Testimony by Marilyn M. Doyle, MD
House Public Health
Testimony on House Bill 970 by Rep. Philip Cortez
March 21, 2017
Chairman Price and members of the committee, the Texas Medical Association appreciates the opportunity to present comments on behalf of our more than 50,000 members in support of House Bill 970. I’m Dr. Marilyn Doyle, and I’m a general pediatrician and an assistant professor of medicine at Dell Medical School. I support the pediatric residency program at Dell Medical School and care for patients at the East Austin CommUnityCare clinic here in Austin.
We are pleased that Representative Cortez is again proposing the development of a state plan to prevent and treat Streptococcus pneumoniae in Texas. S. pneumoniae has been a leading contributor to illness and death in some populations in Texas. It can cause pneumococcal disease, which includes pneumococcal pneumonia, meningitis, and sepsis. Each of these can lead to acute illness requiring hospitalization and can result in disability and even death. Texas represents a substantial proportion of the more than 400,000 annual cases of pneumococcal disease in the United States. And while pneumococcal disease is a very serious risk for our aging population, many people don’t realize it also can cause severe illness in the patients I care for — those under the age of 6, and other children whose health conditions make them more vulnerable to serious infections.
But we can prevent most cases of pneumococcal disease with timely vaccination of young children, adults age 65 and older, and children and adults of any age with weakened immune systems. Each adult 65 years and over should be vaccinated routinely for pneumococcal disease. While most adults in this age group are Medicare-insured and should have access to vaccination, perhaps 25 percent or more are not vaccinated. Both in Texas and in the United States, the 2015 vaccination rate for the pneumococcal vaccine averaged about 70-72 percent for those in the 65-and-older age group.
We do better in vaccinating young children in Texas against this disease, with 83 percent of children receiving the recommended pneumococcal vaccine dosage (2015); the national average is slightly higher at 84 percent (NIS Vaccination Coverage Levels in Texas and U.S.). But most importantly, I can assure you: Improving the vaccination rate of young children for pneumococcal disease is resulting in decreasing disease and death in young children.
We hope that one of the outcomes of developing a state prevention plan will be to learn why more of our elderly adults and vulnerable young children are not fully vaccinated, and to identify areas of the state with low vaccination rates. Unfortunately, we have limited information on the vaccination of adults, so it’s essential we learn more about those who are at risk of severe illness from exposure to S. pneumoniae. This includes adolescents and adults younger than age 65 with chronic conditions like asthma or kidney disease, diabetes, or cancer or a cardiac condition. We must identify ways to ensure this population knows about the benefits of vaccination — particularly if they are uninsured. We are alarmed at the potential funding reductions in our state’s Adult Safety Net vaccination program, which could result in uninsured adults having less access to vaccination.
While Texas needs a complete state prevention plan for S. pneumoniae, we recognize that a collaboration of stakeholders now could bring immediate benefit. By gathering advocates, consumers, organizations, and individuals, we can begin identifying community-based and state vaccination and education resources, the educational needs of the target population, and clinical resources and developments. Texas’ large and diverse population presents a unique opportunity to bring together a diverse group to help develop prevention strategies for those who most need support to avoid becoming ill from pneumococcal disease.
We thank Representative Cortez for bringing HB 970 forward for your consideration, and we look forward to the opportunity to work with you on its implementation.
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