Immunizations

August is National Immunization Awareness Month, and the San Diego County Immunization Initiative (I-3), a coalition of more than 150 public and private health-related organizations, is asking people throughout the region to check if they and their loved ones are up-to-date on their immunizations. August is a particularly good time to focus community attention on the value of immunization. Parents are enrolling children in school, older students are entering college, and seniors and the healthcare community are preparing for the upcoming influenza season.

National Immunization Awareness Month is also an opportunity to celebrate immunization as one of the great public health success stories of the 20th century (1). As a proven and cost-effective method to protect the public's health, vaccines provide protection both to individuals and to the community as well by preventing the transmission of infectious diseases to persons who cannot be, or are not, immunized. "Before vaccines protecting against diseases such as measles, polio and pertussis became available, those diseases caused tens of thousands of deaths each year in the U.S.," said Nancy Bowen, M.D., Health Officer for San Diego County. "Because today's vaccines are recognized as safe and effective, members of our community can and should be protected by being up-to-date on their immunizations."

At the same time, the celebration should not obscure the fact that more work needs to be done. Americans can be proud that the U.S. experiences relatively few cases of many of the vaccine-preventable diseases, like measles, polio and rubella. But the occurrence of cases of other vaccine-preventable diseases are illustrating the gaps in vaccination coverage in locations throughout the country.

Pertussis, for example, is often spread by unprotected parents or siblings to infants too young to be fully immunized. This year in San Diego County,124 pertussis cases have been reported as of late June, as compared to 49 cases reported for the same period last year. Of these, 35 (28%) were less than one year of age, 24 (19%) were children ages 1-9, 34 (27%) were children or adolescents ages 10-19, and 31 (25%) were adults over 20 years of age.2With regards to pertussis immunization in particular, there is good news. There had been no pertussis-containing vaccine approved for use in children 7 years of age or older. Because the effectiveness of the pertussis immunization received as an infant begins to wane after 5-6 years, an approved vaccine for older children and adolescents is needed. To address this issue, earlier this year, GlaxoSmithKline and Sanofi-Pasteur's Tdap (Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed) vaccines, for use with 10-18 year olds and 11-64 year olds, respectively, received approval from the U.S. Food and Drug Administration. Official recommendations for use of Tdap were issued after the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) meeting in late June 2005.

It is important to remind patients and families that vaccine-preventable diseases have not gone away, but still threaten the community. The resurgence of polio in Nigeria and the spread of this disease to Yemen and Indonesia serve as powerful reminders that it is critical to maintain high immunization rates in San Diego County so that diseases once thought to be under control don't reappear in the community to cause more illness and suffering.

Each year, the nation spends billions of dollars treating people for vaccine-preventable diseases, and each year, on average, more than 47,000 people die from these diseases. It makes so much more sense to prevent diseases rather than have to deal with the diseases themselves and the suffering they cause.

Healthcare providers play a pivotal role in helping their patients keep their immunizations current. Patients look to providers for advice and guidance on health issues. Of course, there are many demands on providers' time, but it is very important for them to take advantage of every opportunity to discuss the importance of immunization with patients. Those patients may have questions that only their providers can answer.

The CDC and the County of San Diego Health and Human Services Agency's Immunization Branch currently recommend that children receive vaccines against thirteen infectious diseases, including diphtheria, tetanus, pertussis, measles, mumps, rubella, chickenpox, polio and others. Adolescents should be vaccinated against tetanus, diphtheria and meningococcal disease, and others that may have been missed earlier, like hepatitis A and hepatitis B. Immunizations recommended for adults include vaccines against influenza, pneumococcal disease, tetanus and diphtheria.

For more information about vaccines, vaccine-preventable diseases and a wealth of helpful materials, please contact the San Diego County Immunization Initiative at 619-692-8661, or visit www.immunization-sd.org and go to the Health Care Providers section. More information about National Immunization Awareness Month is available at the Partners for Immunizations website at www.partnersforimmunization.org.

1. Morbidity and Mortality Weekly Report; April 02, 1999; 48(12): 241-243.
2. Immunization Branch, County of San Diego Health and Human Services Agency, 2005.

San Diego County Healthcare Statistics:

In 2004, 116 cases of pertussis were reported in San Diego County. This had been the highest yearly total since 2002, when 230 cases were reported.1 In contrast, no cases of polio, measles, diphtheria, tetanus or Haemophilus influenza type b were reported in the County in 2004.2

1. Immunization Branch, County of San Diego Health and Human Services Agency, 2005.
2. Ibid.

To request additional health statistics describing health behaviors, diseases and injuries for specific populations, health trends and comparisons to national targets, please call the County's Community Health Statistics Unit at (619) 515-4318. To access the latest data and data links, including the 2004 Core Public Health Indicator document, go to www.sdhealthstatistics.com.