Will Humble Disease Control, Early Childhood, Vaccination, Wills Blog

MMR Vaccination Rate Continues Its Insidious Decline During the Ducey Administration

Maricopa County Department of Public Health confirmed three related cases of measles. One case is an adult and the other two are kids. Whether these cases transition from an outbreak to an epidemic will depend on how many contacts the cases had with unvaccinated classmates.

MCDPH teams will also be checking the vaccination status of the classmates of the pediatric cases. Vaccination rates at the school attended by the index cases will be a key determinant of whether these initial cases cascade into an epidemic. The downward slide of vaccination rates makes it more likely that we’ll have additional cases coming from the index case school. But why?

As has been the case throughout the Ducey Administration, childhood vaccination rates have continued their insidious decline, with the statewide immunization rate for Kindergarteners now at 91%… well below the community immunity threshold for measles of 95%.

See: Governor: Education parental choice on value of vaccinations by Howard Fischer

State law requires the ADHS to collect data about the vaccination rates for Child Care/Preschool; Kindergarten; and 6th grade. Schools submit the data to the ADHS each fall. In the spring ADHS is required to publish the data by school. Rather than showing the actual vaccination rates, the system records the percentage of exemptions (personal, medical and religious) as a proxy for vaccination rates.

ADHS posted the data in April. There are some aggregate tables but also a big giant spreadsheet with the vaccination rate by school. A clever parent that knows how to sort in Excel could quickly find the vaccination rate for their kid’s school. Here’s the big file with all the school data: Arizona Reporting Schools Coverage

There are also some summary tables with coverage levels for various vaccines by geographic region:

Vaccination rates aren’t uniform across the state. Yuma and Santa Cruz counties continue to enjoy the highest vaccination rates (above 95% for MMR among Kindergarteners). Also as usual… Yavapai had the lowest vaccination rates with MMR coverage at only 74% and nearly 10% of students totally unvaccinated among Kindergarteners.

Another continuing trend… students enrolled in charter schools have vaccination rates much lower than students in district public schools. Also, higher income districts tend to have lower vaccination rates.

There are several evidence-based strategies that can be implemented at a statewide level, but such initiatives require leadership by a state health department director & governor…  something that’s in short supply these days.

Interventions to increase pediatric vaccine uptake: An overview of recent findings

For information on school immunization requirements, review the Guides to Arizona Immunization Requirements for Child Care/Preschool and Grades K-12.

Far and away the most effective (and highest ROI) intervention to improve childhood vaccination rates is to eliminate the ability for parents to exempt their kid from the school vaccine requirement with the ‘personal exemption’. Governor Ducey & the state health directors during his tenure have had zero interest in eliminating the personal exemption.

Editorial Note: Governor Ducey has been hostile to vaccination mandates (e.g., eliminating the personal exemption), even signing several bills eroding public health authority (see PowerPoint). His health directors remained completely silent as he signed those bills – signaling their tacit support for the erosion of public health authority. 

 

Perhaps childhood vaccination will again become a priority when we get a new governor in 118 days (but who’s counting).

Will Humble Disease Control, Vaccination, Wills Blog

Measles Returns to Arizona for the First Time Since 2019

Maricopa County Department of Public Health confirmed three related cases of measles. One case is an adult and the other two are kids. One of them had been hospitalized, but all 3 are recovering.

Whether these cases transition from an outbreak to an epidemic will depend on how many contacts the cases had with unvaccinated folks in their friend groups or at school. No doubt that Maricopa County staff have been busy doing case investigations to figure out just that.

Assuming the cases cooperate, Maricopa will be able to figure out who those unvaccinated contacts are (if any) and urge them to quarantine for the remainder of their incubation period. Cooperation of the cases and contacts and the fidelity to isolation and quarantine are critical to the success of the interventions. They will also likely urge unvaccinated contacts to get the measles vaccine right away. If taken within 3 days of the exposure it can be effective at preventing an infection.

