Washington state health officials credit new regulations that made it more difficult for parents to obtain an exemption from the requirement that children to be fully immunized before entering school.

Under the old rules, to obtain an exemption parents only had to sign a certificate indicating that they object on medical, religious or philosophical grounds.

Proponents of the new law said the ease with which exemptions could be obtained in Washington is one reason why the state has the highest vaccine exemption rates in the country.

Under the new law, parents seeking an exemption must get information from a health care provider about the benefits and risks of vaccine before the provider signs a Certificate of Exemption form.

Kids with exemptions tend to cluster geographically, often living in the same areas, going to the same schools — creating “pockets of under-vaccinated children at risk of outbreaks,” Washington state health officials say.

Click on map for more information about exemption rates

Schools with higher exemption rates have higher rates of diseases like measles and whooping cough (pertussis).

Currently, Washington state is in the midst of a whooping cough epidemic with more that 1,000 cases reported so far just this year.

At this rate, the state is projected to see more than 3,000 cases in 2012, the highest rate seen in decades.

Important points:

• All recommended vaccines for Washington children under age 19 are provided at no-cost through the state’s Childhood Vaccine Program.

• Health care providers may charge an office visit fee and a fee to give the vaccine, called an administration fee — but people who cannot afford the administration fee can ask their regular health care provider to waive the cost.

• For help finding a health care provider or an immunization clinic, call your local health agency (doh.wa.gov/LHJMap/LHJMap.htm), visit the ParentHelp123 resource finder (https://resources.parenthelp123.org/) or call the Family Health Hotline (www.parenthelp123.org/resources/family-health-hotline) at 1-800-322-2588.

• Information about the exemption law (www.doh.wa.gov/cfh/Immunize/) is available online.

By Judith Graham

This story was produced in collaboration with 

Doctors assess patients’ breathing, heart rate and blood pressure routinely at office visits. Soon, they may be adding body mass index to that list too.

Tracking this measure – an indicator of whether someone is obese or overweight – as if it were a vital sign at medical checkups is among a new set of strategies recommended for battling obesity, a concern that some experts predict will affect 42 percent of adults by 2030.

Although professional medical societies have said for years that physicians should monitor patients’ body mass index, most doctors fail to do so.

For example, a 2006 survey of family physicians found that fewer than half checked BMIs for children over the age of 2, even though 71 percent knew this has been recommended.

Just over 40 percent of adult patients in commercial HMOs had documented BMI measurements in 2009 and 2010, according to a survey by the National Committee for Quality Assurance, an organization that evaluates health plans. That figure falls to 12 percent for patients in commercial PPOs, a more common type of plan.

The Institute of Medicine last week called for the medical profession and health insurers to become more rigorous in their approach in a report proposing an anti-obesity campaign that would involve every part of society, from individuals and families to schools, communities, workplaces, the food industry and the media.

Pointing to the more than 90 million children, teens and adults counted as obese, well-established links to medical conditions such as diabetes, hypertension, heart disease, and arthritis, and annual healthcare expenses exceeding $190 billion, the report urged comprehensive and sustained action.

For physicians, monitoring body mass index – a ratio of height to weight – is at the top of the list of priorities because it’s the best way to identify people who have a weight problem. (Adults are counted as obese if they have a BMI of 30 or higher; children if their BMI is at the 95 percentile or higher for kids of the same age and sex.)

“We need to normalize the process of obesity screening and lifestyle counseling so they’re usual and people expect this,” said Dr. Sandra Hassink, a member of the panel that prepared the IOM report and director of the Obesity Initiative at Nemours, a pediatric health system in four states.

Medical Groups Call For Change

Groups such as the American Medical Association and the American Academy of Pediatrics have recommended regular BMI checks for years. Several health care systems also have embraced the practice.

Kaiser includes BMI as a “vital sign” in electronic medical records for nearly 9 million members, and it is planning to do the same for physical activity, another contributor to the obesity epidemic, said Ray Baxter, the plan’s senior vice president for community benefit and health policy. (Kaiser Health News is not affiliated with Kaiser Permanente.)

