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MNAAP Newsletter

Opening Vaccine Dialogue Across Cultures: Measles Outbreak in Minnesota

nusheen ameenudinBy Nusheen Ameenuddin, MD, FAAP

“Most of you already know Dr. Nusheen, because she sees your kids” is how I was introduced on my home turf at the first of a series of talks with Minnesota’s Somali community. It was during our state’s worst measles outbreak to date.

By the week before Memorial Day this year, Minnesota had already reached 69 measles cases, more than all U.S. cases in the previous year. Because the outbreak primarily affected unvaccinated Somali children, our state health department, American Academy of Pediatrics chapter and others partnered with leaders in the Somali community to train and dispatch teams of imams (religious leaders) and physicians to engage and inform the community about this threat.

I feel privileged to work with a vibrant patient population that includes many Somali-Americans. I met some families as new arrivals to this country, while others have become my second generation of patients. We are fortunate that Minnesota’s children’s health insurance coverage is at an all-time high of 97 percent, thanks to Medicaid and CHIP. But despite having some of the best health measures in the nation, we still struggle with the highest disparity in health outcomes between ethnic groups.

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Lessons Learned on Increasing MMR Vaccines During the Outbreak

By Anne Valaas-Turner, MD, FAAP

On August 25, 2017, the Minnesota Department of Health declared an end to the measles outbreak…. along with a collective, statewide sigh of relief. As part of this announcement, Commissioner of Health Dr. Ed Ehlinger thanked all of the health systems, hospitals, clinics, doctors, pediatric clinicians, clinic staff and local public health who worked so hard to contain the Spring epidemic. He also highlighted the Allina Health System, which according to MDH records, provided the most MMR vaccine during the outbreak.

Pediatric staff reflected on this news and identified several key beliefs and lessons that we learned.

Communications: We were immediately notified of the measles outbreak by the MDH vaccine preventable disease listserv. Lesson: It may be useful to include “helpful e-mail lists to join” as part of the onboarding process for new providers.
Team structure: As a pediatrician, I share work space with my assistant, two partners, and their assistants. It was easy to teach the team the new vaccine recommendation, since we all work together in the same space. I will begrudgingly admit that the daily huddle system I sometimes rail against allowed for communication up and down the leadership structure about our measles response. We also got regular updates about the number of MMR doses in clinic, which was helpful.

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Pain-Reducing Measures in the Office Setting for Pediatric and Adolescent Immunizations

By Katy M. Bos, MS, APRN, ACNS-BC, PCNS-BC – Pediatric Clinical Nurse Specialist, Mayo Clinic and Robert M. Jacobson, M.D., F.A.A.P. – Professor of Pediatrics, Medical Director, Employee and Community Health and Southeast Minnesota Region Immunization Programs, Mayo Clinic

Bos_Katy_M_16JL robert-jacobson-bw

Part of a child’s routine medical care is vaccinations. In the first six years, a child will get up to 25 to 30 injections. The World Health Organization (WHO) suggests that needle pokes are a painful and anxiety-provoking health-related experience, potentially leading to a lifetime of fear of needles, vaccine non-compliance, negative health attitudes, and health care avoidance behaviors by children and their caregivers. The WHO also expressed concern that these negative effects could potentially lead to lower vaccine coverage rates and risk of vaccine-preventable diseases.

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HPV Vaccine: Helping Parents Separate Facts from Fallacy

By Vijay Chawla, MD, FAAP, Mayo Clinic

VijayChawlaPapilloma viruses are small DNA viruses that cause species- and tissue-specific disease. There are more than 200 types of human papilloma virus (HPV), which infect the skin and mucous membranes and are transmitted by contact. Lifetime risk of HPV infection exceeds 75 percent, and new HPV infections occur across the lifespan, albeit with a peak in young adulthood. While most infections clear within months, a minority produce complications.

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Minnesota Immunization Law Changes Update — One Year Later

By Ben Christianson and Lisa Randall, MDH Program Staff

Changes to Minnesota’s Immunization Law took effect on Sept. 1, 2014. The law now more closely aligns with current national immunization recommendations. Some examples of the new requirements included:
• Meningococcal and Tdap for seventh graders,
• Hepatitis B and hepatitis A for children in child care or early childhood programs, and
• Timing of the final doses of DTaP and polio for kindergarteners.

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