Where I Stand: Immunizations key to effective health programs

Wednesday, Aug. 28, 1996 | 11:59 a.m.

The Clark County Health District is a joint venture of Clark County and the cities of Las Vegas, North Las Vegas, Henderson and Boulder City. Since 1962, the Health Board, with members from each council and area, has provided policy guidance and support, and the staff has delivered needed public health services to our Southern Nevada communities.

The 320 employees take pride in the program. Yet, the services for this remarkable community -- a million residents plus more than 2 million visitors and 5,000 new residents each month -- are being accomplished with fewer employees per capita than in our sister county to the north.

Within our mission, "to protect and promote the health, the environment and the well-being of the community," there are important public health service priorities. None is more historic than control of infectious disease. In this regard:

* The district treats and manages all tuberculosis in the community. Each year, more than 100,000 people come for skin tests; more than 100 undergo treatment for active TB and more than 1,000 people receive a six-month treatment program to prevent later active TB.

* Sexually transmitted disease is treated in a clinic, open all day every weekday, with 50 or more people seen on a walk-in basis. Contacts are found and treated. Our HIV program is a major partner in this community's AIDS control effort.

* Many other infectious disease problems are monitored and treatment is assured.

Our permitting and inspection of more than 8,000 food establishments to assure clean and safe food management are to prevent and limit food illnesses such as those affecting Japan and its tourists. What city could be more at risk than Las Vegas? Preventive measures, plus alertness and 24-hour responsiveness to any possible food-related illness, are ongoing priorities.

The primary basic public health service that controls most infectious disease in a community is the child immunization program. For 30 years, the health district has offered at many locations free immunizations to any and all children. For several years, this has been helped by more immunizations from private physicians and health maintenance organizations. The result is a high level of immunization protection against -- and absence of -- vaccine-preventable diseases in our community. These are measles, mumps, rubella, tetanus, diphtheria, pertussis and polio.

Historically, community immunization levels of more than 70 percent of the children have generally provided "herd immunity" against disease propagation. Epidemics occurred in settings of less protection. This accounted for experience (before vaccine) when cycles of infection outbreaks occurred a few years apart, as enough susceptibles again accumulated to support spread in the young-child population. Thus we could have several million measles cases in one year.

In recent years, outbreaks have been limited and found in clusters or communities of nonimmunized children. Some colleges or religious groups, less accepting of vaccines than others, have experienced measles outbreaks. Last spring saw an outbreak in southern Utah.

In Clark County, no epidemic is likely because, overall, more than 90 percent of our children have been immunized. Of 200,000 school and college students, more than 98 percent are protected. Of children who have attended day care, more than 92 percent have completed their series of immunizations. Of 2-year-olds, almost 60 percent have complete status and the others are significantly, though not yet completely, immunized.

Much like a wet forest prevents large fires despite campfires being present, a well-immunized community is safe from an epidemic of measles or other vaccine-related disease even when a few cases are introduced from visitors or the unimmunized. For this reason, the public anxiety last spring about measles cases and a potential epidemic exceeded medical reality.

However, a high level of community protection does not ensure that every individual is safe from infection -- especially with our exposure to 600,000 visitors each week. Therefore, the district focuses on encouraging full immunizations for all children.

Our other achievements include:

* For the past four years, with particular support of area hospitals, physicians and nurses, we have achieved a rare and growing protection against hepatitis B infection. More than 90 percent of almost 17,000 children born in Clark County each year now gain first protection against this hepatitis disease by immunization before leaving the hospital. A follow-up for further immunizations is made to each family after returning home.

* The health district has opened its immunization data bank to shared access with private providers. Increasingly, other providers of medical care, for whom this information is important, are now sharing access to our computer records. Since children often get immunizations from more than one source, it is important to know which immunizations a child has had. This can result in fewer missed opportunities for immunization, promote a higher level of age-specific immunity to diseases that are now vaccine-preventable and assure not only community protection against epidemics, but also individual child protection. We hope our electronic information services (including our Internet home page -- http://www.cchd.org/cchd/) will help and reduce paper costs, speed communication and improve quality of service.

We encourage every parent to obtain all immunizations for each child at an early age. It is the simplest, cheapest way to protect the child's health, now and in the future.