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By: Alyssa Clader, Development and Business Manager with insight from Juan Daniel Garcia, Supervisor Parents as Teachers and ICTC Education Chair Parenting is hard work! How do you help your children learn, grow, and develop to realize their full potential? Parents as Teachers, a FWISD program, has the tools to equip you. Parents as Teachers help parents understand child development and connects them to the resources needed to make the best choise for each family. Best of all, it's a completely FREE program! Juan "Danny" Garcia is the supervisor of Parents as Teachers and serves as the Education Committee Chair for ICTC. When asked why the partnership between ICTC and Parents as Teachers is so important, he stated "What makes our partnership so important is the fact that our families are in need of immunization information not just for the children that are in our program but also the older children that could need their immunizations. Also knowing sooner when Immunizations events are taking place helps our Social Workers inform our parents that are in need when and where immunizations are taking place." For more information on Parents as Teachers, please visit: ParentsAsTeachers.org.

October is known for pumpkin spice lattes, football, Halloween and...flu shots?! That's right! If you haven't already received your flu shot, do so now to protect yourself during flu season! Tarrant County has an abundance of locations to help protect you against flu season! Call your child's health care provider to see if they are offering flu clinics. Tarrant County Public Health clinics are available throughout the county. Local pharmacies have the flu vaccine in stock and sometimes offer giftcards with a flu shot. Have you heard someone say, "The flu shot gives you the flu!" or "Do I really need the flu shot?" There are several misconceptions about the flu vaccine. Thankfully, the CDC tackles these questions and more! So while you are rooting on your favorite football team or taking your kids to the pumpkin patch, remember to stop and get your family vaccinated! Photo courtesy of Alisa Anton from Unsplash

Our Spring Teen Project and our August Back-to-School Vaccine Events are over and the numbers are in! Below is our 2018 Vaccine Events Report. We are so thankful to First Grandmothers' Club, Tarrant County Medical Society Alliance Foundation, and The Ellermeyer Family Charitable Fund of the North Texas Giving Day for sponsoring a combined $16,848 in vaccine administration fees. In 2018, 7,744 clients were vaccinated with 19,412 doses of vaccine! WOW! We are continually grateful to our sponsors, volunteers, members, and partners for all the hard work and time put in to these 2 vaccine projects.

By: Erika Thompson, PhD, MPH, Assistant Professor, School of Public Health, UNTHSC The long days of summer have us enjoying time off of school, camps, and vacations. But the school year is right around the corner. August will be spent stocking up on school supplies, but there is an essential step you can do now to get prepared – vaccinations. The state of Texas, like many states in the US, require students to get certain vaccines to go to school. If it’s your first time to Texas or your kiddo is starting kindergarten, there are several types of vaccines that are needed. And, to start 7th grade there are at least two required vaccines for your tween. This means that kids need to have all required vaccines before starting school. Vaccines are safe and effective prevention tools that keep our families healthy. This is a small step that will protect your child from diseases that devastated communities in the past. So get prepared now by visiting your local clinic or healthcare provider to get your student up to date on vaccinations. This will ensure a smooth transition into the school year, and lets you cross off on thing on your to-do list! Photo by pan xiaozhen on Unsplash

Think vaccines are just for children? Think again! Vaccines protect adults from 14 serious, possibly deadly, diseases. Besides an annual flu shot, adults should receive a tetanus shot every 10 years. There are additional vaccines needed depending on age, job, health conditions, travel, lifestyle and vaccination history. ICTC provides all adult vaccines for adults with no insurance for $8 each dose at our events. If you have your shot record, remember to bring it with you! Red More Details Here:

ICTC supports all children having a medical home and should consult with their provider for vaccines. There are several ways to obtain vaccines in Tarrant County. Besides ICTC’s low-cost vaccine events held in August, there are community clinics located throughout the county that offer all required and recommended vaccines. Tarrant County Public Health Cook Children’s Community Clinics JPS School-Based Health Centers or you may call 2-1-1

