Healthy Neighborhoods, Healthy Families
Immunizations are one focus of the Healthy Neighborhoods, Healthy Families (HNHF) initiative which is working to transform an area in the Southside of Columbus through a comprehensive neighborhood revitalization program. Using a public-private partnership model between Nationwide Children’s Hospital, the City of Columbus, Community Development for All People, United Way of Central Ohio and many other local partners, it is aimed at improving the quality of life for families in the area, and ultimately helping children to grow up healthier.
HNHF has taken a five-pronged approach to strengthening the neighborhood for children and families: affordable housing; education; health and wellness; safe and accessible neighborhoods; and workforce and economic development. Since it was launched in 2008, HNHF has had an impact in all five focus areas on the neighborhood surrounding Nationwide Children’s Hospital’s main campus.
To date, 21 houses are slated for renovation and 24 property owners have received home improvements. The housing component has attracted nearly $1 million in United Way funding and $2.4 million in federal stimulus funding. Health and wellness efforts include a new charitable pharmacy, vaccination clinics and antiobesity programs in local schools. Education efforts include mentoring at schools and the neighborhood is safer with volunteer-staffed walking routes for children going to school. Around economic development, the hospital has held local vendor open houses to increase business going to neighborhood firms. Approximately 10,000 residents are impacted a year by these efforts.
Immunization rates have improved locally; however, the City of Columbus has much lower rates than Columbus suburbs.
Children Completing the 4:3:1 Immunization Series by their 2nd Birthday
Columbus City, Columbus Suburban, Ohio and United States, 1996, 2000, 2004 and 2008
Immunization is a proven way to keep people healthy. In the United States, immunization has resulted in achieving record or near-record low levels of vaccine preventable childhood diseases. For example, 500,000 cases of measles were reported each year prior to 1963. In contrast, today there are only about 50 cases a year reported in the United States, and most of these originate outside the country.
This is a fantastic public health success, but it does not mean the diseases we immunize against cannot come back in force. The viruses and bacteria that cause many of them are still circulating in the U.S. and other countries. Recent years have witnessed outbreaks of “old-time” vaccine-preventable diseases, such as pertussis (whooping cough), measles and mumps throughout the U.S. Each unvaccinated child is at risk of getting these diseases and spreading them to others.
And, vaccine preventable diseases are often more severe in young children. The chances of having a serious reaction to vaccinations is extremely small compared to the health risks associated with the diseases they’re intended to prevent.
Today’s recommended vaccines have been rigorously tested, and they are carefully monitored when in use. They have been shown to be safe and effective for millions of children. Still, many parents worry about the possible side effects of vaccines and the number of shots that are recommended. If they turn to the Internet for answers, myths and misinformation abound. Good Internet sources of information include the American Academy of Pediatrics, the U.S. Centers for Disease Control and Prevention and Nationwide Children’s Hospital.
“Ensuring the health of all children is a community responsibility. Immunizing children appropriately is a safe and proven way of helping them stay healthy.”
Sean Gleeson, MD, medical director, Partners for Kids and vice president of Community Health and Wellness
Gage Miller would hate to miss school because he was sick with the flu. But that’s not the only reason he should avoid this common illness.
A 9-year-old with cerebral palsy, Gage is at higher risk of developing complications from the flu than are most children. So when his grandmother and guardian, Cecil Peer, learned that Gage should get seasonal flu and H1N1 vaccinations, she did not hesitate.
Cecil was notified as part of Nationwide Children’s Hospital’s pilot program during the 2009-2010 flu season to ensure high-risk patients were immunized. Cecil learned of the program through the Section of Physical Medicine and Rehabilitation, where Gage is treated with Botox injections in his legs every 3 months. The shots relax his muscles to help him stay more mobile.
“Gage has seizures and uses a wheelchair to go to and from school, but he can walk with a walker and go short distances on crutches,” explains Cecil. “He loves to swim.”
Like most children, Gage has not experienced side effects from flu vaccines in the past. And, according to Cecil, he didn’t have any this time.
“Gage can’t risk getting sick from the flu. He has enough to deal with,” says Cecil Peer.
It is vitally important that young children receive recommended immunizations on time.
Attention also should be given to immunizing all children over 6 months of age against the seasonal flu, which each year is responsible for more child deaths than all other vaccine preventable diseases combined.
Several programs are being tested or launched in Franklin County to help ensure our children are up to date on their childhood immunizations and vaccinated appropriately against seasonal flu.
Women, Infants and Children (WIC) - Primary Care Centers Program
The Franklin County WIC program is piloting a program with Nationwide Children’s Hospital to improve the immunization rates of Columbus’ children. The program works by reaching out to families when they have scheduled visits at the WIC clinic located inside Nationwide Children’s Northland Primary Care Center (PCC).
Two weeks before scheduled visits, WIC staff identify children under the age of three and send their names to the PCC, which has their medical records. The PCC staff check to see if children are up to date on immunizations and well child visits, or have followed up on recommended tests. If health care needs are unmet, the PCC will contact the parents, discuss the need and try to schedule a PCC visit on the same day as the WIC appointment. If that is not possible, they will schedule an appointment on another day.
“Sometimes parents are not aware that the children are behind on their shots when we contact them,” explains Northland PCC charge nurse Tina Hardy. “This is a great way to remind them, and parents have been very willing to schedule immunization appointments.”