Teams will also be checking the vaccination status of the classmates of the pediatric cases (assuming they’ve been in school). Best practice procedures include excluding unvaccinated contacts from school for at least one incubation period (up to 21 days) and vaccinating susceptible contacts within 72 hours of exposure.

Maricopa County Public Health will be using authority in ARS 36-624 and state communicable disease rules for measles in AAC R9-6-355. Measles (Pages 34-35) which call for:

Determining which measles contacts will be quarantined or excluded (from school), according to R9-6-303, to prevent transmission; and arranging for immunization of each nonimmune measles contact within 72 hours after last exposure, if possible.

R9-6-303 gives the county health department the ability to issue isolation, quarantine and other control measures. The details of that authority and best practice procedures are on pages 20 and 21 of the communicable disease rules.

Because the average incubation period for measles is 11–12 days (range of 7–21 days) this investigation will be ongoing throughout September and most likely beyond. It’ll be at least a couple of weeks before we’ll know how much (or whether) this cascades into an epidemic.

Much will depend on how much contact the cases had with unvaccinated folks before they were symptomatic, how good case and contact cooperation is, and whether folks follow MCDPH recommendations & instructions.

Measles cases in Arizona: What to know about symptoms, vaccine (azcentral.com via Stephanie Innes)

Will Humble Professional Development, Wills Blog

Annual AzPHA Public Health Awards: Accepting Nominations Now!

Each year AzPHA recognizes public health professionals & health care workers across Arizona are performing extraordinary services to our community at our annual awards event. Many of our awards go back decades.

We’re proud to announce that the 2022 awards program will be held on:

Thursday. October 27, 2022
5:00pm – 8:30pm
Outdoor Courtyard at the Maricopa Medical Society
326 E Coronado Rd #101, Phoenix, AZ 85004
This will be an outdoor, happy hour event. Registration begins Monday, September 5, 2022
Please take a moment to view our award categories and submit your entries by September 15, 2022

Nominate Here

Award Categories
Will Humble Professional Development, Suicide Prevention, Wills Blog

AzPHA Suicide Prevention Awareness Month Breakfast & Learn 

Friday, September 9 (9-10am)
Firearm Violence & Suicide Prevention: Three Evidence-Based Interventions 

Our presentation will help attendees appreciate the importance of gun violence prevention in reducing suicide rates. This presentation will approach the problem from 3 distinct aspects.

  • The work of the Everytown Survivor Network to raise awareness through storytelling. A survivor (Carol) will share her story.
  • The work of Moms Demand Action to raise awareness about the prevalence of suicide and the distinct role of guns in making suicide attempts more deadly along with the policy recommendations that could reduce suicide rates.
  • The work of the Be SMART For Kids (besmartforkids.org) which raises awareness of the importance of safe storage in deterring unintentional shootings, suicide, and homicide, especially in children and teens. 

Our advocacy work is unique in that we address multiple roots of violence – including weak gun laws, easy access to firearms, lack of education on safe storage and firearm responsibility, and the intersection of gun violence and suicide.

Our Speakers:

Carol Bates is a Massachusetts native who is a mother of 3 and grandmother of 2. She has been retired for almost 20 years from a diverse career including being a small business owner and a political consultant. Since retirement, she has been an active community volunteer and activist, volunteering at the Ronald McDonald House and with Moms Demand Action.

She has also been a board member on the Human Rights Project and the National Abortion Rights Action League. As a survivor of gun violence, she shares her son’s story in the hopes that no one else will ever have to endure the pain of losing a child.

_______

RJ Shannon, born and raised in Chicago, has lived in Phoenix, Arizona for 41 years as a mother, musician, health educator, community mobilizer, and social justice advocate. For 30 years, RJ has worked in the areas of community violence prevention; HIV in communities of color; health equity; racial justice; and women’s and LGBTQ2S rights.

She is an active member of AZPHA, serving on the Health Justice committee and previously as a board member when employed by the AZ Department of Health Services. As a member of Moms Demand Action for Gun Sense in

America, RJ proudly represents an organization dedicated to ending gun violence and looks forward to the potential collaborative efforts of AZPHA and Moms.