So why the problem? Many harried physicians are unprepared to advise people about how to change their behaviors, unconvinced they have time to do so, and therefore look skeptically at screening, said Dr. Robert Kushner, clinical director of the Comprehensive Center on Obesity at Northwestern University.

If doctors are overweight themselves, they’re less likely to recognize the issue in their patients, research shows. What’s more, doctors aren’t trained in medical school to handle weight issues.

They also often aren’t convinced obesity treatments work, and many believe there aren’t good community programs to which they can refer patients.

“The question is, how many programs are out there for primary care doctors to refer to in the community, and answer is – not many,” said Dr. Ned Calonge, a Colorado physician who is the immediate past chairman of the U.S. Preventive Services Task Force.

Northwestern is tackling a part of that by weaving instruction in “lifestyle medicine” throughout all four years of a new medical school curriculum being introduced this August.

Another significant problem has been a historic lack of reimbursement from insurers for obesity screening and counseling. That changed last year for seniors, when Medicare said it would cover up to six months of weight loss counseling for obese beneficiaries as part of a package of new preventive services. Nearly 13 million Medicare members are thought to be obese.

Meanwhile, new preventive services guidelines from the government call for all insurance plans to cover obesity screening and counseling without charge to patients.

And insurers are expanding childhood obesity programs following a 2010 recommendation from the U.S. Preventive Services Task Force that endorsed comprehensive weight management programs for youngsters at least 6 years old. Previously, the task force supported BMI screening but not weight loss programs.

Seeking Evidence-Based Programs

For the insurance industry, the challenge now is providing evidence-based programs that can be introduced on a broad scale.

UnitedHealth Group is promoting “Join for Me,” a year-long behavioral modification program piloted with the YMCA of Greater Providence, R.I., in which youngsters 6 to 17 years old, accompanied by a parent, learn about healthy eating and exercise in a group led by a coordinator.

“Doctors are in short supply” and it makes sense to conduct intensive behavioral change programs in the community, not in their offices, said Dr. Deneen Vojta, senior vice president of UnitedHealth’s Center for Health Reform & Modernization.

For overweight and obese adults, the company is looking at offering a version of the Diabetes Prevention Program, a well-studied intensive intervention that has been shown to help people lose weight.

WellPoint has taken a different approach, choosing to work through doctors and with the Alliance for a Healthier Generation, an organization that’s trying to convince health plans to offer more comprehensive coverage for obesity counseling and treatment.

The alliance asks participating plans to offer four visits with a child’s primary care doctor and four visits with a dietitian if the youngster is found to be overweight or obese.

So far several plans, including WellPoint, Aetna, Humana and Highmark, Inc., have signed up, and 2.4 million children are covered.

WellPoint recently launched a limited pilot study of this type of benefit in California and is learning what physicians need and members want before deciding whether to roll it out more broadly, said Harvinder Sareen, clinical program director for the insurance company.

Insurance companies and some self-insured employers are also exploring the use of financial incentives — cash payments or reduced premiums or deductibles – to motivate members to keep their weight in check and to adopt other lifestyle changes.

One program at UnitedHealthcare offers members up to $250 for reaching a BMI of 25 or less, and similar incentives for not smoking and lowering cholesterol and blood pressure.

“Is there coverage [for obesity] is yesterday’s conversation. Today’s conversation is how to design coverage to encourage people to use it and continue using it,” said Karen Ignagni, president of America’s Health Insurance Plans, an industry trade group.

Others disagree that coverage for obesity counseling is adequate.

“The problem is there’s no real incentive for the insurance industry to pay for better prevention and treatment, because the costs are immediate while the benefits are long-term,” said Dr. David Ludwig, director of the new Balance Foundation Obesity Prevention Center at Children’s Hospital, Boston. “Although reducing the prevalence of obesity is one of the most profitable investments the healthcare system could make, it doesn’t make a lot of sense for individual plans when families change policies every three to five years.”

Updated at 2:00 p.m. on May 13 to clarify the description of the NCQA study findings.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

The United States has a higher rate of babies born too early – and therefore at greater risk of death or health problems – than more than 125 other countries, including Rwanda, Uzbekistan, China and Latvia, according to a report out today.

