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Vaccination of students is down. Can schools catch up?

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Wendy Hasson, a critical care pediatrician in Oregon, knows the tragedy that can happen to an unvaccinated child. As the nation reeled from the coronavirus pandemic, one of them young Portland patients missed vaccinations against bacteria that can cause meningitis. The child became dangerously ill and nearly died.

“These infections are rare but they can be particularly devastating,” said Hasson, medical director of pediatric ICU at Randall Children’s Hospital, recalling that the child suffered permanent brain and kidney damage and lifelong disabilities. “It’s a tragedy because the patient was previously a completely normal, healthy child,” she said. Parents are often eaten up with regret, she says.

Health officials worry about scenarios like this as students across the country, now returning to school, have fallen behind on routine school vaccinations during the pandemic. Families missed doctor’s visits and annual medical checkups. and some have never been vaccinated against diseases such as poliomyelitis, measles, whooping cough and diphtheria.

The toll of the pandemic is hard to dispute. In Virginia, statewide mandatory vaccination rates among kindergartners and teens dropped 10 percentage points between fall 2019 and fall 2021, to about 86%, according to state data. Officials attributed the decline to fewer visits from healthy children, months of virtual learning, fluctuations in kindergarten enrollment and other factors.

Arkansas saw vaccinations for children and teens drop more than 12% from 2019 to 2021. And in DC, more than 30% of students hadn’t met the requirements by mid-August, although the City officials believe the number is much lower due to complexities in record keeping. City health officials said they don’t have comparative pre-pandemic data “due to changes in reporting methods.”

California officials said in August that more than one in eight students in that state were behind on a required kindergarten vaccine — a vaccine against measles, mumps and rubella — after pandemic disruptions to daily life resulted in missed shots and vaccination delays. The state did not provide directly comparable data, but said one in 24 kindergartners missed one or more vaccinations in 2019.

Now, as schools open for the fall, efforts are being made to close the gap. Vaccination centers have been set up in school buildings. Automated letters and phone calls were sent to parents. Reminders were posted at bus stops.

“We are cautiously optimistic, but we also know that there is work to be done to ensure that children are caught up with vaccines, or in some cases they have not been vaccinated and that they are made. vaccinate,” said Georgina Peacock, director of the Division of Immunization Services at the Centers for Disease Control and Prevention.

Nationally, data from pandemic years on school vaccinations has lagged. But a sizable drop can be seen in the number of orders placed for a key federal vaccine program and other fall 2020 data, Peacock said.

Orders for the federal program for families in need – Vaccines For Children – fell 14% in fiscal year 2020, compared to the previous year, officials said. There was a partial rebound in fiscal 2021, but it was still 6% below pre-pandemic levels. For this year, through May, orders are 4% lower than in 2019.

More measles cases in five months than at any time since 1992

The CDC’s compilation of state and local data for 2020 showed a one-point drop in childhood vaccinations, but Peacock pointed out that even that change represents 35,000 kindergartners. That same year, she said, another 400,000 kindergarten children failed to show up to schools, leaving their vaccination status unclear.

“The pandemic has been a very big change and disruption to our society, and so this kind of drop in healthy child visits and therefore childhood vaccinations hasn’t been seen in this way in the past,” said Peacock.

States vary in vaccination requirements and in the types of exemptions they allowbut they often include injections to prevent poliomyelitis, chickenpox, hepatitis B and meningitis, as well as diphtheria and tetanus, as well as measles, mumps and rubella. In college, requirements may include vaccination to protect against meningitis, diphtheria, and tetanus. Several jurisdictions require vaccinations against HPV, which is linked to cervical cancer.

The coronavirus vaccination is not required at most schools – although DC requires it for students 12 and older.

National data shows that 60% of 12 to 17 year olds are fully vaccinated against the coronavirus, as are 30% of children aged 5 to 11. Vaccines for under-5s were first offered this summer.

The danger of not being vaccinated against important diseases emerged recently in Rockland County, New York, where a 20-year-old man contracted polio, sparking a wave of public health concern about this highly contagious and potentially fatal disease that causes permanent paralysis in approximately 1 in 200 infections.

Before that, measles outbreaks in 2019 caused similar alarm. More than 85% of cases in the first nine months of this year were associated with pockets of underimmunized people, including New York’s Orthodox Jewish communities, according to a CDC report. City officials have accused anti-vaccine groups of spreading misinformation.

Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and a voting member of the FDA’s Vaccine Advisory Committee, recalled that measles was the most contagious of vaccine-preventable diseases – finally eliminated in 2000 in due to school mandates. Decades later, with the coronavirus, mandates are mired in “culture wars,” making the issue much more complex, he said.

Pandemic has led to fewer teens being vaccinated against HPV, CDC says

Still, Offit said the country was slowly catching up with routine vaccinations delayed by the pandemic. “Are we where we were before this? Offit asked. “Not yet.”

Vaccinations for teens have taken a big hit, said Judy Klein, president of the nonprofit Unity Consortium, which campaigns on the issue. HPV vaccinations — recommended but not required in most states — fell 11% in fiscal year 2022, following declines in 2020 and 2021, she said. “HPV is essentially a cancer vaccine,” she said. “It’s not something that will appear tomorrow; it will appear in years.

In DC, where schools open Monday, students who show up without all their shots have 20 school days to come into compliance. Many jurisdictions have similar grace periods. Still, advocates worry that racial disparities in vaccination rates mean any exclusion would primarily affect black students.

Thomas Farley, senior deputy director of DC’s Community Health Administration, said that in the past few weeks the agency has sent 25,000 letters to parents of students missing their vaccines. Mobile teams organized vaccination days in schools with low vaccination rates. High schools with health centers offer injections.

Farley said he believed few, if any, students would be out of school. “Vaccination mandates have been used by every state in the country for decades,” he said. “They work. When parents are notified that your child must be vaccinated to go to school, they will have their children vaccinated. For those who are waiting for the last day, “they will have the possibility of going during the day, of vaccinate the child and come back”.

Maryland provided data showing that kindergarten vaccinations dropped 9 to 11 percentage points between the 2019-20 school year, when much of the school year was unaffected by the pandemic, and the 2020-2021 school year, a time when students learned the most from a distance. time. “It impacted vaccination reports,” state health officials said.

In Maryland’s largest school system, in Montgomery County, the vaccination non-compliance rate had reached 23% last September. After a flurry of catch-up efforts, the rate fell to 14% in December and then to 11% in the spring, said Mark Hodge, senior administrator of school health services at Montgomery. A few days before the start of the school year, an update was still being finalized.

Hodge said amid the turmoil of the pandemic, school nurses and other health care workers in schools were overwhelmed with covid-19-related responsibilities. “There just weren’t enough people to do all the covid stuff and do all the other stuff too,” Hodge said.