Immunization’s Big Opportunity:

Series Completion

By Dale Dauten, Syndicated Columnist

“Close your eyes and imagine that your body is going to double in size in the next five to six months. Can you picture it? Go ahead; I’ll wait.”

That arresting image was offered up by Dr. Scott Hamstra, STC’s Medical Advisor, as part of his discussion of how series completion is far trickier for adults than for children. Here’s where the doubling in size comes in…

“When you are first born,” Dr. Hamstra explains, “you still have some antibodies from mom’s immune system. But by six months, you’re on your own. You’ll also double in size by 6 months, and that same amount again by your 1st birthday. That’s one reason babies sleep so much. Meanwhile, parents can see the changes before their eyes. And since a baby doesn’t come with a user’s manual, they have questions and concerns to bring to the doctor. Along with that comes immunizations to grow their invisible immune system strength and keep them healthy as they physically grow.


“Later the kids are thrown into the wider world as they start school, and get 4 year-old immunization boosters. Then, until age 11, they simply get a flu vaccine each year. What happens at 11? They are becoming teenagers and go from small elementary schools to much larger junior high schools, high schools and colleges. We figured out they needed some immune boosting.”

The upshot is that the timing of childhood vaccinations matches the need to boost the immune system. It follows a logical life pattern; it just makes sense.

“But then,” Dr. Hamstra continues, “folks become adults and the adult vaccines don’t match to life. Adults get the first in a series of shots and say, ‘Hold on – I have to come back?’ With flu shots, you at least have the colder winter ‘flu season’ and it makes sense. Other vaccines like Hepatitis A, Hepatitis B or shingles, don’t match our adult life cycles or events.”

So what’s a conscientious health-care provider to do with a series like Shingrix?

I know what they did at the pharmacy where I got my first dose of Shingrix: the nurse put my name and the date on a handwritten sticky note on the second dose and stuck it in the refrigerator and told me to come back after two months.

This did not surprise STC’s Kristen Hutchinson, who said, “We’re trying to get people off Post-It notes.” She added, “Most pharmacy management systems aren’t set up for multi-dose, so the solution for many pharmacists is to write a Post-It note. Then they may call the patient about the second dose only to find out that patient already got it somewhere else. Or, in the case of Shingrix, where supply issues have persisted, I’ve heard of cases where someone came in for a first-dose and the pharmacy was out. So when they call the patient to say it’s in stock, they learn that the patient already got the shot somewhere else and the effect is to remind the patient that you delivered bad service the first time around.”

The solution is, of course, to improve the reminder process.

Working with pharmacy messaging providers, STC is now making available a text messaging or mail card reminder service. Leveraging ImmsLink, the bidirectional data service, so the reminders only go to those who haven’t had the next dose, no matter where they get it.

Moreover, in the spirit of “what gets measured gets done,” anyone using the reminder system will be able to analyze completion rates – checking improvements over time, or looking for offices or pharmacies that are getting particularly high or low rates and learning what’s behind those rates.

It turns out that simple text messages can make a dramatic difference.

In one small study of the HPV vaccine, researchers at Duke University (Matheson, et al, National Association of Nurse Practitioners, 2014) sent a test group a series of three text reminders and saw an 81% increase in patients getting the second dose on schedule (38% versus 21% in control group) — 81%!

We’ll report back as soon as we have data from the new reminder service.

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Vax Stats of the Month

The Most Vulnerable Births in the U.S.?

by Bill Davenhall, Geomedicine Analyst, STC Health Analytics (

According to the National Center for Vital Statistics (NCVS), 3.853 million babies (live births) were born in the United States in 2017. Of those, 324,599 were births where the hospital bill was not covered by any insurance – not by Medicaid or by private insurance. That’s about 8% of the babies.

While another 43% had Medicaid helping pay the bill, any cutbacks in Medicaid immunization programs could seriously jeopardize these babies’ chances of getting protected from infectious diseases in their first year. So how to make sure the 8% are not forgotten and end up becoming hosts to diseases that should have been eradicated decades ago? One place to start is by asking, “How many vulnerable babies will be born in my State or in my County that will not be properly immunized due to being unable to pay for the vaccinations?”

If you have every wondered about such things, perhaps you should become familiar with an impressive web site for such data – it’s called “Wonder,” a program developed and maintained by the US CDC that can answer your questions with real and authentic Natality data (extracted from every baby’s birth certificate). It is not a sample but a complete census of all births.

The CDC’s Wonder “Natality” database system is free and provides access to data you probably never thought existed. It does have restrictions on its use — you will need to agree to abide by their rules. Some county data is suppressed due to confidentiality restrictions, but it accounts for every birth in every state. The Wonder data system will even provide a data table that you can import into Excel for analysis, reporting or mapping – and it’s fast.

You will also discover many other important areas of “births” in which data is available such as information on mothers, fathers, prenatal experience, birth complications of mothers and babies, birth order, and other relevant birth related factors such as APGAR scores, birth weights, and maternal outcomes.  

The table below shows all births by Payment Source in 2017. WONDER how your State stacks up? Visit the site and be sure to select the database labeled (2016-2017 Expanded). Let us know what you discover!

Photo credits, from Unsplash: Lubomirkin, Ferenc Horvat, Minnie Zhou