Health providers working to get Minnesota childhood vaccinations back on track post-COVID

ROCHESTER, Minn. — In 2020, as health care workers fought the spread of COVID-19, many people delayed routine medical care. Childhood immunizations were no exception.

For the 2019-20 school year, 92.85% of incoming Minnesota kindergartners were fully vaccinated against polio , one of the five required vaccinations to attend school at that age. For the 2021-22 school year, polio vaccine coverage dropped to 89.31%, and the other required immunizations for kindergartners experienced similar declines.

“And we saw an even bigger drop for the adolescent shots, the ones for seventh grade,” said Minnesota Department of Health epidemiologist Ben Christianson, referring to the meningococcal and Tdap vaccinations. Meningococcal vaccine coverage for seventh-graders dropped 8 percentage points between 2019 and today.

Minnesota’s decrease mirrors a worldwide trend.

“We’ve seen these rates of routine immunizations decrease worldwide,” Christianson said. “Because of that, we’re going to see more and more prevalence of these diseases.”

This drop in immunization rates has less to do with anti-vaccine misinformation — which proliferated as COVID-19 vaccines were developed and distributed — and more to do with delayed medical care.

“We didn’t see a large increase in families filing nonmedical exemptions,” Christianson said. “The biggest increase was just in students who fell in the ‘in-progress’ or ‘missing doses,’ so they just hadn’t either gotten the final doses for the series that they had started, or they hadn’t submitted that documentation to school.”

This pause in routine care during the pandemic is something that Dr. Robert M. Jacobson has noticed in his practice. Jacobson is a pediatrician and vaccine researcher at Mayo Clinic Children’s Center.

“The pandemic, early on, made it very hard for families to get in to see their providers,” Jacobson said. “As a result, we ended up having a lot of children who actually missed their appointments, and it was very frustrating that this happened.”

While a delayed start doesn’t impact most childhood immunization series, Jacobson said some vaccines like rotavirus have a time limit.

“You have to get the first dose in the first 14 weeks of life, and you have to get the last dose of this two-or-three-dose series by eight months,” Jacobson said.

For children who fell behind on their vaccination timeline, Jacobson said clinics like Mayo are taking several steps to help remind families and get them in to see a provider.

“We use every visit to vaccinate, and not just the well-child (visits). An acute visit for an ear infection, follow-up visit for a persistent problem with constipation, an injury at home or in daycare – we use that visit to vaccinate,” said Jacobson. “We use the moment when they’re here to get them vaccinated rather than ask them to come back later.”

Nurse-only appointments, which Jacobson said are more brief and easier to schedule, can also be part of a child’s immunization journey.

“Actually, our nurses have taken this on the road and often will show up in a community that has high rates of undervaccinated children and will vaccinate on a Saturday to get people up to speed,” Jacobson said.

This kind of health care outreach plays a crucial role in distributing flu shots. But, like with other immunizations, efforts to vaccinate kids against influenza were stymied by COVID-19. Nationally, the CDC found that flu vaccination coverage in minors dropped 5 percentage points between 2019 and 2020.

“Just with quarantine, we maybe had more kids sign up, but then the no-show rate was higher because on the day of the clinic, that child might have been in isolation or quarantine, or the school had switched back to distance learning,” said Tanya Edgar, nurse manager for Olmsted County’s school-age services program.

Jacobson says coordinating flu shot clinics for schools in and around Olmsted County takes a lot of time and effort — but those efforts build toward a larger goal.

“Society ends up saving money on medical care, as well as all of the costs associated with families having to stop what they’re doing and take care of children with medical problems,” he said. “Some of these vaccines prevent a lifetime of disability.”

Jacobson mentioned, in particular, the rubella vaccine, which prevents congenital rubella syndrome. A pregnant, unvaccinated person exposed to rubella could develop that syndrome, which can cause fetal deformities that lead to miscarriage or lifelong disabilities for the infant.

“The vaccine can be a tremendous financial resource to a community by preventing those tragedies and the downstream care that those tragedies result in,” Jacobson said.

“We’ve been lucky here in the United States that some of these diseases, polio and measles, it’s been many decades since we’ve had large numbers of cases of these diseases,” Christianson adds. “Immunizations are the reason for that and really are one of the No. 1 public health prevention strategies out there to help protect the health and safety of children.”

Jacobson’s takeaway for families: Even though they’re not required for school, the COVID-19 and flu vaccines are routine childhood immunizations.

“I like to make sure parents know the COVID and flu vaccines are just as routine as the diphtheria, tetanus, pertussis and polio vaccine,” he said. “I want parents to do it because it’s right for their child and not because it checks off some box.”