Washtenaw County Schools Working to Reduce Elevated Vaccine Waiver Rates

Parents of children in Washtenaw County schools excuse their children from being vaccinated at a rate that is troubling local public health officials.

Washtenaw’s immunization waiver rate was the 20th highest out of 83 Michigan counties.

Database: See vaccination rates at Washtenaw County public and charter schools

Requiring that students at public and charter schools submit vaccination reports or waivers at the beginning of certain school years is one of the primary methods states use to ensure child immunization.

Students entering kindergarten, seventh grade, or changing school districts are required to submit report their vaccination records no later than the first day of school.

If the record is incomplete, parents can either ensure their children to receive the required vaccinations or sign a waiver form.

“Reporting means we need to know the status of at least 90 percent of the school by November 1 and that increases to 95 percent in February,” Washtenaw County Public Health immunization nurse coordinator Christina Karpinski said.

“The school secretaries are constantly working on getting this information from parents to make sure the kids are reported.”

Vaccination is tied to districts’ state school aid funding. The Michigan State School Aid Act of 1979 mandated that districts failing to meet the reporting deadlines would lose 5 percent of their state funding.

“What we work on as a health department is making sure that students are not just reported, but complete,” Karpinski said.

“People sometimes just sign the waiver because they think ‘I don’t have to get my kid vaccinated because everyone else did.’”

Karpinksi said that attitude can be dangerous, as lower levels of vaccination in a population can put everyone at risk.

Lower Vaccination Numbers, Higher Infection Numbers

Nationwide, public health officials are becoming increasingly concerned with low vaccination rates as measles infections are at their highest levels since the early 1990s. A number of cases of the potentially fatal respiratory infection have been documented in Ohio, but none have been reported in Michigan in the last 10 years.

“We need to keep our kids in school so they can optimize their educational opportunities,” vaccination policy expert Matt Davis, with the Child Health Evaluation and Research Unit at the University of Michigan, said.

“When kids get sick with vaccine preventable diseases that is an avoidable problem. We know how to keep kids healthy and in school and that’s by giving the recommended vaccines on the recommended schedule.”

Washtenaw County is in the midst of a second straight year with high pertussis, or whooping cough, levels in its schools. Public health officials said the outbreak was preventable and was caused by lower vaccination rates. Pertussis is characterized by the “whooping” cough that can make it extremely difficult for those with the infection to breath.

Washtenaw County vaccination rates fall behind state averages

One case of mumps, which can cause fever, headache and swelling of the brain and spinal cord has also been reported in the county in 2014.

School districts are responsible for notifying parents about the vaccination requirements and following up to ensure that records or waivers are completed.

“You let them know up front what the expectations are, what the due dates are, when we need the forms by and that they have to be inoculated by a certain date,” Teresa Cornelison, administrative assistant to the superintendent and secretarial supervisor at Ypsilanti Community Schools.

“We always let parents know up front what we need as part of our registration process and we train our people in the building what to look for in those immunization records so they can help parents on the spot.”

Most of the large school districts in the county had between seven and 12 percent of their students on waivers, with fully vaccinated students making up between 88 and 92 of the student population. The data is kept by the Washtenaw County Public Health Department and was obtained by The Ann Arbor News through a Freedom of Information Act request.

Manchester Community Schools had a higher waiver rate than most of the county at 17 percent, while Ypsilanti Community Schools had a waiver rate of just 1 percent across the district.

What the Districts Are Doing

The new Ypsilanti School district had a lower level of reporting than other districts in the county, with just 88 percent of students reporting as fully vaccinated or turning in the waiver form. However, all but 1 percent of those who did report were fully vaccinated.

Cornelison attributes those numbers to an emphasis at the secretarial level that vaccination is important.

“The waiver is not really something we offer up front,” she said.

“We say ‘your child needs to be inoculated’ and then we stay firm with it. It seems to work. If a person has a real objection they can of course fill out the waiver, but they may say ‘I don’t have a doctor here,’ so we help them with that. We help them get to the clinic through the county or direct them to a doctors office.”

Ann Arbor Public Schools has 88 percent of its students reporting as fully vaccinated and 9 percent have submitted waivers. District spokeswoman Liz Margolis said schools in the city work hard to get students either immunized or to fill out waiver forms.

“We aren’t making judgment calls,” she said. “Some schools will have a higher number of waivers than others and that’s just how it is. I think we can safely say we do see the impacts sometimes though.”

