Set Your Child Up for a Healthy School Year with Vaccines

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As a parent, a big part of your job is ensuring your child’s health and well-being. You want your child to thrive! One of the most effective and safe ways to ensure your child’s health is by keeping them up to date with their vaccines; this is especially important as you send them back to school this fall.

Outbreaks of vaccine-preventable diseases do happen.

We don’t see evidence of vaccine-preventable diseases in our everyday lives like the generations before us did. This provides a false sense of comfort and makes some people think it’s okay to delay or skip routine childhood vaccines. The truth is, these diseases are no longer a part of our everyday reality because vaccines work. Still, the viruses and bacteria that cause vaccine-preventable diseases haven’t gone anywhere, and with low vaccination rates in a community, we risk spreading them. Delaying or skipping routine childhood vaccines is a dangerous risk to take with your child. It also puts others at risk, including vulnerable individuals like cancer patients and the elderly.

In Rockland County, New York, where there is a low polio vaccination rate, one individual was recently diagnosed with the disease. This is the first polio case in the U.S. since 2013. Wastewater samples verify that the virus is circulating in the community. Polio can cause paralysis and death, and young children are especially susceptible. But polio is not the only cause for concern. This interactive map from the American Academy of Pediatrics shows other recent outbreaks across the country, including mumps and measles. These potentially dangerous diseases can return and spread in our communities if we let vaccination rates drop.

Make sure your child’s vaccines are up to date.

Recent reports show a significant decline in routine immunizations. In Colorado, data show that while Colorado childhood vaccination rates are improving, they are still lagging behind pre-pandemic levels. This means we are not where we need to be to ensure our community’s health. While this is cause for concern, it shouldn’t cause panic. It should, however, prompt you to ensure that your child is on schedule with routine vaccines such as DTaP (which protects against diphtheria, tetanus, and pertussis), MMR (which protects against measles, mumps, and rubella), and Hib (which protects against Haemophilus influenzae type B).

You can find a list of all the vaccines required for Colorado school and childcare entry here, and you can check your child’s vaccine records through the Colorado Immunization Information System. If your child is behind on their vaccine schedule, it’s okay. You can still get them on track! By making sure they are caught up, you can have confidence in knowing you’ve given your children the best protection – especially as they return to school and spend their days around other students. When kids are vaccinated, they protect their friends and classmates, too. Vaccination can also ensure your child won’t be excluded from school or miss important learning opportunities due to illness.

Making sure your child has been vaccinated against COVID-19 is important, too. Throughout the COVID-19 pandemic, some people have proclaimed that COVID-19 infection in kids is not a big deal. That’s often not the case, as many healthcare workers describe, including Children’s Hospital Colorado emergency physician Dr. Lalit Bajaj. Dr. Bajaj shares his experience caring for hundreds of kids with COVID-19 in this YouTube video. He describes the COVID-19 complication that many children develop, called MISC, as “a devastating syndrome that happens about four to six weeks after a child gets COVID.” There is also concern over flu and kids this coming season as described in this article from USA Today stating that experts “are worried school-age children and teens may be at more risk this year.” Making sure your child gets their flu and COVID-19 vaccines will help keep them healthy at school and throughout the respiratory illness season.

A note on safety.

Some parents have fears about vaccine safety. The truth is, vaccines undergo rigorous testing and are monitored for safety continuously. In fact, as Voices for Vaccines points out, “you are 333 times more likely to be struck by lightning than to have a serious adverse reaction to a vaccine.” So while your child may experience mild reactions such as redness at the injection site, fatigue, or mild fever (all of which mean the vaccine is working to create immunity) after vaccination, the chances of them having a serious reaction are extremely rare. Vaccines are safe, vaccines are effective, and vaccines protect us!

Trust the experts and ask them your vaccine questions.

It’s completely normal to have questions about vaccines – especially when it comes to your child! There is a lot of information out there regarding vaccines, but a lot of it isn’t accurate. Especially on social media – vaccine misinformation is rampant. Navigating all these voices makes it difficult to make informed decisions. To be sure the information you get is correct, talk to your child’s medical provider about your concerns – they’re the expert on your child’s health!

Be a part of the solution!

You probably did not grow up in a time or place where vaccine-preventable diseases were common. Unlike generations before us, childhood death and severe illness are likely not familiar experiences. But without vaccines, we risk these diseases coming back.  We can all do our part to protect our children and others they interact with. We can help ensure their school community is healthy by vaccinating them against vaccine-preventable diseases, COVID-19, and flu. Vaccines are one of the best tools you have to protect your child’s health and set them up for a successful school year! For more information about where to get vaccines for your child including no and low-cost vaccine clinics, visit our Vaccine Information page or schedule a visit with your child’s medical provider today.

Immunize Colorado was formed in 1991 in response to alarmingly low vaccination rates across the state. At the time, only about 50% of Colorado’s children were adequately vaccinated. A group of physicians and other concerned individuals came together to strategize how to best protect Coloradans from vaccine-preventable diseases. Much work remains. You can donate or discover other ways to get involved to support our commitment to healthy Colorado communities today!

