Practice Title: PROMOTE Vaccination, Everyone, Everyday
Department: Middlesex County Office of Health Services
Size: Large (Population of 500,000+ people)
State: New Jersey
Summary of Practice:
Middlesex County NJ is a County in Central NJ with a population of approximately 860,000 residents and 25 municipalities. Middlesex County office of Health Services is a large Health department that is the health department for 24 of the 25 municipalities. The county's racial makeup is 41.9% White, 9.8% African American, 0.53% Native American, 26.5% Asian, and 9.06% from two or more races. Hispanic or Latino of any race were 22.4% of the population. Seventy one thousand (71,000) people fall below the poverty line. Forty seven percent (47%) of residents have a non English language as their primary language at home. Over seventy three thousand (8.5%) have no medical insurance. More than 52,000 are non- citizens (unauthorized population)
Vaccine preventable Outbreaks in adults can be prevented by maintaining high vaccination rates. Despite this relatively easy intervention, vaccination rates for many of these preventable diseases in the United States still remain low.
Our health department has several public health clinics for uninsured and underinsured. These clinics are for child health, Child lead clinic, Adult sexual health (STD) , CEED (Cancer Education and Early Detection) , and Tuberculosis. Although every one of these clinics is well attended, they are NOT attended for vaccination and, in fact, most of the population attending is under vaccinated, unvaccinated or behind on their vaccinations.
Beginning in 2010, a practice of “Promoting Vaccines, Everyone, everyday” was implemented to encourage all adults (19 and older) visiting any clinic to receive any number of vaccines that would get them current on their vaccine status. This was done on site when the patient arrived, either when bringing a child for treatment or when presenting to an adult clinic for another reason.
The simple goal of the practice is to bring every visitor’s vaccination status to “up to date” on all eligible vaccines. The goal was to have 80 percent of the eligible adult population receive their outstanding vaccinations. The objectives--Implement a protocol where all clinical staff actively interview and provide education adult visitors regarding their vaccination status and, evaluate every chart regarding missing vaccination, and strongly recommend missing vaccines to every patient. This protocol became a matter of practice at each visit, regardless of type.
During the ten years of the program evaluation (2010-2020) the data indicates that over 20,000 non scheduled vaccines were given to visitors to our clinics. These vaccines included were HPV, Shingles, Varicella, Pneumonia, TD or Tdap, Hep A/B combined Hep A, Hep B, and flu.
The success of the program is largely due to the routine nature of the promotion (every adult 19 and older who enters any clinic is asked about vaccination) and also the trust of the clinic staff. The staff is multilingual and can communicate well with the client. When a parent comes in to bring their child/baby to our clinic, we identify the needed and missing vaccination of the parent and can offer vaccines for the parent at that same visit. The parent didn’t come in for vaccines for themselves but leaves fully updated with their own vaccines. Since the parent is not likely to receive this care for themselves elsewhere due to time or funding constraints, the public health significance of this practice is remarkable.
While vaccination in children has been one of the tools used in closing some health disparities by preventing childhood diseases, the same drive to improve vaccination rates in adults helps towards achieving health equity for minority and vulnerable adult populations.