In tow of the previous responses about socioeconomic status and the gaps in immunizations. I'm honestly surprised that we haven't came up with a solid immunization plan for our country yet, since everyone's immunizations effect one another and the overall decrease and eventual irradiation of a specific pathogen in the region (Polio being one of them in America). I think sometimes we forget that our choices when regarding vaccinations effect everyone, and not just ourselves or our region. I understand vaccinations and those getting their vaccinations is already a public health concern, but it almost needs to be a country wide initiative if we really want to get anywhere with it. Those that preach of their benefits, are typically already strong believers in them. But I think if we had it as more of a government plan, up front it would cost us, but after taking into account the saved hospitalization costs from those not vaccinated, we would save money as a whole. (Sorry, I'm a little riled up from the debate...ignore me please.)

• Kaitlin Weisshappel

@Alex, i think you're definitely on to something by talking about the opportunities for predicting who will be at the highest risk and how this could be used to let physicians know that a conversation about it is highly important. However, @James you raise a good point about how increasing incentive for high risk patients to actually vaccinate is a necessity. Wouldn't you think that it would be beneficial for insurance companies to provide some kind of financial benefit or policy for those that get vaccinated? Wasn't the ACA passed to provide everybody with adequate health insurance and isn't it centered around primary care and preventative medicine? Perhaps maybe make an addendum to include this as a type of preventative medicine if it isn't already. After all, if insurance is based on risk analysis isn't it financially worthwhile for companies in the long run to decrease the risk that those they insure will get sick? Maybe a lower premium or something of the sort? I honestly have very little knowledge of this aspect of health care and and just thinking what makes the most sense to me. If anybody has any insight about it I think that'd be great.

• Gage Winger

@Zheng Wang

Many pharmacists are able to and do give vaccinations in pharmacies. These are typically restricted to certain types (influenza, Hep B, etc.), but they are certainly an option. There are also specialized pharmacies that give travel vaccinations or a wider variety of vaccinations.

However, I think that given the amount of vaccines children need to receive and the somewhat stringent timelines that it actually ends up being more convenient to schedule with a physician. At a pharmacy, they really don't have all the details of the child's medical history and pharmacy-hopping could result in lost or difficult to retrieve immunization records.

@Carly Gridley, I have always been curious about the specific timelines set for vaccinations and it has been especially relevant beginning medical school and trying to cram them all in. I think it is particularly interesting that it is not advised to get a second dose of a vaccination early, but that it is fine to receive the immunization late

• Jaime Jones

@zheng Wang

I agree with potential concerns of so many live vaccines at once. It seem that often the CDC compares vaccines to medications in terms of side effects, adverse reactions, etc. We have entire courses dedicated to understanding potential negative interactions and harmful effects of taking certain medications together, which wouldn't be an issue normally.

Based on what we learned in class, in theory there shouldn't be problems from introducing multiple antigens at once to our immune system, but I'm just curious if there is research being done specifically targeting concerns from overloading the immune system, or potential cross-interactions between the vaccines themselves, if that makes sense.

• David Anson

@Alex Matelski

I agree that automating certain processes in the healthcare pipeline can increase workplace efficiency for physicians. Patients that are likely to comply would certainly benefit from instructions/reminders of their own or their children's vaccination schedules, especially since the schedule may vary for each vaccine as Carly mentioned.

However, patients who are 'high-risk' for missing vaccinations may be non-compliant for various socioeconomic reasons. Having an automated system for identifying such individual patients could prove useful for guiding a physician's interaction with 'high-risk' patients, but this may or may not solve the issue of the patient's compliance. How could doctors increase the incentive for 'high-risk' patients to adhere to vaccination schedules? Also, how do you ensure that patients understand instructions given to them?

• James Dotimas

I didn't realize that inactivated and live vaccines activated the immune system in such different ways that their timings are different. I wonder if too much live vaccines given in too short of a time period overwhelms the immune system, and how that level was actually discovered.

One thing that would be really interesting if there were some way for parents to just go to a pharmacy for immunizations, instead of having to schedule a full physician visit. If the parents or healthcare workers in the pharmacy were trained to give vaccines, there may be more compliance because of hours outside of normal work hours and relative ease.

• zheng Wang

I believe there is a large population of UIUC COM's students that are interested in family medicine - I imagine these sorts of schedules will be committed to memory eventually.

My interest in this is specifically in how it might be made more proactive in the future: e.g. how do we avoid letting children fall behind in vaccination schedules?

I think there is a major opportunity here for predictive analytics - using sociodemographic, economic, and regional indicators to tell us who might be at most risk to miss vaccinations for their newborns. I think if systems are really sophisticated, this sort of thing will be automatic, generating special patient instructions/physician advisories for patients identified as 'high-risk' in the EMR.

What do others think? I feel like immunization/vaccination is a good frontier to see how predictive analytics line up with our 'clinical intuition' as doctors - lots of data and lots of public benefit from effective systems.

• Alex Matelski