________

Marie Thearle MD is a volunteer with Moms Demand Action as the Arizona State elections lead. She is a retired physician whose encore career is as an adjunct professor. As a mother of two children, she is passionate about working to reduce the public health crisis that is gun violence.

______

Candace Vodicka is a volunteer with Moms Demand Action for Gun Sense in America and the Phoenix Co-lead for the Be SMART program. She is a former elementary school teacher. As a mother of three young girls, Candace is committed to creating a safer future through outreach and education of gun violence prevention.

Register Here
Will Humble Professional Development, Wills Blog

Loan Forgiveness & Healthcare

Using executive action that doesn’t need congressional approval. President Biden announced a federal student loan relief plan for some folks holding student loans. While there aren’t a ton of details yet, student borrowers who hold loans with the Department of Education and make less than $125,000 a year are eligible for up to $20,000 in student loan forgiveness if they obtained Pell Grants for college. Individuals who make less than $125,000 a year but did not receive Pell Grants will be eligible for $10,000 in loan forgiveness.

The administrative action that payments on remaining balances can be capped at 5% of their monthly income. Like I said, there aren’t a lot of details yet on who qualifies and under what circumstances- but I hope this will include loans for trade schools and the like.

Arizona’s Loan Repayment Programs

Arizona has several successful loan repayment programs for primary care providers designed to incentivize them to practice in rural and underserved parts of the state. In exchange for a commitment to serve, providers can get direct relief for a significant portion of their student loans.

The Arizona State Loan Repayment Programs include the Primary Care Provider Loan Repayment Program for public, non-profit providers and the Rural Private Primary Care Provider Loan Repayment Program for providers in rural private practice sites.

These programs aim to promote the recruitment and retention of health care professionals by repaying their qualifying educational loans in exchange for their two-year commitment to provide primary care services in federally designated Health Professional Shortage Areas (HPSA) or Arizona Medically Underserved Areas

Join this Nurse Corps Scholarship & Nurse Corps Loan Repayment Program webinar Tuesday Sept. 6 from 12pm-1pm

Applicants must agree to either a full-time (40 hours/week) or a half-time (20 hours/week) service requirement for a minimum of 2 years. Eligible applicants include:

  • Physicians (MD or DO) in the following fields of practice:
    • Family medicine
    • Pediatrics
    • Obstetrics
    • Internal medicine
    • Geriatrics
    • Psychiatry
  • Advance practice providers in the fields of family medicine, pediatrics, obstetrics, internal medicine, or geriatrics:
    • Nurse midwives
    • Physician assistants
    • Nurse practitioners
  • Dentists
  • Pharmacists
  • Behavioral health providers:
    • Nurse practitioners and physician assistants certified as behavioral health specialists
    • Clinical psychologists
    • Clinical social workers
    • Professional counselors
    • Marriage and family therapists

A chart of award amounts based on the year and priority status is available on the program website.

Will Humble Disease Control, Wills Blog

eMed Tool Turns At-Home Rapid Tests into Actionable Results

With the federal government phasing out paying for PCR COVID testing, home rapid tests will become more important for diagnosis & treatment as well as satisfying travel & visa COVID testing requirements.

For the first time, at home rapid tests can now provide results that are actionable for diagnosis & treatment while also satisfying administrative travel testing requirements. The process that turns a home rapid test into actionable information was created under a partnership between eMed and Abbott Labs. 

The eMed tool is pretty simple. Even I was able to do it. The package insert gives you a step-by-step process to use with your cell phone. I think it even works with those android phones. It’s a ‘virtually proctored test’ and produces verified results within about 20 minutes.

If you follow all the directions, you get a CLIA-waived laboratory result that’s accepted by CMS & CDC… meaning the results can be used for diagnostic purposes and to prescribe antiviral medications. Negative test results satisfy international travel requirements because the results are accepted by CDC and CMS.

