COVID-19 plus measles? Kids aren't getting their vaccines, and doctors are worried

COVID-19 has infected some of Dr. Sonder Crane's youngest patients—the newborn who tested positive because its mother had the coronavirus, the 14-month old who caught it at day care.

Now, on top of that, she and other pediatricians across the country worry about this possible scenario: Outbreaks of preventable diseases, like highly contagious measles, because children have missed getting their immunizations during the pandemic.

Robert Redfield, director of the Centers for Disease Control and Prevention, cautioned last week that the pandemic coupled with the flu season could create the "worst fall, from a public health perspective, we've ever had" if people don't follow the CDC's COVID-19 guidelines.

"It's a concern because we're in the middle of a global pandemic and we're approaching the fall, cold and flu season," said Crane, who works at Children's Mercy West pediatric clinic in Kansas City, Kansas.

"We're going to start seeing people get sick from regular stuff. And if you throw in unvaccinated children, we're developing into other areas that could start other outbreaks, other pandemics.

"We've had outbreaks of measles, pertussis and whooping cough. I don't really want to go through that again. I don't think anyone does."

School districts, public health departments and pediatricians are prodding families to get caught up on those vaccines before kids go back to school in a few weeks. In North Carolina, the governor last week even extended the proof-of-immunization deadline to give families more time to get the required immunizations.

"As we navigate COVID-19, it remains essential for families to stay up-to-date on school immunizations," Jackson County Health Department Director Bridgette Shaffer said in announcing that the department would host traveling immunization clinics in eastern Jackson County to make them more accessible to families. The last one will be Sept. 11 in Independence.

The department reminded parents that Missouri law requires students to be up-to-date on their immunizations, and there are no plans "to provide extra time to get vaccinated." Kansas has no plans to do that either.

Health professionals have watched immunization rates drop across the country by as much as 40% to 50% since the beginning of the pandemic as parents—some because of stay-at-home orders, some out of fear—stopped taking their kids to the doctor.

A new national survey by Orlando Health found that while 84% of 2,000 respondents believe vaccines are the best way to protect their children from infectious diseases, two-thirds are still nervous about taking their child to the pediatrician for wellness visits because of COVID-19.

Immunization "is probably the most important preventive tool that we have as far as preventing the spread of contagious disease. So with or without a pandemic, that remains true," said Tracy Russell, executive director for the nonprofit Nurture KC, which promotes vaccinations through its Mid America Immunization Coalition.

"What we want is herd immunity to prevent the spread of disease. And, without that, you start seeing these contagious diseases creep back in that we have felt we had eradicated in years past."

The Orlando Health survey found 38% of parents who responded don't believe their children need all the vaccinations their pediatrician recommends.

The push to catch up

States typically track immunizations through the federally funded Vaccines for Children Program which distributes free vaccinations, through state health departments, to about 50% of children in the United States through age 18.

Doctors who participate have been ordering fewer doses through the program since the spring.

In Kansas, for instance, vaccine orders from January to July declined 21% compared to the same time last year. May was the worst month, with 24,688 fewer vaccine orders compared to May 2019, with orders picking up considerably by July, according to the Kansas Department of Health and Environment. (Missouri numbers were not available.)

Concerned that office visits had dropped off, the American Academy of Pediatrics launched a national #CallYourPediatrician campaign in May.

"Right at the beginning when we had closures and stay-at-home orders, our offices, as far as primary care offices ... we kind of stopped seeing well-child visits," said Wichita pediatrician Gretchen Homan, president-elect of the Kansas chapter of the American Academy of Pediatrics.

"We were seeing the younger kids, the babies, and under age 2, but the older kids, in the very early time of the pandemic ... were told to stay home and so we missed some of those regular appointments where we would normally vaccinate the elementary and older kids.

"So right now we're back open, full capacity. But we've changed the way we do things. We want to make sure that families understand our offices are redesigned to consider the safety recommendations of the pandemic, so it is definitely safe to take your child in for a well child visit."

