Doctor’s Orders: A different approach to raising the state’s lowest vaccination rates

LA CROSSE, Wis. (WKBT)– Some of the lowest childhood vaccination rates can be found in western Wisconsin. It’s a trend that has only gotten worse with vaccination rates are on the decline in more than half of Wisconsin’s counties.

Using data from the Wisconsin Department of Health Services, News 8 Now Investigates found the percentage of children up-to-date by age two on their combined seven vaccine series was down in 43 of 72 counties from 2017 to 2018. That would include vaccines for polio, measles and a number of others.

Behind Clark County, Vernon County has the second-lowest vaccination completion rate in the state. Less than half of the children in the county are up-to-date with their combined seven vaccine series by age two.

“They went up [to] 48 percent. 48.47 percent for 2018,” said Beth Johnson, director for the Vernon County Health Department.

As a whole, the county’s rate has gone up between 2017 and 2018. Johnson said they hold vaccination clinics for those without insurance and they have information on hand for people with questions.

“Well, we certainly provide education as much as we can. Always educating about the importance of vaccines,” Johnson said.

But still, for Johnson and other health officials, it’s concerning.

“That’s where disease outbreaks can arise from– pockets of under-vaccinated people,” said Dr. Raj Naik, a pediatrician with Gundersen Health System.

Data from DHS shows a growing number of families are using a personal conviction waiver so their child can attend school without getting immunized. Certain schools have a much greater number of immunization waivers than the state average.
Part of the concern for these health care providers is not only that the families who chose not to get their immunizations would get sick, but the children who can not get immunized because of serious medical conditions or allergies.

Last year, a measles outbreak sickened 1,282 people in 31 states. It was the greatest number of cases reported in the U.S. since 1992, according to the Centers for Disease Control and Prevention.

“We’ve been fortunate so far, but that doesn’t mean we’re not at risk here in the state of Wisconsin,” Naik said.

Instead of trying to educate individual parents and families about the benefits of vaccines, Naik is trying something new.

“It’s important that we make sure that everybody is achieving as high of a rate as possible with regards to childhood vaccination to prevent these disease outbreaks,” Naik said.

Naik is using a $120,000 grant from the American Academy of Pediatrics Chapter Quality Network to improve childhood immunization rates throughout Gundersen’s coverage area. He’s created interactive tools to make it easier to order vaccine supplies, information on ideal practices and patient education tools. These are available through a provider portal to staff at all of Gundersen’s clinics.

“A lot of what we’re trying to do is to empower families and healthcare providers to do the right thing,” Naik said.

He’s bringing additional training to pediatrics and family medicine clinics in 22 communities that may be at more risk than others. That includes Onalaska, La Crosse, Whitehall, Galesville, Sparta, Tomah, La Crescent, Houston, Harmony, Spring Grove, Decorah, Waukon, Calmar, Postville, West Union, Fayette, Praire du Chien, Boscobel, Viroqua, Hillsboro, Wonewoc and Elroy.

“I consider these our big opportunities where they see a lot of children and we can do even better,” Naik said.

According to the Wisconsin Department of Health Services, 56.8% of children in Crawford County are up to date with their combined seven vaccine series by age two. That covers illnesses like diphtheria, tetanus, and whooping cough; polio; measles, mumps and rubella. The MMR is one of the more controversial.

“A lot of people don’t want it because they’ve heard in the past that it causes autism,” said Teri Johnson, a medical assistant at Gundersen Health System’s Prairie du Chien Clinic.

A 1998 study published in the medical journal Lancet linked the vaccine to autism. It was later retracted, but the misconception remains to this day.

But misinformation about vaccines isn’t the only reason why kids aren’t getting immunized. Dr. Naik has identified a few other major reasons.

One of them is the provider hesitancy. Meaning, doctors, nurses or support staff might be unsure about asking someone if their child has been vaccinated or if they would be willing to get vaccinated.

“They might be concerned that it takes too much time, or they might have misconceptions themselves,” Naik said.

And, there are missed opportunities.

“A child comes into a clinic for something outside of their traditional well child care and they’re deficient in immunizations and they leave the clinic without ever getting it,” Naik said.

These doctors, nurses and other staff are learning how to use interactive tools and 10 major interventions to eliminate the potential barriers.

“A lot of people come in with that mindset that I’m not going to give that immunization,” Teri Johnson said.

But simple ways to approach a patient could make the difference.

“‘ I see you’re due for your tetanus today. Should we update that while you’re here?’ Or,’ I see your child missed their six-month immunizations. You’re here today. Shall we do that?'” said Teri Johnson, giving an example of an intervention scenario.

So far, teaching the medical providers these methods and tools seem to be paying off. Since Dr. Naik started this new effort, the percentage of children in Gundersen’s service area who complete the combined seven vaccine series has increased from 84 percent in March 2019 to 88 percent in January 2020.

“We’re saving all kinds of children from dying. We’re saving children from being hospitalized and from having severe complications from these awful diseases,” Naik said.

According to the La Crosse County Health Department, different vaccines have different thresholds that would help prevent these diseases, as shown in the chart below. For example, if 85% of people had completed their Diphtheria vaccines, it would protect susceptible people from getting sick.

Disease Threshold
Diphtheria 85%
Pertussis 92 – 94%
Polio 80 – 86%
Measles 83 – 94%
Mumps 75 – 86%
Rubella 84 – 85%

While it’s exciting for Naik to see the results, there’s still more work ahead. He’d like the system to reach a 90 percent completion rate for children between 19 and 35 months of age. That would be beyond most of the minimum thresholds for vaccines in the combined seven series.

The grant that made this work possible will end this Spring. But the tools and resources Naik has created for staff will continue to live beyond that in the hopes that this upward trend can continue.

“We’ve set these lofty goals and my expectation is that as an organization we can achieve those lofty goals,” Naik said.

Naik hopes Gundersen can be a leader not just in the state but regionally and even nationally. It would show other providers how they too can turn around some of the lowest vaccinated areas and stop preventable diseases from spreading.