By Claude-Alix Jacob, MPH, NACCHO President and Chief Public Health Officer for the Cambridge (MA) Public Health Department

Vaccines are one of the most important achievements in public health and have prevented wide-scale illness and death since their conception. The Centers for Disease Control and Prevention estimates that vaccinations will prevent more than 21 million hospitalizations and 732,000 deaths among children born between 1994 and 2013.¹

Despite their incredible ability to prevent the spread of harmful diseases, gaps in vaccination coverage persist. In 2014, a record-breaking 667 cases of measles were reported nationally, the largest number of cases since measles was declared eliminated in the United States in 2000. In my own backyard, Harvard University recently experienced an outbreak of mumps that affected over 50 students, faculty, and staff. My health department worked collaboratively with the Massachusetts Department of Public Health and Harvard University Health Services to facilitate diagnosis and laboratory testing, disseminate public health messaging, and conduct contact tracing investigations.

National Immunization Awareness Month
August is National Immunization Awareness Month, an opportunity to raise awareness of the importance of immunization in the pursuit of closing existing coverage gaps. The month is sponsored by the National Public Health Information Coalition (NPHIC), which has developed a toolkit featuring sample messages and campaign materials to increase vaccination rates for infants, children, teens, pregnant women, and adults; each week in August will focus on a different age group and corresponding message:

• 1–7: Vaccines are not just for kids (adults)
• 8–14: Protect yourself and pass protection on to your baby (pregnant women)
• 15–21: A healthy start begins with on-time vaccination (babies and young children)
• 22–28: Ensure a healthy future with vaccines (preteens and teens)

Local Health Department Innovation
Local health departments continually employ innovative strategies to meet the vaccination challenges in their communities, as demonstrated by several of NACCHO’s Model Practices Program awardees in recent years. The Florida Department of Health in Broward County used a point-of-dispensing (POD) model recommended by the Guide to Community Preventive Services to accommodate the surge of children in need of back-to-school immunizations. By implementing an electronic tracking system in POD stations, the department was able to increase the rate of immunizations by 38%.

In 2014, in response to concern about clusterings of unvaccinated children in schools and daycares in its communities, the Multnomah County (OR) Health Department developed a cooperative measles response protocol for public health agencies to use in the event of a school or daycare measles outbreak. The department created a toolkit and conducted tabletop exercises with its partners to ensure an effective and efficient response in the event of an outbreak.

Snohomish Health District in Everett, WA, developed card sets and brochures comparing the benefits and risks of vaccines to help healthcare provider educate parents who are hesitant about vaccinating their children. The cards helped health providers and clinicians address parent concerns about vaccine safety.

NACCHO Support for Local Health Department Immunization Efforts
NACCHO has developed a variety of tools and resources to help local health departments promote immunization in their communities. NACCHO’s human papillomavirus (HPV) project is one such example. HPV is the most common sexually transmitted infection in the United States and is responsible for nearly 26,000 new cases of cancer each year. HPV infections are responsible for the majority of cervical cancer and have been increasingly linked to several other cancers.^2,3 The combined cost of HPV-associated cancers and other conditions is estimated to be $8 billion per year in the United States.⁴

Despite the widespread availability of a highly effective vaccine, coverage rates for the HPV vaccine remain low. In 2014, with support from the Centers for Disease Control and Prevention, NACCHO awarded funding to 10 local health departments in states with the lowest HPV vaccination rates to participate in an action planning process and receive technical assistance to increase HPV vaccination rates in their communities. NACCHO designed an action planning process that engaged local health departments to conduct an environmental scan of their community resources, identify key community stakeholders, and participate in an action planning meeting facilitated by NACCHO staff. These local health departments worked with state immunization programs, cancer and immunization coalitions, private medical providers, pharmacies, schools, and faith-based organizations to develop strategic focus areas to guide the implementation of their initiative. NACCHO has funded a second cohort of 10 local health departments and will continue to share key themes and lessons learned with other local health departments.

NACCHO is also committed to helping local health departments build capacity to bill third-party payers for vaccinations and other clinical services. NACCHO created a toolkit with resources, templates, and tools for local health departments to use. More than 200 resources have currently been collected from state billing guides, the Centers for Medicare and Medicaid Services, state health departments, local health departments, insurance companies, and vendors of products such as electronic medical records and billing clearinghouses.

Resources
National Immunization Awareness Month is an opportune time to reflect on local health departments’ successes in promoting immunization and assess how we can strengthen its protection of population health in the future. For more information about NACCHO’s immunization program, visit http://www.naccho.org/programs/community-health/infectious-disease/immunization. To learn more about National Immunization Awareness Month and download the toolkit of resources, visit https://www.nphic.org/niam. More resources can be found below.

• 10 Ways to Promote National Immunization Awareness Month
• Health Department Strategies to Promote HPV Vaccination
• Guide to HPV Resources for Local Health Departments
• 2016 Immunization Schedules
• National Adult Immunization Plan
• Ten Local Health Departments Share Their Strategies to Increase HPV Vaccination Rates
• Barren River District Health Department Partners with Western Kentucky University for HPV Prevention Efforts
• Model Practice: Using Tracking Technology in a Point-of-Dispensing Vaccination Operation – Florida Department of Health in Broward County
• Model Practice: Quad-County Measles Protocol and Toolkit Development

NACCHO Policy Statements

• Increasing HPV vaccination rates in males and females
• Comprehensive immunization programs

References

1. Benefits from Immunization during the Vaccines for Children Program Era — United States, 1994-2013,MMWR)
2. International Agency for Research on Cancer. (2007). Monographs on the evaluation of carcinogenic risks to humans. Volume 90: human papillomaviruses. Lyon, France: World Health Organization, International Agency for Research on Cancer.
3. Gillison, M.L., Alemany, L., Snijders, P.J., Chaturvedi, A., Steinberg, B.M., Schwartz, S., et al. (2012). Human papillomavirus and diseases of the upper airway: Head and neck cancer and respiratory papillomatosis. Vaccine, 30(5 Suppl.), F34-54.
4. Chesson, H.W., Ekwueme, D.U., Saraiya, M., Watson, M., Lowy, E.R., & Markowitz, L.E. (2012). Estimates of the annual medical costs of the prevention and treatment of disease associated with human papillomaviruses in the United States. Vaccine, 30(42), 6016-9.