By Kate Ruder, Kaiser Health News
WESTMINSTER — Melissa Blatzer was determined to catch up with her three children on a recent Saturday morning at a walk-in clinic in this suburb of Denver with their routine vaccinations. It had been about a year since the children’s last shots, a delay Blatzer attributed to the pandemic.
Two-year-old Lincoln Blatzer, in his fleece dinosaur pajamas, waited anxiously in line for his hepatitis A vaccine. His siblings, 14-year-old Nyla Kusumah and 11-year-old Nevan Kusumah, were there for their TDAP, HPV, and meningococcal vaccines, plus a COVID-19 shot for Nyla.
“You don’t need to make an appointment, and you can take all three at once,” says Blatzer, who lives several miles away in Commerce City. That convenience outweighed the difficulty of getting everyone up early on a weekend.
Child health experts hope that community clinics like this one, along with the return to face-to-face classes, more visits to good children, and the introduction of COVID shots for younger children, can help boost routine vaccinations among children, who are given during the pandemic have declined. Despite an uptick, immunization rates are still lower than they were in 2019, and differences in rates between racial and economic groups, especially for black children, have worsened.
“We’re still not back where we need to be,” says Dr. Sean O’Leary, an infectious disease pediatrician at Children’s Hospital Colorado and a professor of pediatrics at the University of Colorado School of Medicine.
Routine vaccinations protect children against 16 infectious diseases, including measles, diphtheria and chickenpox, and inhibit transmission to the community.
The introduction of COVID shots for younger children is an opportunity to catch up with routine vaccinations, O’Leary said, adding that children can get these vaccines together. Primary care practices, where many children are likely to receive the COVID injections, usually have other childhood vaccines on hand.
“It’s really important that parents and caregivers work together so that all children are aware of these recommended vaccines,” says Dr. Malini DeSilva, an internist and pediatrician at HealthPartners in Minneapolis-St. Paul area. “Not just for the health of the child, but also for the health of our community.”
People were reluctant to undergo routine immunizations at the height of the pandemic, said Karen Miller, an immunization nurse manager for the Tri-County Health Department in Denver, who ran the Westminster clinic. National and global data confirm what Miller saw on the spot.
According to a recent study by scientists at the Centers for Disease Control and Prevention, the World Health Organization and UNICEF, global childhood vaccination rates fell from 2019 to 2020. Reasons included reduced access, lack of transportation, concerns about exposure to COVID and interruptions in the supply chain, the study said.
The third doses of the diphtheria, tetanus and pertussis vaccine (DTP) and polio vaccine fell from 86% of all eligible children in 2019 to 83% in 2020. Worldwide, 22.7 million children had their third dose of DTP, according to the study. in 2020, compared to 19 million in 2019. Three doses are much more effective than one or two at protecting children and communities.
In the United States, researchers examining 2019 and 2020 data on routine vaccinations in California, Colorado, Minnesota, Oregon, Washington and Wisconsin found significant disruptions in vaccination coverage during the pandemic that lasted through September 2020. For example, the percentage of 7-month-old babies who were up to date with the vaccinations dropped from 81% in September 2019 to 74% a year later.
The proportion of black children informed about vaccinations in almost all age groups was lower than that of children in other racial and ethnic groups. This was most pronounced among those who turned 18 months old: Only 41% of black children of that age received vaccinations in September 2020, compared with 57% of all children aged 18 months, said DeSilva, who led that study.
A CDC study of data from the National Immunization Surveys found that race and ethnicity, poverty and lack of insurance caused the largest differences in vaccination coverage, and the authors noted that additional efforts are needed to counteract the disruptions of the pandemic.
In addition to the problems caused by COVID, Miller said, competing life priorities such as work and school hinder families from keeping up with the shots. Weekend vaccination clinics can help working parents give their children routine vaccinations while they receive a flu or covid shot. Miller and O’Leary also said reminders by phone, text or email can boost vaccinations.
“Vaccinations are so effective that I think it’s easy for families to put vaccinations on the back burner because we don’t hear about these diseases very often,” she said.
It’s a long and tedious list that includes hepatitis A and B, measles, mumps, whooping cough, polio, rubella, rotavirus, pneumococci, tetanus, diphtheria, human papillomavirus, and meningococcal disease. Even a small drop in vaccination rates can lead to outbreaks. And measles is the perfect example of concern to experts, especially as international travel opens up.
“Measles is one of the most contagious diseases known to mankind, which means we have to maintain a very high vaccination rate to prevent it from spreading,” O’Leary said.
In 2019, 22 measles outbreaks occurred in 17 states in mostly unvaccinated children and adults. O’Leary said outbreaks in New York City were under control because surrounding areas had high vaccination rates. But an outbreak in an undervaccinated community could still spread beyond borders, he said.
In some states, a significant number of parents were against routine childhood vaccinations for religious or personal reasons even before the pandemic, posing a new challenge for health professionals. For example, 87% of Colorado preschoolers were vaccinated against measles, mumps and rubella during the 2018-2019 school year, one of the lowest rates in the country.
Those rates rose to 91% in 2019-20, but are still below the CDC’s target of 95%.
O’Leary said he doesn’t see the same hesitation for routine immunizations as he is for COVID. “There has always been a hesitation about vaccines and vaccine refusals. But we have maintained vaccination coverage above 90% for all routine childhood vaccines for quite some time,” he said.
Malini said the “ripple effects” of missed vaccinations continued earlier in the pandemic into 2021. When children returned to face-to-face learning this fall, schools may have been the first place families learned about missed vaccinations. Individual states set vaccination requirements and allowable exemptions for access to schools and childcare facilities. Last year, Colorado passed a school-entry immunization law that tightened the exemptions allowed.
“Schools, where vaccination requirements are generally enforced, have been stretched for a variety of reasons, including COVID,” O’Leary said, adding that managing vaccine requirements may be more difficult for some, but not all, schools.
Anayeli Dominguez, 13, was at the Westminster clinic for a TDAP vaccine because her high school had noticed she was not up to date.
“School nurses play an important role in identifying students who need vaccinations, as well as connecting families to resources, both within the district and in the wider community,” said Will Jones, spokesperson for Denver Public Schools.
Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.