ST. LOUIS — While the pandemic has left many children across the country behind on their required immunizations, the problem appears even more pronounced in Missouri.
Nationwide, amid COVID-19 concerns and lockdowns in the spring and summer of 2020, millions of children across the U.S. missed routine doctor appointments and their scheduled vaccinations.
The latest federal data shows many have since caught up: The immunization rate among kindergarteners for the 2020-21 school year lagged slightly behind what it was the year prior, dropping from to 94% from 95%. That translated into about 35,000 more children entering school without protection from highly contagious diseases.
The national data looked at the measles, mumps, rubella vaccine; the tetanus, diphtheria and whooping cough vaccine (DTaP); and the chicken pox vaccine. The nation’s target is a 95% immunization rate.
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In Missouri, data shows rates fell even more than the national average — and haven’t recovered. The latest data from the 2021-22 school year shows just 91% of kindergarteners were caught up on the same shots, down from 94% two years prior.
“Basically we’ve been playing catch-up for two years now,” said Dr. Kendra Holmes, president and CEO of Affinia Healthcare. “There are many children who have missed their checkups and their recommended vaccinations over the past two years as a result of the pandemic.”
Dayson Anderson, 4, gets his shoes tied by his father, Roderick Mondaine, on Saturday, July 30, 2022, before a physical and immunizations as his mother, Dominique Anderson, watches at Affinia Healthcare's Medical and Dental Community Day for Children at its headquarters in St. Louis' Carr Square neighborhood. Pandemic-related conditions have contributed to many children being behind on required shots.
Holmes said the recent historic flash flooding that hit the St. Louis metropolitan area also challenged parents in getting kids ready to head back to class.
“I think a lot of parents thought they had a little bit of extra time to get them vaccinated and get their physicals done prior to school starting, but now they have this additional challenge of having to clean up homes and to rebuild,” she said.
Missouri also requires kindergarteners to have the polio and hepatitis B vaccines, which showed immunization rates of just of 92% and 94% respectively, compared with 95% and 96% two years ago.
Rising exemptions are also partly to blame. Missouri data shows 2.7% of kindergarteners received a religious exemption from immunization requirements last school year, up from 2.3% the year before. Five years ago, it was 1.9%.
Missouri also tracks rates for eighth graders, which the state requires to start the year with an additional vaccine similar to DTaP and a meningococcal vaccine. From the 2019-20 school year to the last school year, the rates for both those vaccinations dropped from 95% to 91%, data shows.
The return of preventable diseases
Doctors and health officials fear diseases that have become rare because of widespread vaccinations could reemerge among pockets of the unvaccinated and put other vulnerable populations at risk.
“More important than simply being a requirement for attending public school, routine vaccination prevents infectious diseases that caused death or severe disabilities for many generations,” said Sara Evers, acting director of the St. Charles County Department of Public Health.
“When vaccination levels decrease, these preventable diseases can and do return, as we’ve seen with measles and mumps outbreaks in recent years,” she said.
Measles is so contagious that it requires a 95% immunity rate in a community to avoid an outbreak, according the U.S. Centers for Disease Control and Prevention.
Measles was declared eliminated in the U.S. in 2000, but 2019 saw the greatest number of reported measles cases since 1992. About 10% of those who get measles must be hospitalized.
In July, the U.S. saw its first case of polio in nearly a decade in an unvaccinated New York man.
Vaccinations have also plummeted worldwide, according to the World Health Organization. Some 25 million children missed out on vaccination in 2021, 5.9 million more than in 2019 and the highest number since 2009.
Dr. Jason Newland, a Washington University pediatric infectious diseases specialist at St. Louis Children’s Hospital, said worldwide infection rates also increase one’s risk locally.
“If there’s anything we’ve learned with COVID-19 is that we are one world,” Newland said. “Someone somewhere else can easily bring a vaccine-preventable infection like measles to an area, and if you have bunch of unvaccinated people, you can see a measles outbreak.”
Newland said the reasons U.S. children are reporting lower vaccination rates are not entirely clear yet. Some fear that skepticism surrounding the COVID-19 vaccine has come into play.
“So people have said, ‘Well, I’m not sure about that (COVID-19 vaccine),’ which then led maybe some to say, ‘Well I’m not so sure of some of these other routine vaccines,’” Newland said. “That’s not proven, but that is definitely a concern, and it makes sense to all of us that that might happen.”
In Missouri, federal data shows nearly 61% of the population older than 5 are fully vaccinated against COVID-19. The COVID-19 vaccine was approved in June for those younger than 5, to as young as 6 months.
‘It has to be about community’
Health officials say they are trying to get kids caught up, offering back-to-school clinics and extended hours.
Affinia, with clinics serving families with public health insurance across St. Louis, has been ramping up outreach efforts since January by offering expanded hours on Saturdays and making calls to those who have not been in for appointments, Holmes said.
“We have what we call navigators who actually reach out to those parents who may not at that point be engaged in the health care system at all and call them, get their transportation set up so they can get back into the health center and get those kids vaccinated,” she said.
Holmes said she is actually seeing families become more confident in vaccines overall as the safety and effectiveness of COVID-19 vaccines have been proven over time in reducing hospitalizations and deaths. For those still unsure of the benefits, Holmes said she asks them to consider others.
“That is something I constantly stress,” she said. “Maybe your child will be fine, but what about that child who is immunocompromised or has chronic asthma or some condition where they are vulnerable and they are at risk?
“At some point, it has to be about community and not just our own individual children or our own individual selves. That’s what vaccination is about: keeping the entire community and your child healthy.”
