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Ask, Acknowledge, Advise: Tips and advice you can use
October 2012
In This Issue
Answering your questions
Vaccines in the news
Featured investigator
What we're reading
A visit from Ari Brown
Resource spotlight
Greetings Clinicians--

 

Welcome to the October 'Let's Talk Vaccines' newsletter.  We are nearing the end of the training phase, with just five more trainings to complete before we reach our target of 25 intervention clinic trainings.  In addition to follow-up work with the intervention clinics, we are currently identifying a plan for data analysis and publications.

   

With flu season upon us, this is a reminder to get vaccinated and encourage your patients and their families to do so as well. 

 

Best wishes,

David Grossman, MD, MPH

Group Health Research Institute

"Let's Talk Vaccines" study Principal Investigator

   
Answering your questions

   

Dr. DunnBelow is a response to a question submitted at a recent training.  We encourage participants in this study to submit their questions, whenever they arise, throughout the study.  We will share some answers here, but all will be available on our study website.

Why are vaccinated people getting pertussis?
 

The resurgence of pertussis is a nationwide phenomenon; however, the problem has been particularly pronounced in Washington State, where we are having our worst outbreak in seventy years. One striking characteristic about the current pertussis epidemic is the fact that cases are frequently occurring in persons who have been vaccinated against pertussis--and even in those who have a confirmed history of whooping cough.  Per the MMWR reprort released by the CDC, it does appear that the primary contributing factor is the fact that neither infection nor vaccination appears to produce lifelong immunity to pertussis.

 

Data on duration of immunity following vaccination is variable. Older studies had suggested that vaccine-induced immunity lasted four to twelve years in most people, but more recent studies (done on populations of children who have only received the newer acellular vaccine, i.e. DTaP) suggest that duration of immunity may be only 3-4 years. Even for those who become infected with wild-type Pertussis (i.e. those who catch whooping cough), immunity is not long-lasting. It is estimated that immunity following infection is four to twenty years.   

 

In order to limit epidemic spread of disease, it is necessary to minimize the likelihood that an infected person will be exposed to someone to whom they can transmit the disease. This is relatively easy to do if most of the population has lifelong immunity from vaccination or illness (a "measles outbreak" is often limited to one or two dozen people) or if a disease does not spread easily with casual contact. Pertussis is a prime example of the opposite case; it spreads very easily from person to person, and because immunity to pertussis fades over time, there are always large numbers of people that are susceptible to infection. Subsequently, it is important that as many people as possible have been vaccinated in the recent past.

 

Another common question is whether a person that received the Tdap vaccine several years ago should be given a booster. The answer is currently "no". However, that may change in the near future. Because rapid waning of immunity associated with DTaP vaccine is now well-documented, it is suspected that a similar phenomenon may occur following Tdap vaccination, which may lead to a future Tdap booster.  More data and analysis will be necessary before any recommendation change (the vaccine was only licensed 7 years ago). 

 

Responses to many additional questions can be found in the 'Let's Talk Vaccines' Discussion Forum.  

 

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Vaccines in the news 

Bird drinking coffeeOn a September 20th segment of The View, Dr. Oz was a featured guest, where he spoke about vaccination issues.  While he did emphasize the value of vaccination, he also stressed the importance of parental autonomy and that his own children were vaccinated on a delayed schedule.    

 

Citing a New England Journal of Medicine study, the New York Times published an article about Washington State's 2011 exemption law, including impacts and the local particularities that led to such high exemption rates in the state.

 

A recent article in Forbes magazine grapples with seemingly irrational behavior surrounding vaccines.  The author explores the historical conflict surrounding the smallpox vaccine in explaining that "when people want to believe something, even the strongest evidence that their beliefs are misguided often fails to alter their worldviews."    

