy et al., 2005). However, as aforementioned, the government agencies, such as the CDC (2011) and FDA (2013), have recognized the contribution of vaccines for reducing many childhood infectious diseases, many of which have been eliminated in the United States due to effective vaccines.

It is the responsibility of public health authorities and local, state, and federal governments to adequately communicate with and educate individuals and communities to increase their understanding of the importance of receiving vaccinations, ensuring their children are vaccinated, and also to present them with the options available to them in addition to explaining the consequences of their actions (i.e. refusing to have child vaccinated or follow immunization schedule as recommended), so they can make informed decisions. It is quite obvious that a major concern is the welfare of the population as a whole. There will absolutely be individuals who will not be willing to comply and will outright refuse to have their children immunized despite the risk of contracting the disease as well as the potential benefit of protecting themselves and others, and stopping further spreading of the disease."Parents should know that the risk of being harmed by a vaccine is significantly smaller than the risk of serious illness that comes with infectious diseases," explains Marion Gruber, Ph.D., director of the Office of Vaccines Research and Review (FDA, 2013). "Vaccination is a very important step to get children off to a healthy start” (FDA, 2013). As such, immunizing children before kindergarten is essential to assure that the health and wellbeing of the child and of those within the community are safeguarded against vaccine-preventable diseases.

Morbidity/Mortality / Risk Factors / Community Health Strategies
Diphtheria / Major cause of illness and death for children in 1920s; 206,000 cases and 15,520 deaths.
With vaccination development, cases decreased.
Higher case-fatality rates in children 5 years and under. / Bacteria can be passed among people in U.S. even though diphtheria is rare. / The target population for this health profile table is children entering kindergarten. With this population in mind, it is essential that public health professionals utilize the school setting as a means of promoting health among children. According to the World Health Organization, there are more children than ever who receive a formal education and “school are an efficient way to reach school-age youth and their families in an organized way, and to ensure the individual growth essential for national development” (1999). It is evident that in almost every community around the world, the school setting is where children spend a great portion of their time and this is the place where education and health programs can have the “greatest impact because they can reach students at influential stages in their lives – childhood and adolescence” (WHO, 1999). The following strategies can and should be offered to school-age children to promote and improve health:
  • Hand washing
  • Nutrition and selecting healthy food options
  • Physical activity and exercise
  • Preventive health
  • Education on tobacco and substance use to prevent children from engaging in or adopting these unhealthy behaviors
  • Immunization programs offered by schools
  • Mental and emotional support; counseling services

Hepatitis B / 25 percent of children who become infected are expected to die of related liver disease in adulthood.
20 to 30 percent of Americans acquired infection during childhood.
12,000 children born to mothers infected with hepatitis B were infected each year before infant immunization program implementation.
Estimated 33,000 children (10 years of age and younger) of mothers not infected were infected each year before routine recommendation for vaccination.
Greatest number of new infections declined among children and adolescents as a result of vaccinations. / Chronic hepatitis B infection increases risk for chronic liver disease, cirrhosis, and liver cancer.
Measles / Prior to measles immunization, nearly everyone in the U.S. got measles; 450 measles associated deaths each year between 1953 and 1963.
3 of every 1,000 with measles with die in the U.S.; in developing countries, 1 of every 100 with measles will die.
Approximately 2.7 million deaths due to measles could be expected if immunizations were. stopped / Potential for those who are not immune to get measles if exposed to the virus.
Most cases associated with international visitors or U.S. residents who had exposure to measles while traveling abroad
Mumps / 1 in 20,000 reported cases of mumps, which was major cause of deafness in children prior to introduction of vaccination.
Serious side effects less common in children compared to adults.
Mumps very common in U.S. children; 300,000 reported cases every year, before vaccine had become available.
Incidence of mumps declined in 2001 to 266 cases; likely due to children receiving second does / Communicable disease and prolonged contact among persons can facilitate transmission.
Serious complications, like inflammation of the brain can occur but is rare; prior to mumps vaccination, mumps encephalitis was leading case of viral encephalitis in U.S.
Pertussis (DTP) / Prior to availability of immunizations, almost all children developed whooping cough; between 150,000 to 260,000 cases of pertussis were reported each year; 9,000 pertussis-related deaths. / Potentially severe illness, results in prolonged coughing spells lasting for many weeks, at risk for causing pneumonia and leading to brain damage, seizures, and mental retardation.
Pneumococcal / Caused 63,000 cases of invasive pneumococcal disease and 6,100 deaths annually prior to available vaccine.
Incident rate reduced by about 85% due to vaccination.
Vaccine reduces spread from children to adults.
35,000 fewer cases of invasive pneumococcal disease, including 21,000 fewer cases in children / Children may spread pneumococcus to adults.
Children who developed pneumococcal meningitis also developed long-term complications such as deafness or seizures.
Rubella (German measles) / Mild in children.
Many developing countries do not include rubella in childhood immunization schedule. / Up to 90% of infants born to mothers with rubella during first trimester will develop congenital rubella syndrome, which results in heart defects, cataracts, mental retardation, and deafness
Tetanus / More commonly a disease of adults but unvaccinated children still at risk.
Since tetanus bacteria are widespread in environment, only immunization will prevent tetanus.
Severe, often fatal disease; 29 percent of reported cases end in death. / Bacteria widely distributed in soil and street dues, found in animal waste and very resistant to heat and germ killing cleaners.
Unvaccinated children at risk for tetanus.
Infectious but not contagious, immunization will not protect others from disease
Type b (Hib) Meningitis / Prior to vaccine availability, Hib was the most common cause of bacterial meningitis in children; 20,000 invasive cases annually, two-thirds were meningitis and one-third other life threatening invasive Hib diseases.
One of every 200 U.S. children under 5 years of age got invasive Hib disease.
One killed 600 children each year and left those who survived with deafness, seizures, or mental retardation. / Stopping immunization would likely result in increase of Hib cases and deaths.
Risk for Hib diseases like bacteria in the blood, pneumonia, or inflammation of epiglottis.
Varicella (chickenpox) / Highly contagious disease; usually mild, but can be severe in some persons.
Almost all persons in U.S. suffered from chickenpox by adulthood; 4 million cases, 11,000 hospitalizations, 100-150 deaths annually.
Vaccination for chickenpox had large impact on reducing cases of chickenpox and related morbidity, hospitalization, and deaths; decreases of almost 90% over prevaccination numbers. / Children at particular risk for serious complications such as secondary bacterial infections, dehydration, pneumonia, and central nervous system involvement.