Widening the Circle of Inclusion on the Road to Vaccine Equity

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Summer brings many observances: In June, we celebrate LGBTQIA Pride, Juneteenth, and World Refugee Day; July is Disability Pride Month and Black, Indigenous, and people of color (BIPOC) Mental Health Month. These observances are about addressing fundamental rights and the health and well-being of marginalized people. It seems timely that in August, we round out the summer with National Immunization Awareness Month. Vaccines have been one of the most important and impactful achievements of public health, but marginalization and inequity put a damper on our ability to fully realize their potential benefit to our communities.

Marginalization

A recent review in PLoS One defined marginalization as “systemic processes through which certain populations are excluded or relegated to the periphery of political and socioeconomic resources. The systemic structural and social inequalities produced by marginalization (e.g., residential segregation, disparities in employment and income, lack of access to affordable healthcare, barriers to mobility) are perpetuated by ideologies such as racism, sexism, heterosexism, ableism, and xenophobia, and increase vulnerability to poor health outcomes.” 

Throughout the COVID-19 pandemic, Black, Latinx, American Indian, Alaska Native, Native Hawaiian or Other Pacific Islanders, and other minorities disproportionately experienced higher infection rates, higher death rates, and were more severely affected by economic impacts than other racial and ethnic groups. This marginalization carried over to COVID-19 vaccination, evidenced by the Centers for Disease Control and Prevention’s COVID Data Tracker which reports disparities in COVID-19 vaccination status among racial/ethnic minorities, as well as people with disabilities, people who experience homelessness, those involved with the justice system, and more. The COVID-19 pandemic has shed light on, and in some cases worsened, health disparities that already existed.

Marginalization Leads to Health Inequity

A 2020 article in The Global Citizen captures how marginalization affects equity in healthcare: “People living in poverty cannot afford health care; people with health conditions that are stigmatized become marginalized; when women are not seen as equal to men, their health becomes less important; when racism marginalizes people of color, their needs go unmet. From financial barriers to stigma to gender to race — marginalization makes fully accessing good health impossible for marginalized groups.” We can look to Maslow’s Hierarchy of Needs which shows that basic foundational needs must be met before growth and learning can occur.  Likewise, health is foundational to all other pillars of well-being – educational, social, emotional, and economic. And vaccines are foundational to health. 

Quality healthcare and equitable healthcare access concern all citizens of a community. We should all be working to support greater access to and accurate information about preventive care, including life-saving vaccines, for everyone. Vaccines have the power to benefit us all on a community-wide scale. When one person in a community is vaccinated, they protect not only their individual health, but the health of those around them. Ensuring affordable and easy access to vaccines for everyone is how we can start to chip away at marginalization and inequity.

The Road to Vaccine Equity

Vaccines have lowered incidence of or even eliminated many infectious diseases. But while we benefit from their efficacy, it can be easy to overlook that many of the viruses and bacteria that cause these diseases still exist. In a letter to the editor from the Spring/Summer 2000 issue of NEEDLE TIPS from immunize.org, E.J. Gangarosa, MD, MS notes, “Imagine losing not one, two, three, or four, but five babies! It was common in the pre-vaccine era. Like our family, many families lost several children to these diseases. We forget. Time blurs our memories of these common tragedies of yesteryear. I remember well, during the winter and spring of each year, hearing the whoop of pertussis in movie theaters, school assemblies, and assorted gatherings. Today, few have ever heard this, and those who have, forget.” 

Individuals who are un- or under-vaccinated can spread these infections, and in communities where there are large gaps in vaccinations, we run the risk not only of backtracking and losing hundreds of years of progress toward eradicating terrible diseases, but also losing lives. What’s more, the people most at risk for adverse complications from vaccine-preventable diseases are those who have been marginalized and may not have affordable or easy access to health care treatment. We’ve seen this play out during the COVID-19 pandemic. Ensuring equitable access to vaccination is one of the best ways to prevent illness and complications like hospitalization or death. 

The National Vaccine Advisory Committee addressed vaccine equity gaps in their recommendations in 2021. Along with data reporting deficiencies, they cited access, affordability, knowledge and awareness, attitudes, beliefs, and vaccine acceptance as barriers. Acknowledging these barriers is critical to understanding how to address them on the long road to vaccine equity.

Widening the Circle: A Cooperative Effort

Efforts to widen the circle to include marginalized communities must be dynamic. We must meet people where they are at times convenient for them, and connect to them in ways that are culturally relevant. This will allow us to develop relationships, build trust, and ensure people have accurate information to make informed decisions about vaccination. This is how we can make people feel truly welcomed and turn marginalization into inclusion to pave the way for equity. 

The work of Julissa Soto, the recipient of Immunize Colorado’s highest honor, the 2022 Big Shot of the Year award, demonstrates this. Her work has resulted in the vaccination of more than 14,000 Latinx adults, teens, and children. Recently, Julissa co-hosted a Community Conversation in Spanish on the COVID-19 vaccine with Dr. Aimee Bernard, Assistant Professor at CU. After the event, she reflected:

“It was a conversation we all actually participated in. It was like we were all sitting around the kitchen table as a family. Everyone there, even the quiet ones, were part of the community family and wanted to know more. With a feeling of equity because it included everyone. Unlike most webinars, it was not talking down to but talking with the people.”