Visit the eMed website

Here’s a bullet list of what the tool does:

  • Individuals receive a CLIA-waived laboratory report accepted by the CDC, meaning the results can be used to prescribe antiviral medications.
  • The lab report is also accepted by major airlines when COVID-related travel restrictions are in place (for certain international travel destinations).
  • Testing data & reports can be made available through a customizable dashboard to public health agencies, employers, schools.
  • Previously purchased FDA-authorized testing kits can be transformed into a Test-to-Treat enabled experience by simply adding an eMed QR code.

eMed says they’re expanding their model to include testing for influenza, HIV, STDs/STIs, a women’s health package (including UTIs, yeast infections, etc.), drug testing, Monkeypox etc.

Visit the eMed website

Note: This isn’t a sponsored post or anything. I just put it up because it looks like a useful tool especially now that the fed’s are phasing out paying for PCR testing.

Will Humble Disease Control, Wills Blog

Arizona Has a COVID-19 Exposure Notification Tool Now (and It’s Free)!

Wehealth Arizona is an exposure notification app that notifies you if you have been exposed to Covid-19 and helps connect you with trusted resources. It enables everyone to help keep each other and their families safe while maintaining full privacy and personal liberty.

Download the Wehealth Arizona app

If anyone tests positive for Covid-19, they can choose to anonymously share that with the app. Other app users who came in contact with that person in the last 14 days automatically receive an anonymous notification of their level of exposure. As more people get tested using self-test kits rather than at a lab, these anonymous reports also help everyone understand the true prevalence and burden of infections in a community in addition to the official case counts.

This app is the fastest and most scalable way to quickly notify people of exposure, helping people make informed decisions to slow down the spread and seek timely treatment to reduce the risk of severe disease. This link can be used to report a positive result https://wehealth.org/arizona or if you don’t already have the app you can use the same link to install the app.

The app works even when you travel outside of Arizona. It’s fully anonymous, doesn’t collect any personal data or location data and there’s no way to know who is getting notified and no way to know where the notification came from. It is built on the Google Apple Exposure Notification (GAEN) protocol and the open source key server and verification server.

The app is integrated with the national key server maintained by Association of Public Health Laboratories (APHL), and is fully interoperable with all other exposure notification apps in other states.

Wehealth Arizona was the first Covid-19 exposure notification app to pilot in the United States in August 2020. It was called Covid Watch Arizona at the time. It is the result of continued collaboration between the University of Arizona, Arizona Department of Health Services and WeHealth (a Public Benefit Corporation). The app is proven to work.

A study at the end of the pilot analysts estimated that it may have helped reduce the average number of people infected by 12%.

Will Humble Marijuana, Social Determinants, Wills Blog

Expunging Cannabis Possession Convictions Made Easier in AZ 

One conviction can lead an individual or family into a downward spiral. With the passage of 2020’s Prop 207 (Smart & Safe Arizona Act) people with marijuana possession convictions (for less than one ounce) can now have the charges expunged through Reclaim Your Future with the AZ Justice Project: Reclaim Your Future, Free Arizona Marijuana Expungement.

Expunging a previous conviction can be a game changer as it can open jobs, housing and even restore rights or lessen sentences/fines. It is a great opportunity and could make a major impact on someone’s life and improve the health status of an entire family.

AZ Justice Project is also willing to present on this opportunity or host a table at an event.  If you’re interested in them doing so, please email Lenna at lenna.ortega@azjusticeproject.org.

Will Humble Public Health Law, State Legislature, Wills Blog

The List of Ballot Measures is Set: At Least 5 of Them Will Influence Public Health

The list of ballot measures is now set. The challenges to the voter initiatives have been settled, and the language that’ll be on the ballot is settled. In all, there will be 10 propositions on your ballot. Eight were proposed by the legislature and 2 are voter initiatives.

Five of them are constitutional amendments including changes to how elections are handled, how voter initiatives need to be crafted (and the threshold needed to pass them), property tax exemptions, and one that creates the office of Lieutenant Governor. These are all 100 Series measures because they change the constitution. Here’s the ballot language for Propositions 128, 129, 130, 131, and 132. You can also view the propositions here.

