Immunization rates drop during COVID-19 pandemic

Public health officials fear avoidance of doctors could lead to outbreaks of other diseases

Leah Russin’s daughter was born at the Palo Alto Medical Foundation shortly after the shelter-in-place order went into effect in March. There, the newborn received her first dose of the hepatitis B vaccine, protecting her against the viral infection that may lead to chronic liver disease and liver failure.

Russin’s daughter was supposed to go for a routine checkup in May where she would to receive a second dose of the hepatitis B vaccine, along with vaccinations against diseases like polio, pertussis, also known as whooping cough, and haemophilus influenzae, which can lead to ear, eye or sinus infections. But the spread of the coronavirus in the Bay Area had her wondering if they should skip the appointment.

“We had a lot of questions about whether it was safe to go to the office versus staying home,” said Russin, executive director of Vaccinate California, an advocacy group run by volunteers. “What was the right thing to do? I talked to our family pediatrician. We determined together that the right thing to do was to come in and make sure that the doctor got to see her.”

Many parents in the Bay Area share Russin’s concerns of taking their children to the clinic during the pandemic. While some, like Russin, have decided to keep coming in for checkups and immunizations, others have stayed away from clinics.

As a result, the number of vaccinations given to children (infants through 18 years old) in the state plunged by more than 40 percent in April compared to the same month in 2019, according to the California Department of Public Health.

Randy Bergen, a pediatric infectious disease doctor at Kaiser Permanente Northern California, said he is most concerned about outbreaks of measles and pertussis, which require a high rate of immunity in the community to prevent spreading from person to person. And clinicians also worry about the spread of the flu.

“As we move into the flu vaccine season, we’re definitely worried that there’s also not going to be as much of an uptake of a flu vaccine because people are going to be worried about coming to the medical centers,” Bergen said.

Gena Lewis, a pediatrician and the associate director of the UCSF Benioff Children’s Hospital Oakland Primary Care clinic, cautioned that an outbreak of a flu in the fall and winter during the coronavirus pandemic would spell even more challenges. Unvaccinated children are more likely to spread the flu to adults and seniors who are at a higher risk of life-threatening complications from the flu, Lewis said.

“The No. 1 health improvement that we as a human species have accomplished is vaccines. That’s why so many of us are able to live a longer life,” she said. “Several generations ago, it was not uncommon for children to die of measles, and pertussis or whooping cough. It’s so important for kids to continue to get those vaccines. Those diseases still exist. They still circulate in the community. And with people not getting vaccinated, there will be more of those diseases.”

While infections of pneumococcal and haemophilus influenzae diseases have significantly decreased over time, Bergen added, clinicians are also concerned that the diseases may return if the low rate of vaccination persists.

The UCSF Benioff Children’s Hospital Oakland Primary Care clinic has taken steps to ensure a safe environment for families, Lewis said. Staff wear masks and face shields. Patients are screened at the front door. Children who are ill are directed to a different floor. And others who are healthy and have a well-check visit are brought to the exam room from the front door to avoid potential exposure to COVID-19 at the waiting area.

During the first two weeks of the shutdown, Lewis said the clinic instructed patients to avoid coming in until clinicians figured out how to create a safe environment. But after two weeks, the clinic implemented prevention procedures and told families that it was critical for them to come in to receive health care.

While the number of patients visiting the clinic has since increased, Lewis said there are still roughly 10 to 15 percent fewer patients compared to before the coronavirus.

The California Immunization Coalition, an advocacy group, has launched campaigns to promote vaccination during the COVID-19 pandemic. According to Catherine Flores Martin, executive director of the coalition, parents may think that their children do not need to be vaccinated since they are learning from home, devoid of physical contact with their classmates.

But state law still requires students to be immunized against certain diseases including measles, mumps and pertussis. And the state has not changed immunization requirements for schools during the pandemic.

“[San Francisco Unified School District] continues to support students and families, and collaborate with community clinics, to ensure all students are up to date on required immunizations for school, even during distance learning,” Laura Dudnick, spokesperson at SFUSD, wrote in an email.

Russin’s son in first grade has received all vaccinations recommended by health experts, including those required under state law. She said she and her family will soon get their flu shots as well.

“The only place where you are certain to receive real evidence-based medical information is from a medical professional,” Russin said. “Call your doctor. Ask about COVID protections. And ask about which vaccines are appropriate right now.”

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