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Immunizations Medicine Summer 2015 | Volume 14, Number 2 encephalitis tetanus RUBELLA MUMPS meningococus pertussis ENCEPHALITIS MEASLES PERTUSSIS ROTAVIRUS meningococus MUMPS meningococus MEASLES tuberculosis RUBELLA diphtheria CHICKENPOX meningococus CHICKENPOX pneumococus meningococus rotavirus ENCEPHALITIS PNEUMOCOCUS FEVER TETANUS DIPHTHERIA TETANUS hepatitismumps POLIO encephalitis hepatitis measles pneumococus POLIO DIPHTHERIA FEVER CHICKENPOX tuberculosisRUBELLA tuberculosis diphtheria DIPHTHERIA meningococusMUMPS pneumococus encephalitis ENCEPHALITIS polio TETANUS diphtheria pertussis polio hepatitisRUBELLA meningococus ENCEPHALITIS DIPHTHERIA MEASLES YELLOW RUBELLA TETANUS measles Immunizations MEASLESpolio meningococus PERTUSSIS MEASLES RUBELLA measles tetanus rubella YELLOW tuberculosisENCEPHALITIS pneumococus CHICKENPOX RUBELLA measles What physicians rubella pertussis PNEUMOCOCUS need to know encephalitis diphtheria MUMPS meningococustetanus pneumococus measles rubella tetanus measles rotavirus tetanus rubellaPOLIOmeningococus hepatitisHEPATITISFEVER PERTUSSIS RUBELLA FEVER hepatitis FEVER HEPATITIS chickenpox poliorubella encephalitisTETANUSpertussis rubella DIPHTHERIA rotavirus tuberculosis FEVERHEPATITIS POLIO yellow DIPHTHERIAYELLOW polio pneumococus YELLOW polio ENCEPHALITIS chickenpoxrubellaRUBELLA rotavirus ENCEPHALITIS pertussis ROTAVIRUS tetanus chickenpox hepatitisFEVER encephalitis ENCEPHALITIS POLIO rotavirus ROTAVIRUS DIPHTHERIA YELLOW pertussis PNEUMOCOCUS PERTUSSIS RUBELLA polio CHICKENPOX ROTAVIRUS pneumococus CHICKENPOXCHICKENPOX hepatitis pertussis chickenpox encephalitis pertussis FEVER TUBERCULOSIS ENCEPHALITIS RUBELLA pneumococusPOLIO YELLOWfever pneumococus RUBELLA POLIO poliofever ROTAVIRUS mumpsMENINGOCOCUS RUBELLA PNEUMOCOCUS RUBELLArubella CHICKENPOX tetanus POLIO FEVERmumps PNEUMOCOCUS chickenpox TUBERCULOSIS FEVER hepatitis tetanus MUMPS mumps ROTAVIRUS mumpsrotavirus TETANUS polio pneumococus MUMPS TETANUS rotavirusTUBERCULOSIS DIPHTHERIA pneumococusRUBELLA MUMPS POLIO PERMIT NO. 27 NO. PERMIT LINCOLN, NE LINCOLN, PAID US POSTAGE US 233 South 13th Street PRSRT STD PRSRT Ste. 1200 Lincoln, NE 68508 Nebraska Medicine is published quarterly by the Medicine Summer 2015 | Volume 14, Number 2 233 South 13th Street, Ste. 1200 Lincoln, NE 68508 Phone (402) 474-4472 An overview and introduction to this issue ........... 3 Fax (402) 474-2198 www.nebmed.org My vaccine perspective .......................... 4 Nebraska Medical Association Overview of adolescent immunizations ............. 6 2014-2015 Board of Directors President Adult immunizations in 2015: what works .......... 10 Richard Blatny, Sr., MD, Fairbury President-Elect Human papillomavirus (HPV) infection Harris Frankel, MD, Omaha Secretary-Treasurer and vaccination .............................. 12 Todd Pankratz, MD, Hastings Immediate Past President Vaccine hesitancy and strategies to address it ........ 14 Kevin Nohner, MD, Omaha Board Members Parental decisions to not vaccinate: Ron Asher, MD, North Platte is it time to take a stand or understand? ......... 16 Jane Bailey, MD, Omaha Bo Dunlay, Jr., MD, Omaha Warning! Undervaccinated health care Deb Esser, MD, Omaha personnel in this facility! ........................ 18 Jose Friesen, MD, Grand Island Jim Gigantelli, MD, Omaha Shweta Goswami, Omaha Matthew Hrnicek, MD, Lincoln Logan Jones, Omaha Aparna Kailasam, Omaha Jason Kruger, MD, Lincoln Gerald Luckey, MD, David City Michelle Sell, MD, Central City Irsa Shoiab, Omaha Leah Svingen, Omaha Britt Thedinger, MD, Omaha Tod Voss, MD, Pierce Jordan Warchol, MD, Omaha Ex-Officio Board Member KC Williams, Lincoln The Nebraska Medical Association in no way endorses any opinions or statements in this publication except those accurately reflecting official association actions. Page 2 Nebraska Medicine | Summer 2015 An overview and introduction to this issue by Linda K. Ohri, Pharm.D., MPH Information System (NESIIS) as this medical director of Children’s Hospi- registry grows more complete. tal, Omaha, and staff from the Doug- e continue to confront many The reports in this issue are intended las County Health Department. The Wsocietal challenges related to to provide updates and commentary coalition began in response to control of vaccine preventable diseases on recommended immunizations in measles outbreaks and low im- (VPDs). U.S. measles outbreaks are childhood (Michelle Petersen, MD), munization rates identified in increasing in number and size (2013: adolescence (Shirley Delair, MD, MPH) Omaha and outstate Nebraska, 11 outbreaks; 187 cases; 2014: 23; 628; and for adults (Rudy Kotula, MD). To as well as across the country. 