Saline Area Schools district nurse Karan Hervey said she has been very concerned about immunization rates dropping across the country and that she is leading a team effort to increase the rates in her district.

She said there will always be a small percentage of waivers that will never change but that she has focused on the cases that she can “turn around.”

“We try to be proactive instead of reactive here, and anticipate the needs of families and help them connect with the resources they need,” she said.

“In the past we might have said ‘we have a deadline to meet with the health department so just sign the waiver if you’re not vaccinated.’ But now we’ve reduced our waiver rate and we’ll continue to work on that.”

Saline Area Schools had an 8 percent waiver rate and 92 percent of students reported as fully vaccinated in 2014. Waiver rates at the district’s elementary and middle schools were all below 10 percent.

Waiver percentages varied widely in charter schools across the county. Ann Arbor Learning Community had 21 percent of its students on waivers and Honey Creek Community School had 32 percent, while New Beginnings Academy had just a 3 percent waiver rate.

Higher waiver rates were seen at high schools, where the only students reporting were ones who were new to the district. Karpinski said that the higher rates could in large part be attributed to foreign exchange students and other international students coming into the schools who had either different or incomplete immunization records and did not want further vaccination.

Six schools across the county had full immunization rates of 99 or 100 percent: Bryant Elementary School and the Roberto Clemente Center in Ann Arbor, the Central Academy Kindergarten, South Meadows Elementary in Chelsea, Saline Alternative High School and the Washtenaw County Juvenile Detention and Young Adult Programs.

NewLink Genetics: Ready to Test Ebola Vaccine

An Iowa drug developer is preparing to test a possible Ebola vaccine in humans, as scientists race to develop ways to prevent or fight a virus that has killed more than 1,000 people in a West African outbreak.

NewLink Genetics is planning an initial phase of testing involving up to 100 healthy volunteers and is talking with regulators about the study, said Brian Wiley, the company’s vice president for business development. He declined to say whether the drug developer has submitted an application for the research to the Food and Drug Administration.

Chief Financial Officer Gordon Link said Thursday the timing of the testing, which would involve up to 100 healthy volunteers, is uncertain.

“We’re getting a lot of assistance from a number of sources to accelerate this, so exactly how long it’s going to take is a little uncertain because people are greasing the paths as much as they can,” he said.

There is no proven treatment or vaccine for Ebola, and the current outbreak, which also has sickened nearly 2,000 people, is the largest in history. The outbreak was first detected in March in Guinea and spread to Liberia, Sierra Leone and Nigeria.

Other possible Ebola vaccines under development include one developed at the National Institutes of Health that is set to begin early-stage testing in humans this fall.

On Wednesday, Canadian drugmaker Tekmira Pharmaceuticals Corp. said it wasn’t ready to make its experimental Ebola drug available in Africa.

NewLink Genetics Corp. is planning to test a vaccine that was discovered by scientists working for the Canadian government. The U.S. drugmaker has an exclusive license to take it through clinical trials and then sell it if regulators grant approval.

NewLink said the vaccine has been 100 percent effective in preventing deadly Ebola infections in non-human primates, and it acts quickly enough to show effectiveness in animals that received a typically lethal dose of the virus.

The vaccine contains an antigen from the Ebola virus, and it essentially teaches a person’s immune system how to fight the virus.

“This is a very traditional vaccination process,” said Dr. Nicholas Vahanian, NewLink’s chief medical officer.

Researchers will be focused mainly on the vaccine’s safety in the initial round of testing, but they also will measure the antibodies the subject’s body produces to fight the virus.

“By measuring their immune response to the vaccine, you can predict the effectiveness,” Vahanian said.

The company also is working to line up manufacturing partners to make additional doses of the vaccine.

“It is not a particularly challenging vaccine to manufacture,” Vahanian said. “We are expending all our efforts to be able to secure additional manufacturing partners so we can meet high demand.”

A total of 1,500 doses have already been produced by a contract manufacturer in Germany, and the Canadian government purchased all of them. The government is setting aside some for NewLink to use in clinical research, and it also plans to donate between 800 and 1,000 doses to the World Health Organization, which is coordinating the international response to the latest outbreak.

Earlier this month, NewLink, which has no products on the market, announced a $1 million contract with the U.S. Defense Threat Reduction Agency to help fund research leading up to the human testing.

