Merced County Immunization Program Immunization Rates Best Practices Annie Carlson, RN, PHN Merced County Dept of Public Health My name is Annie Carlson, Immunization Coordinator for Merced County Department of Public Health. I’m here today to talk to you about best practices Used by Merced County Health Department to raise immunization rates of two County clinics.

Objectives Describe the importance of immunization rates in disease prevention Identify partners who are essential to help increase immunization rates. Explain how the immunization registry can be used to target children not up-to-date Describe practices used at the MCDPH to increased vaccination rates Read objectives

Incidents of Disease   1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Measles 1 3 2 High immunization rates are correlated to low incidents of vaccine preventable diseases, making it important for vaccine providers to have a system in place that not only deliver vaccines to all eligible children, but to be able to evaluate how good of a job they are doing.

Area of Focus Storage and handling. Vaccination technique and administration. Vaccine delivery. At the MCDPH we have not always done a good job of balancing components of the vaccine delivery system. We have primarily focused on vaccine technique and administration, storing and handling vaccine, and making sure every kid who pass over our threshold get all the immunizations they are due to have.

Clinic assessment rates We have had a continual fluctuation in our CASA and COCASA rates over the past 10 years in spite of our immunization processes and reminder and recall system. Not only have our immunization rates remained low but our missed opportunity rates have been as high as 19%. Over the past two years while maintaining balance between other components of the vaccine delivery system, we have refocused more attention on strategies that will help us increase immunization rates and decrease our missed opportunity rates.

Essential Partners Other Medical Providers County Agencies Doctor offices Clinics County Agencies Cal Works; WIC; HSA Schools and Head Starts and Childcare Many of the children seen at the health department are seen at other providers in our community. They attend schools and child care centers who also have a vested interest in them being up-to-date on their immunizations. Other State programs even though requirements are not as strict also require these children to be up-to-date on their immunizations. By partnering with these agencies a universal message is be sent through out the community; all child need to be up-to-date on their immunizations. The Health Department participates in outreach fairs sponsored by many of these agencies to help build stronger relationships.

Immunization Registries Having access to the registry has helped us to easily identify the cohort of two year old children who are being evaluated on their status for being up-to-date for series 4:3:1:3:3:1. The list is pulled up each quarter and children are evaluated for missing shots and the parents are notified by phone or letter. Parent who direct contact is made and who have taken their children to other providers are asked if we can call and get their child’s shot information to up-date the immunization registry. We take this opportunity to inform the parents of the importance of the registry in tracking their child’s immunization record into a permanent database the ability of always being able to provide them with a record if they need one. Parents who say they will bring their child in for shots are tracked and called after one week if they do not show up. If they still do not show up they are called again in two weeks. They are then sent a letter and is given one month to respond. After calling them one more time they are then MOGE’d in the registry to remove them from our clinic list. Using the registry to run our yearly CoCASA report also saves us time and allows for a more in-depth clinic assessment to be done on a yearly basis.

Ways to Increase Immunization Rates Balance and refocus activities Quarterly assessment checks Reminder recall Running quarterly clinic assessment rates allows us to track and refer children who are in need of immunizations throughout the year to their medical provider or they may come to the Health Department. Along with careful handling and storing vaccine and providing vaccines as indicated by the ACIP and State guidance clinic assessments must be a routine part of your clinic’s balancing act. An aggressive reminder to parents can be very time consuming but will pay off in the end, even if the child is going elsewhere to get vaccinated.

Conclusions What works Provider education Parent education Outreach programs Challenges Labor intensive Parental concerns of vaccine safety Parental excuses Language barriers Changes in address and phone numbers Providing yearly immunization up-dates being an available resource for Medical Provider offices helps to foster good relations with provider offices. Outreach into the schools and health fairs also increase visibility of the Health Department. Having a compassionate answer for parents who are concerned about the controversy surrounding vaccines and certain disease helps them in making some tough decisions about vaccinating their children. The biggest challenge is, it is extremely labor intensive on the part of some Health Department staff. Parents who are unable to be reached by phone are sent letters and advised of their child’s missing immunizations. They can receive up to four phone calls in addition to the letter depending on if they are responding to our request. Some parents are concerned about news reports about vaccines being unsafe. Other parents use excuses like: lost of insurance or lack of transportation. Many times the parents of these children move around frequently and change phone numbers in a matter of weeks and some are just outright evasive.

Questions???