by Lloyd F. Novick, MD, MPH

---

The March/April issue of the Journal of Public Health Management and Practice focuses on vaccine preventable disease. The lead editorial, authored by Kevin Dombkowski, highlights the importance of vaccinations as one of the most important public health interventions of our time. He outlines the challenges in the delivery of vaccines to children and adults including vaccine procurement, inventory management, assessment of vaccine status, and subsequent documentation. Emphasis is placed on   information technology using individual electronic health records (EHRs) linked to a jurisdiction’s immunization information system (IIS).

Several articles in this issue provide examples of the importance of IIS. Kuramoto and colleagues’ “Use of Person Locator Service to Facilitate Immunization Information System-Based Reminder Project” shows that implementation of person locator services by the Minnesota Department of Health could improve data quality of address information in the IIS and add to success of outreach efforts by IIS users. Woinarowicz and Howell’s “Using the North Dakota IIS to Assess the Response of Health Care Providers to the ACIP Recommendation for Tdap Vaccination During Pregnancy” demonstrates an increase of Tdap vaccine during pregnancy in women from 31.5% in 2013 to 60.6% in 2018. 

Marlow and co-authors’ “Health Departments’ Experience With Mumps Outbreak Response and Use of Third Dose Of Measles, Mumps, and Rubella Vaccine” documents 150 mumps outbreaks reported to U.S. Health Departments in the period January 2016 to June 2017.  These investigators distributed an online survey in 2017 to all 81 members of the Council of State and Territorial Epidemiologists. Results from this survey were considered in the October 2017 meeting of the Committee on Immunization Practices that led to a recommendation for use of a third dose of MMR vaccine to persons at risk for mumps during an outbreak. A second article by these authors, “CDC Guidance for Use of a Third Dose of MMR Vaccine During Mumps Outbreaks,” is also published in this issue, as is an article by Jamison Pike and co-authors, “Cost of Responding to the 2017 University of Washington Mumps Outbreak: A Prospective Analysis.” Responding to this University of Washington outbreak required significant resources with labor being the largest driver of costs.

Two articles address vaccine preventable diseases in vulnerable populations. Koeller and colleagues’ “Responding to a Mumps Outbreak Impacting Immigrants and Low-English Proficiency Populations” describes a March-July 2018 mumps outbreak in Chester County, Pennsylvania, in an immigrant community, some of whom spoke no English, were uninsured, and undocumented. Lewis and colleagues, “Vaccination Capability Inventory of Community, Migrant, and Homeless Shelters,” write that little is known about providing vaccinations to vulnerable adults using these facilities.

Any discussion of the importance of vaccines in 2020 must include the problems of vaccine hesitancy or anti-vaccination or anti-vax. This is a reluctance or refusal to be vaccinated or have one’s children vaccinated against contagious diseases despite overwhelming scientific consensus about the safety and effectiveness of this measure. This has been responsible for decreasing vaccination rates and outbreaks of vaccine preventable disease, including 1282 cases of measles in 31 states in 2019 reported by CDC. We refer our readers to an excellent “State of Public Health” column we published in September/ October 2019 by Michael Frasier, Executive Director of the Association of State and Territorial Health Officials (ASTHO), “Blinding Me With Science: Complementary Head and Heart Messages Are Needed to Counter Rising Vaccine Hesitancy” outlines an approach to counter hesitancy, recommending that public health leaders appeal to both rational (“head”) and irrational (“heart”) decision making. 

A special supplement, Advancing Legal Epidemiology, is also published with this issue. Legal epidemiology is emerging as a distinct field important to public health practice. This evolving discipline recognizes that understanding and implementation of law is required for the prevention of disease and injury and the promotion of health. Sponsored by the Temple University School of Law and the Centers for Disease Control and Prevention, the authors describe the development of legal epidemiology including its research methods and tools. Articles include the application of this discipline to chronic disease prevention, housing conditions, workforce development, alcohol use among pregnant women, and concussions associated with youth sports. Efforts are discussed to include more legal studies within public health education. This groundbreaking issue will promote the further spread of legal epidemiology throughout our profession.

---

Lloyd F. Novick, MD, MPH is Professor Emeritus of the Department of Public Health at the Brody School of Medicine, East Carolina University. Previously, he was chair of this Department. He has served as the Commissioner of Health and Secretary for Human Services of Vermont, Director of Health Services for Arizona, and Director of the Office of Public Health for New York State. Previous academic positions include Professor and Director of the Preventive Medicine Program for SUNY Upstate Medical University, Professor and Chair of Epidemiology at the University of Albany School of Public Health, and Clinical Professor and Director of the Teaching Program in Epidemiology and Public Health at the University of Vermont, College of Medicine. [Full bio]