About 12 percent of U.S. babies are born at 37 weeks or less, according to the report, which found a worldwide range of as few as 4.1 percent of babies in Belarus to as many as 18 percent in Malawi. Full term is considered 39 weeks.

Click to view interactive map and charts

While nearly two thirds of all pre-term births worldwide occur in Sub-Saharan African and Asia, the U.S. rate shows that “this is not just a developing country issue,” says Chris Howson, vice president for global programs at the March of Dimes.

His organization, along with the World Health Organization, Save the Children and the Partnership for Maternal, Newborn & Child Health, produced the report. It says about one million pre-term babies worldwide die shortly after birth, while others can suffer lifelong health problems.

Born Too Soon is a joint effort of almost 50 organizations, including the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Seattle Children’s.

“This report sounds the alarm that prematurity is an enormous global health problem that urgently demands more research and resources,” said Craig Rubens, MD, PhD, executive director of GAPPS and contributor to the report.

“Even if every known intervention was implemented around the world, we would still see 13.8 million preterm births each year; we could only prevent 8 percent,” he said.

Maternal risk factors include being under- or over-weight, having diabetes or high blood pressure, smoking, being younger than 17 or over age 40.

Rates within countries can vary widely. In the U.S., for example, the pre-term birth rate for white women in 2009 was 10.9 percent, compared with 17.5 percent for African American women, the report says.

In the U.S. and some other developed countries, pre-term births are also linked with a higher use of fertility drugs, which are associated with mothers carrying twins, triplets or more, increasing the chance of early labor. Some births in the U.S. are also induced early, either because the mother is having health problems or for the convenience of the doctor or mother.

Because pre-term births are costly and dangerous, physician groups, organizations like the March of Dimes and even some employers have ongoing efforts to discourage women and their doctors from scheduling births before 39 weeks, unless there is a health reason to do so. The Obama administration launched a $40 million program in February aimed at reducing the number of premature births, especially elective deliveries.

Those elective early births are also the subject of a March of Dimes education campaign, which says even though the absolute numbers are small, the risk of death for babies born just one to two weeks early is twice as high as for those born at 39 weeks.

Howson says the groups that signed on to the report have made a variety of suggestions for lowering the rate worldwide, ranging from inexpensive injections that can be given to mothers in preterm labor to help develop fetal lungs to encouraging women to have health exams before they get pregnant to check for risk factors.

“A preterm baby indicates a failure in the system,” he says.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Today, parents need to address serious issues like bullying and gun safety.

During National Safe Kids Week, April 21 – 28 (www.safekids.org), Polyclinic pediatrician Dr. Melissa Hathaway is offering tips for keeping kids safe from both every day threats to health and safety, and the life threatening issues of the day.

Review Safety Often

As a pediatrician, Dr. Hathaway reminds parents to review safety issues often to keep up with their growing and changing child.  “Make it a habit,” advises Dr. Hathaway.  “One of the reasons children have accidents is because they develop so fast that caregivers have a hard time keeping up.”

She recommends that parents and caregivers think about safety in terms of age and by situation – “at home, at play, as school, and on the go.”

Dr. Hathaway points out that as a community, we all have a duty to protect children from two of the biggest dangers: guns and bullying.

Gun Safety

“Sadly, there have been several recent gun-related tragic events in the Northwest, says Dr. Hathaway.  “The best way to keep your children safe from injury or death from guns is to never have a gun in the home, car, or anywhere your child has access to.

Talk to your children about the dangers of guns and what to do if they find themselves in a situation involving a gun.”

While parents may take every precaution at home, they should not forget to find out if there are guns in the homes where their children play.

“It can be hard for a parent or caregiver to ask about guns,” she points out.  “One way to ask is, ‘My child is very curious.  Do you have guns or anything dangerous that he might get into?’”

She suggests that for those who do choose to keep a gun in the home, always keep the gun unloaded and locked.  “Also lock up bullets and store them in a separate place, and make sure to hide the keys to the locked boxes.  Children are naturally curious, and their innate urge to discover new things can overcome any parent’s warnings.”

Bullying

Bullying is becoming increasingly common and can be a deadly problem.  Bullying is defined as unwanted, aggressive behavior that involves a real or perceived power imbalance.  The behavior is repeated, or has the potential to be repeated over time.