Shares of the Ames, Iowa, company soared more than 12 percent, or $2.86, to $26.30 in Thursday afternoon trading, while broader indexes climbed less than 1 percent.

US Ebola Outbreak ‘Possible’ But Likely Not Large: CDC Chief

Washington (AFP) – People with symptoms of Ebola will inevitably spread worldwide due to the nature of global airline travel, but any outbreak in the US is not likely to be large, health authorities say.

Already one man with dual US-Liberian citizenship has died from Ebola, after becoming sick on a plane from Monrovia to Lagos and exposing as many as seven other people in Nigeria.

More suspected cases of Ebola moving across borders via air travel are expected, as West Africa faces the largest outbreak of the hemorrhagic virus in history, said Tom Frieden, the head of the US Centers for Disease Control and Prevention.

The virus spreads by close contact with bodily fluids and has killed 932 people and infected more than 1,700 since March in Sierra Leone, Guinea, Nigeria and Liberia.

“It is certainly possible that we could have ill people in the US who develop Ebola after having been exposed elsewhere,” Frieden told a hearing of the House Subcommittee on Africa, Global Health, Global Human Rights and International Organizations.

“But we are confident that there will not be a large Ebola outbreak in the US.” Frieden also told lawmakers that people with symptoms of the disease would inevitably spread worldwide, and indeed numerous countries have already begun testing patients with fever and gastrointestinal distress who have recently traveled to West Africa.

“We are all connected and inevitably there will be travelers, American citizens and others who go from these three countries — or from Lagos if it doesn’t get it under control — and are here with symptoms,” Frieden said.

However, a CDC spokesman later clarified that Frieden was not saying the United States was bound to get Ebola cases.

“It is inevitable that people are going to show up with symptoms. It is possible that some of them are going to have Ebola,” said CDC spokesman Tom Skinner.

There is no treatment or vaccine for Ebola, but it can be contained if patients are swiftly isolated and adequate protective measures are used, Frieden said.

Healthcare workers treating Ebola patients should wear goggles, face masks, gloves and protective gowns, according to CDC guidelines.

- Equipment lacking -

Ken Isaacs, vice president of program and government relations at the Christian aid group Samaritan’s Purse warned that the world is woefully ill-equipped to handle the spread of Ebola.

“It is clear that the disease is uncontained and it is out of control in West Africa,” he told the hearing. “The international response to the disease has been a failure.” Samaritan’s Purse arranged the medical evacuation of US doctor Kent Brantly and days later, missionary Nancy Writebol, from Monrovia to a sophisticated Atlanta hospital.

Both fell ill with Ebola while treating patients in the Liberian capital, and their health is now improving.

“One of the things that I recognized during the evacuation of our staff is that there is only one airplane in the world with one chamber to carry a level-four pathogenic disease victim,” Isaacs said.

He also said personal protective gear is hard to find in Liberia, and warned of the particular danger of kissing the corpse farewell during funeral rites.

“In the hours after death with Ebola, that is when the body is most infectious because the body is loaded with the virus,” he said. “Everybody that touches the corpse is another infection.”

U.S. Ebola Virus Patient Being Treated in Atlanta Faces Crucial Days

An American infected with Ebola in Liberia was being treated and monitored in the U.S. on Sunday, as doctors worked to provide care in what will be a crucial few days in his attempt to recover from the deadly disease.

About a week after his first symptoms of Ebola were reported, Kent Brantly, a doctor, was in an Atlanta hospital’s special isolation unit. He had arrived Saturday, flown from Liberia in a chartered air ambulance, and he appeared in fairly good condition as he walked, covered from head to toe in a protective suit, into the unit at Emory University Hospital.

Plans to soon bring a second American Ebola patient from Liberia to the same hospital were on schedule, according to the air-charter company hired to do the job.

An Emory spokeswoman wouldn’t comment Sunday on the condition of Dr. Brantly, a 33-year-old from Texas, who was infected while working at an Ebola treatment center operated by two U.S. faith-based organizations. Tom Frieden, director of the Centers for Disease Control and Prevention, which is based in Atlanta right near Emory, told Fox News on Sunday that Dr. Brantly “appears to be improving, and that’s encouraging.”