2015, to 6/26/15: 5; 178).1 Pertussis achieve the goal of “Optimal Immuniza- The goal of this coalition is is considered an endemic illness again, tion across the Lifespan,” prevention “Optimal Immunization across occurring across all 50 states, with through vaccination must be accepted as the Lifespan.” The website is 28,639 U.S. cases reported in 2013, and a responsibility of all health providers, located at: www.ImmunizeNebraska. 28,660 in 2014.2 Many more cases go regardless of specialty or patient popula- org. Associate membership is open to unreported. Influenza and pneumonia tion served. Meera Varman, MD, ad- advocates from across Nebraska. I also continue as the eighth leading cause of dresses HPV vaccination, where there has encourage all providers to attend the death in the latest 2013 statistics, both in been slow acceptance by various medical annual Immunize Nebraska conference, deaths across the entire U.S. population providers as well as parents over the nine held in Omaha in early June each year. (56,979) and for Nebraska (343).3 years since first approval, despite its po- This conference provides approximately While overall daycare and school tential to prevent several cancers in both seven hours of immunization-related mandated pediatric immunization genders. A report by Archie Chatterjee, continuing education credit for physi- rates are high, non-mandated child and MD, PhD, discusses factors involved in cians, NPs, PAs, nurses, and pharmacists; adolescent vaccination rates are less than vaccine hesitancy and refusal, and general more information may be found on optimal, and adult immunization rates approaches by providers to address this the website. in the U.S. are generally unsatisfac- problem. Katie O’Keefe, DNP, APRN- Over the years, one focus of ITF tory.4 Early season (November) 2014-15 NP, further discusses strategies on how to advocacy has been on legislation at the influenza immunization rates for the U.S. effectively promote vaccination in com- Nebraska Unicameral regarding immu- were estimated at 40.3% across all ages.5 munication with patients. Finally, Cathy nization issues. I encourage you to stay Furthermore, GPS (Geographic Posi- Carrico, NP, FNP-BC, will address the informed about current activities to: tioning System) population studies have need for and strategies to achieve a health 1) Oppose efforts to add a Philosophical demonstrated location / time clustering provider’s personal acceptance of optimal Immunization Exemption in Nebras- of pertussis or measles cases associated vaccination to protect both themselves ka. Research shows that states with with regions also showing increased rates and their patients. non-medical exemptions in place have of non-medical immunization exemp- Most of the authors for the articles in lower rates of vaccination and higher tions.6,7,8 While no such studies have this issue are members of the Immuniza- rates of VPDs.8 yet been published for Nebraska, we tion Task Force – Metro Omaha (ITF). 2) Add a requirement for meningococ- may look forward to the possibility of This all-volunteer coalition of immu- cal meningitis immunization for assessing such population trends through nization advocates was started in 1991, adolescent school entry (Legislative use of the Nebraska State Immunization through the efforts of Dr. Don Glow, (continued on Page 21) Page 3 Nebraska Medicine | Summer 2015 My vaccine perspective by Michelle Petersen, MD our long-term unit. Her mom had not the last few decades. Pertussis has a 1% Pediatrician been vaccinated and she had no immu- fatality rate in infants under two months NMA Past President, Lincoln nity as a newborn when her brother got of age with complications of pneumonia his kindergarten vaccines. She contracted (22%), seizures (2%), and bradycardia, s a pediatrician, one of the most polio from him as he processed the oral apnea, encephalopathy and others. Re- Aimportant jobs I have is working polio vaccine; she remained ventilator search found the spike in infant cases was together with parents to assure their chil- dependent and non-mobile when her mirrored in the 15-17 year age group. dren are healthy and protected. Illnesses paralytic polio did not improve. The This information has precipitated use of shift from season to season, but current inactivated polio vaccine avoids a reduced booster dose of the pertussis vaccinations and the discussion vaccine-associated polio rarely related to portion of pediatric DTaP through Tdap that they bring are daily rou- the live oral polio vaccine. use beyond the initial childhood vaccine tine. When reviewing the vac- We took care of a 3 year old whose schedule. Of note, the Tdap version of cines with families, I have often mom had taken him to a neighborhood this vaccine is recommended for all new explained the diseases by telling “chicken pox party.” Another child in parents, older
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