At the height of the coronavirus pandemic this spring, many families fearful of setting foot inside a doctor’s office avoided pediatric checkups. Physicians converted in-person visits to virtual appointments.
That fueled a sharp downturn in Connecticut’s immunization levels for vaccine-preventable diseases. Data show 39,140 fewer vaccine doses were distributed by the state Department of Public Health to medical providers in April – a 43% decrease over the amount circulated during the same month in 2019.
In May, 32,908 fewer doses were sent to doctors’ offices, a 34% drop. And in March, as COVID-19 began to spread in the state, 9,464 fewer doses were distributed, down 13% from the same month in 2019.
Physicians request the doses from the health department based on demand from patients.
“Some offices closed down totally. Some cut back on their hours, so access was a part of it,” said Mick Bolduc, vaccination coordinator for the Connecticut Immunization Program. “But I also think a major part of it was that parents were concerned about COVID-19 and they did not want to have their children going into provider offices.”
Connecticut is not alone. Across the country, immunization rates have plunged since the start of the pandemic.
Nationally, there was a 2.5 million drop in non-influenza vaccines ordered from the federal Vaccines for Children Program between Jan. 6 and April 19, according to a report by the Centers for Disease Control and Prevention. There also was a 250,000 decrease in the number of measles vaccines ordered during that period.
PCC, a pediatric electronic health records company, gathered vaccine information from 1,000 independent pediatricians nationwide. Using the week of February 16 as a pre-coronavirus baseline, PCC found that during the week of April 5, the administration of measles, mumps and rubella shots dropped by 50 percent; diphtheria and whooping cough shots by 42 percent; and HPV vaccines by 73 percent, the New York Times reported.
Doctors and health experts in Connecticut said that even as state and federal stay-at-home orders were issued, families were more likely to keep up with immunizations for infants than for older children.
“For the most part, the pediatricians did a great job of vaccinating the very young infants – the vaccines that are required for those at two, four or six months, which are so critical for the prevention of disease in that first year of life,” said Dr. Juan Salazar, the physician-in-chief at Connecticut Children’s Medical Center.
“There was a much more significant delay in vaccinating the older kids – the 4- and 5-year-olds, the 11- and 12-year-olds, and certainly, the 15- and 18-year-olds – because while those vaccinations are critical, there probably was less of a pressing need until we learned more about the pandemic,” he said.
But with Connecticut schools reopening for five-day school weeks in the fall, health experts hope families will vaccinate their children during the summer months.
“With the push to get schools open, it’s going to be very important to get the kids back in,” Salazar said.
Vaccinations begin to rebound
In June, the most recent month for which the state has data, the number of vaccine doses issued by the health department rose. The department distributed 90,366 doses – up by 32% over the number issued in June 2019.
Experts and physicians attributed the increase to families playing catch-up on shots they would have received during the winter and spring months. With the growth rate of COVID-19 cases and hospitalizations slowing down in Connecticut, some parents and their children have felt comfortable venturing back into doctors’ offices, and physicians have begun offering more in-person visits.
“The overall trend in the cases of COVID-19 going down makes parents a little bit more confident of going back into provider offices,” Bolduc said.
Medical practices are also taking precautions to put patients at ease. During the spring months, some offered drive-through vaccinations for children or arranged to have vaccines administered outside under tents.
As indoor appointments return, physicians are ensuring sick children who come in are separated from well children. In some cases, healthy children might be seen during different times of the day than sick kids, or they may be seen in different parts of the building.
Waiting areas in some offices have become obsolete. Patients sit in their cars until it’s time to meet with the doctor.
For Dr. Ryan Gorman, a family physician with the Trinity Health of New England Medical Group, in-person appointments resumed slowly.
When his Farmington office reopened last month, Gorman began by arranging virtual visits with parents to learn what vaccines their children needed. Then the families would pull up to the building and call to notify the doctor of their arrival.
“Rather than waiting in the waiting room, they are brought directly back to a room to get the immunization,” he said.
The state has not relaxed its requirement for children to be immunized before returning to school, so medical practices are preparing for an influx of patients in July and August.
“There have been no workarounds. It’s still going to be a strict requirement,” Gorman said. “So there are, in my practice, hundreds of people who will not be able to return to school until they’re immunized.”
Mandatory immunizations for school-age children include measles, mumps and rubella, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, and haemophilus influenzae type B, an infection that can lead to bacterial meningitis.
Declining vaccination rates had been a concern in Connecticut even before the coronavirus crisis.
Last fall, state health officials released data showing an increase of 25% in the number of students claiming the religious exemption to vaccinations.
The data show 134 schools at which fewer than 95% of kindergarteners received a measles vaccination in 2018-19, up from 102 schools a year earlier. The 95% threshold is recommended by the CDC to maintain herd immunity.
Lawmakers had been pushing a bill that would eliminate the state’s religious exemption, but the legislative session was suspended amid the pandemic. A brief special session is planned for this month, though legislators who had hoped to address the exemption issue now say police and voting reforms will take precedence.
Still, health officials are optimistic that vaccination rates will increase as the year goes on.
“With a concerted effort among providers – not just private physicians, but also community health centers, school-based health centers and local health departments – everyone’s doing their part to get these kids caught up,” Bolduc said. “We are confident we will be able to get them back on track.”