swine flu
The aims of this study are to assess: (1) whether state reporting laws for novel H1N1 influenza and emerging infections impact the ability of public health to collect data elements on individual cases, (2) whether state reporting laws for novel H1N1 influenza and emerging infections impact the ability of public health to develop recommendations for disease prevention, control, and treatment, and (3) the effect of “home rule” in a state’s infectious disease reporting structure on the state’s ability to develop such recommendations. The research team will conduct mapping and implementation studies by collecting data in three areas: legal authority, epidemiologic data collected on novel H1N1 influenza cases, and CDC and state recommendations. Methods will include an inventory of each state’s reporting laws/structure for emerging infections and interviews with state officials. Findings have the potential to impact law, public health policy, and epidemiology. Infectious disease reporting is the foundation for public health’s core functions in infectious disease prevention and control. Novel H1N1 influenza provides a critical example of the difference in states’ ability to promptly gather relevant data on a disease of national importance. This study has great public health significance because it is extremely important to understand the role law played in the differences among states. Law is a potentially modifiable factor and policymakers may choose to improve state laws if value is demonstrated. By addressing the proposed questions, we hope to assess the public health benefit/detriment of differing state authorities for reporting. Findings may impact policy by showing the effect of reporting laws on public health response and suggesting modifications to disease reporting laws that states may want to adopt.
Grant Number: 68401
Funding Date: Mon, 11/15/2010
Researching Institution: Minnesota Department of Health
Researcher: Richard Danila, Ph.D., M.P.H.; Anne Barrry, J.D., M.P.H.
Publication Date: 12/07/2009
The Problem:
Vaccine coverage for preventable disease is an essential public health goal. Low vaccine coverage rates enable otherwise avoidable outbreaks of harmful diseases. CDC: Vaccines and Immunizations.
The Law:
State vaccination laws require children to be immunized prior to entering school. National Vaccine Program Office: Immunization Laws. Subject to instances where exemptions apply, these laws require written proof of a child’s immunization status provided from a health provider. For examples of state vaccination laws, see Colorado (6 CCR 1009-2), Iowa (Iowa Administrative Code), Nebraska (173 NAC 3) and Massachusetts (105 CMR 220.000).
The Evidence:
In a systematic review, a Community Guide expert panel reviewed the evidence concerning the effectiveness of requiring vaccinations as a condition of matriculation into child care, secondary school or college. Briss PA, Rodewald LE, Hinman AR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med 2000;18(1S):97-140. The review identified nine studies in the U.S. and Canada that measure the impact of these requirements. Of the nine studies, seven examined the impact of school laws; one examined vaccination mandates for child care, and one looked at requirements for college attendance. Six studies measuring the effect of vaccination requirements on the incidence of specific diseases (e.g., measles) found an inverse relationship suggesting that laws reduce rates of the targeted diseases. Three studies also observed a positive relationship between mandated immunization programs and rates of vaccination among the target populations. On the basis of this evidence, the reviewers concluded that there is sufficient evidence that school vaccination requirements are an effective public health intervention aimed at increasing vaccination coverage and decreasing the incidence of certain diseases.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is sufficient evidence supporting the effectiveness of requiring vaccinations as a condition for attending child care facilities and schools.
Additional Information:
The Centers for Disease Control and Prevention has compiled and provided online access to all state vaccination laws.
The Immunization Action Coalition also has online maps showing specific legal requirements for the fifty states.
Additional Resources: Centers for Disease Control and Prevention, Immunization Action Coalition
Publication Date: 12/07/2009
The Problem:
Vaccine coverage for vaccine preventable disease is an essential public health goal. Vaccination against specific diseases is particularly important for high risk populations, which may include individuals of a certain age (e.g., greater than 68 years for Pneumococcal Polysaccharide) or with specified medical conditions (e.g., HIV/AIDS for influenza). CDC: General Recommendations on Immunization.
The Law:
Laws and policies require vaccination (subject to enumerated exceptions) as a condition of certain jobs. In some states, state law or hospital policies require hospital staff to be vaccinated against influenza. In Rhode Island, for example, health care workers with direct patient contact must be vaccinated for measles, mumps, and rubella. RI Code R. 14-090-007. Illinois requires rubella vaccinations for nursery workers. Ill. Admin. Code tit. 77, § 250.1820.
The Evidence:
In a systematic review, a Community Guide expert panel attempted to systematically review the evidence concerning the impact of requiring vaccinations outright or as a condition of specified activities such as employment as a healthcare worker. Ndaiye SM, Hopkins DP, Shefer AM, et al. Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high-risk adults: a systematic review. Am J Prev Med 2005;28(5S):248-79. The reviewers were unable to locate any studies that measured the impact of these laws in the U.S. As a result, the reviewers concluded there is insufficient evidence to currently evaluate the effectiveness of these laws and policies as public health measures aimed at protecting vulnerable populations against specific diseases.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is insufficient evidence to assess the effectiveness of requiring vaccinations as a condition for specified jobs as a means of reducing incidence of specific diseases among particularly vulnerable populations.
Additional Information:
The Centers for Disease Control and Prevention has compiled and provided online access to state laws requiring or encouraging vaccination of health care workers.
Additional Resources: Centers for Disease Control and Prevention
Publication Date: 12/07/2009
The Problem:
Vaccine coverage for preventable disease is an essential public health goal. Low vaccine coverage rates enable otherwise avoidable outbreaks of harmful diseases. CDC: Vaccines and Immunizations.
The Law:
To increase vaccination rates among specified adult populations, states authorize or require hospitals to create standing orders. Standing orders allow healthcare workers without prescription authority to prescribe and or administer vaccines under defined circumstances. Without standing orders, such vaccinations would be barred by laws regulating medical practice and the scope of patient-doctor relationships. Laws that provide standing order authority to non-physicians apply to registered nurses (Rev. Code Wash. § 18.79.260, Washington), pharmacists (N.D. Admin. Code 61-04-08-03, North Dakota) and physician assistants (ORS § 677.515, Oregon)
The Evidence:
In a systematic review, a Community Guide expert panel reviewed 11 studies assessing the use of standing orders to deliver vaccines to specified adult populations. Briss PA, Rodewald LE, Hinman AR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med 2000;18(1S):97-140. Of the 11 studies, six measured the impact of standing orders as an isolated intervention and five measured the effectiveness of standing orders in conjunction with other interventions. The reviewers identified a median 28 percent increase in vaccination among targeted populations following the adoption of standing order policies. The panel viewed all the results as strong evidence that standing orders improve vaccination coverage in adults as standalone intervention or as part of broader multifaceted interventions.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is strong evidence supporting the effectiveness of standing orders as a public health intervention aimed at increasing vaccination rates.
Additional Information:
The Centers for Disease Control and Prevention has compiled and provides online access to all state vaccination laws.
The Immunization Action Coalition also provides online access to maps showing specific legal requirements for the fifty states.
Additional Resources: Centers for Disease Control and Prevention, Immunization Action Coalition
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Public Health Law Research is a national program of the Robert Wood Johnson Foundation. It is housed at the Temple University Beasley School of Law.