Pandemic-Related Drop in Childhood Vaccinations Concerning

Childhood vaccination rates are dropping across the country. This decrease has nothing to do with concerns or beliefs about the vaccinations themselves. Instead, the lower vaccination rate is largely due to a drop in available doctor or clinic appointments and parental fear of COVID-19 affecting their children. This is concerning because a reduction in vaccination rates could result in bursts of disease activity in addition to the current COVID-19 pandemic. Childhood diseases like measles, can cause serious complications, including sepsis.

Vaccinations already lower in the U.S.

According to a report issued by the Centers of Disease Control and Prevention (CDC), vaccination rates for children in Michigan dropped by over 20% over the past two months. While this report focuses on one state, other states are showing similar vaccination rates. Unfortunately, the number of children receiving vaccinations for largely preventable diseases was already dropping due to parental resistance to vaccines. Last year this led to serious hotspot outbreaks of measles throughout the country. The U.S. almost lost its status of  having eliminated measles as a result. The fact that even more children will be unvaccinated due to pandemic fears could result in an even higher increase in childhood diseases in addition to COVID-19 infections and the upcoming seasonal influenza.

How we know vaccination rates are dropping

A program called the Vaccines for Children Program (VFC) provides federally funded vaccines to about half of the children in the country. They noticed a decline in vaccine orders already during the week of March 16^th, just after the U.S. declared a national emergency to try to control the spread of the novel coronavirus that causes COVID-19.

According to an article in the New York Times, published on April 23, 2020, an electronic health records company collected information from pediatricians across the country. The doctors reported:

• A 50% drop in MMR (mumps, measles, rubella) vaccinations
• A 73% drop in HPV (human papillomavirus) vaccination
• A 42% drop in vaccines for diphtheria and pertussis (whooping cough)

Not unique to the U.S.

Although these reports focus on the U.S., the country is not the only one experiencing the vaccination decline. Many countries have stopped certain vaccination programs altogether. These include mass polio and measles campaigns. This will have a severe effect in parts of the world that are already struggling with health care. Twenty-three countries have stopped their measles vaccination program and others are still deciding. Experts estimate that 78 million children will miss the immunization.

Polio still has a grip on some parts of the world. Politics and wars have already had an impact on the number of children who were immunized. Now with the pandemic, The Global Eradication Initiative (GPEI) issued a call for immunizations to be held off for at least the first 6 months of 2020. This is concerning because not only will many more children will be exposed to the disease, but the virus may then spread to countries that had eradicated it, that no longer see polio

Keeping the vaccination schedule

Currently, most children in North America receive several regular vaccinations within the first two years. Regular boosters and a few new vaccines follow later in childhood. According to Ashanti W. Woods, MD, a pediatrician at Mercy Family Care Physicians in Baltimore, MD, the well-baby appointments that include vaccines occur at 2, 4, 6, 12, 15, and 18 months. “The next time you get shots after 18 months is when you turn 4,” he explained. By delaying these vaccinations, the schedule is thrown off. The unvaccinated children may become exposed to these illnesses when they would typically be immune.

“But baby is staying inside anyway.”

Parents who choose not to bring their infants for well-baby checks and routine vaccines may argue that since they are locked down or confined, their child will not be exposed to other viruses either. “ I actually agree with the parent,” Dr. Woods said.

“I say, you’re absolutely correct. You’re not going out, so as of now, while you’re quarantined, you’re right. You are protected against, X, Y, and Z illness.” He also pointed out though, that as the country moves out of isolation, parents can’t always guarantee the health of people the child comes in contact with. “So, while Mom and Dad have baby at home, they’re absolutely correct that, there’s a great chance baby is at lower risk of being exposed to something as opposed to if they were in their daycare or in school. However, as restrictions ease, as Mom and Dad move around a little bit more whether it’s to work or going to the grocery store, the baby’s risk increases little by little, and baby is still going to need his or her vaccines.”

Doctor’s offices can play a role in increasing vaccinations again

Dr. Woods believes that it is up to the pediatricians and clinics to help parents and guardians feel secure enough to bring their children in for vaccines. “It’s going to start with the medical side of things, the medical staff, the pediatrician’s office, and the health department,” he said.

“We’re going to have to recognize that families are going to feel this way.” For the time being, Dr. Woods’s office is only seeing patients who are 2 years and younger,  and only for well appointments and vaccines. “In other words, kids who are older than 2 or kids who were sick and who would traditionally be coming in for their runny nose, pinkeye or strep throat, we’re not seeing those patients in office. We’re offering care to them by telehealth, but we’re not physically seeing them in the office.” The staff can tell families of vulnerable children that they have a clean clinic. “The clean clinic simply means anybody coming through the door is healthy, not sick, they’re under 2, and they’re here for the same reason that you’re here, which is to get some vaccines.”

Other accommodations include families waiting in their car instead of the waiting room, only one parent/guardian with one baby, and removing toys from the waiting room. Since the appointment is only for the well baby check and vaccination, the whole process is quite quick, Dr. Woods pointed out. “This ultimately allows your child to get their vaccines, stay on time with their vaccine schedule and with minimal exposure to your child and to you, the parent. Because parents don’t want to get exposed to this stuff, either, right?”

What about older kids and their vaccinations?

Dr. Woods and other pediatricians are vaccinating children 2 years and younger, but what about the older children who are also due for inoculations? Dr. Woods explained that after age 18 months, the next time a vaccine is due is at 4 years. His office is planning to start bringing in these children this month. “Have we missed some kids who turned 4 years of age, and they haven’t gotten their vaccines? The answer is, yes.” But it’s important to realize that 4-year-olds have some immunity from the earlier vaccinations. “All the shots that you’re getting at 4 years of age are vaccines that you’ve had before. These are your boosters,” Dr. Woods said.

Ask questions

If you are unsure about bringing your child to the doctor’s office or clinic, there are questions you can ask that may help set your mind at ease. For example, ask about the extra precautions the office is taking to protect everyone, including you and your child. You can ask about alternatives if you really don’t feel comfortable – what does your pediatrician suggest. If you don’t feel comfortable with the answers, you could see if there is another doctor who you might transfer to.

Infection prevention – and ultimately sepsis prevention – relies heavily on vaccinations for preventable illnesses for both children and adults. If you’re concerned about this preventative care during the pandemic, speak with your doctor and see what options are available.

To learn more about the different types of infections and illnesses that can either cause sepsis or raise your risk for contracting infection, visit the Sepsis and… library.