Health
An analysis released by Trust for America's Health (TFAH) finds that fewer than 90 percent of children ages 19-to-35 months old have received the recommended vaccination against measles, mumps and rubella (MMR) in 17 states.
New Hampshire has the highest MMR vaccination rate for preschoolers at 96.3 percent, and Colorado, Ohio and West Virginia have the lowest at 86 percent, based on data from the latest completed National Immunization Survey from 2013.
No state in the Northeast was below 90 percent, while eight states in the South, five in the West and four in the Midwest had rates below 90 percent. Nationally 91.1 percent of preschoolers are vaccinated.
"Sadly, there is a persistent preschooler vaccination gap in the United States. We're seeing now how leaving children unnecessarily vulnerable to threats like the measles can have a tragic result," said Jeffrey Levi, PhD, executive director of TFAH. "We need to redouble our national commitment to improving vaccination rates."
Healthy People 2020 set 90 percent as the baseline national goal for preschooler MMR vaccinations. Reaching the national rate of 91.1 percent has helped reduce measles rates by 99 percent. Achieving even higher vaccination rates would help protect even more individuals and increase "herd immunity" protection for the wider community.
The U.S. Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommend that every child receive a first dose of the MMR vaccine after reaching the age of 12 months old. A second MMR dose is recommended for 4-to-6 year olds.
"It is so important that communities maintain high levels of MMR vaccination-because measles is so infectious-and especially when outbreaks are occurring around them," said Litjen (L.J) Tan, MS, PhD, chief strategy officer of the Immunization Action Coalition. "To have pockets where community immunity is below 90 percent is worrisome as they will be the ones most vulnerable to a case of measles exploding into an outbreak."
Rates of preschooler vaccinations are typically lower than for school-age children, since they are not yet in the school system, which require vaccinations for children to attend.
Among kindergarteners, 94.7 percent have been vaccinated for measles, with a high of 99.7 percent in Mississippi and a low of 81.7 percent in Colorado.
States differ significantly in policies allowing parents to "opt-out" of the attendance requirements. Within states, even states with high MMR vaccination rates, there can be communities with groups of individuals who are unvaccinated, making these communities vulnerable to measles and other preventable diseases.
In January 2015, CDC issued a Health Advisory about an ongoing multi-state measles outbreak, which has been linked to more than 102 cases in 14 states so far. Most individuals who get the measles are not vaccinated – including infants.
In 2000, measles was declared virtually eliminated in the United States, when cases dropped to around 60. Measles rates remained below 100 from 2002 to 2007, with many of those cases linked to overseas travel. In 2014, there was a surge in measles, with at least 23 outbreaks and more than 600 cases.
Measles is a highly contagious, viral illness that can lead to health complications, including pneumonia, encephalitis and eventually death. Prior to routine vaccination, measles infected approximately three to four million Americans, killed 400 to 500 individuals and led to 48,000 hospitalizations each year.
Vaccines undergo rigorous review and testing for effectiveness and safety by the Food and Drug Administration (FDA) before they are released to market and safety is also tracked through several monitoring systems once they are in use.
Numerous reviews, including by all of the existing studies by the Institute of Medicine (IOM), have concluded that the MMR vaccine is safe and has no causal link to developmental disorders.
Overall, there is a long-standing preschooler vaccination gap in the United States. More than 2 million preschoolers do not receive all recommended vaccinations on time: 27.4 percent do not receive the full childhood series; 27.4 percent do not receive the rotavirus vaccine; 18 percent do not receive the pneumococcal vaccine; 16.9 percent do not receive the diphtheria, tetanus and whooping cough vaccine; 9.2 percent do not receive all three doses of the hepatitis B vaccine; 8.8 percent do not receive the chickenpox vaccine; and 7.3 percent do not receive the polio vaccine.
In addition, many infants (by 13 months) do not receive all recommended vaccines: 43.2 percent do not receive the chickenpox vaccine; 12.6 percent do not receive the pneumococcal vaccine; 10.7 percent do not receive the meningitis, pneumonia and epiglottis Hib vaccine; 10.6 do not receive the diphtheria, tetanus and whooping cough vaccine; 15.4 percent do not receive all three doses of the hepatitis B vaccine; and 6.3 percent do not receive the polio vaccine.
