Immunization Exemptions and Pediatric Care

As a family nurse practitioner working in a pediatric outpatient clinic, assistant teaching professor Lacey Eden (BS ’02, MS ’09) educates parents about the general health of their child. Eden frequently addresses parents’ questions and concerns regarding immunizations for their child due to the requirement that parents provide either proof of completion or a certificate of exemption before their child can be enrolled in school.

Because of her experiences talking with parents about immunizations, Eden decided to research the rising immunization exemption rates in Utah. She is currently working on a standardized education module for immunization exemptions and also a mobile app called Best for Baby.

Education Model for Immunization Exemption Rates

Immunization exemption rates, particularly those granted for philosophical reasons, have risen drastically in Utah over the last few years. The rise in exemptions may have played a role in several recent outbreaks of vaccine-preventable diseases (measles and pertussis) in Utah, which prompted Eden to research the education provided for parents who wish to obtain an exemption. Currently she is investigating the specific education requirements for philosophical immunization exemptions in all states across the country and how effective this education is at combating the rise in exemption rates.

In her research, Eden found that all 50 states allow medical exemptions for immunizations, 48 states allow religious exemptions, and 18 states allow philosophical exemptions. Utah is one of the 18 states that allows all three types of exemptions. While 18 states allow philosophical exemptions, only 14 states require education before granting exemptions. The type of education parents receive varies from state to state and from county to county throughout Utah.

Eden has discussed her study with several prominent leaders of various associations and departments, including the health director and the immunization manager at the Utah State Health Department and the chair of the Utah Department of Human Services, in efforts to implement a standardized education module for Utahns to complete in order to gain a philosophical immunization exemption. She has also been invited to participate on an immunization exemption task force with several key participants in the state and with fellow College of Nursing faculty—Dr. Beth Luthy (MS ’05), Gaye Ray (AS ’81), Dr. Janelle Macintosh, and Dr. Renea Beckstrand (AS ’81, BS ’83, MS ’87). This task force is charged with creating a standardized education module that can teach parents the signs and symptoms of diseases, what to do if their child contracts a disease, and what to do in the case of an outbreak. The module will also answer frequently asked questions about immunizations and provide information about obtaining low-cost immunizations.

The Association of Immunization Managers and the Centers for Disease Control and Prevention have contributed to this project by aiding in the data-collection process and reviewing the research questions on educational requirements in reducing immunization exemptions.

Best for Baby App

In 2013, the Advisory Committee on Immunization Practices (ACIP) published its recommendation that pregnant women should get a Tdap vaccination between 27 and 36 weeks of pregnancy. Infants do not receive this vaccine until two months of age, but in the womb they do inherit temporary protective antibodies from their mothers, so it is essential for mothers to receive the vaccine and pass antibodies to their children in utero.

Despite being recommended by the ACIP, very few women receive the Tdap vaccine during their third trimester, so Eden, who serves as chair of the Utah County Immunization Coalition, decided to educate soon-to-be parents through a free mobile-device app called Best for Baby (now available on iTunes).

Though geared toward increasing Tdap immunization rates, the app does much more than just teach about vaccines. The program sends expectant parents weekly push notifications that provide updates on their baby’s development and when they need to see their OB/GYN. Additionally, updates tell parents what tests to expect at their next appointment, what those tests look for, and why they are performed. The app continues to give parents monthly push notifications for two years after the birth of the child. These updates include when the child should see a care provider, what developmental milestones he or she should reach during the month, and what immunizations that child should receive.

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