Originally published at the Wall Street Journal
Natalie Hayden is postponing vaccinations for her 15-month-old daughter because she fears her family could contract the coronavirus or another infection from a visit to their St. Louis pediatrician’s office.
Mrs. Hayden, whose immune system is compromised by medication she takes for Crohn’s disease, says she typically has her children vaccinated but is being ultra cautious about interactions outside of their home during the pandemic.
When Kimberly Beury’s 4-month-old daughter was due for a round of vaccinations early last month, the Princeton, N.J., mother initially thought the risk of going to the doctor’s office with her baby outweighed the benefits. It took a call from the pediatrician’s office to convince her that enough precautions would be taken inside the office—from temperature checks to mask-wearing requirements—to make it safe.
Both women believe in the value of vaccinations and in the past have kept their children on schedule. Now, however, many parents like them across the U.S., fearful of exposure to the coronavirus and other illnesses in doctors’ offices, are delaying vaccinations for their children that they would typically pursue.
Pediatricians say delays in immunizations for highly contagious diseases including the measles, rotavirus and whooping cough risk outbreaks of those illnesses as social-distancing orders lift.
The immunization rate for all recommended childhood vaccines declined about 40% in the U.S. from late February through mid-April, according to Physician’s Computer Co., a provider of electronic health-record systems. The data are based on vaccines administered by more than 1,000 pediatricians in 40 states who use PCC’s record system.
Apart from health concerns, some families that see the value of vaccinations have canceled appointments because parents lost their jobs and health insurance, pediatricians say.
Pediatricians across the country are experimenting with new safety measures within their offices in an attempt to limit the risk of infection from visits and persuade patients to return. They are designating office hours for well and unwell patients, barring siblings and more than one guardian from accompanying each child, and in some cases administering vaccines to patients in cars.
“It’s a huge amount of orchestration now” to deliver vaccines to patients who need them, said Dr. Andrea Hagani, chief executive of Pediatric Healthcare Associates in Fairfield County, Conn., adding that staying on schedule with immunizations is crucial.
When families get behind schedule, it means a child “does not have the full potential immunity to the disease until they are caught up, thereby making them susceptible to these infections for longer periods of time,” Dr. Hagani said. The person can also spread the illness during that time, she said.
Pediatric Healthcare Associates, which has five locations and 35,000 patients, requires all the children it sees to be vaccinated.
Its offices now screen patients over the phone and draw shots while patients wait in their cars. Staff then escort the patient and one caretaker—who must wear a mask—to an exam room to administer the necessary vaccines.
Dr. Laura Luzietti, medical director at Every Child Pediatrics in Colorado, said the organization’s visit volume initially dropped by about half, in part because patients put off vaccines.
“We can make this [pandemic] problem worse if we start to see the emergence of measles and stuff like that,” Dr. Luzietti said.
The Centers for Disease Control and Prevention publishes a recommended vaccine schedule for children and a catch-up schedule with the minimum time needed between doses.
Many parents take vaccines for granted because they have become so routine and effective that outbreaks of infectious diseases are fairly rare, pediatricians say. They warn that serious diseases such as the measles and polio haven’t been eradicated, just kept at bay by preventative shots.
Measles can lead to pneumonia, brain swelling and death. There were more than 1,200 measles cases reported in the U.S. last year, the most since 1992, with cases primarily among unvaccinated people, according to the CDC.
Children are typically vaccinated against more than a dozen diseases including polio, which can result in paralysis or be fatal; rotavirus, which leads to severe diarrhea and dehydration; and pertussis, known as whooping cough, which can lead to lung infections and death.
The pandemic has interrupted vaccination campaigns in developing nations, too, putting them at risk of new epidemics, The Wall Street Journal reported last month.
While children are out of school and social-distancing orders are in place, it’s less likely diseases will spread, pediatricians say, but as some states begin lifting restrictions unvaccinated children could quickly find themselves at risk.
Community Health Center Inc. in Connecticut said its staff makes 2,500 calls a day to patients about appointments for vaccines and chronic care.
“When one of the nurses is saying we need to get you in for this, they understand we’re being highly intentional about this visit,” said Mark Masselli, the organization’s chief executive. The group, with 150,000 patients, is first targeting the youngest patients who are behind on vaccines.
Ms. Beury in New Jersey said she realized after talking to a nurse that delaying her daughter’s four-month shots would mean pushing back subsequent rounds of vaccinations.
Her eventual trip to the doctor with her daughter late last month was “surreal,” she said. The doctor wore a mask and goggles, while Ms. Beury wore a mask and tried to use her tone of voice instead of a smile to reassure her daughter.
“If you’re a nonverbal four-and-a-half-month old, you’re looking at mommy’s face to get clearance—’Is this okay?’” she said.
The dangers of delaying or skipping immunizations stretch beyond the risk of near-term outbreaks. Vaccines for ailments such as human papillomavirus protect children from cervical, penile, anal and throat cancers longer term.
“The numbers will tell you it’s guaranteed that some American kid today is going to die in 10 to 20 years of HPV as a result of Covid,” said Chip Hart, director of pediatric solutions at PCC.
Some schools and athletic groups have begun relaxing physical-exam requirements in light of the pandemic, a trend some pediatricians say is concerning. Plus, with many summer camps closed, children may skip vaccines that would have been required to enroll.
Indiana High School Athletic Association Inc., a nonprofit, said earlier this month that forms for physicals from the 2019-2020 school year would be valid the following year, citing stress on the medical community caused by the pandemic.
Bobby Cox, commissioner of the IHSAA, said the decision was made “with considerable discussion and the support of” a branch of the Indiana State Medical Association that includes medical professionals across several disciplines.
Mrs. Hayden in St. Louis said she consulted with her family’s doctors to determine when to get her daughter vaccinated. The pediatrician created separate appointment spaces for well and unwell patients, but some families still bring sick children to the “well patient” office, her doctor said. The risk made Mrs. Hayden decide to put off until July the varicella and hepatitis B vaccines her daughter needs.
Mrs. Hayden said she doesn’t want her daughter to fall behind, but for now, “it just gives me more peace of mind to just keep her safe and not at the doctors and not coming down with something.”