Mallory Metzger, Immunization Law Health Educator II, Oregon Immunization Program
It is hard to imagine the school immunization process without Peggy Lou Hillman. That’s because she has been there from the beginning. Soon Peggy will be retiring from the Oregon Immunization Program after nearly 50 years of working in public health. Peggy is an immunization school law and forecasting expert, resident historian, seasonal decorator, and number one advocate for our partners.
Whether or not you know Peggy, you know her work. Go outside and take a deep breath and thank Peggy for the clean air. After college, Peggy began working at the Tuberculosis and Respiratory Disease Association where she helped institute clean air requirements and car emission testing. These policies have led to the Department of Environmental Quality car emission testing that we see today.
Peggy Hillman, Immunization Law Health Educator II, Oregon Immunization Program
After you take that deep breath, walk over to a school yard and watch kids running and playing outside. These healthy kids can thank Peggy for helping create the first immunization laws for school attendance in Oregon back in 1981. As the Immunization Program Coordinator for Multnomah County, Peggy hand-wrote thousands of exclusion letters in the early years of the law.
Once you have gone for that walk, get in a car and drive with a sense of safety because all the babies being driven around are in car seats. Yep, that’s her too. While at Multnomah County, Peggy started the car seat loan program, which ensured all families regardless of income could protect their babies.
When asking Peggy about her career in public health she responded, “I fell into a career that I didn’t even know existed and it has given to me as much I have given to it.” You have given to us more than we can fathom. On behalf of the Oregon Immunization Program and all those living and breathing in Oregon, thank you Peggy!
Quynh Tran, Pharm.D Candidate 2016
Pacific University School of Pharmacy
The role of pharmacists has come a long way from the classical “lick, stick, and pour” dispensary role (that is, “lick and stick the label, count and pour the pills”) and is experiencing significant growth and development. With the expansion in the scope of practice, community pharmacists are able to take on a stronger role in support of public health to improve vaccination rates and reduce the burden of vaccine preventable diseases. According to the American Pharmacist Association, three proposed roles that pharmacists can play in improving immunization rates include acting as immunization advocates, acting as facilitators and hosting other health care professionals to provide immunizations to the public, and lastly, taking on active roles as immunizers.
Pharmacists in all states are permitted to administer vaccinations, and the role of pharmacists in adult immunizations has increased significantly over the past few years. In 2011, Oregon pharmacy law allowed pharmacists to immunize adolescents down to age 11, and then in January of 2015, the law further lowered the age to 7. With less than half of adolescents receiving their yearly influenza vaccination, this change in pharmacy law can help more children get vaccinated and provide better access to immunizations.
The Oregon Immunization Program evaluated the impact of this change in the Oregon pharmacy law by using data from the Oregon ALERT Immunization Information System (IIS) limited to Clackamas, Marion, Multnomah, Polk, Washington and Yamhill Counties. The program compared influenza immunization rates before 2011 (2001 – 2010) and after the law was passed in 2011 (2011 -2014), between adolescents aged 11 -17 and those aged 7 – 10. Results revealed that between 2007 and 2014, adolescent influenza immunizations at community pharmacies increased from 36 to 6,372, with the largest increase happening after the law change, from 262 in 2010 to 2,083 in 2011. This evaluation demonstrated that expanding the scope of the pharmacist in immunizing adolescents can provide better accessibility to an adolescent population who may otherwise be unlikely to receive immunizations at clinics. This in turn can substantially help increase adolescent influenza immunization rates.
- Robison, Steve G. (2016). Impact of Immunizing Pharmacists on Adolescent Influenza Immunizations. Manuscript submitted for publication.
- Rothholz, Mitchel C. (2013). Role of community pharmacies/pharmacists in vaccine delivery in the United States [PowerPoint slides]. Retrieved from http://www.pharmacist.com/role-community-pharmaciespharmacists-vaccine-delivery-united-states-0
Thirty years ago, five School-Based Health Centers (SBHC) opened their doors in Oregon with the goal of providing patient centered health care services for all students, whether or not they have health insurance coverage. Today Oregon has 75 certified SBHC’s that operate in urban, suburban and rural school districts. Oregon SBHC Map
SBHCs are medical clinics that offer primary care services within or on the grounds of a school. Each SBHC is staffed by a primary care provider, other medical, mental, and/or dental health professionals and support staff.
SBHCs focus on reducing barriers that can keep youth from accessing health care such as transportation, cost and concerns about confidentiality. SBHCs bill Medicaid and many are credentialed with private insurance, but students may not be denied service for inability to pay for services.
Since inception, preventative health services such as immunizations have remained a core function for Oregon SBHCs. Certified SBHCs participate in the Vaccines for Children (VFC) program and offer all ACIP routinely recommended vaccines at each site. Bringing vaccines to the school results in fewer missed opportunities for all vaccines as well as preventing school exclusion due to incomplete immunization status. Parent involvement and consent is managed by frequent communication between the SBHC and home.
Ceci Robe, manager for Rogue Community Health SBHCs in Jackson County, describes the importance SBHCs place on vaccine education and outreach. “We get the word out to students and staff in many ways, such as targeting 11th and 12th graders for meningococcal vaccine and HPV. We also outreach for Hepatitis A, and offer immunizations to siblings of students. We provide flu clinics for all district students and staff. We have a close partnership with the school’s registrar and create a system of referral. We get going in September and by February all students are compliant and no one is excluded from school. This is a great benefit to the student and schools.”
Ceci feels all encounters are an opportunity to evaluate and discuss vaccination status. “It only takes about 15 minutes, so we can update a student at school, during lunch. We are constantly monitoring the immunization status of all students that come into the health center for any reason. We update ALERT in a timely manner, so when the student transfers schools they have an updated record in hand.”
Summer is winding down and it’s time to gear up for a new school year. That means more kids coming in for vaccines. What do you need to know about immunizations for back to school this year?
- Old religious exemptions to immunization signed prior to March 2014 are no longer valid. Senate bill 895 removed the provision that allowed old religious exemptions that were in place before the implementation of the new nonmedical exemption process. This is a great opportunity to discuss vaccines with parents who claimed an exemption for their child years ago. Parents will have two options:
- If the child has received the vaccines, the parent needs to fill in the vaccine dates on the Certificate of Immunization Status, sign the form and turn it into the school.
- If the parent wants a nonmedical exemption for their child, they need to get education about the benefits and risks of immunization from a health care practitioner or the online vaccine education module. If you are a health care practitioner and provide education to the parent, print off and complete the Vaccine Education Certificate available at healthoregon.org/vaccineexemption (go to the “For Providers Only” section at the bottom of the page). Mark “yes” next to each vaccine you provided education about for which the parent wants to claim an exemption. The online vaccine education module is also available at the same web address.
- Remind parents to update immunization records with their child’s school or daycare every time their child receives a vaccine.
- Make sure to screen for and give all recommended vaccines when you give school-required vaccines. When a student comes in for Tdap vaccine, give HPV and meningococcal vaccines as well. Adolescents can be a hard population to reach, and you might not see the patient again for several years. And don’t forget about flu vaccine!
Update from the 2014-2015 school year
For the first time in more than a decade, Oregon’s nonmedical exemption rate decreased: 5.8% of kindergartners had a nonmedical exemption to one or more vaccine in 2015 compared to 7.0% in 2014. Check out the graph above to see the nonmedical exemption rate over time. Thank you to clinics, schools and child care programs for helping to implement the new process for claiming a nonmedical exemption, and helping protect more kids against vaccine preventable diseases!