Protect Your Baby with Shots by Two

Broward County is in the southeastern portion of the State of Florida, with Miami-Dade County to the south, and Palm Beach County to the north.  In 2017, Broward County was the second most populous county in Florida, and the seventeenth largest county in the nation. Broward County has a diverse population with residents representing more than 200 countries that speak over 130 languages 31.4% of the residents are foreign-born.  Broward County is a minority/majority county demonstrated by its 2017 population by race (Black 28.4%, Asian 3.6%, Hispanic 28.4%, more than one race 0.2%, and White 61.6%). Shots by Two (SB2) is a voluntary vaccine reminder program that serves the parents of infants 2 years old and under. 5.8% of the population in Broward County is under 5 years old.

One of the best ways that a parent can protect their infants from serious childhood disease before the age of 2 is through immunization. Vaccines can prevent serious and deadly diseases in infants and young children who are more vulnerable to the risk of an infection. The vaccines work with a child's body's natural mechanism to develop immunity to diseases. An increase in the incidence of whooping cough was reported in 2016 with more than 17,000 reported cases. One recent study reported that whooping cough deaths among babies could be prevented if all babies received the first dose on time at 2 months old. Although measles cases and outbreaks occur in United States, it is not as common as it is in other countries around the world. Measles can be deadly and can cause pneumonia, encephalitis (swelling of the brain), and even death. Vaccinating babies, as per the recommended schedule, gives babies the best protection against 14 childhood vaccine preventable diseases.

The goal of the Shots by Two program (SB2) is to prevent childhood vaccine-preventable and infectious diseases by ensuring 95% of the children aged two years are fully immunized. The objectives are: 1) Ensure 30% of the newborns for each month in the calendar year are enrolled in the SB2 program; 2) Ensure at least 90% of the parents enrolled in the program receive immunization reminders for their children; and, 3) Educate the community on the importance of immunizations for children aged two years and under through at least 36 community presentations.

The Florida Department of Health in Broward County (DOH-Broward) has been administering the Shots by Two (SB2) program for parents of babies 2 years old and under since 2015. As part of the program, parents can sign up to receive a series of postcards, as reminders that their babies are due for vaccinations. The consent forms to enroll in the program are provided to community partners and healthcare providers, including birth certificate departments at various labor and delivery hospitals. Once the parents enroll in the program, the information is uploaded into the State of Florida's SB2 database. A report is run monthly to determine the infants that require a vaccine. During a baby's first two years, the program mails seven colorful "birthday" cards with pictures of stuffed animals and the message, "It's Time to Immunize.” The two components of the SB2 program are education and promotion. The DOH-Broward senior nurse, who serves as the liaison for the program, educated community partners on the importance of immunizations for children aged 2 years and under through presentations. The presentation included an overview of the vaccine preventable diseases, SB2 program, vaccination schedule and the different ways that the parents can access the program. The program was also promoted through marketing campaigns and community partners. The marketing campaign included bus wraps, print media, and retail frames in neighborhood stores. The campaign targeted underserved communities in Broward County. Educating the community partners about the SB2 program facilitated in an increase in enrollment for the calendar year 2017. The community partners included various labor and delivery hospitals, coalitions, advisory councils, pediatrician offices, childcare centers and Women, Infants and Children (WIC) clinics. In addition, a survey is administered annually to analyze the immunization rates among children who are aged 2 years or under in Broward County. As part of the 2016 assessment, a list that contains the 1,874 names of the babies that were born in January 2016 was generated. Parents whose child's vaccination records are not up-to-date were contacted via telephone. The initial phone call served a reminder to the parents to vaccinate their child and the SB2 program was also offered to the parents. In addition, the follow-up phone call further investigated whether the reminder was effective and obtained information on the barriers that prevented the parents from getting their child vaccinated. It also captures the demographics of the population, which enables DOH-Broward to prioritize the immunization activities around populations in need.

As a result of the SB2 program, the immunization levels in two-year-old children in Broward County increased from 80.4% (2016) to 90.1 % (2017). Although the program was understaffed in 2017, 7,764 infants were enrolled in the program. The total enrollment for 2016 was 8,695. In 2018, with adequate staffing, the enrollment increased to 9,179 (January1-December 2). Also, about 90% of the parents enrolled in the program received immunization reminders for their children.

Website  www.shotsby2.com

Although most infants receive their vaccines by the age of 2, a significant proportion of the population does not, leaving the whole community at risk. Vaccines can prevent life-threatening diseases like measles, whooping cough or polio and can help children by providing early immunity in life. Delaying the vaccines can put the children at risk of becoming ill with preventable diseases. Following CDC's recommended schedule for immunizations can protect the infants from potentially life-threatening and preventable disease. Before 2017, Broward County's immunization completion rate for two-year-olds consistently ranked below the state average. As enrollment in the SB2 program increased an increase the immunization rates was observed.

The target population served by the SB2 program is the children in Broward County who are two years old and under. In 2017, Broward County reported 22,321 live births and 7,754 (34.7%) were enrolled in the SB2 program. Although 7,764 children were enrolled in the program in 2017, the actual reach of the program is far more extensive. 48,420 reminder postcards were sent out to the parents during the same year. Address changes and/or errors in the address has contributed to 10% of returns. It cannot be determined or guaranteed that every single parent has been offered the program at the labor and delivery hospitals. To address this issue, DOH-Broward is closely working with hospital's birth certificate departments to promote the SB2 program, as each parent will be visited by the department for the completion of the birth certificate forms. In the past the SB2 program was offered by nurses, unit secretaries or Healthy Start staff. Historical data of this practice indicate that there was no significant increase in the enrollment rate.

All the various strategies of the SB2 program have been utilized and only Broward County has the Shots by Two program making it unique. It is a creative way to inform/remind families that their children under the age of two years are due for vaccines. Attractive, colorful Birthday” cards with pictures of stuffed animals and the message It's time to immunize” are mailed to enrolled parents/guardians during an infant's first two years. The vaccination reminder postcard also encourages the parents to take their child to their primary care provider or DOH-Broward clinic for vaccines. The ease of access and the simple enrollment process make the program a great success. The SB2 program is offered in the labor and delivery hospitals, pediatrician, OB/GYN and DOH-Broward clinics. It is also available through community partners and Shots by Two enrollment events. Parents can also enroll in the program using their computer or smartphone at www.Shotsby2.com. While text messages and phone call reminders can be easily forgotten, a postcard is a tangible item that the parents can hang on their refrigerators or other prominent areas in their home. Each time they see that postcard, it can spark a reminder to get their infants vaccinated.