Are you new to Texas? Is your child is starting public school for the first time? Do you want to know what vaccines are required to enroll in a public school in Texas? You've come to the right place! We have linked the 2018-2019 Texas Minimum State Vaccine Requirements for Students K-12th Grade. We know this can be overwhelming, which is why we have immunization counselors at all of our events to help you navigate what vaccines your child will need. Just remember to bring your shot record. View the Texas Vaccine Requirements for Students Grades K-12 Below

The HPV vaccine is cancer prevention. Why get vaccinated? According to the CDC, HPV vaccine prevents infection with human papillomavirus (HPV) types that are associated with many cancers, including: Cervical cancer in females Vaginal and vulvar cancers in females Anal cancer in females and males Throat cancer in females and males Penile cancer in males It is recommended that all boys and girls receive the 2 dose series starting at 11 or 12 years old. However, all boys and girl 9-26 years old can receive the vaccine. During our August Back to School Vaccine Events, all HPV vaccine administration fees will be paid for, thanks to the generous donation from the Ellermeyer Family Fund of the North Texas Community Foundation. This means your child can receive the vaccine at NO COST TO YOU! Still not convinced? Texas Medical Association has a GREAT resource page: https://www.texmed.org/HPV/ As always, we are happy to answer any questions related to HPV.

The Center for Children's Health led by Cook Children's developed a family survey for ICTC that is distributed during our August events. This survey is used to help us with our results based accountability strategic plan answering two questions: How well are we doing? Is anyone better off? This year we received 850 completed surveys, which is about 19% of families served. We are happy to report the survey revealed 74% of participants felt it would be difficult to receive vaccines for their child if this event was not offered and 89% of participants feel vaccines will prevent their child from catching certain diseases. If you would like to see the results of all the questions, the survey is attached below.

Opting Out of Vaccines for Your Child Cameron M. Rosenthal, MD1; Lindsay A. Thompson, MD, MS1,2 Author Affiliations Article Information JAMA Pediatr. 2020;174(9):916. doi:10.1001/jamapediatrics.2020.2475 COVID-19 Resource Center During the ongoing coronavirus disease 2019 (COVID-19) pandemic, there has been a critical decline in children receiving their routine vaccines. While we focus on preventing the COVID-19 outbreak, we cannot forget protecting against vaccine-preventable illnesses. As a parent, you may have questions or concerns about your child’s vaccinations. If you are unsure or choose not to vaccinate, you need to understand the consquence of that decision. The rate of vaccine-preventable diseases, such as measles, is increasing around the country because too many people choose not to vaccinate, decreasing herd immunity. While we continue to face the challenges of a global pandemic, it is more important than ever that people take advantage of defenses provided by vaccines. An unvaccinated child is more likely to need to go to a clinic or hospital when sick, which could increase their risk of being exposed to COVID-19. Consider the following information. First, seek information from trusted sources. To keep your child safe, ask questions and request information about vaccines from your child’s physician. Online resources are helpful and easy to find; however, just because something is on the internet does not make it true. Blogs, editorials, or other opinion pieces may have serious misinformation. The resources at the end of this Patient Page can help you evaluate health information on the internet. Vaccines do have some possible adverse events, including soreness, mild fever, and headache. Most adverse events are rare and are often linked to an allergy or specific medical condition. Your child is far less likely to be hurt by a vaccine than by the disease itself. Second, think about what your child may miss if you decide against vaccination. We learned from recent outbreaks that unimmunized children might need to be excluded from everyday activities. During the outbreaks of chicken pox in 2007 and measles in 2019, some unvaccinated children had to stay out of school for weeks. Unvaccinated children who get sick may need invasive tests to ensure that a deadly, vaccine-preventable disease is not the cause of their illness. Third, do not believe myths. The most widely known myth is a reported link between the measles, mumps, and rubella vaccine and autism. It came from a false study in the 1990s that was later retracted by the journal that initially published it. Since then, many research studies have shown no connection between autism and any vaccine. While the prevalence of autism has increased over the past 20 years, the increasing numbers are largely because we understand and can diagnose it better. As your child gets older, they may seek vaccine information on their own. Unvaccinated teenagers have asked for vaccines for themselves after seeking information on vaccine risks and benefits. In addition to protecting your child, vaccines give benefits to your extended family and community. Much like social distancing measures that are being put into place during the COVID-19 pandemic, there are personal and community benefits to vaccinating your child. We know questions will continue as we wait for a COVID-19 vaccine, but before delaying or opting out of vaccinations, please do your due diligence to inform yourself in making the best decision for your child. For More Information How to evaluate health information on the internet: https://ods.od.nih.gov/Health_Information/How_To_Evaluate_Health_Information_on_the_Internet_Questions_and_Answers.aspx Evaluating health website: https://nnlm.gov/initiatives/topics/health-websites Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration: https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e2.htm?s_cid=mm6919e2_e&deliveryName=USCDC_921-DM27863#F1_down The JAMA Pediatrics Patient Page is a public service of JAMA Pediatrics. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your child’s medical condition, JAMA Pediatrics suggests that you consult your child’s physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, email reprints@jamanetwork.com. Back to top Article Information Published Online: July 27, 2020. doi:10.1001/jamapediatrics.2020.2475 Conflict of Interest Disclosures: None reported.