These are the types of connections we must strive to make; harnessing the full benefit of vaccines is going to take all of us working together. We cannot truly be a healthy community when marginalization and inequity are allowed to exist. This sentiment is echoed by Lilla Watson: “If you have come here to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together.” We are all bound together.

Since Immunize Colorado was formed over 30 years ago, our work has aimed to widen the circle of vaccine equity and protect all Coloradans from vaccine-preventable diseases. From establishing the Colorado Refugee & Immigrant Immunization Taskforce, launching the Colorado Vaccine Equity Taskforce, launching the Together We Protect Vaccine Equity Fund in partnership with the Caring for Colorado Foundation and 11 other foundations, and offering low-cost vaccine clinics through our Shots for Tots and Teens program, our commitment to this work is steadfast. 

But much work remains to be done! From a simple one-time or recurring donation to becoming a Vaccine Advocate to learning more about the Colorado Vaccine Equity Taskforce, or simply staying informed through our newsletter, you can make a difference to impact vaccine equity in Colorado!

Filtering Fact from Fiction: Navigating Vaccine Misinformation

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With so much information on the internet and various social media sites, and amid unprecedented political division, it can be hard to distinguish fact from fiction – especially regarding vaccines. You might feel frustrated navigating the constantly changing information that seems to come at us from multiple sources 24/7. You might be asking yourself: What are the risks vs. benefits of vaccines? What is the best way to keep my family safe and healthy? What information should I believe? We’re here to help untangle the truth from fiction and address some common vaccine concerns.

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What Kinds of Vaccines Exist, and How Do They Work to Create Immunity Against Disease?

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How Vaccines Work to Create Immunity

In nature, when a pathogen such as a bacteria or virus enters the body, it will reproduce, causing an infection and illness. The body can usually respond to an infection and slowly recover—that is, the body’s natural immune system recognizes the pathogen and fights it off. After the body recovers, some immune cells will remember the pathogen and be prepared to fight it off if it sees it again. This is called infection-derived immunity, or immunity that comes through being infected or sick.

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What Does ‘Endemic’ Mean? How Do Vaccines Play a Role?

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The COVID-19 pandemic is approaching its third year. More and more states are declaring, “The [COVID-19] emergency is over” and stressing we are moving to an ‘endemic’ stage with the coronavirus. But what does that really mean? And is it truly the case?

Literally, endemic means a disease or condition is “regularly found among particular people or in a certain area.” In today’s context, it would be easy for us to think that ‘endemic’ means something positive. You could take it to mean the pandemic is closing up shop and leaving us alone; that it is letting us get back to the way life was pre-pandemic. Not exactly.

‘Endemic’ is a word in epidemiology meaning only that something follows a pattern (think: seasonal flu) and is therefore more predictable. It does NOT mean a disease is less deadly, or less likely to cause severe illness; it only means the rates of infection are more or less static.

With COVID-19, cases are still rising and falling somewhat erratically; we are lucky to be in a downward trend after the explosive infectiousness of the Omicron variant early this year, but there is no evidence a more virulent strain will not come along next. The World Health Organization (WHO) has said explicitly we are not at the endemic stage of the virus worldwide.

This is particularly concerning in areas around the world with low vaccination rates, most notably countries on the African continent and Afghanistan. Continued spread of SARS-CoV-2 makes additional variants more likely to crop up and spread to other parts of the world (including the U.S.), and those variants are unpredictable by definition. The next variant could be more infectious and more deadly; it could be less infectious and less deadly; it could cause even more breakthrough cases than Omicron but continue to be like a mild cold in vaccinated individuals. In short, we just do not know what will happen next.

Scientists say the data is promising, but it has not stabilized yet. COVID-19 will only be less of a threat when as many people as possible are vaccinated. High vaccination rates will slow the pandemic enough to level out hospitalizations and severe illness, and limit community spread. Even so, this wouldn’t mean COVID has been eliminated—only that it’s more predictable. Even in an endemic stage, 40-100,000 people in the U.S. could die every year from COVID-19. That’s higher than flu, which claims 12-52,000 lives in the U.S. each year.

So how do we handle living with the pandemic moving forward? Even as mask mandates are relaxed in many localities, mask wearing remains a best practice for keeping yourself protected—especially indoors and in crowded areas. We can also make sure we are vaccinated and boosted against COVID-19 and ensure those around us who are eligible (everyone age 5+) are vaccinated and boosted when they’re able.

At a policymaking level, prioritizing equitable access to the COVID-19 vaccine, expanding pediatric doses to the 6 months – 4-year age range when appropriate, and urging individuals to be reasonably cautious when traveling are all common-sense measures we should take.