American Ebola patient Dr. Kent Brantly arrived from West Africa for treatment at Emory University Hospital on Saturday. His is the first known case of Ebola to be treated in the U.S. Another infected patient, charity worker Nancy Writebol, is expected to arrive in the coming days. Photo: AP

Samaritan’s Purse, one of the charities operating the center and the group that brought Dr. Brantly to Liberia, also said Sunday that the doctor’s condition was improving, and Dr. Brantly’s wife, Amber, said in a statement that she was able to see her husband and that he was in good spirits.

The other infected aid worker, Nancy Writebol, who had been helping decontaminate workers at the clinic for the other charity, SIM USA, was expected to arrive soon for treatment. A SIM USA spokesman couldn’t be reached for comment; a news release from the group Friday said she was in serious condition.

The next several days will be critical for the two patients. Ebola has taken the lives of as many as 90% of those it has infected in past outbreaks.

There is no vaccine or treatment for the viral hemorrhagic fever, which causes symptoms such as fever, headaches, vomiting and diarrhea and can puncture blood vessels to cause internal bleeding. But good supportive care, such as fluids to replace those lost in vomiting and diarrhea, medication to bring down fevers, and antibiotics for complications can improve a patient’s chances by keeping the immune system as strong as possible to fight off the virus.

In fact, early treatment may have helped keep the death rate lower in the current outbreak in West Africa, according to Stephan Monroe, an emerging infectious diseases expert at the CDC. Of 1,323 cases, 729 have died, according to the World Health Organization, putting the death rate at 55%.

Dr. Brantly and Ms. Writebol began receiving supportive care as soon as they were diagnosed, according to their respective charities. Dr. Brantly also got a blood transfusion from a 14-year-old boy who survived Ebola under Dr. Brantly’s care, in the hope that antibodies would help him, too, fight off the virus. Both Dr. Brantly and Ms. Writebol received an experimental serum, the charities said, though they didn’t specify what the treatment was.

An Emory spokeswoman wouldn’t comment on what treatments are being used at the Atlanta hospital.

There are several vaccines and drug treatments in development and testing for Ebola, but none have been approved by regulators. Commercializing them is a challenge given that Ebola is a rare disease, said Thomas Geisbert, who works on potential Ebola vaccine platforms as a researcher at the University of Texas Medical Branch at Galveston.

“Ebola is very rare—there is not a financial incentive for large pharmaceutical companies to make vaccines for Ebola,” he said. “It’s really going to require government agencies or a foundation.”

Vaccines would be helpful not only as a preventive tool, but to stop transmission during outbreaks, said Thomas Ksiazek, director of high-containment laboratory operations at Galveston National Laboratory. They can be given shortly after infection, and having a vaccine to offer could help draw out contacts of a patient, he said—something that has been hard to do in this outbreak.

“If you identify all of these people at risk, that would reduce the chance of them becoming ill and transmitting it on to others,” he said.


Dr. Ksiazek, a veteran of multiple Ebola outbreaks as a former special pathogens branch chief at the CDC, is heading to Sierra Leone Aug. 11 to help with outbreak-control efforts, part of an all-hands-on-deck call by the WHO. Ebola is such a rare disease that no more than 300 medical and public health professionals have experience with outbreaks, said Dr. Ksiazek’s former colleague at the CDC, Pierre Rollin, who has been in West Africa for most of the past four months.

“People with this experience are getting to be overwhelmed,” Dr. Ksiazek said of the reasons he was asked to come. He said he would help lead a team of epidemiologists tracking the outbreak.

Samaritan’s Purse said it expected to finish evacuating this weekend all but its most essential personnel from its operations in Liberia. SIM USA is evacuating nonessential personnel, too, though sending in another American doctor to help at its Ebola treatment center near Monrovia, Liberia.

Doctor Margolis Finishes Tenure as MSMS Chair of Licensure and Discipline Committee

Doctor Philip M. Margolis recently chaired his last meeting of the MSMS Committee of Licensure and Discipline after serving as chair of the committee for the past 14 years. At the end of the meeting Doctor Margolis was presented with an award for his service and dedication to the committee. Doctor Scot Goldberg, the incoming chair, offered his thanks to Doctor Margolis for his service. “Doctor Margolis’ dedication to peer review and regulation of the profession has made him the model of what the chair of this committee should be. I have big shoes to fill. Doctor Margolis has provided yeomen’s service to our profession. For that, we are eternally grateful.” Doctor Goldberg begins his tenure as chair at the next meeting on September 17.
Doctor Philip M. Margolis with friend and
Washtenaw County Medical Society colleague
Doctor Michael W. Smith

Washtenaw County Public Health Cites Successes and Challenges During National Immunization Awareness Month

Washtenaw County ranks first among Michigan counties for vaccinating children against seasonal flu – but near the bottom (66 of 84 counties) for fully vaccinating 13- to 17-year-olds. During August, Washtenaw County Public Health reminds residents that vaccines are not just for kids. Vaccines are safe and one of the best tools available to prevent serious and sometimes deadly diseases in our community.

