Kindergarten Immunization Status in Buncombe County Jennifer - - PowerPoint PPT Presentation

Kindergarten Immunization Status in Buncombe County

Jennifer Mullendore, MD, MSPH October 2, 2018

Source: NIAID

% of Kindergarteners with Non-Medical Exemptions, 2016-17

Source: CDC, SchoolVaxView, online

Permissible Exemptions from Required Immunizations in NC

• Medical Exemption (NCGS 130A-156)

– Can only be certified or requested by a physician licensed to practice medicine in NC – “…a required immunization is or may be detrimental to a person's health due to the presence of one of the contraindications…”

Permissible Exemptions from Required Immunizations in NC

• Religious Exemption (NCGS 130A-157)

– “If the bona fide religious beliefs of an adult or the parent, guardian or person in loco parentis of a child are contrary to the immunization requirements…, the adult or the child shall be exempt from the requirements.” – Submission of a written statement of the bona fide religious beliefs and opposition to the immunization requirements

# of Kindergarteners with Exemptions vs. Enrollment, Buncombe County, 1999-2017

20 40 60 80 100 120 140 160 500 1000 1500 2000 2500 3000

99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10 10-11 11-12 12-13 13-14 14-15 15-16 16-17 17-18

# Kindergarteners with Exemptions # Enrolled Kindergarteners

Non-medical

Enrollment Medical

Source: NC DHHS, Immunization Branch

% of Kindergarteners with Non-Medical Exemptions, Top 10 Urban Counties & NC, 2017-18

Source: NC DHHS, Immunization Branch

1.20% 1.30% 2.30% 2.20% 5.70% 1.10% 0.50% 1.10% 0.80% 1.20% 1.90%

0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00%

Statewide Gaston New Hanover Union Buncombe Durham Cumberland Forsyth Guilford Wake Mecklenburg

% of Kindergarteners with Non-Medical Exemptions, Top 10 Urban Counties & NC, 1999-2017

Buncombe

0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00%

99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10 10-11 11-12 12-13 13-14 14-15 15-16 16-17 17-18

Buncombe Cumberland Durham Forsyth Gaston Guilford Mecklenburg New Hanover Union Wake Statewide

New Hanover Union

Source: NC DHHS, Immunization Branch

WHAT HAPPENS WHEN WE LACK COMMUNITY IMMUNITY?

# Confirmed Cases of Select Vaccine-Preventable Diseases, Buncombe County, 2014 - 2018*

4 12 4 60 3 6 15 11 3 35 3 2 9 30 16 14 17 29

10 20 30 40 50 60 70 Hepatitis A Hepatitis B -- acute Hepatitis B -- carrier Influenza death, 18+ yrs Pneumococcal meningitis Whooping cough (pertussis) 2014 2015 2016 2017 2018* * As of 9/25/2018

Challenges to Addressing Vaccine Hesitancy

• Success of immunizations
• Distrust of science, traditional sources of

scientific authority

• Internet
• Social media
• “Backfire effect” – become more entrenched in

beliefs when falsehoods debunked

Promising Interventions to Improve Immunization Rates

• Peer-to-peer communication by parent

advocates for childhood immunizations

• Messaging to address moral values of the

vaccine-hesitant

• Stricter state immunization requirements
• Web-based, social media interventions during

pregnancy

SHIELD OF PROTECTION – Buncombe County Immunization Coalition

Goal: Increase Immunization Uptake in Western North Carolina

Social-Ecological Model

Mcleroy, K.R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351-377.

Public Policy Community Organiza- tional Inter- personal Individual

How can you help?

• Get immunized!
• Join our Immunization Coalition
• Support BCHHS obtaining de-identified data

from schools on exempted vaccines

• Support having schools and child care facilities

post their immunization rates

• Support state policy change on requirements

for non-medical exemptions