https://www.bbc.co.uk/ideas/videos/what-would-a-world-without-vaccines-be-like/p09773sc Thanks to vaccines, many of us have grown up without fear of contracting diseases such as polio and diphtheria. Do we take them for granted?

The uneven rollout of COVID-19 vaccines in December created at least one bright spot for Texas physicians: It highlighted how the state could make vaccination more efficient. Problems arose quickly with the COVID-19 vaccines because there were too few doses to go around as well as technical problems with storage and distribution, says Jon Roth, executive vice president and CEO of the Dallas County Medical Society (DCMS). For instance, Pfizer/BioNTech’s vaccine – the first one available – required ultra-cold storage and came in 975-dose lot sizes. Physicians were among the top groups designated to receive vaccines, but for the most part, only those at hospitals and large medical groups could easily obtain them. “It wasn’t feasible for our non-hospital affiliated practices to enroll as a [vaccine] provider themselves,” Mr. Roth said. “And that begged the question, how are we going to get our community physicians and their staffs vaccinated?” Texas – like most other states – doesn’t have the public health infrastructure to handle a mass-vaccination program quickly, he said. Despite this, by mid-January Texas had managed to lead the nation in doses administered, according to the Texas Department of State Health Services (DSHS). This success was made possible, in part, when in January DCMS set up its own infrastructure by working with the local pharmacies that had received vaccine doses. Together, they began to vaccinate the 35,000 or so physicians and their staff members in Collin, Dallas, Denton, Grayson, and Tarrant counties, Mr. Roth says. The partnership allowed physicians to easily arrange an appointment in a designated pharmacy or to attend one of several mass vaccinations events, says Christine Becker, MD, an internal medicine specialist. She, the two other physicians in her Dallas practice, and their staff members were able to get COVID-19 shots through DCMS. “It was a well-oiled machine,” she said. “I got there and got the vaccine in probably less than 5 minutes after I arrived. … I can’t say enough good about the Dallas County Medical Society and the North Texas alliance for getting this together for the physicians and their staffs.” Unfortunately, physicians in other counties were not so lucky. In many rural areas, even hospitals still had not received vaccine doses by early January. And despite help from county medical societies, physicians in other highly populated areas often struggled to find pharmacies where they could find vaccine doses for themselves, their staffs, and their patients. This rough debut for COVID-19 vaccines is just the latest among other ongoing hiccups with vaccine distribution and tracking that have frustrated Texas physicians, says Jason Terk, MD, a Keller pediatrician and chair of the Texas Public Health Coalition, which counts the Texas Medical Association as a member. Those problems start with the state’s vaccine registry, ImmTrac2, Dr. Terk says. (See “Talk to Patients About: What is ImmTrac2?” page 28). Though intended to help physicians, ImmTrac2 can add to the paperwork and hassle of registering and tracking vaccinations. Other problems include vaccine exemptions for philosophical reasons, which have risen about 350% between the 2005-06 and 2019-20 school years, according to DSHS data. Despite the pressing need to improve vaccinations rates, physicians will need to keep expectations for widespread reform in check because the pandemic could significantly hamper efforts to pass bills in this year’s Texas Legislature, says Troy Alexander, TMA’s director of legislative affairs. (See “Staying the Course,” January 2020 Texas Medicine, pages 20-27, www.texmed.org/StayingTheCourse.) “It’s going to be so difficult to pass a bill of any kind that it’s going to be a limiting factor on both sides [of the vaccine issue],” he said. Nevertheless, the highly visible problems with distributing COVID-19 vaccines seem to have created momentum to make some improvements in the state’s vaccination infrastructure, which remains a legislative priority for medicine, says Dr. Terk, past chair of TMA’s Council on Legislation. “We’re at the point now where the seriousness of infectious disease outbreaks is