Over 12,000 Coloradans have died from COVID-19, and that number is still rising. We are still losing nearly 1,000 Coloradans to the coronavirus every month, and in January 2022 alone more than 50,000 Americans lost their lives. What’s more, our health care workforce is facing burnout and staffing shortages at unprecedented rates. Low-income countries have vaccination rates of around 12%—not nearly high enough to offer community-level protection against disease spread. The emergency is not over. Things are looking up from even a few months ago, but that is why it is more important than ever to stay vigilant and keep on the current path. If we do, we can continue to curb the pandemic at mass scale and save lives all over the world—and then one day, maybe, we can call COVID-19 endemic.

The Importance of Staying Current with Your Child’s Vaccinations (Especially During the Pandemic)

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Since our organization’s launch over 30 years ago, we at Immunize Colorado have worked to keep children safe and healthy by advocating for and partnering to provide routine vaccinations. Some parents may have hesitations about vaccines, amplified by misinformation online and a natural worry about doing what’s best for their child’s safety. So we’re here to set the record straight about routine immunization: what parents need to know about the safety, effectiveness, and necessity of childhood vaccinations. 

Vaccination against infectious diseases benefits each child individually, and benefits every other child in our community, especially immunocompromised children who cannot be vaccinated due to medical reasons. Vaccination has been closely studied for decades and proven safe and effective by clinical trials and widespread usage, and side effects are exceedingly rare. All vaccines recommended by the Centers for Disease Control and Prevention (CDC) and required by Colorado law for school and child care entry have been tested extensively and continuously monitored for safety. Unfortunately, there has been an increase in false information about vaccines that claim they are unsafe and don’t work. You may have even heard some of these claims in your circles. These myths about vaccination can seem scary, and having concerns is normal; but it’s important to remember to turn to experts, like your child’s doctor, if you have questions or concerns about vaccination.

The truth is, vaccinations keep children from experiencing the dangerous effects of diseases like mumps, chickenpox, tetanus, polio, and many others. For example, before the polio vaccine was widely used, as many as 57,000 children became sick with the disease each year, and over 15,000 were partly or fully paralyzed, requiring assistance just to keep breathing. Now, cases of polio are rare in the U.S., precisely because of the effectiveness of the polio vaccine. 

Unfortunately, the progress we’ve made across the world in eliminating terrible diseases like smallpox and polio is being put at risk. Childhood routine vaccinations have fallen by 60-80% in 2020-2021 across the vaccine schedule because of the COVID-19 pandemic. 72% of kindergartens in Colorado saw a decrease in polio vaccination, with similar rates for chickenpox, MMR, and DTaP coverage. These drops put every child at risk of catching these extremely high-risk diseases and becoming severely ill; even children who are vaccinated are at a higher risk if there’s community spread of any of these diseases since no vaccine is 100% effective. The more children that are vaccinated in a given community, the safer every child is.

Vaccination is the single best decision we can make to protect our children’s health. Given the impacts of the COVID-19 pandemic, it’s more important than ever to talk to your child’s doctor about getting them back up to date with their immunizations, especially as children return to school and begin to gather again. Regular immunizations should be prioritized for children under 2, who are the most at-risk for contracting dangerous diseases, and during any routine wellness visits throughout childhood and adolescence. Now that the COVID-19 vaccine is available for children 5-11 and teens 12-17, it’s an excellent opportunity to check with your child’s health care provider to make sure they’re up-to-date with all other recommended vaccines.

Further questions? Check out Immunize Colorado’s vaccination FAQ or ChildVaccineColorado.org for answers.  

Vaccine Requirements in Colorado: What You Need to Know

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Vaccinations are vital to maintaining the overall health of our kids and our communities. Unfortunately, Colorado lags behind other states in vaccination rates for child care- and school-aged-children, leaving tens of thousands of kids vulnerable to severe illness from vaccine-preventable diseases. In fact, Colorado ranked 44th in the nation for vaccination rates for kindergartners in 2020. The rate of MMR vaccination in Colorado for kindergartners recorded during the 2019-2020 school year hovers around 91%, lower than the Healthy People 2030 goal of 95%, and low enough to put many of our schools at risk for a potential outbreak–which can prove deadly even to otherwise healthy children. Routine vaccinations have slipped even further since the start of the COVID-19 pandemic, leaving children even more vulnerable to vaccine-preventable illnesses. And though vaccination rates have recovered slightly from an initial substantial drop, the number of doses administered from mid-March 2021 through late October of this year was 7.1% lower than that same period in 2019. There’s still work to do to improve and maintain our state’s immunization rates, and vaccine requirements are one tool we have to accomplish that goal.

Recent focus on COVID-19 vaccine requirements has raised questions about the broader place of vaccine requirements in our society. In Colorado, vaccine requirements for school and child care entry have been in place since 1978. Colorado also has flu vaccination requirements for health care providers to help prevent the spread of flu in health settings, and recently adopted moderate COVID-19 vaccine requirements to help curb the spread of COVID-19. These vaccine requirements have helped support vaccination and generally helped to keep deadly diseases like measles and polio out of our schools and communities. For instance, since 2014, Colorado has reported only five cases of measles. One of the major factors affecting childhood vaccination rates in Colorado is the lenient process by which parents can exempt their child from school vaccine requirements.

