Since the beginning of the 19th Century, immunizations have saved millions of lives. Now routinely implemented worldwide as the cornerstone of public health, immunizations are regarded as one of the most important life-saving measures of all time (Rémy, Zöllner, & Heckmann, 2015). In American history, immunizations became a common practice with the mandate of the small pox immunization in 1827 (Rémy, Zöllner, & Heckmann, 2015). Since then, laws have continued mandatory school immunizations to prevent outbreaks of communicable diseases (Omer et al., 2006). However, there have been unforeseen consequence of immunization success; namely, now most Americans lack firsthand experience with serious communicable diseases. Lack of experience with immunization preventable diseases has led to parents focusing less on the overwhelming benefits of immunizations and more on possible adverse events (Gust et al., 2009).
As the perceived benefits of immunizations decrease, parental requests for school immunization exemptions have increased (Wang, Clymer, Davis-Hayes, & Buttenheim, 2014). All states in the United States allow at least one type of immunization exemption, whether it be for medical, religious, or philosophical reasons. Utah is one of 18 states allowing philosophical exemptions from immunizations (Centers for Disease Control and Prevention [CDC], 2015). In fact, exemptions in Utah for Kindergarten immunizations rose from 2.1% in 2007 to 4.4% in 2013, of which 95% were for philosophical reasons (Utah Department of Health, 2014). With this rise in Utah exemption rates, the integrity of the herd effect in Utah has been compromised. Additionally, only 75.2% of Utah’s children, at 2 years of age, have received all recommended vaccinations (Lampros, 2015). While herd immunity requires a 95% immunization rate to be effective, unimmunized infants and children are at greatest risk of acquiring highly virulent diseases, such as measles and pertussis (Wang, Clymer, Davis-Hayes, & Buttenheim, 2014). Consequently, Utah has experienced several outbreaks of immunization preventable diseases, such as measles and pertussis, during the last 5 years.
According to Omer et al. (2006), there is a direct and positive correlation between the ease of the personal exemption process and the request for immunization exemptions. Mean exemption rates increased approximately 6% per year in states that grant philosophical exemptions with ease (Omer et al., 2006). In contrast, states with a difficult exemption process, such as intricate paperwork and extensive administrative processes saw no statistically significant change in exemption rates (Omer et al., 2006).
The state of Oregon has traditionally struggled with higher than average philosophical exemption rates. As a result, Oregon also has higher than average communicable disease outbreaks. To combat the rising philosophical exemption rate, Oregon enacted a law in 2014 that mandates parents seeking philosophical exemption to first get a Vaccine Education Certificate from their healthcare provider or after completing an online education module (Oregon Health Authority, 2014). While it is still too early to determine the effectiveness of required immunization education in Oregon, it should be noted that Oregon’s 2014-15 kindergarten exemption rates rapidly declined from 7.1% to 6% in one year (Seither et al., 2015). As a state that allows philosophical exemptions from immunization, Utah may also benefit from a standardized immunization education module.
The purpose of this project is to promote the administration of immunizations, educate parents of their importance and to increase the herd immunity in Utah. A secondary purpose is to mentor nursing students through the process of creating an online education module for parents choosing to exempt their children from immunizations.
Methods:
The purpose of this project is to mentor nursing students through the process of creating and implementing a standardized education program for parents choosing to exempt their children from immunizations, and to assist local health departments in Utah with the exemption process.. Initially, faculty met with undergraduate students for orientation to the project, including background description of immunization perceptions in parents requesting exemption for their children. Furthermore, student mentoring included bi-monthly group and/or individual supervision meetings. Mentored students collaborated with Utah public health officials and immunization experts to further understand the need for a standardized immunization education module.
Because the students will be mentored by faculty that participate on the state Immunization Exemption Workgroup, professional collaboration will take place with public health experts including Utah Association of Local Boards of Health (UALBH), school nurses, school secretaries and principles, and the Utah Immunization Program manager. Additionally students will attend meetings and collaborate with the Northern Utah Immunization Coalition (NUIC), the Salt Lake County Immunization Coalition, the Utah County Immunization Coalition (UCIC), and the Utah State Department of Health (USDH).
With the mentorship of faculty, the students collaborated with UALBH and the Utah Immunization Program Manager to create the outline for the module through May – November 2017. During these collaborative and mentored experiences, students collected and reviewed information about communicable diseases, how parents can protect their unimmunized child in the event of a disease outbreak, and what requirements and guidelines are in place regarding quarantine of unimmunized school-age children. The module will assist parents to take responsibility and be proactive advocates for their children.
With the widespread use of online education, the development of an online standardized education module caters to the familiarity of web use in daily living. The mentored students and faculty collaborated with The Summit Group, a public relations and web design and development company, to design and program the immunization exemption module. The module was built around the information and data collected by the faculty, students, and collaborative agencies, and was standardized and will be made available online across the state for all parents requesting an exemption.
Upon completion of the online module, review and testing of the module will take place during February-June 2018. Faculty and mentored students will meet with UALBH and the Immunization Program Manager weekly to complete edits and make corrections to the module before it is distributed to the local health departments throughout Utah.
Results:
This project resulted in an enriched service-learning environment for students while addressing an incredibly timely need in the community. Although the implementation of this project is in its infancy, it is anticipated that standardized education will provide parents with correct information about immunizations and will result in fewer immunization-exempted children. Thus, the herd immunity in our state will increase, protecting those who are unable to be immunized.
Conclusion:
It is suggested that other states implement standardized education, especially states that permit philosophical exemptions. It is our hope that by providing standardized education, our communities will better understand how immunizations work, why they are needed, and will ultimately improve the herd immunity within our nation.