“When everyone stays up to date on their vaccinations, we are all healthier,” says Dr. Alice Penrose medical director with Washtenaw County Public Health.

On time vaccination can prevent serious illnesses like the flu, measles and whooping cough. In 2013, however, 11 percent of Washtenaw County preschool and school children were not fully vaccinated. This gap leaves all area children more vulnerable to serious illness.

Washtenaw County has a higher percentage of parents waiving recommended vaccines for their school-age children than other Michigan counties. Washtenaw ranks 63rd among Michigan counties for vaccine waivers.

Washtenaw’s waiver rate is one of several factors likely contributing to the high number of pertussis or whooping cough cases. Washtenaw County had nearly 200 cases of pertussis in 2013. Pertussis continues to circulate in 2014 with several new cases reported each week.

“Scientific research has shown that vaccines are safe and do not cause autism, allergies or other disorders. If you have questions about vaccine safety, ask your medical provider,” says Chris Karpinski, RN, immunization nurse coordinator at Washtenaw County Public Health.

National Immunization Awareness Month

Throughout the month of August, Washtenaw County Public Health will provide weekly information, tools and resources on our website http://publichealth.ewashtenaw.org, Facebook and Twitter.

Most people know that babies and children get vaccinated, but teens and adults need to make sure they are protected as well. Vaccines offer benefits that go beyond protection from one disease. Adults who get an annual flu vaccine are healthier and have a lower risk of stroke, heart attack and pneumonia than those who skip it. Pregnant women who get Tdap and an annual flu vaccine pass immunity onto their child for protection in the first few months of life.

Vaccine Recommendations for All Ages

If you are unsure which vaccines are recommend for you or your loved ones, use the guides below and talk with your health care provider. Talking with your health care provider is important. Vaccine recommendations change with age and other factors, such as where you live, work or travel and any medical conditions you may have.

Everyone age 6 months and older needs a seasonal flu vaccine every year. Other vaccinations work best when they are given at certain ages.

· Children 6 years and younger: http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf

· Preteens and teens 7 to 18 years: http://www.cdc.gov/vaccines/who/teens/downloads/parent-version-schedule-7-18yrs.pdf

· Adults over 18 years: http://www.cdc.gov/vaccines/schedules/downloads/adult/adult-schedule-easy-read.pdf

· Pregnant women: http://www.cdc.gov/vaccines/pubs/downloads/f_preg_chart.pdf

Washtenaw County Public Health

Washtenaw County Public Health offers vaccines to children and adults regardless of insurance status or income. Call 734-544-6700 or visit our immunizations page at http://publichealth.ewashtenaw.org. For information about local vaccination rates, see Washtenaw County’s Immunization Report Card as of June 30, 2014 http://www.michigan.gov/documents/mdch/Washtenaw_447508_7.pdf

Washtenaw County Epi Update: Listeria Testing (7/23/14)

Washtenaw County Public Health (WCPH) received further guidance from MDCH and CDC regarding possible patient exposure to Listeria monocytogenes. Below is information from the CDC about testing for Listeria. Invasive listeriosis is most often diagnosed through blood or cerebrospinal fluid culture.

“Although the guidance document suggests stool culture as an option, it is important to note that stool testing for Listeria has not been evaluated as a screening tool for listeriosis and, in general, is not recommended for the diagnosis of listeriosis. Ingestion of Listeria occurs frequently because the bacterium is commonly present in the environment. Therefore, intermittent fecal carriage and shedding of Listeria is frequent (about 5% in unselected populations, but substantial variation exists) and rarely indicative of infection. Stool culture for Listeria may also have low sensitivity and, is not available in the vast majority of clinical laboratories.“ (CDC)

CDC Listeria website: http://www.cdc.gov/listeria/index.html


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