In Colorado, children are required to be vaccinated before they enter school or child care. However, state regulations allowing parents to exempt their children from these vaccination requirements are incredibly lax when compared with other states. In addition to a Medical Exemption (which all U.S. states allow), Colorado is one of only 15 states to also offer a personal belief exemption, called a Non-Medical Exemption (NME). Previously it required very little effort to claim a personal belief exemption (including a religious exemption) from school immunization requirements. Parents could simply write on a piece of paper—even a post-it note or a napkin—that they wished to exempt their child and their school had to accept it. There was also no way statewide to tell if parents were simply not in compliance (they simply hadn’t submitted their child’s vaccine record to the school) or were taking a personal belief exemption for their child since there was little to no standardization of the exemption process.

In 2020, Senate Bill 20-163 was passed to create an “equal-effort” system, whereby parents seeking an NME are required to submit the same kind of documentation as a parent seeking a Medical Exemption or a parent submitting their child’s immunization records to their school. Parents can no longer submit exemptions via napkin. The legislation created a Certificate of Non-Medical Exemption, which was created and is maintained by the state health department, that needs to be submitted to the school. The Certificate must obtained either from an immunizing provider who signs the form or through completion of an online educational module about vaccination. This Certificate can be completed once for child care, and must be completed again before kindergarten and every subsequent year that the parent still wishes to claim an NME for their child.

Despite this new process, we are still one of the states with the easiest ability to obtain an NME. The ease of obtaining an NME creates an environment where vaccine rates in schools can remain at dangerously low rates, allowing the spread of severe, preventable diseases that parents may not fear as much as they used to—thanks to widespread vaccination and near-elimination of these diseases which historically caused many cases of severe illness and even death. The difficulty we face lies in overcoming vaccine hesitancy or inaction on the part of parents to raise the immunization rates of child care- and school-aged-children.

The fact is, vaccines are safe and they save lives. They prevent diseases, hospitalization and death, and they save the U.S. billions of dollars in direct medical costs. Longstanding, bipartisan vaccine requirements in our state and across the nation have led to historic successes in keeping debilitating and deadly diseases out of our schools and communities.

Immunize Colorado has created a fact sheet to dispel myths about Medical and Non-Medical Exemptions, clarify what is currently required for children to enter child care or school, and explain the enormous benefits to vaccinating children before they start gathering in schools or child care environments where diseases can easily spread. This resource aims to help parents stay up to date on the latest required vaccines in Colorado, while emphasizing the importance of getting children vaccinated and the continued positive impact that vaccine requirements have on our state’s students and communities.

VIEW & DOWNLOAD FACT SHEET

Fulfilling Goals of an AmeriCorps VISTA Immunization Outreach & Education Coordinator During the COVID-19 Pandemic

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By Hannah Fryczynski

It’s no secret that for public health professionals everywhere, this last year and a half has been challenging, stressful, daunting, and at times disheartening. The pandemic has taken a toll on Americans in every way possible, including life expectancy and long-term physical and mental health outcomes. It has tested public health agencies’ capacity and resources and revealed all the ways in which public health organizations do not have the support and funding they truly need to respond to the nation’s most important health issues. In more recent times, the challenge has become fighting for the idea of public health itself – to promote and protect the health and wellbeing of all. Public health programs are critical to a nation’s health, whether that be at the national, state, or local level.

Especially in a time like the pandemic, responding to the varying needs of those affected by COVID-19 is imperative — through patient treatment, contact tracing, outreach and education, outbreak response, mental health resources, and vaccine clinics. To be in the public health profession during such unprecedented times is to acknowledge and fight existing barriers and respond to our most vulnerable populations, even when our work is challenged from all directions.

I joined the Immunize Colorado CO-mmunity Corps VISTA program in October 2020 and began my year of service at Garfield County Public Health. There are about 60,000 people in Garfield County, with around 30% of the population identifying as Hispanic. The rural county is bordered by Pitkin, Eagle, and Mesa counties, and we have a large working class in the service and hospitality industry. Towns within the county have differing political and cultural values that impact the work Garfield County Public Health does, specifically related to COVID-19 response. The largest barrier that continues to exist in my county is COVID-19 vaccine hesitancy. As CO-mmunity Corps members, our responsibility is to promote education and access to immunizations through the development, implementation and evaluation of immunization activities in the counties we serve. Vaccine hesitancy is the most substantial barrier I have faced in trying to uphold this responsibility, but it has also become my strongest motivator in conducting outreach in the community.

Volunteering at a back-to-school night, promoting routine immunizations and the COVID-19 vaccine

I have taken on various roles in the department, from contact tracing to co-managing our COVID-19 vaccine equity project, to presenting at the Public Health in the Rockies conference. Although COVID-19 response was not included in the original position description, there were capacity issues at my local public health agency when I joined that could not be ignored, and so I jumped in and began case investigation and contact tracing. Case investigation gave me valuable perspective on the diverse community of Garfield County. I learned more about epidemiology in half a year than I ever had before, and took on greater responsibilities working with the Epidemiology team.