All 50 states require specified vaccines for students, though all school immunization laws grant exemptions for medical reasons, and some states, including Kansas and Missouri, allow exemptions for religious reasons, according to the National Conference of States Legislatures.

Locally, districts require students to stay current on their immunizations whether they plan to take classes in person or from home.

"Even if the student is enrolled virtually, they could be participating in extracurricular activities that occur in-person or they may be virtual one semester and in-person the next," said Lisa Cox, spokeswoman for the Missouri Department of Health and Senior Services.

Students might not have all the required vaccinations by the time school starts if they are trying to catch up, since there is specific timing required between doses, said Cody Kennedy, spokeswoman for Olathe public schools.

But students are allowed to attend as long as they are as up-to-date as they can be, said Kennedy.

"No matter what kind of learning model families are choosing, whether it's going to be hybrid or stay-at-home or in-person, no matter what model you choose, all kids need to be fully immunized for school," said Homan.

"The schools have a process by which they go through and look at all the kids' records and make sure they're up-to-date with the school requirements.

"And then it does usually take some time, but they'll have conversations with families and identify anyone who is past due and encourage them to go and get their vaccine."

In the Shawnee Mission district school nurses "reach out to the families to make sure they catch up with the required immunizations," said spokesman David Smith.. "We generally find that our nurses are able to work with the families to get their kids caught up."

Get a flu shot, too

The Johnson County measles outbreak in 2018 is not far from pediatrician Jennifer Mellick's mind. She took care of some of those sick kids, some of whom spent time in quarantine.

It was the biggest measles outbreak in Kansas since 1990, set off when an infant who was too young to be vaccinated picked up the virus in Asia, then returned to a Johnson County day care. A separate outbreak kept the Kansas City Health Department busy on the Missouri side.

Even though the CDC declared measles eliminated from the U.S. in 2000, "there's an outbreak of measles somewhere in the United States every year," said Mellick, with Pediatric Partners in Johnson County. "And so if we see that waning immunity statewide and countrywide, we could potentially see a big outburst of it.

"Do we really need measles and COVID at the same time? I would go with no. Not like our health care providers don't have enough to deal with right now."

The hospitals don't need that added stress, either, something Nate Girard and others at the Mid America Immunization Coalition are thinking about. The bistate advocacy group works with health professionals and families in five metro counties—Jackson, Clay and Platte in Missouri and Wyandotte and Johnson in Kansas.

"If we were to see a resurgence of those diseases and those individuals were in the hospital, we're already seeing hospitals overloaded and their capacity sometimes struggling because of COVID," said Girard, the coalition's coordinator.

The coalition works to get metro area children and adults immunized. The pandemic forced the group to change plans to visit residents in the 500 senior living facilities in the area this summer to talk about adult vaccines, including flu, shingles and pneumonia.

"If you just look at the impact of COVID on those facilities in particular, it makes you realize how critically important it is that we're able to get that education out there," said Russell.

Orlando Health's survey found that 74% of parents across the country are more concerned about COVID-19 than the flu, but the health system stressed the importance of flu vaccinations for the whole family.

The CDC's Redfield also urged Americans to get a flu vaccine during his recent interview with WebMD's chief medical officer, John Whyte.

Redfield said 47% of Americans were vaccinated for the flu last year, and the CDC would like to boost that to 65%, noting that the federal agency has purchased millions of extra doses to distribute this fall.

"Please don't leave this important accomplishment of American medicine on the shelf," Redfield said. "This is a year that I'm asking people to really think deep down about getting the flu vaccine."

The Immunization Coalition has scheduled free flu shot clinics on the Kansas and Missouri side this fall, beginning Oct. 1 at Kansas City Kansas Community College.

"Certainly we've seen in the urban core more incidences of COVID as well as poorer outcomes, and I think anytime you add another disease on top of that—the flu, which we know is coming—it makes it even more important to convey that these services are available," said Russell.