Download Community Health: Immunization- Children Entering Kindergarten

Running Head: IMMUNIZATION – CHILDREN ENTERING KINDERGARTEN
Immunization – Children Entering Kindergarten
Week 3 Assignment
Lindsay Ann Abrigo
March 17, 2014
MPH 584 – Community Health
Dr. Kimberly Brodie
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IMMUNIZATION
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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 vaccinepreventable 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
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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
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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
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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.
Diphtheria
Hepatitis B
Morbidity/Mortality
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.
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
Risk Factors
Bacteria can be passed among
people in U.S. even though
diphtheria is rare.
Chronic hepatitis B infection
increases risk for chronic liver
disease, cirrhosis, and liver
cancer.
Community Health Strategies
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
IMMUNIZATION
Measles
Mumps
Pertussis
(DTP)
Pneumococcal
Rubella
(German
measles)
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.
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
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
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.
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
Mild in children.
Many developing countries do
not include rubella in childhood
immunization schedule.
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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
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.
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.
Children may spread
pneumococcus to adults.
Children who developed
pneumococcal meningitis also
developed long-term
complications such as deafness
or seizures.
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
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
IMMUNIZATION
Tetanus
Type b (Hib)
Meningitis
Varicella
(chickenpox)
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.
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.
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.
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retardation, and deafness
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
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.
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: http://www.cdc.gov/vaccines/vacgen/whatifstop.htm
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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 http://www.cdc.gov/washington/docs/
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: http://www.cdc.gov/features/catchupimmunizations/
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: http://www.cdc.gov/vaccines/vacgen/side-effects.htm
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:
http://www.cdc.gov/vaccines/vac-gen/whatifstop.htm
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: http://www.fda.gov/BiologicsBloodVaccines/
ResourcesforYou/Consumers/ucm345587.htm
Food and Drug Administration. U.S. Department of Health and Human Services, (2010).
Vaccines, blood & biologics: Vaccines. Retrieved from website:
http://www.fda.gov/BiologicsBloodVaccines/Vaccines/default.htm
Healthy People 2020. U.S. Department of Health and Human Services, (2013).
Immunization and infectious diseases: Objectives. Retrieved from website:
http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topi
cId=23
Healthy People 2020. U.S. Department of Health and Human Services, (2013).
Immunization and infectious diseases: Overview. Retrieved from website:
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid
=23
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 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497722/pdf/
16134564.pdf
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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: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6230a3.htm
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: http://www.who.int/school_youth_health/media/en/
94.pdf
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