With the rollout of the COVID-19 vaccines came the need for outreach and education, and I was more than excited to take on a new role within COVID-19 response that directly related to the goals of being a CO-mmunity Corps member. Each week, our Hispanic Outreach Coordinator and I would host a Facebook Live dispelling myths about the vaccine and answering common questions. We began to create fun and engaging animated videos that promoted important messaging for current public health guidance and information on our social media for both COVID-19 vaccines and routine immunizations.

More recently, there has been an increased need in the community to continue education on the COVID-19 vaccine, especially for healthcare workers hesitant to receive one. I created an educational presentation on the vaccine (including its safety, the science behind it, how it was made and how it works) and have been able to present at multiple long-term care facilities and other organizations in the county with the help of my bilingual colleague. The objectives of the presentation have been to provide a space for people to ask any questions they have about the vaccine and share educational resources, with the overall goal of planting the seed of encouragement for those who have been resistant to the idea of getting vaccinated.

Presenting at Public Health in the Rockies on “Fighting the Pandemic in Your Backyard: The evolution of disease mitigation in Garfield County”

Being a VISTA during the COVID-19 pandemic has been a unique journey; it has shown me how important it is to be able to roll with the punches and pivot to respond to the highest needs of the community. One of the main goals of AmeriCorps VISTA service is to empower individuals and communities, and with the ever-changing landscape of the pandemic, I have continued to go back to this goal time and again. To remain resilient and put service for others above all else has been a grounding mantra. With limited knowledge working in a rural setting, this past year has provided me the opportunity to learn how to reach a community that faces different barriers to accessing essential health services and education. We used the resources available to us to reach as many people as possible and fulfill the goals of the CO-mmunity Corps. This year has demonstrated the need to remain empathetic to community members, even when the pushback to public health interventions feels like it is overpowering the work we are trying to accomplish — especially as AmeriCorps members. As service members, we do not choose the communities we serve; instead we work to promote and improve the health and wellbeing of every person, regardless of their race, socioeconomic background, political affiliation, or location.

Assisting with one of our COVID-19 vaccine clinics

I’d like to extend a special thank you to Danielle Dudley and Sara Brainard, who were always open to my ideas and encouraged me to take on the projects I proposed. And a big thank you to Rachel Kappler, Dana Wood, Brisa Chavez, and Yerania Moreno, who worked with me to achieve many of the goals I set out to accomplish throughout my year. My time at Garfield County Public Health has been nothing short of an amazing learning experience and one that I will never forget as I continue on my path in the public health field.

Hannah Fryczynski is an Immunization and Outreach & Education Coordinator, on assignment with Garfield County Public Health through the CO-mmunity Corps AmeriCorps VISTA program.

Colorado’s Top Vaccine Experts Answer Common Questions About COVID-19 Variants, Vaccines for Kids, Vaccine Boosters and More

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On September 15, Immunize Colorado hosted two of Colorado’s top immunization experts for a town-hall style panel discussion of the latest updates on the COVID-19 pandemic and vaccination. Panelists Dr. Sean O’Leary, Pediatric Infectious Diseases Specialist at Children’s Hospital Colorado, and Heather Roth, Immunization Branch Chief at the Colorado Department of Public Health and Environment (CDPHE), answered audience questions about COVID-19 variants, COVID-19 vaccines (including potential booster doses and availability for young children), and the status of routine vaccination in Colorado.

In this blog post, we share the panelists’ answers to some of the most common questions about the pandemic, COVID-19 vaccination, and routine vaccination in Colorado, as well as some resources that healthcare providers can use to continue encouraging vaccination in their patient populations.

(Please note that the landscape of the pandemic and vaccination continues to change rapidly; this information is current as of September 24, 2021.)

On Variants

How does the Delta variant compare to previous versions of the virus?

As far as infectiousness, the Alpha variant, which became predominant last winter, was 50% more transmissible than the original strain of COVID-19. The Delta variant is 50% more transmissible than the Alpha variant was. The R0, or average number of cases that will occur resulting from a single infected individual, is between 5 and 9 for the Delta variant, which is higher than what we saw with Alpha and the original strain. Delta is at least twice as transmissible and has made it more difficult to control the pandemic. It’s why we’re seeing a huge surge, particularly in places with under vaccination and places that have fewer protective measures in place.

As far as severity, there have been some studies that say Delta is more severe than previous strains, and some that say it’s less—essentially the science isn’t yet clear. There’s not a huge difference in severity for kids, either. But the focus shouldn’t be on severity, necessarily. Because Delta is far more transmissible, you could argue that it is more severe because it is infecting and hospitalizing a lot more people.

What percent of cases in Colorado can be attributed to Delta?

In Colorado, 99.77% of COVID-19 cases are the Delta variant. It is the predominant strain across the US.

How concerned are you about future variants?

