Academic journal article Journal of School Health

A State-Based Immunization Campaign: The New Mexico Experience

Academic journal article Journal of School Health

A State-Based Immunization Campaign: The New Mexico Experience

Article excerpt

Hepatitis B prophylaxis through immunization has become an increasingly effective protective measure across the United States.[1] Various cohorts have been targeted and methodologies used by public health officials in order to attain optimal coverage of the population.[2] New Mexico is in its third year of school-based hepatitis B immunization programs. New Mexico's approach to this issue is characterized by significant rates of participation, high vaccination series completion, and minimal financial investment. This article reflects how the Roll Up Your Sleeves[3] campaign was piloted and modified and its resulting successes.

PROGRAM ORIGINS

In New Mexico, the Public Health Division within the State Department of Health is responsible for administering a key portion of the community public health system. This system consists of a state office, four district offices supporting 50 local public health offices (PHOs), and a network of community contractors. The Immunization Program is part of the Communicable Disease Prevention and Control Bureau at the state level to which immunization data are reported and stored. Each district is responsible for program planning and implementation and retains some degree of autonomy. The hepatitis B effort, part of the Immunization Program, has a Hepatitis B District Nurse Coordinator (DNC) within each district, and this individual is responsible for initiating and implementing hepatitis B vaccination, primarily through school-based clinics.

Also of note in New Mexico is DOH's Childhood Immunization Campaign and the Vaccines for Children Program through which private providers can obtain vaccine at little or no cost for children who are eligible for Medicaid or are un- or under-insured for vaccinations. Because of this public-private partnership, there has been an increased awareness and prevention of vaccine-preventable diseases which is particularly significant given New Mexico's large population of migrants from across the border.

Based on the 1990 census, New Mexico ranks first in racial/ethnic diversity. According to the U.S. Estimated Census Data 1994, the population distribution by race and ethnicity is 49.8% non-Hispanic White, 37.6% Hispanic, 8.9% American Indian, and 3.6% other groups.

PILOT PROJECT

Historically, hepatitis B infection rates in New Mexico have been above the national average. When the pilot project was proposed, the known rate of infection was 13.5 per 100,000 while the national rate was 4.8 per 100,000. The project was initiated in two middle schools, one with a school-based health center (SBHC) and one planning a SBHC. Student participation in the project was based on completion of two hours of classroom education and a parent or guardian's signature authorizing the immunizations. The project was expanded into six other schools in the state during the 1994-95 academic year. The rate of completion in the pilot project ranged from 81% to 96%.

PROGRAM IMPLEMENTATION MODELS

Due to the success of the pilot project and availability of vaccine, the decision was made to offer school-based immunization projects to all public school districts and private schools. Based on recommendations of the Advisory Committee on Immunization Practices (ACIP), the target population was seventh grade students. Three models were implemented across the state: the public health nurse and school nurse initiative; the hospital-coordinated "Adopt-a-School" approach; and the public health nurse, school nurse, and community volunteer collaborative.

Nurse Initiatives

Success of this model related to the historic connection between the local public health nurse (PHN) and school nurse (SN) and their mutual credibility. The Hepatitis B District Nurse Coordinator functioned in a consulting role, providing training on project implementation and attending the first clinic at each site. …

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