Rates of most vaccine-preventable diseases remain low.

Immunization of high-risk children against hepatitis A is keeping New Mexico’s rate of this disease below the national rate.

Improvements in New Mexico’s public health system are boosting the state’s ability to detect and respond to outbreaks and other public health emergencies.

New Mexico residents and healthcare practitioners are taught the early symptoms of plague and hantavirus infections.

Information about preventing hantavirus, plague and other diseases is conveyed to the public.

Department of Health (DOH) responds to outbreaks of vaccine-preventable diseases by immunizing or treating people at risk of infection.

On-call inquiry response is provided to the public, and to medical, veterinary and environmental professionals, 24 hours a day, 365 days a year, by DOH.

Develop appropriate educational materials to help people protect themselves from rodent-borne diseases.

More research is needed on ways to rodent-proof buildings, using materials that are affordable and easily available in rural areas.

Determine the causes of declining vaccination rates in New Mexico.

More resources are necessary for community-based public health workers.

Private and public community outreach activities need to be organized to promote appropriate vaccination.

Develop strategies for vaccine distribution and facilitate the development of policies to promote appropriate and timely vaccinations, including school and day-care immunization requirements.

New Mexico leads the nation in hantavirus (57 total cases, Figure 1) and plague (232 total cases). Both of these diseases are spread by rodents. The number of plague cases has not been unusually high in the past two years. However, 1999 and 2000 saw an upsurge in hantavirus illness, with ten cases each year, including five deaths in 1999 and three in 2000. These are the highest numbers of yearly cases since the initial outbreak in 1993, when 18 cases with 10 fatalities occurred. Clearly, these diseases are here to stay in New Mexico and are not likely to go away on their own; we need to focus on preventing them at the community level.


Rodent-borne diseases are more common among persons with substandard housing in rural areas. Such homes are often difficult to make rodent-proof. It can also be difficult to get prevention messages to people in some rural areas, due to language and cultural barriers. Education of the medical community has increased the early recognition of these diseases, and has undoubtedly saved lives. In addition, experts in ecology and geography have collaborated on research to improve our ability to predict high-disease years. This work, which uses data on weather and climate, shows promise and may help us target prevention activities more effectively.

For many years, New Mexico had one of the nation’s highest rates of hepatitis A, a viral disease of the liver. Since 1996, health-care practitioners in areas of New Mexico with the most cases have been immunizing children against the disease, using federally purchased hepatitis A vaccine. Statewide rates of the disease began falling soon after the immunization program began, and are now below the national rate (Figure 2).


Our overall childhood immunization rate for 1998 was 73%, increasing in 1999 to nearly 76%. This is well below the national average. The reasons are unclear, but several factors probably play a part. Some private providers, instead of giving immunizations themselves, are referring children to public health clinics for immunization. This is occurring because of low reimbursements paid by insurance plans. It results in missed vaccinations, since parents and children must make another, separate trip. Also, New Mexico does not have a system for tracking the vaccination status of individual children; this results in confusion about how up-to-date children are, and missed opportunities to vaccinate.

So far, our relatively low vaccination rate has not led to any known outbreaks or increases of most diseases. No measles cases have been confirmed in the state since 1996. Numbers of severe infections from the bacterium Haemophilus influenzae type B in children have decreased dramatically; these rates remain low. However, New Mexico has a persistent problem with one serious disease -- whooping cough, or pertussis. In 1999, 224 cases of the disease were reported to the Office of Epidemiology. Undoubtedly there were many more cases that were not recognized or reported, especially among adolescents and adults. Three New Mexico infants have died from the disease and more have been hospitalized within the past few years. This is partly due to the lack of a booster vaccine for persons older than seven years, an increasing number of children unvaccinated by parental choice, and healthcare providers not always well informed about the scope of the problem in New Mexico. Control of pertussis requires identification of cases through interviews and diagnostic testing; giving preventive medications to contacts; and vaccinating infants and other highly susceptible children. The importance of these tasks, usually done by public health nurses, reminds us of the need to maintain a network of public health and other clinics. The Vaccines for Children program of the New Mexico Department of Health (DOH) aims to increase childhood immunization levels by providing publicly purchased vaccines to all children up to 18 years old.

In addition, advances in vaccine technology hold great promise for the near future. Among the upcoming products are combined vaccines that result in fewer shots for infants, and new vaccines against old diseases. Chicken pox, or varicella, is a mild childhood disease for most people; however, it can be a life-threatening illness in adults who have never been immunized or had the disease. Thus, every year thousands of children and adults across the United States are hospitalized and some die from it. Beginning in the fall of 2000, children entering state-licensed child-care centers are required to have proof of immunity, either from having the disease or through receiving the safe and highly effective vaccine. In 2002, that requirement will extend to children entering school. Children in the U.S. are now offered a new pneumococcal vaccine, which will prevent a severe form of meningitis and a common type of middle ear infection. Along with keeping children healthier, this vaccine promises to reduce the number of visits to pediatricians. It can also reduce the need for antibiotics; some antibiotics, because of past overuse, are now useless in treating common infections.

There is growing concern nationwide that the United States may be targeted for attacks by terrorists using biological warfare agents (e.g., anthrax, plague, smallpox) or chemical agents. To prepare for such attacks, a broad coalition of healthcare, public health and scientific agencies in New Mexico has come together to study ways to detect and respond to them. In addition, the Department of Health is using resources granted by the federal government to bolster public health laboratories, disease surveillance systems, and public alert networks that can be used to respond to biological or chemical agent attacks. Even if, as we hope, such attacks do not occur, the preparation efforts will not be wasted: the resulting improvements in public health systems are long overdue and will help us detect and respond to routine infectious-disease outbreaks.

New Mexico Department of Health, Office of Epidemiology

• (505) 827-0006
  
  

Immunization Program

• (505) 827-2326