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 3000 160 # Kindergarteners with Exemptions 140 2500 # Enrolled Kindergarteners 120 2000 100 1500 80 60 1000 40 500 20 0 0 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 Non-medical Enrollment Medical Source: NC DHHS, Immunization Branch

% of Kindergarteners with Non-Medical Exemptions, Top 10 Urban Counties & NC, 2017-18 Mecklenburg 1.90% Wake 1.20% Guilford 0.80% Forsyth 1.10% Cumberland 0.50% Durham 1.10% Buncombe 5.70% Union 2.20% New Hanover 2.30% Gaston 1.30% Statewide 1.20% 0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00% Source: NC DHHS, Immunization Branch

% of Kindergarteners with Non-Medical Exemptions, Top 10 Urban Counties & NC, 1999-2017 6.00% Buncombe 5.00% 4.00% 3.00% New Hanover Union 2.00% 1.00% 0.00% 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 Source: NC DHHS, Immunization Branch

WHAT HAPPENS WHEN WE LACK COMMUNITY IMMUNITY?

# Confirmed Cases of Select Vaccine-Preventable Diseases, Buncombe County, 2014 - 2018* 70 60 60 50 40 35 30 29 30 20 17 16 15 14 12 11 9 10 6 4 4 3 3 3 2 0 Hepatitis A Hepatitis B -- Hepatitis B -- Influenza death, Pneumococcal Whooping cough acute carrier 18+ yrs meningitis (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 Public Policy Community Organiza- tional Inter- personal Individual Mcleroy, K.R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15 (4), 351-377.

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