Right now, we are focused on the Delta variant because it’s so highly transmissible. Could future variants become more transmissible? It’s hard to say at this point, but it’s certainly possible. Our biggest concern is getting vaccines in arms because we know vaccines are effective against Delta in protecting from severe illness that’s more likely to lead to hospitalization and death. In fact, there’s an inverse linear relationship when it comes to vaccination rates and hospitalization and death—communities with higher rates of vaccination have lower rates of hospitalization and death, and vice versa.

In essence, the vaccines are doing a great job at keeping people out of the hospital and keeping people alive. The vaccines have been effective against the Delta variant. Breakthrough cases are making headlines but are very uncommon compared to those who are being hospitalized who are by and large unvaccinated.

On Vaccine Boosters

What is the difference between an “additional dose” of COVID-19 vaccine and “booster dose”?

The difference is semantics. We’re still working to determine the best primary series for the vaccine; for immune-compromised folks, the CDC and FDA have determined that two doses of the mRNA vaccines don’t offer enough protection (or stimulate enough immune response) and therefore have authorized a third, additional dose for this population—meaning that the primary vaccine series for immune-compromised individuals is three doses.

A booster dose, however, is the term for an additional dose in people who mounted a sufficient immune response from the first two doses, but whose immunity may have waned over time.

What are the current recommendations for a booster dose for the public, and when might they be available?

The Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) met on September 17 and reviewed Pfizer’s application for booster doses for those 16 years and older. At this meeting, VRBPAC voted unanimously to approve a booster dose of Pfizer’s COVID-19 vaccine for those 65+ years and others 16+ at high risk for getting serious ill with COVID-19 or being exposed (such as healthcare workers), noting there is not yet enough data to support boosters for everyone 16+.

The CDC’s Advisory Council on Immunization Practices (ACIP) then met on September 23 to consider the FDA’s decision, and voted to recommend a booster dose of Pfizer’s vaccine for adults 65 and older, residents of long-term care facilities, and those over 50 at risk of getting severely ill from COVID-19 due to underlying health conditions. They also recommended a booster dose for people ages 18-49 with underlying conditions. The CDC adopted ACIP’s recommendation but went a step further to also recommend boosters for people 18-64 who live or work in settings that put them at high risk of getting COVID-19. (These recommendations are only for those who received an initial two-dose series of Pfizer vaccine; these individuals should receive a booster dose six months after their second dose.)

People might be confused by these new recommendations because of news earlier this summer that the White House wanted to make booster doses available to the public staring in September. However, the White House announcement was premature because the science was still unclear regarding the need for booster doses in healthy populations. We now have an official answer from the experts, which is that booster doses will only be needed, at least for now, for certain populations.

With the new recommendation, what is CDPHE’s plan for delivering/administering those doses?

CDPHE has looked at provider capacity to determine how many booster doses they could give per week, compared to booster doses planned based on different booster recommendations. CDPHE has well over enough capacity to vaccinate everyone eligible for a booster dose. They may employ some small vaccination clinics but are unlikely to reintroduce the mass vaccination clinic model.

What do we know about “mixing” vaccine brands for booster doses? In other words, if someone originally received Moderna, should they receive the same for booster dose?

There is not enough information on this, and it likely won’t be sufficiently studied to make a recommendation either way for some time. Right now, the recommendation for immune-compromised folks is to get the same product they got for their first two doses of mRNA vaccine; however, if the same vaccine is not available, they can receive the other brand. There is currently no recommendation for an additional dose of Johnson & Johnson vaccine, but one may come in the coming weeks.

On Covid-19 Vaccines For Kids Under 12

What is the expected timeline for COVID-19 vaccines to be available to those under 12 years old?

On September 20, Pfizer made an announcement that their clinical trial data showed a robust immune response from the vaccine in kids ages 5 – 11. Pfizer is expected to submit the data to the FDA shortly. It will take time for FDA to review the data, so the earliest we might see a formal authorization could be October. Pfizer will likely submit their data for 2 – 5-year-olds in November for FDA review. Moderna is several weeks behind Pfizer, so they may be submitting data for kids under 18 in the coming weeks.

Will the recommendations for the pediatric population be different?

Both Pfizer and Moderna are testing the vaccine at lower doses in the pediatric population, but their vaccine series’ will likely include the same number of doses and the same dose schedule as is approved currently.

Are the vaccines being tested against the Delta variant in pediatric populations? How does initial vaccine efficacy look for pediatric populations?

Right now, Delta is the main variant that’s circulating in the U.S., so the pediatric vaccines are automatically being tested against Delta. However, the trials in younger children are not looking specifically for vaccine efficacy, but rather they’re observing whether the vaccine elicits an immune response and comparing this to the upper age groups in which we know the vaccines are effective.

What should providers do to prepare for vaccinating younger populations with COVID-19 vaccine?