 

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Featured investigator

Ginny Heller, MSW
Immunization Program Manager
WithinReach 
 
Ginny Heller is the Immunization Program Manager at WithinReach. She has been the lead staff for the Immunization Action Coalition of Washington since 2003 and Vax Northwest since 2008. She provides leadership in the development and coordination of these statewide immunization efforts, including strategic planning, building public/private partnerships, and social marketing. Ginny has an extensive background in coalition building, advocacy, and community-based health promotion.  She has a graduate degree in Social Work from the University of Washington. 

WithinReach makes the connections Washington families need to be healthy, and Vax Northwest is integral to that work, but in ways that extend traditional coalition work.  From Ginny's perspective, a primary strength of Vax Northwest is the public-private partnership at its core.  Any large-scale social change initiative (e.g. reducing vaccine hesitancy) requires cross-sector coordination and collaboration, which explains why Vax Northwest is composed of key Washington State immunization actors.  Her ultimate hope is that this partnership will serve as a model for health promotion efforts.

Because of the unique nature of work being evaluated, national researchers and the CDC are paying attention to our efforts.  In addition to the 'Let's Talk Vaccines' randomized control trial and the Immunity Community efforts, Vax Northwest recognizes the prenatal care provider as another avenue to vaccine hesitancy.  Further strategies are being considered that promote earlier (36-39 weeks pregnant) conversations about the childhood immunization schedule--during the time when parents are actively making their vaccine decisions.

What we're reading

  

Bird4Here are some recent articles that are informing or work:
  • Greg Poland's article  "Vaccine education spectrum disorder: the importance of incorporating psychological and cognitive models into vaccine education" argues that vaccine education efforts are unimodal and are not well-adapted to the preferred cognitive and decision-making confines of intended recipients.  This article is an excellent follow-up to the Forbes article about vaccine (ir)rationality referenced above.
  • The CDC has released the latest state level childhood immunization rates from the National Immunization Survey.  The data indicate that immunization rates in Washington continue to improve, but that Washington still does not meet state or national goals.  The report also mentions clusters of undervaccinated children, which create particularly vulnerable communities.
  • A study just released by the New England Journal of Medicine offers new evidence supporting the argument that immunity conferred by the DTaP vaccine wanes dramatically over time.  The study of vaccinated children in California showed that risk of contracting whooping cough after the fifth DTaP dose increased 42% per year each year post-vaccination.   

 

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Information literacy Bird2

 

Any readers who have attended the 'Let's Talk Vaccines' training have heard John and Todd talk about the challenge of information literacy in relation to immunization information found online.  Often, anti-vaccine entities have polished, sophisticated, and efficient-looking sites, especially when compared to the difficult-to-navigate and text heavy CDC website.  In an era when the best-looking resources are often conflated with the most well-informed site, this is particularly problematic.

 

Communicating the need to be information literate with parents is a delicate task.  Parents likely believe they are information literate (no matter how obscure the information they find online might be), and if they cite information found online, they likely find it credible.  A provider's job, then, is to navigate these situations as appropriate.  First, applaud the parent for doing research and identifying questions for the provider.  Listen to and acknowledge these concerns, but also share how tested scientific studies reach different conclusions.  If the visit does not allow time to discuss/evaluate their concerns, take time to read/explore the issue in private and then make a plan to follow-up with them after you are well-versed in the material and your response.   

 

If a parent is genuinely curious, versus having clearly formed ideas and decisions upon arrival, encourage the parents to use any of the information literacy tools found on our website.  Stress that these tools can help them identify reputable information; make it a collaborative endeavor versus a student-teacher one.     

 

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Resource Spotlight: History of Vaccines

 Historyofvaccines.org is an outstanding resource for those interested in the timeline of vaccine developments and the key milestones in eradicating disease.  Timelines can be viewed through several different themes ('Diseases and vaccines', 'Pioneers', 'Science and society', etc.), and there are Spanish translations of these materials on the site as well.  The site is full of impactful visual aids, fun facts, and relevant contextual information.  For those looking to educate younger generations about vaccines, there are several activities that can be used to learn about herd immunity, the immunization schedule, and understanding risk, among others. 

 

 

 

Comic relief 

 

 

 

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