Community physicians key to prevention efforts

The role of community physicians is critical in the global effort to reduce childhood illness through vaccination. Vaccine researcher Kathryn Edwards, M.D., the Sarah H. Sell and Cornelius Vanderbilt Professor in Pediatrics and director of the Vanderbilt Vaccine Research Program (VVRP), says community physicians make critical research possible in both the development of vaccines and the evaluation of their effectiveness.

Edwards says the first 20 years of her vaccine research at Vanderbilt took place mostly through local pediatricians’ offices, where she and her colleagues tested everything from the whooping cough vaccine early in her tenure to the nasal spray flu vaccine in just the last decade.

“It has been one of the most rewarding parts of my career. My greatest hope is that in this new, more complex, and challenging era of health care that this excellent spirit of collaboration will continue to be strong. We have several studies right now that come from community evidence to inform the effectiveness of vaccines,” Edwards said.

One current project examines a vaccine’s impact on secondary illnesses, like pneumonia. Both the influenza and pneumococcal vaccines impact development of many infections with these germs, but it is not yet clear the extent to which they can specifically prevent the development of pneumonia. Carlos Grijalva, M.D., MPH, assistant professor of Preventive Medicine, and Marie Griffin, M.D., MPH, professor of Preventive Medicine and Medicine, are looking at community vaccination records of children and adults to determine the effectiveness of vaccines for both influenza and pneumonia in preventing health care visits for pneumonia and other respiratory illnesses.

“Research of this type takes a lot of effort on the part of the community practitioners,” Edwards said. “They have to consider how they document things, look up charts and send them to us, and that can take quite a bit of time. They have been very understanding, and we depend on the excellent quality of the work they do in giving and documenting vaccinations. This is pivotal to answering basic questions about how vaccines are doing in preventing disease,” Edwards said.

As the largest and most comprehensive Vaccine Center in the region, Vanderbilt commonly partners with public health entities like the U.S. Centers for Disease Control and Prevention (CDC) and local and state health departments on projects. A large CDC-led project, in coordination with the medical director of Tennessee’s Immunization Program, Kelly Moore, M.D., MPH, is working to get more community physicians involved in vaccine safety. The project, called the Vaccine Safety Advice Network (VSAN), is a pilot project utilizing Vanderbilt physicians in the vaccine research program to quickly answer vaccine safety questions from the pediatricians’ offices.

“If any pediatrician has a question about a patient reaction to a vaccine, or vaccine safety, they email the VSAN system, and that alerts us to pull our experts together to examine the question and provide an answer within 24 to 48 hours,” Edwards said.

The collaborative work of pediatricians and other physicians from primary care clinics all over Middle Tennessee is essential to the work of Vanderbilt’s vaccine programs. Edwards said they also make it possible for their patients to be part of the same critical work that will continue to find answers to prevent serious childhood illness.

– by Carole Bartoo