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MNAAP Newsletter

What’s New with Influenza Vaccines Available this 2018-2019 Season?

robert-jacobson-11052368By Robert Jacobson, MD, FAAP, and Jennifer Brickley, RN, Mayo Clinic

Charles H. Mayo, MD, one of the famed Mayo brothers wrote, “Today the only thing that is permanent is change.” That might have been a hundred years ago, but it’s certainly still the situation with influenza and its prevention nowadays. This coming fall for 2018-2019 clinicians will once again have changes to the recommendations that will affect their practice and their patients.

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Vaccine Exemptions: Where Does Minnesota Stand?

By Margo Roddy, MN Department of Health; Diane Peterson, Immunization Action Coalition

Compulsory vaccination for children enrolled in childcare facilities and schools has been a major contributor to the longstanding success of the immunization program in Minnesota and in programs across the country. The recent occurrence of large measles outbreaks has served to shine a bright light on the role that non-medical exemptors play in fueling the spread of disease in school, childcare and community settings.

A chart has been developed that provides detail on the variable ways that states implement their non-medical exemption procedures (i.e., the compulsory steps parents must complete to secure a non-medical exemption). You can view the chart at

Minnesota requires that the parent obtain a notarized signature to exempt from a vaccine requirement for non-medical reasons. Other states have moved to requiring more substantial steps, including receiving education from a doctor or public health prior to opting out. Meanwhile, California has eliminated the non-medical exemption as an option for their schools.

Statewide in Minnesota, non-medical exemptions for all vaccines for kindergarteners have been stable over the past 7 years, from 1.60% in 2010‒11 to 1.69% in 2016‒17. While the statewide non-medical exemption rate remains low, some Minnesota schools, school districts and counties have higher rates that leave more children vulnerable to disease.

To see a list of kindergarten exemption rates by county, school district, and individual school, visit


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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