manifest,” he said. Opt-in vs. opt-out Improving ImmTrac2 tops TMA’s priority list for the 2021 Texas Legislature, and that will require not one but several reforms, Dr. Terk says. The nation’s 49 vaccine registries, including ImmTrac2, fill an important public health role. By age 2, more than 20% of U.S. children see more than one health care professional, resulting in scattered medical records, according to the U.S. Centers for Disease Control and Prevention. Vaccine registries help consolidate that information so physicians, health departments, and others know what diseases an individual is protected against, says Joseph Schneider, MD, a Dallas pediatrician at UT Southwestern Medical School and chair of TMA’s Committee on Health Information Technology. That kind of tracking becomes especially important during an outbreak of a vaccine-preventable disease like COVID-19. To support those goals, changing ImmTrac2’s opt-in system is one of TMA’s highest vaccine-related priorities, Dr. Terk says. Opt-in means Texans must give consent before having their vaccine information stored in the registry. Most other states use an “opt-out” system in which vaccine information is automatically stored unless patients ask to have that information left out. (See “Opt In vs. Opt Out,” page 24.) When it comes to emergency situations – like vaccinating people for tetanus after a hurricane or tracking COVID-19 vaccinations – ImmTrac2 registration is mandatory for everyone. Patient records are automatically stored for five years after the event before being expunged, though patients have the option of keeping them in the registry afterward. Otherwise, Texas’ opt-in system creates added hassle and paperwork for physician practices, patients, and DSHS, says Donald Murphey, MD, pediatric infectious disease specialist at Dell Children’s Medical Center in Austin. Most vaccine recipients are young children, and Texas’ opt-in system encourages hospitals or those assisting with births to inform families about the need to opt-in. After that, it’s up to physicians and patients to discuss the registry. Then comes the paperwork: Physicians and hospitals must then process consent forms for the child to forward to DSHS. Changing ImmTrac2 to an opt-out system would greatly reduce that extra workflow, Dr. Murphey says. “You’d only have paperwork if someone said they didn’t want to be in the registry,” Dr. Murphey said. Texas also has three different forms – one each for children, adults, and for disasters – and the adult version has other consent categories for first responders and their relatives. In total, there are five different consent categories, each of which requires a special EMR code. Those separate forms, categories, and codes are unique to Texas, which presents challenges for physicians and EMR developers, Dr. Schneider says. “Ideally, there should be one consent form with a single ‘yes’ or ‘no’ field,” he said. “The EMR should be smart enough to be able to send the birth date and whether the individual is a first responder. Forcing physicians to find or store separate forms is another example of a burden that should be removed.” Texas opt-in system creates other types of problems because patients obtain vaccines at different locations over time. For example, if one parent of a minor chooses to withdraw that child’s vaccine records from ImmTrac2, that eliminates any record that the child was previously enrolled in the system. If the other parent takes the child to a different physician and gives consent, ImmTrac2 doesn’t know that consent was previously withdrawn. The child’s vaccine information unknowingly would be entered back into the registry and could be incomplete. That situation could be fixed by allowing ImmTrac2 to hide the patient’s information – not eliminate it – and reactivate the information if the patient chooses to do that, Dr. Schneider says. It could also be fixed by allowing “hashing,” a notation that someone has previously withdrawn from ImmTrac2. This would ensure the physician sees and can honor a patient’s withdrawal request. All vaccine data would be deleted except for the date of withdrawal. Even with such changes, switching from opt-in to opt-out still allows patients to protect their privacy by leaving ImmTrac2 if they choose, Dr. Terk says. “We have a strong interest in protecting privacy,” he said. “But we can balance that priority in a more