There will be 3 legislative referrals on your ballot. These are 300-series propositions because they were referred to the ballot by the legislature that modify earlier voter initiatives. These are about allowing Dreamers graduating from AZ schools to get in-state tuition at public AZ colleges & universities, changing what’s required in order to vote, and modifying how rural fire districts are funded. These are Propositions 308, 309 and 310. You can view those propositions here.

There are 2 voter initiatives on the ballot, the Predatory Debt Collection Protection Act and the Voter Right to Know Act. The courts threw out the Free and Fair Elections Act because they said they were 1,500 short of the number of valid signatures it needed (the full supreme court ruling isn’t published yet). These will be Propositions 209 (Predatory Debt Collection Protection Act) and Prop 211, the Voter Right to Know Act (the attorney general hasn’t approved that ballot language yet).

So far, AZPHA has only taken a position on one of the measures…  we are urging a Yes vote on Proposition 209: the Predatory Debt Collection Protection Act. The AZPHA Board will be deliberating whether to ask membership to endorse or oppose an additional 4 (and maybe 5) measures. Below are the write-ups that I submitted that’ll be in the voter publicity pamphlet. So far, these are only my opinions, not those of AZPHA.

View this fabulous summary of all 10 propositions including arguments for & against & disclosing who is supporting and opposing each measure. This is a must-see resource brought to you by Rachael Leingang & Hank Stephenson from the Arizona Agenda.

Initiatives

Vote YES On Proposition 209: The ‘Predatory Debt Collection Protection Act’

Vote for Transparency. Vote ‘YES’ On Proposition 211 the ‘Voters Right to Know Act’

 

Legislative Referendum

Vote the Golden Rule: YES on Prop 308

‘Proposition 310 May Save Your Life, Vote YES

‘Keep Your Power: Vote No on Proposition 132’ 

 

The Board will be reviewing Prop 210 (Voters Right to Know Act) and Propositions 308 (Dreamers), 310 (rural EMS), and 132 (supermajority for voter initiatives with a fee) to potentially ask membership to support 308 and 310 & oppose 132.

We’re also looking at whether we should oppose Prop 128,  Prop 129, & Prop 309.     

Prop 128 would allow the legislature to repeal voter-approved measures in its entirety if any part of the law is declared unconstitutional or ‘illegal’. Initiatives and laws are declared partially unconstitutional all the time.  For example, the U.S. Supreme Court declared the matching funds provision of the Arizona Clean Elections Act unconstitutional, but the broader law is still valid. If voters approve Prop 128, the legislature could scrap the whole Clean Elections Act with a simple majority vote. 

Prop 129 would limit future voter initiatives to a single subject. That would eliminate initiative backers’ ability to propose initiatives that touch on several aspects of the law, as the Free and Fair Elections Act would have, and the Clean Elections Act did.

Proposition 309, a legislative referral born from SCR1012.  This one would require identification to drop off your early ballot at an early voting site or Election Day polling place and require more proof that you are who you say if you mail back your early ballot.

Over the last several years, AzPHA has become an increasingly credible source of information for Arizona residents… as such, we can play an important role in informing the electorate about the potential public health impacts of the various voter initiatives and referenda (good and bad).

You can view all 10 propositions here
Will Humble Climate Change, Prevention, Wills Blog

 Climate Change & Human Health in Arizona: What Health Professionals Need to Know

COMMUNITY GRAND ROUNDS:

 Climate Change and Human Health in Arizona:
What Health Professionals
Need to Know

 Wednesday, September 7th, 12-1pm AZ

Presenters:

Edward Maibach, Ph.D.
Distinguished Professor and Director of the Center of Climate Change Communication, George Mason University

Ronda Seifert, RN BSN IBCLC
Public Health Nurse, Chair of Arizona Health Professionals for Climate Action

Brian Drummond, MD FAAEM
Clinical Associate Professor of Emergency Medicine, University of Arizona

Click Here to Register Now
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