Providers should enroll as a COVID-19 vaccine provider if they are not already. CDPHE has recently announced the COVID-19 Primary Care Vaccination Program, which aims to increase engagement and enrollment of primary care providers in Colorado’s COVID-19 vaccination program by providing financial support to community-based organizations and health care service providers. Providers should also consider storage and handling requirements and prepare to have to store and administer additional doses of vaccine, including routine vaccines, flu vaccines and COVID-19 vaccines. Providers can focus on staff training, particularly in vaccine administration and motivational interviewing strategies to help parents make the decision to vaccinate their kids during office visits.

What are your thoughts/concerns about off-label use of COVID-19 vaccines in pediatric populations?

Safety is the top concern when vaccines is being studied, since they’re given to large populations of healthy people. In the US, we have a reliable process for reviewing and monitoring vaccine safety, and we need to stick to that process; it’s delivered us safe, effective vaccines for many decades. Right now, there is limited safety data on COVID-19 vaccines in younger age groups; until we see a recommendation from the FDA and CDC based on this data, we need to be very careful about giving the vaccines to kids who aren’t yet eligible under current recommendations, as doing so could be dangerous. Giving a young child a dose meant for an adult (or, in this case, meant for a kid over 12) could be problematic. Kids aren’t small adults; their immune systems are different, which is why the dose given to younger kids will likely be smaller.

What parents can do until vaccines are approved for their young children is make sure they’re vaccinated with other routine vaccines!

On Colorado’s School And Healthcare Worker Vaccination Requirements

Does CDPHE have any updates to share regarding the implementation of the new school entry immunization law that went into effect this school year? What proportion of exemptions are coming in through providers compared to the online education module?

CDPHE has a team supporting schools and child care centers in technical assistance for implementing the new law, especially the online module piece. So far, the department has seen 40,925 exemptions come through for 6,800 kids. Of these exemptions, 99% have been submitted through the online module, which means only 1% have been obtained through a healthcare provider. And 99% of the exemptions coming in are non-medical.

What is the new Board of Health requirement for healthcare worker COVID-19 vaccination?

The new requirement mirrors the influenza vaccine requirements that have been in place for years for healthcare workers, both contractors and direct staff. Healthcare workers will need to be fully vaccinated by October 31st. The requirement helps level the playing field across all facilities and will hopefully help to increase uptake at long-term care facilities, which have seen lower staff vaccination rates.

On Routine And Flu Vaccination

Can flu vaccine be co-administered with COVID-19 vaccine, and in the same arm?

Yes! Influenza and COVID-19 vaccines can be administered at the same time, in the same arm. The CDC has determined that the benefits of co-administration of the COVID-19 vaccine with other vaccines outweigh the potential minor risks. Co-administration is being tracked in the Vaccine Adverse Event Reporting System (VAERS) to continually monitor safety.

How can partners across the state support routine vaccination?

There’s not just one thing that can help increase routine vaccination—there are many evidence-based strategies. These include standing orders for vaccinations, reminder/recall to patients, patient communication and more. Providers should use CIIS to access their patients’ immunization data and see which patients need to be caught up. Engaging in as many of these strategies as possible will help improve routine vaccination.

What is encouraging is that we haven’t, anecdotally, seen a big shift in parents’ attitudes about childhood vaccinations.

On Provider Guidance For Covid-19 Vaccination

How should providers determine if someone is fully vaccinated, especially when administering booster doses?

The best practice is to use the Colorado Immunization Information System (CIIS) when determining someone’s vaccination history. All COVID-19 vaccine doses are required to be reported to CIIS.

Where would you recommend a provider seek guidance or additional input for specific patient situations where the recommendations for vaccination may be unclear for their circumstance?

Providers should carefully read the CDC recommendations on their website; the answers to some of these more specific questions are often included in the guidance. Providers can also consult the infectious disease specialists in their circles to see if they have recommendations.

CDPHE also has public health nurse consultants available. Providers may call 303-692-2700 to be triaged to a public health nurse consultant or send an email to cdphe_covidvax@state.co.us. The CDC also has an email address to which healthcare providers can submit immunization or vaccine-preventable disease related questions: nipinfo@cdc.gov.

CO-mmunity Corps Blog Series: Reflections on the COVID-19 Vaccine Rollout in Jefferson County & The Continued Need to Share Information

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By Hannah Sullivan

I started serving as an AmeriCorps VISTA member at Jefferson County Public Health (JCPH) in August of 2020. As the end of my service year now quickly approaches, I have been taking time to reflect on my experiences.

COVID-19 Vaccine Rollout – The Early Days

Easily the most exciting event over the past year was the Emergency Use Authorization and subsequent rollout procedure of an effective COVID-19 vaccine (well, technically three vaccines). When this process began in December, it was elating to think that life could potentially return to “normal,” but daunting to ponder the logistics of the mass distribution effort. The biggest challenge during this phase was trying to balance efficiency with equity. It was imperative to vaccinate as many people as possible while working to provide opportunities for people who had been most impacted already by the pandemic, and those facing barriers to access the vaccine. For example, a clinic with 1,000 appointment slots could fill within minutes if it was posted on the JCPH website, but it would be filled by folks with access to the internet, time, and flexibility. To make 1,000 calls and register people without computers would take many more resources.

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