equitable way that supports the health of Texans by having a more functional registry.” The registry also is part of TMA’s goal to improve overall vaccination rates in Texas. An opt-out system would allow ImmTrac2 to do more to help physicians and proactively improve immunization rates, Dr. Murphey says. For instance, many patients fail to get second doses, and an opt-out system could reach a wide swath of patients with reminders to follow up with their physicians. According to DSHS, however, ImmTrac2 does not have “the functionality on its own to inform the individual clients they need a second dose of a vaccine,” a spokesperson said in an email. “There are no immediate plans at this time to add that, but health care providers can generate those reminders from within ImmTrac2.” And while physicians’ desire for a single form is understandable, “due to the requirements of ensuring individuals have a full understanding of what their consent entails, each type of consent (child, adult and disaster) must be captured on different forms,” the DSHS spokesperson said. “It would be difficult to combine all required information onto a single page with all the language, links, and data points needed.” Physicians also want to end the practice of allowing philosophical exemptions from vaccination for school children, Dr. Terk says. Between September 2019 and September 2020, there were about 73,000 Texas children exempted from vaccination for non-medical reasons, according to DSHS data. Many of the people claiming exemptions live in the same neighborhoods, attend the same churches, or send their children to the same schools, Dr. Terk says. That makes those areas ripe for outbreaks of vaccine-preventable diseases like measles. “Birds of a feather flock together, and we will see more and more outbreaks as the exemption rates increase,” he said. If exemptions stay, TMA will push for greater data transparency from the schools that grant philosophical exemptions. Currently, DSHS is required to report exemptions at the individual school level for private institutions, but only at the district level for public schools. Many parents with children who are immunocompromised and therefore cannot get vaccinated need to know the specific exemption rate for their child’s school, not just the school district, says Mr. Alexander, TMA’s lobbyist. If their child’s public school has a vaccine exemption rate above 5% to 7% for measles, for instance – the level at which community immunity breaks down for that disease – that school may be vulnerable to an outbreak and no longer safe for that child. TMA’s other vaccine priorities include: Additional funding and infrastructure for COVID-19 vaccines to accommodate surge capacity in the coming months. This would include funding items like medical supplies and refrigeration units. It might also provide grants to hospitals, medical practices, and local public health entities to improve COVID-19 vaccination. Ensuring public school funding is not withheld from school districts that properly bar unvaccinated students from attending school. Requiring families to have a licensed Texas physician sign off on any medical exemptions from school vaccines. Currently, out-of-state physicians can sign off on them as well. Creating a public-private partnership for vaccine development that resembles the Cancer Prevention and Research Institute of Texas (CPRIT). Providing stronger legal protection for employers who require vaccinations. Requiring all senior care facility residents’ and employees’ vaccine status to be entered into ImmTrac2. TMA’s efforts to improve vaccination will be bolstered by its new educational campaign, Vaccines Defend What Matters. (See “Vaccines Defend What Matters,” page 23.) Meanwhile, in the coming months, physicians have a responsibility to talk up the importance of COVID-19 vaccines with patients and the public, Dr. Becker says. Finally getting her shots has helped her feel safer while treating patients. “You’ve got all the garb on already, so I feel like I have another layer of protection,” she said. But the shots only work if they’re taken by as many people as possible, she says. “[We need to] encourage people to take the vaccine,” she said. “Encourage patients and other doctors so we can get this thing dampened down and controlled.” Tex Med. 2020;117(3):20-25 March 2021 Texas Medicine Contents Texas Medicine Main Page