Some key recommendations for improving vaccination rates include:
– Increasing public education campaigns about the safety and effectiveness of vaccines;
– Minimizing vaccine exemptions – states should enact and enable universal childhood vaccinations except where immunization is medically-contraindicated. Non-medical vaccine exemptions, including personal belief exemptions, enable higher rates of exemptions in those states that allow them;
– Increasing provider education and vaccine standard of practice to help ensure providers are responsibly promoting the importance of vaccination to their patients and actively tracking whether patients have received all recommended vaccinations and providing them when they have not;
– Bolstering immunization registries and tracking to help ensure children's and adults' immunizations are up-to-date, and providers can identify when an individual is missing a recommended vaccination. Immunizations registries should be integrated with electronic health records (EHRs) and be interoperable across providers, so, for instance, if a child goes to the doctor with a stomach virus or visits a specialist, they can easily flag if a child has not received a vaccine and can provide it then. There should also be increased education for providers to support and expand vaccinations as standard practice and to discuss and track vaccination histories with their patients;
– Expanding alternate delivery sites – the National Vaccine Advisory Committee (NVAC) has recommended including expansion of vaccination services offered by pharmacists and other community immunization providers, vaccination at the workplace and increased vaccination by providers who care for pregnant women; and
– Supporting expanded research and use of alternatives to syringe administration of vaccination – experiences with alternative delivery methods, such as using the nasal mist intranasal administration of live-attenuated influenza vaccine (LAIV), have been well-received by the public and have contributed to increased uptake in pediatric and adult vaccinations.
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UKIAH, Calif. Childbirth is no laughing matter, or is it!? Ukiah Valley Medical Center (UVMC) joins a growing number of health care facilities to offer nitrous oxide, often referred to as laughing gas, to women in labor at the Family Birth Center.
Nitrous oxide is a mixture of nitrogen and oxygen gases. It is a noninvasive analgesic that reduces anxiety and pain, can be used late in labor and is self-administered, thus giving the laboring mom the ability to control her pain when she needs it.
Nitrous oxide takes effect in seconds, doesn’t inhibit labor contractions, and has little side effects for mother or baby.
Mendocino Community Health Clinic Obstetrician and Gynecologist Karen Crabtree, M.D., medical director of Care for Her, championed the use of nitrous oxide.
As she explained, “Nitrous oxide has a long history of success in other countries with very successful outcomes. Since FDA approval, we’ve been preparing for the launch which has included manufacturing of special equipment and training of nurses and staff. UVMC is one of the few hospitals in Northern California to offer nitrous oxide. As a small hospital, it is very cutting edge to have this option available.”
“Adding nitrous oxide gives women another choice in an area where there are few options,” said Casey Ford, director of Perinatal Services at UVMC. “Many women want to avoid the interventions that prevent them from getting out of bed to use the Jacuzzi, shower, or just walk around. With laughing gas it is never too early or too late to take the edge off of the pain, and it can be initiated in minutes.”
Nitrous oxide has been in use at UVMC since the beginning of December. Approximately 20 women have used it.
“I offered it to my patient, a first time mom, and she loved it,” said Agnes Calumpang, a registered nurse at the Family Birth Center. “She started it at 3 centimeters and used it to 7 centimeters. She was very happy with the results and liked the fact that she was in control.”
Birth centers around the country are beginning to show more interest in nitrous oxide as an option for women in labor.
However, UVMC is the only facility North of San Francisco, and South of Portland, OR to offer nitrous oxide as a pain management option for mothers to be.
Given all of its benefits, nitrous oxide truly provides expectant mothers with an opportunity to laugh while in labor.
The Family Birth Center offers a state-of-the art facility, with large private birthing suites and a Special Care Nursery. The center also offers educational and support classes for expectant moms and caregivers.
The Family Birth Center is located at Ukiah Valley Medical Center, 275 Hospital Drive in Ukiah.
For more information about classes, please call 707-463-7550 or visit us online at www.uvmc.org/birthcenter .
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