*Information for Morbidity/Mortality and Risk Factors columns was retrieved from:
Centers for Disease Control and Prevention. National Center for Immunization and Respiratory Diseases, (2013). Vaccines and immunizations: What would happen if we stopped vaccinations? Retrieved from website:

References

Centers for Disease Control and Prevention. (2011). Ten great public health achievements— United States, 2001-2010.American Medical Association, 306(1), 36. Retrieved from
greatachievements.pdf

Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Diseases. (2013). School starts soon - is your child fully vaccinated? Retrieved from website:

Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Diseases. (2014). Vaccines and immunizations: Possible side-effects from vaccines. Retrieved from website:

Centers for Disease Control and Prevention. National Center for Immunization and Respiratory Diseases, (2013). Vaccines and immunizations: What would happen if we stopped vaccinations? Retrieved from website:

Food and Drug Administration. U.S. Department of Health and Human Services, (2013). Vaccines, blood, & biologics: Vaccines for children - a guide for parents and caregivers. Retrieved from website:
ResourcesforYou/Consumers/ucm345587.htm

Food and Drug Administration. U.S. Department of Health and Human Services, (2010). Vaccines, blood & biologics: Vaccines. Retrieved from website:

Healthy People 2020. U.S. Department of Health and Human Services, (2013). Immunization and infectious diseases: Objectives. Retrieved from website:

Healthy People 2020. U.S. Department of Health and Human Services, (2013). Immunization and infectious diseases: Overview. Retrieved from website:

Kennedy, A. M., Brown, C. J., & Gust, D. A. (2005). Vaccine beliefs of parents who oppose compulsory vaccination. Public Health Reports, 120(3), 252-258. Retrieved from
16134564.pdf

Schneider, M. (2011). Introduction to public health. (3rd ed.). Sudbury, Massachusetts: Jones and Bartlett Publishers.

Seither, R., Shaw, L., Knighton, C. L., Greby, S. M., & Stokley, S. Centers for Disease Control and Prevention, Immunization Services Division, National Center for Immunization and Respiratory Diseases. (2013). Vaccination coverage among children in kindergarten — United States, 2012–13 school year. Retrieved from website:

Walkinshaw, E. (2011). Mandatory vaccinations: No middle ground.Canadian Medical Association Journal,183(16), 1830-1831. DOI: 10.1503/cmaj.109-3994

World Health Organization. WHO's Mega Country Network for Health Promotion. (1999). Improving health through schools: National and international strategies. Retrieved from website:
94.pdf