Other Vaccinations For Kids Have Declined

Wisconsin is falling behind in children’s vaccinations for a host of illnesses, and the state health department is urging parents and health providers to boost immunizations for kids to make up for lost ground.

To draw more attention to the need for more children to get all of their childhood shots, the Wisconsin Department of Health Services (DHS) is highlighting “national immunization week” this week and singled out a list of 18 Wisconsin clinics and other health providers that have gotten more than 90% of the 2-year-old children they serve the full round of vaccinations.

“You can’t raise [immunization] rates if you’re not giving vaccinations,” said Stephanie Schauer, manager of the DHS vaccination program. “There has been quite a bit of lost ground when it comes to childhood immunizations.” Schauer spoke with reporters in a Zoom call Monday.

Children up to the age of 2 receive a series of vaccines that protect against diphtheria, tetanus, pertussis (whooping cough), polio, measles, mumps, rubella, haemophilus influenzae type B, hepatitis B, varicella (chickenpox) and pneumococcal bacteria.

Rates for some childhood vaccines had started to plateau in 2018 and 2019, Schauer said, and the start of the COVID-19 pandemic in the late winter and early spring of 2020 “exacerbated some of those trends.”

In 2019,  72.1% of Wisconsin 2-year-olds received the full series of the standard vaccines for their age group, Schauer said. In 2020, that had dropped to 69.9% of 2-year-olds. “That seems like a relatively small dip,” Schauer said. But across the state, that could amount to “hundreds or even thousands of children not being fully up to date.”

Using the month of April as a reference for comparison, from 2015 through 2019 on average more than 102,000 vaccines were routinely given each year to Wisconsin 2-year-olds in that month.

In April 2020, early in the pandemic, only 67,000 of those vaccines were administered, a drop of about one-third. In that month a year later, the number rose to 87,000 — still more than 10% short of the pre-pandemic average.

DHS hasn’t finished compiling 2021 vaccination data. “I’m hoping that we’ll see improvements,” Schauer said. “But I think there still is a ways to go to catch up back to where we had been — and to go further. We really do need to be even higher than we have in previous years.”

Playing catch-up

While parents of children younger than 5 have been watching for the approval of a COVID-19 vaccine for that age group, it’s not clear when that will come. But in the youngest group eligible for that vaccine now, children ages 5 to 11, as many as three out of four haven’t started the series.

As a result, health providers are playing catch-up to ensure that routine vaccinations, such as for measles, mumps and rubella, are being given, as well as the COVID-19 vaccine for children who are eligible.

The pandemic itself likely kept families away from health providers, who in the first year often sought to discourage in-person visits when there was not an emergency. Parents may also have been reluctant to go to the doctor or take their children, for fear of exposing them or being exposed to the novel coronavirus, Schauer observed.

Later, as COVID-19 vaccines became available, vaccine skeptics and objectors were amplified in Wisconsin and elsewhere. Schauer said some of the opposition to vaccines appears to have extended to “routine childhood vaccines.”

But, she added, it’s not not certain whether that opposition is responsible for the decline in routine vaccines. Other barriers probably played a role, “whether it was having difficulty trying to find an appointment with a health care provider for routine services, or parents being reluctant to bring their kids into a health care provider during the last two years.”

The message that DHS wants parents to hear is that the standard vaccines for children have a long track record and have been monitored for decades. The current measles-mumps-rubella vaccine was licensed more than 50 years ago, Schauer said, and its two-dose regimen has been 97% effective.

After the first vaccine for measles was licensed in 1963, the incidence of that once-common childhood illness fell nationwide by 95%. “So the vaccines we are talking about in keeping kids up to date and healthy really continue to be shown to be safe and effective and continually monitored,” Schauer said. “That’s an important piece that I think parents need to hear about vaccines.”

How outbreaks happen

When fewer children are protected, diseases circulate more easily, Schauer said. In 2018-2019, a measles outbreak started in the U.S. when people lacking immunity brought the illness back from an overseas visit to communities with lower vaccination rates.

The episode shows how contagious measles can be. “Measles requires a high level of community immunity, whether that’s having had the disease [or having] been vaccinated to prevent the spread,” said Schauer. “It’s one of the most infectious diseases out there, bar none.”

In one site of the outbreak in New York, 77% of local school children were reported to be vaccinated. “Now that doesn’t seem very low,” she said. “But for measles, you really need to be somewhere in the upper 90s [percent] to really prevent outbreaks occurring in the community.”

Wisconsin escaped that outbreak, “but it could easily have happened here,” Schauer said. Vaccination rates for various illnesses vary from county to county in the state, with some counties as high as 90% and others lower than 60%.

“We really don’t want to go back to that pre-vaccine era, you know,” she said. In 1963, the year that the first measles vaccine was licensed, there were more than 68,000 cases of measles in Wisconsin and 19 deaths.

Spreading the word

To help increase the overall child vaccination rate in Wisconsin, DHS is launching a new campaign to reach expecting and new parents. The campaign will include information provided on the internet and sent to health care providers, including materials they can give parents about the importance of childhood immunization.

Raising the subject with parents and parents-to-be early can acknowledge they will have questions about vaccines and enable them to get answers in order to encourage them to get their children vaccinated, she explained.

DHS is also working with local and tribal health departments, encouraging them to employ strategies that they have used to encourage more people to get the COVID-19 vaccine, such as holding vaccine clinics in “non-traditional spaces” in the community and partnering with community groups to set up vaccination programs.

“Access is a big piece of what we’ve learned throughout the pandemic,” said Schauer.

DHS is also supporting the federal Vaccines for Children network, which has enlisted 720 health care providers, health departments and tribal clinics. The network provides free or low-cost vaccines for uninsured and underinsured children, as well as those covered by Medicaid or BadgerCare and those from indigenous groups including Alaskan natives and American Indians. Schauer said as many as 50% of the children in Wisconsin are eligible for the program.

“We don’t want families feeling that they can’t have their children immunized because of that financial risk or incurring significant costs,” she said.

Fewer Wisconsin kids get vaccinations, raising risk of outbreaks was originally published by the Wisconsin Examiner.

UPDATE: An earlier version of this article said children receive the vaccines starting at age two, they receive the vaccines in advance of turning two.