January 8, 2013
Child Immunization Rates Can Be Increased With Regular Reminders
Alan McStravick for redOrbit.com - Your Universe Online
It was just about 14 years ago that a study published in the prestigious English medical journal The Lancet unleashed a firestorm of paranoia that swept new and expecting parents. At the time, it appeared to researcher Andrew Wakefield and his colleagues that there was a connection between the child immunization program for measles, mumps and rubella (MMR) and the diagnosis of autism.
Wakefield´s contention was that the MMR vaccine, which contains a live virus, would cause a chronic measles infection in some children. The infection, in turn, caused what Wakefield referred to as “leaky gut” syndrome, a gastrointestinal disorder. It was this secondary stomach issue that led to an inability for the child to properly break down breads and dairy products. Toxins would then release into the bloodstream, making their way to the child´s developing brain.
With such damning evidence against the MMR vaccine, many parents opted not to immunize their children, fearing they could unwittingly cause their children to develop autism.
Although Wakefield´s co-authors withdrew their initial support of the results some six years after the initial study was published and the editors of The Lancet withdrew their endorsement of the study´s findings, the danger of the MMR myth continued to pervade the general consciousness of the public. Part of Wakefield´s undoing came from the revelation of a conflict of interest when it was discovered that he had begun the research on behalf of parents of autistic children who were seeking to bring suit against the manufacturers of the MMR vaccine. And in 2007 media outlets revealed that Wakefield had been applying for patents for his own substitute for an MMR vaccine as well as for a treatment for the purported MMR vaccine-induced gut disorder that he had documented.
Despite Wakefield´s fall from grace, many parents continue to believe that the administration of an MMR vaccine for their newborn child could do more harm than good. This belief flies in the face of further research indicating that autism rates are statistically indistinguishable between immunized and non-immunized children.
RENEWING IMMUNIZATION´S REPUTATION
Public health authorities here in the U.S. have been striving to find ways to ensure that children receive this necessary vaccine and that they receive it in a timely manner. Now, thanks to new research from the Children´s Outcomes Research Program at Children´s Hospital Colorado, researchers have determined that implementing a program of timely reminders from state and/or local health departments is an effective way to increase immunization rates among preschool children — a burden that has typically fallen on the family pediatrician or primary care physician.
The study is set to appear early next week in the American Journal of Public Health. In it, they explain how their results highlight the importance of a unified partnership between state and county health departments and primary care practices to keep young children on regular schedule for receiving their recommended vaccinations.
The study´s lead author Allison Kempe is a Professor of Pediatrics at the University of Colorado School of Medicine. She is also the Director of the Children´s Outcomes Research Program, Children´s Hospital Colorado and the Center for Research in Implementation Science and Prevention (CRISP) at the University of Colorado. Her experience as a health services researcher has spanned 25 years with a primary focus on immunization delivery for children and adolescents.
"Immunizations provide us with the opportunity to prevent most of the diseases that killed so many children in the past. But the job of making sure all children receive immunizations in a timely manner is complicated and requires systems to identify who is not up-to-date and to generate reminder letters, postcards or telephone messages," said Kempe.
"Many primary care providers don't have such systems in place and don't have the time or staff to conduct recall for immunizations at their practices. Our study shows that practices and public health departments working together will be much more successful in recalling children who need vaccinations."
A national initiative called Healthy People 2020 has the goal of increasing by 80 percent the proportion of children aged 19 to 35 months that have received their immunizations. As of 2009, only 44.3 percent of children in that age range had received all of their recommended vaccinations.
"Vaccination is recognized as one of the greatest public health achievements of the 20th century, reducing the incidences of many common and fatal diseases by up to 99 percent," Kempe explained. "Timely immunization is vital for keeping kids healthy and reducing unnecessary costs for Colorado."
By making parents aware that an upcoming vaccination is due or even overdue has proven to be among the most effective ways of raising overall immunization rates, said Kempe.
"If reminder or recall messages can be generated for entire populations within a county by the state and county health departments, this unburdens the primary care practice and is much less expensive overall," Kempe said. "It also has the advantage of reaching children who do not have a usual source of primary care. Our data from surveys of both parents and providers suggest that there is strong support for this approach."
However, the practice of sending out reminder/recall notices falls squarely on the shoulders of primary care facilities. According to the Community Preventive Services Task Force, having such an important task is ineffective in the absence of a unified strategy. They cite several reasons such as competing demands within the practice, staff turnover, added costs related to mailings or telephone call reminders, and the lack of computerized systems able to assist in identifying who might need an immunization at any given time. As it stands, current national data suggests that only 16 percent of primary care providers perform any type of reminder service for child immunizations.
To combat this trend, the authors of the study suggest that a more effective and economical method for a reminder/recall program might be the utilization of public health departments that would be tied into a centrally conducted regional or state Immunization Information System.
In order to perform their study, the researchers conducted a cluster-randomized trial that involved children between the ages of 19 and 35 months who were in need of immunizations. The study aimed at eight rural and six urban Colorado counties. In it, they utilized both central and primary care practice based recall systems to inform the families of the necessity of the upcoming immunization. Practice-based recall participants were first invited to attend a Colorado Immunization Information System (CIIS) training session and were also offered financial support to supplement the mailing of reminder/recall notices.
The authors continued the study for six months after the beginning of the recalls and then compared the percentages of children who were up-to-date on their immunizations with those who did not. The differences, according to the authors, were modest yet significant. A total of 32,125 children and their families were notified for upcoming immunizations. They found the central model of recall was responsible for a total of 18.7 percent of children receiving the proper and timely immunization. By comparison, the practice-based model was only able to recall 12.8 percent of respondents. Additionally, the central model was far more cost effective, spending an estimated $17 per child that was brought up to date when compared to $62 per child in the practice-based model of recall.
"This trial supports consideration of a new paradigm in the way reminder/recall for immunizations should be conducted in this country," Kempe said. "We think the most successful approach is a truly collaborative one between practices, Health Departments and the State Immunization registry."