Immunization and Infectious Diseases

Background

Immunization and the subsequent reduction of vaccine-preventable diseases has been one of public health's most successful preventive health strategies. The incidence of childhood diseases such as measles and polio have dramatically declined as a result.

West Virginia, like the U.S., has been successful in immunizing over 95% of its school-age children. However, the coverage of preschool children remains a challenge for both the state and nation. By the time they are 15-18 months old, children should have much higher vaccination rates. Surveys indicate about 25% of the nation's and 32% of the state's preschool children have not been fully immunized.

The problem of underimmunization can and has allowed the reemergence of vaccine-preventable diseases, as evidenced by the nationwide outbreak of measles in 1989-91. The State Immunization Program has been instrumental in helping to promote activities to maintain high levels of immunization among schoolchildren and increase levels in the preschool population. The childhood Immunization Initiative (CII) is a primary strategy to link and energize these various activities. The CII was launched in 1993 to make sure that children do not become sick or die from vaccine-preventable diseases. A primary goal of this initiative was to increase vaccination coverage levels among two-year-old children to at least 90% by 1996 for the most critical doses of vaccines and for all recommended doses by the year 2000.

CII components include strategies to achieve the following goals:

• Improve the quality and quantity of vaccination delivery services
• Reduce the vaccine costs for parents (Vaccines for Children Program)
• Increase community participation, education, and partnerships
• Improve vaccines and vaccine use

With support from the Centers for Disease Control and Prevention (CDC), the West Virginia Immunization Program has and will continue to follow strategies to enable realization of the objective set forth in West Virginia Healthy People 2000.

The Objective

OBJECTIVE 20.1 Increase the basic immunization series to include 90% of children 24 months of age and younger.

UPDATE The basic immunization series is defined as at least four doses of diphtheria-tetanus-pertussis (DTP), three doses of polio, and one dose of measles-mumps-rubella (MMR) vaccine. Before 1991, the last statewide survey of two-year-old children was conducted in 1983; it indicated that 60.5% had completed the basic immunization series. To determine immunization coverage levels of two-year-old children from 1991 through 1994 a retrospective survey of kindergartners was used by the national and state immunization programs as a uniform method of surveying preschool immunization levels. The last retrospective survey (1994) indicated that 50.8% of West Virginia's preschoolers had completed their basic series by age two. In 1994, the National Immunization Survey (NIS) became one of two primary methods used by the WV Immunization Program to measure immunization levels of preschool children. The other important method involves the assessment of county health department records, used by the program since 1989.

The NIS is a composite measure of vaccination coverage based on data from three sources: (1) a random telephone survey of households with children 19-35 months of age; (2) the Immunization Supplement of the National Health Interview Survey, and (3) data collected from immunization records kept by providers of care to the children whose parents were interviewed. The most recent NIS was conducted by CDC between July 1994 and June 1995. At that time, West Virginia's coverage of children two years of age had improved to 68%, compared to the United States average of 75%. The following table shows 1994-95 NIS-derived vaccination coverage levels for the state and the nation.

The statewide clinic assessments at all county health departments are conducted using the Clinic Assessment Software Application (CASA) developed by the CDC. The CASA-derived data are analyzed to determine progress toward reaching the year 2000 immunization coverage goals for two-year-olds and to identify/target low coverage risk populations for public health intervention strategies. Since 1995, assessments have also been performed at an increasing number of public and private health provider sites to help improve their children's immunization rates.

The coverage levels of the 3,258 clinic records assessed at the county health departments in 1996 indicated that 71% of the two-year-old children assessed had 4 DTP, 3 polio, and 1 MMR. This compares to 65.5% in 1995 and shows a progressive increase every year since 1989 (see Figure 1). Twenty counties had coverage levels below 65%. These counties were chosen for special targeted outreach based on all CII goals except that for 3-Hep B. Coverage for 3 Hep B is low statewide and will be addressed separately.

Meeting the Objective

The West Virginia Immunization Program has promoted activities to help meet Objective 20.2 through the health promotion channels to the community listed in the box above and explained further in the Introduction to this document. Activities have been implemented and coordinated through the following:

• The West Virginia Immunization Action Plan (WVIAP), which funds efforts to strengthen the vaccine delivery system at all levels, including linkages with WIC;

• The Vaccines for Children Program (VFC), which increases access, reduces vaccine costs, and provides vaccine at no charge to private health providers;

• The Statewide Immunization Information System (SIIS), which links all health providers in an interactive network of vital immunization information, and

• Education outreach to providers and communities statewide.

Both traditional and nontraditional modes of delivering information to the public are used: written news releases, public services announcements, printed literature, etc. The Newborn Packet Program has been expanded to at least 90% of birthing centers and hospitals. Programmatic policies and procedural changes and ACIP statements are distributed, and conference and teleconference training opportunities are linked to health care professionals. The first WV Immunization Conference was held November 21-22, 1996. The conference provided information that will help participants (1) provide comprehensive immunization coverage for all age groups; (2) evaluate progress toward meeting our state and national Healthy People 2000 goals, and (3) explore innovative strategies for developing programs, policies, and research to promote immunization.

Specific steps by the WV Immunization Program to increase immunization levels among children two to twenty-four months of age include:

• Increase nurse hours assigned to immunization in health departments.

• Promote IAP-linked WIC/Immunization Program for a six-county region.

• Develop plan to review WIC client records to identify underimmunized children.

• Provide immunization services to all children in MCH programs.

• Implement uniform standards for pediatric immunization practices in all clinics using state-supplied vaccine and encourage adoption of same by other providers.

• Develop computer software program for use by all providers to track and share immunization information.

• Develop computerized system to monitor immunization level of EPSDT/PHS children.

• Implement user-friendly immunization services at community health centers.

• Enhance the data analysis system to track administration and handling of state-supplied vaccine.

• Determine, by survey, immunization levels for preschool children statewide.

• Provide education to community, religious, and professional groups, social organizations, and enrollees in public health programs.

• Provide educational information to all parents of newborn children; provide staff in-service education to health professionals.

• Provide information and educational materials targeting families enrolled with the Child Advocate Office.

• Place additional emphasis on existing immunization policies for foster care staff and day care providers.

• Conduct quality assurance reviews in all county health departments.

Immunization and Infectious Diseases - Meeting the Objective

Lead Entity:
WV Immunization Program

Plan Coordinator:
Samuel Crosby, Jr., Program Manager
WV Immunization Program
Division of Surveillance and Disease Control
WV Bureau for Public Health
(304) 558-2188/ FAX (304) 558-1941

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