To keep a close eye on children who continue to go without needed care after the WIC appointment, the parents will receive two of their three WIC vouchers. They may return in two months to get the third, or any time before that when their children receive care.
“This program is an exciting endeavor between the WIC Program and Nationwide Children’s Hospital,” notes Steve Hill, director of the WIC program for Columbus Public Health. “It has the potential to improve immunization rates substantially among a normally high-risk group of individuals.”
Additional Outreach at Nationwide Children’s Hospital Primary Care Centers
Typically vaccinations are given during well child visits. But since these preventive visits are not made or kept for a variety of reasons, Nationwide Children’s is testing a program at its West Side PCC to provide immunizations during other types of visits. As long as children are not too sick, their doctor will encourage getting needed vaccinations right then and there.
“This program is part of our quality improvement plan,” says William Cotton, MD, Medical Director of the Primary Care Centers. “We’ll evaluate the pilot project based on improving immunization rates, make any needed changes and then implement the program at all our PCCs.”
At the same time the pilot project began, new methods were put in place to better remind families when their next well child visit is due. Instead of generating a reminder postcard based on the address in the Center’s database, patients now fi ll out the address on the postcard themselves. This increases the likelihood the address will be correct, since families may move frequently. Making the reminder postcards available in English, Spanish and Somali languages is another strategy designed to improve their effectiveness.
Columbus Public Health School Vaccination Program
During the 2010-2011 flu season, Columbus Public Health is partnering with Columbus City and other schools to hold flu vaccination clinics at all 123 schools in the district. According to Dr. Nancy Rini, director of Health, Family and Community Services for Columbus City Schools, flu clinics will be held in November and December “to educate as many families as possible about the benefits of flu vaccines and protect children from the flu.”
Columbus Public Health will implement the program, vaccinating students using its Strategic Nurse Team and the Medical Reserve Corps – nurses who volunteer to work in the public health system. To cover 123 schools, three to five clinics will be held on each of several days a week over a period of about four weeks.
Current plans are for the schools to send flu clinic registration and consent forms home with students several weeks beforehand. Nurses at each school will play the critical role of coordinating the effort to register students and making sure they get to the flu clinic. Families with health insurance can pay through their plans, and hardship waivers will be given as appropriate.
“If you want to slow the progression of flu and prevent it from spreading throughout a community, you have to start by vaccinating children,” explains Jim Baker, immunizations program manager for Columbus Public Health. “Children are the most likely to get flu and spread it to others.”
This new program will be evaluated in terms of the number of students immunized and the rate of school absences compared to
years when there were no flu clinics. If it is deemed a success, the flu clinics will be continued annually.
“Besides preventing them from suffering symptoms and complications of flu, keeping our students well improves attendance, which in turn improves their chances of educational success.”
Dr. Nancy Rini, Columbus Public Schools
Nationwide Children’s Hospital
During the 2009-2010 fl u season, six specialty clinics on Nationwide Children’s main campus identified children they see regularly who are at high risk of suffering flu complications and alerted their families about the problem.
Most children who get seasonal flu feel terrible, but can be cared for at home and get better in less than two weeks. But those with certain medical conditions and chronic health problems are more likely to suffer flu complications that require a hospital stay and sometimes result in death. Pneumonia, bronchitis, sinus infections and ear infections are complications that can be caused by flu.
To ensure their high-risk patients were protected, the specialty clinics sent letters to parents encouraging them to have children vaccinated for seasonal flu and H1N1 by their primary care physician, or during a clinic visit. The infectious disease team was able to track patients enrolled in Partners for Kids* to see if this trial program was a success.
“We saw a 40 percent increase in our vaccine rate for at-risk kids compared to the previous flu season, and our rates were well above the national average,” concludes Dennis Cunningham, MD, physician director for Epidemiology and Infection Control at Nationwide Children’s. “With that success, we’ll now expand the program to give the best care to all our patients. We literally have tens of thousands of children we want to vaccinate.”
The program expansion for the 2010-2011 flu season will include giving flu vaccine reminders to everyone who comes to the specialty clinics, is an inpatient during flu season, or visits the Urgent Care Center located in the hospital. If children who regularly visit the specialty clinics do not have a visit scheduled during flu season, their parents will receive reminder letters and/or phone calls. Patients’ medical records will be tracked to make sure they get vaccinated during one of their visits.
Children younger than age 2 have as much chance of being admitted to the hospital for flu as the elderly.
Preventing devastating childhood diseases through immunization is one of the greatest successes of medicine. Yet, in spite of overwhelming scientific evidence to the contrary, some well-meaning but fearful parents – including celebrities with unlimited access to the media – believe vaccines are harmful and refuse to immunize their children.
If left undisputed, this misinformed questioning of vaccine safety could turn back the clock for America’s children, bringing the return of diseases that are genuinely dangerous. Every child who goes unvaccinated puts many other children at risk. To continue keeping our children safe from childhood diseases:
Beyond childhood immunizations, infl uenza vaccination is an important way for all residents of Franklin County, children and adults, to stay healthy during the winter. The vaccine is safe, does not give you the flu and is proven to reduce illness, and even death, in many populations, particularly those at risk. There are many other “flu-like” viruses that occur during the winter that give symptoms such as cough, congestion and stomach issues, but the fever, muscle aches and other consequences of influenza can be prevented.
The American Academy of Pediatrics and the U.S. Centers for Disease Control and Prevention recommend annual seasonal influenza immunization for anyone 6 months and older, whether healthy or at high risk of influenza complications.