Childhood Vaccination Rates Drop Dangerously Low During the Pandemic

 

In March 2020, the US declared a national state of emergency to control the spread of coronavirus (COVID-19). Since then, the loud and consistent message has been to “stay at home” and to only visit the doctor if necessary. Public health officials now fear that the “stay-at-home” message has inadvertently caused another health crisis—a dangerous drop in childhood vaccinations.

This has left children at risk for measles, mumps, whooping cough, and many other vaccine-preventable diseases. Although vaccine-preventable diseases can be more deadly to children than COVID-19, parents are understandably focused on the threat at hand. Amid the COVID-19 pandemic, parents have avoided bringing their children to doctor’s offices for well-child check-ups at which time most vaccinations are given. Experts worry that we will see outbreaks of vaccine-preventable diseases if there continues to be a drop in vaccinations.

High rates of vaccination lead to herd immunity

The ideal rate of vaccinations is about 90-95%. As the number of vaccinated children grows, the spread of disease from one child to another is limited. This type of disease protection is called herd immunity (www.ismp.org/ext/490). The idea is you can live safely within the herd if enough of the herd is vaccinated. While not every single child may be vaccinated, a high rate of vaccination causes an entire group to be protected. Thus, vaccinated children can help protect the half million people nationwide who cannot be vaccinated due to allergies or other medical reasons. But as the vaccination rate drops, herd immunity protection may disappear, and outbreaks of vaccine-preventable diseases may occur.

Drop in vaccinations during the pandemic

According to the Centers for Disease Control and Prevention (CDC), a significant decline in childhood vaccination rates began in March, a week after declaring a national state of emergency. Comparing information from 2019 to 2020, the CDC found a dangerous decline in all (non-influenza) childhood vaccinations, including measles-containing vaccinations (www.ismp.org/ext/498). The decline was less noticeable among children 24-months or younger. This signals some success with an early CDC and American Academy of Pediatrics (AAP) recommendation to prioritize vaccinations for children 24 months and younger during the pandemic. However, the overall drop in childhood vaccination rates is concerning, and doctors are worried about vaccine protection for older children. One concern is that immunity will begin to wane in older children if booster shots are missed by 4- and 5-year-old children for diseases such as measles, mumps, and rubella, or missed by 11-year-old children for tetanus and whooping cough. It is unwise to get behind with childhood vaccinations, even for older children.

A company that provides pediatric electronic health records gathered information from 1,000 pediatricians across the nation and found that measles, mumps, and rubella vaccinations have dropped by 50% during the pandemic. Diphtheria and whooping cough vaccinations have declined by 42%. Human papillomavirus (HPV) vaccinations have declined by 73%. The first dose of the HPV vaccination is typically given to young adolescents (ages 11-12).

Childhood vaccination information from individual states also reveals a dangerous decline. For example, in Michigan, data from the state’s immunization information system show a decline in vaccinations for almost all childhood age groups. According to the health department in Massachusetts, vaccinations were down 68% during April compared to the previous year. Minnesota reported that doses of the measles, mumps, and rubella vaccine dropped by 71% toward the end of March. And, Washington state has already had its biggest measles outbreak in nearly 30 years.

Catch-up vaccinations

Early in March, the CDC, AAP, and the American Academy of Family Physicians urged parents and doctors to maintain vaccination schedules as rigorously as reasonably possible. So, if your child has missed a recommended vaccination due to the pandemic, work with your child’s doctor to bring them up to date. Doctors have been encouraged to identify children who have missed recommended vaccinations and to contact the parents to schedule appointments. But if you do not hear from your child’s doctor and you are uncertain about missed vaccinations, give them a call. Catch-up vaccinations are especially important as states develop plans for reopening. As “stay-at-home” and social-distancing messages become more relaxed, the risk of outbreaks of vaccine-preventable diseases increases among children who are not up to date on their vaccinations.

Your child’s doctor may safely offer catch-up vaccinations for children by:

· Scheduling vaccinations in the morning and sick-child visits in the afternoon to keep sick children away from healthy children

· Lowering the number of children on site at any one time

· Separating well children and sick children in different areas of the clinic or office, or using different treatment rooms for the check-up

· Using one office location for only vaccinations and well-child visits, and another for sick-child visits (if multiple office sites)

· Using separate locations in the community for vaccinations

· Having families wait in a car until an exam room is ready, after which a gowned nurse escorts the child in for the vaccination

· Vaccinating children in the car after check-in by phone

· Providing house calls

Also, some communities have set up vaccination tents in a park or field, are conducting vaccination clinics in parking lots, or are using vaccination mobile units in certain neighborhoods. Some hospitals have set up dedicated trailers or vans for well-baby check-ups and vaccinations in front of the hospital. You may also be able to get your child vaccinated at your local pharmacy (this varies by state).

You can still vaccinate your child if he or she has a mild illness, such as:

· A low-grade fever (less than 101 degrees Fahrenheit)

· A cold, runny nose, or cough

· An ear infection (otitis media)

· Mild diarrhea

However, children with moderate or serious illness—with or without fever—may need to wait until they are better. Ask your doctor or pharmacist if you are uncertain.

Conclusion

Now is the time to catch up on childhood vaccines when waiting rooms are still relatively empty. Do not get caught in a rush before school starts or before daycare centers reopen. Children may need vaccine documentation for school and college. Most vaccines take between 2 and 4 weeks before providing full protection, so plan ahead. The COVID-19 pandemic is a clear reminder of how devastating infectious diseases can be.

Created on July 27, 2020

Medication Safety Alerts

FDA Safety Alerts

Show Your Support!

ISMP needs your help to continue our life saving work