Vaccine rate drop is 'huge concern' for pediatricians during pandemic

Doctors want parents to know they have made important accommodations in their offices to minimize the risk of catching the virus.

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/ Source: TODAY
By A. Pawlowski

As parents and pediatricians try to figure out how to keep kids healthy during a pandemic, immunization may be one of the victims of the coronavirus.

More than 117 million children in 37 countries may miss out on receiving the measles vaccine because of the “challenging period” created by the outbreak, the Measles & Rubella Initiative said in a statement this month.

Pediatricians in the U.S. are reporting a drop in immunizations, too.

During the week of April 12, the number of MMR (measles, mumps, and rubella) shots given to kids dropped by 40% compared to the week of Feb. 16 when COVID-19 was not yet widespread, according to PCC, a Vermont company that develops medical record software for pediatricians.

Those figures don’t measure how many kids are overdue for their first dose of MMR, “the real red alert number,” said Chip Hart, director of PCC’s consulting wing. Children should get two shots of the vaccine.

Skipping the measles vaccine is of particular concern because the highly contagious disease has made a comeback in recent years.

DTaP (diphtheria, tetanus and pertussis) shots dropped by 24% and HPV shots by 62% during the same time period. The data, which was gathered from about 1,000 independent pediatricians in 40 states, actually showed a “significant improvement” over the previous four weeks, Hart noted.

There’s a lot of hesitancy among parents who wonder whether they should delay their kids’ immunizations and well visits during the outbreak, said Dr. Christina Johns, senior medical adviser for PM Pediatrics, which runs urgent care practices across the country.

“It is a huge concern for me as a pediatrician, especially as an acute care pediatrician who takes care of sick children only. If we are not smart now about making sure that kids stay on schedule in terms of getting their immunization, we may be inadvertently creating another public health problem just as we’re trying to manage this one,” Johns told TODAY.

“That would be seeing vaccine-preventable diseases in one year or two years down the road if we have a whole cohort of children who are delayed on their immunization schedule.”

Given that COVID-19 does not appear to affect children as badly as it does adults, many vaccine-preventable diseases could be even more dangerous for children than COVID-19, said Dr. Claire McCarthy, a primary care pediatrician at Boston Children's Hospital.

Hopefully, the drop in vaccination rates will be temporary, she added. It's also important to remember that it's not just vaccines that shouldn't be skipped.

"We are worried about children with illnesses, injuries or chronic health conditions who need medical attention but aren't getting it because their families don't want to risk going to the doctor," McCarthy said.

"Untreated or under-treated conditions can lead to serious consequences."

Some practices closed or weren’t scheduling well visits for children at the start of the crisis. But many parents don’t know pediatricians’ offices have since made important accommodations to minimize the risk of catching the virus, Johns said. They're trying to get the word out that it's OK to come in.

The new precautions may include:

  • Scheduling well visits in the morning and sick visits in the afternoon so that healthy kids can safely come during the early hours after an overnight extensive office cleaning.
  • Splitting areas of the clinic so that patients who are sick are treated in a different part of the practice than patients coming in for well visits.
  • Asking people to call and wait in their cars as they arrive for their visit so that they can be taken straight to an exam room when it’s ready, thereby avoiding a waiting room, Johns noted.
  • Staggering appointment times so that people aren't clustered together.
  • Administering vaccines in the parking lot, Hart said.

Well-child care should occur in person whenever possible, with doctors encouraged to prioritize newborn care, and well visits and immunization of infants and young children through the age of 2 whenever  possible, the American Academy of Pediatrics said in its guidance this month.

It’s important to stick to vaccine schedules because many immunizations require a series of shots in order for a child to be fully protected against a particular illness.

“Many of them, it’s not just a one and done. There’s a specific interval that is given very intentionally as a reminder to your body of what that infection is so that you develop that full way to fight against it,” Johns said.

If the series hasn’t been started yet, it’s possible to delay the shots, she added.

The Centers for Disease Control and Prevention offers a catch-up immunization schedule for children who start late or who are more than one month behind.

Both Johns and McCarthy encouraged parents to call their pediatrician's office to find out the next best steps to take.

"I don't want to see the kids who are presenting into my emergency department with acute measles encephalitis and some of those complications," Johns said.