Dedicated nurses, resource connections help kids in northern Manitoba top vaccination rates

The work of public health nurses is being credited for the relatively high rates of vaccination among children in northern Manitoba.

The province's most recent immunization statistics date back to 2014, but show at age 11, a higher proportion of kids in the Northern Regional Health Authority were complete-for-age on vaccinations than the provincial average on 12 out of 13 shots.

"I think it's awesome that it's being recognized that the north is doing great with vaccines," said Leslie Sraybash, an immunization co-ordinator for the Northern Regional Health Authority. "I definitely think it's a good thing for our region."

The numbers aren't as overwhelmingly superior in all areas, but the northern region beats the provincial average in seven out of 13 shots at age two and nine out of 13 shots at age 17.

In the north, public health nurses are responsible for 99.6 per cent of childhood vaccinations, unlike in other health regions where pediatricians and school programs account for more vaccinations. In Winnipeg, doctors do 72.1 per cent of childhood immunizations (as of 2014), and in other health regions public health nurses do around 80 per cent of vaccinations.

Sraybash said public health nurses are well-positioned to follow up and build connections in the community.

"As public health nurses we develop a lifelong relationship with our families," Sraybash said. "We start the conversation with vaccines right at the beginning and we keep talking about vaccines through the whole process."

Vaccine appointments are booked before a baby goes home from the hospital, she said. The same public health nurse will likely see the family for vaccines five times before the child goes to school, and again when the child is vaccinated in school.

Sraybash said because of that relationship, they're also able to follow up sending a letter about any missed appointments, or a phone call after a couple of missed appointments, asking what barriers might be getting in the way. That might include connecting a family with transportation or child care so they can bring one child in for a vaccine.

"We work together to see how we can help that family and how we can get those children in to get their immunizations done," Sraybash said.

The NRHA also did best among all Manitoba health regions among children with non-continuous residency, such as those who moved to the health region for the first time or moved out of the province and then back.

"The Northern Health Region's commitment to finding this vulnerable group has resulted in the regional staff developing some unique ways to find folks," a health region spokesperson said in an email. That includes prenatal and postpartum referrals and schools and daycaresthat flag new students. "This is a part of their everyday practice so we know this helps identify under-immunized children/youth/adults."

A spokesperson for the Winnipeg Regional Health Authority notes that Winnipegtreatsmany more newcomer kids than the Northern Regional Health Authority does.

Worldwide outbreaks

With measles outbreaks in Ukraine, the Philippines and Brazil, vaccines have been huge news this year. New York state has ordered mandatory vaccinations in some areas. In Canada, 33 cases of measles have been confirmed nationwide, sparking concerns about herd immunity. There was also a mumps outbreak two years ago.

How does herd immunity work?

8 years ago

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CBC's Teghan Beaudette explains how herd immunity works and prevents outbreaks of infectious diseases.

That means talking about vaccines is more important than ever, says U of M community health sciences professor Michelle Driedger.

She says sometimes parents just need more information about vaccine schedules, or time and space to think it through. Sometimes there's just too many things to remember to talk about at a doctor's visit, she said.

"Are some of the numbers a reflection of actual concerns because of vaccines? Are the numbers a reflection of some of the general challenges we face as a society, just in terms of being able to juggle work and kids and appointments?" Driedger wondered.

Driedger is researching whether an interactive website, where people can ask questions and get answers from primary health care providers, would help address the issue. That research is still underway. But ultimately, she says, more data is needed.

There's no magic solution that is going to solve everything. It's going to require a multitude of different things to try to address the issue, to figure out exactly what it is that's going on.- Michelle Driedger

"The fact that this data is only from 2014, given that Manitoba is heralded as one of the jurisdictions that have had an immunization registry, and we're this far behind with our data reports, it's kind of sad."

Where measles outbreaks have been spotted, Driedger said there could be religious or conscientious factors behind immunization rates but there's no way to know.

"There's so many different layers to the immunization, and in particular the child immunization topic," Driedger said.

"There's no magic solution that is going to solve everything. It's going to require a multitude of different things to try to address the issue, to figure out exactly what it is that's going on, and better data helps to contribute to, at least, a better understanding of what we're actually facing. As opposed to kind of guesses on the basis of old data from a few years ago, or OK, we have an outbreak going on so how do we try to get more vaccine into kids?"

A spokesperson for the WRHA said the public health nurse model works in the north, but might not work as well in the city.

"WRHA's focus in probing the immunization rates has not [centred] on comparing the service-delivery models, but rather looking at our rates, assessing what is causing them, and identifying possible interventions that could increase the rates," the spokesperson wrote in a statement.

The province is studying those factors as part of the Immunization Mapping project, he said.

Funded by the Public Health Agency of Canada's Immunization Partnership Fund, the project is using data from local providers and RHAs to single out local factors that could impact rates, and developing local interventions.

"There is no one solution to address vaccine hesitancy," the spokesperson noted.