“Anyone and everyone can help prevent bullying by talking about it, promoting a safe environment, modeling respectful behavior and treating others with kindness,” says Dr. Hathaway.  “Talk to kids about what bullying is, what they should do if they see it happening, and how to stand up to kids who bully. Know the warning signs, talk about it, and intervene immediately if you see bullying behavior.”

Resources

It can be overwhelming for a parent or caregiver to keep track of all the risks inside and outside the home.  “Enlist the help of your family, friends and community to endure your child is safe wherever they go,” says Dr. Hathaway.

There are a variety of websites dedicated to education and awareness regarding safety in childhood and beyond.

Dr. Hathaway recommends:

• The American Academy of Pediatrics HealthyChildren.Org website.

• Washington State Medical Association webpage on bullying: www.wsma.org/patient_resources/bullying.cfm

The total of 1,008 reported as of April 21 is more than reported in all of 2011 and is the highest number of cases since 1,026 were reported in all of 2005.

At this rate, the state is on track to reach more than 3,000 cases for the year; levels that haven’t been seen in more than six decades, officials said.

“We’re very concerned about the risk to infants, especially because of how quickly whooping cough is spreading,” said Secretary of Health, Mary Selecky. “Whooping cough can be life threatening for infants, and they’re too young to get enough doses of vaccine to be protected. That’s why we want everyone else to make sure they’re vaccinated against whooping cough.”

Already this year 71 infants under a year old have been reported to have whooping cough. Eighteen of them have been hospitalized. No babies have died in 2012, but two babies died in 2010 and two in 2011.

Whooping Cough (Pertussis)

Pertussis, the whooping cough bacteria -- CDC photo

Whooping cough, also known as pertussis, is a highly contagious respiratory illness spread by coughing and sneezing.

It is caused by a bacteria called Bordetella pertussis. The name, pertussis, comes from Latin, from per-‘away, extremely’ + Latin tussis ‘a cough.’

According to the U.S. Centers for Disease Control and Preventing, in the 20th century,  pertussis was one of the most common childhood diseases and a major cause of child death in the United States.

Initially, an infection may seem like just a cold. However, during this phase of the infection, which can last several weeks, a person can spread the disease to others.

Patients typically then go on to develop a severe, persistent–often wracking–cough that can last for several more weeks.

The coughing fits can be prolonged and are often followed by a long inhalation that causes the “whooping” sound that gives the disease its name.

The bouts of coughing can leave victims breathless and unable to eat, drink or sleep. Complications of the infection include pneumonia, seizures and death.

Whooping cough can affect people of all ages — but is most serious in infants, especially those too young to get vaccinated or who aren’t fully protected.

There is a vaccine that can prevent infection, but it is not effective in newborns or infants and it wears off with time.

Many cases in the current epidemic are being reported in school age children. The vaccine that young children get wears off over time, so all children age 11-12 should get a whooping cough booster shot, called Tdap, health officials said.

The Tdap vaccine is also recommended for pregnant women and women who recently gave birth.

Getting vaccinated before giving birth helps prevent the mother from spreading the illness to her newborn.

The Department of Health has release a public service announcement featuring Chelsey Charles, a mother whose 27-week-old infant  Kaliah died of whooping cough last year.

“It devastated our family,” Chelsey Charles says. “Don’t wait; go get your Tdap shot before it’s too late for somebody else.”

“This is what we’re trying to prevent,” says Dr. Maxine Hayes, State Health Officer. “When adults get sick with whooping cough it can be miserable, but when babies get the disease, they often must be hospitalized because it’s difficult for them to feed, sleep, and breathe.”

Selecky and Hayes urge all teens and adults to check their immunization status. Many health care providers use the state’s immunization registry and can check which vaccines have been given.

Most health insurance carriers cover the whooping cough vaccine; adults should double check with their health plan.

Whooping cough vaccines are available to all Washington children under 19 years old through health care provider offices participating in the state’s Childhood Vaccine Program.

More information on whooping cough disease and who should be vaccinated is available on Department of Health’s website (www.doh.wa.gov).

The number of reported cases is updated every Tuesday afternoon.

Free vaccine available