Q&A: AAP president concerned about pandemic-related drop in vaccination rates
According to data from PCC, an independent firm that provides pediatric electronic health records software, pediatric vaccinations are down as a result of the COVID-19 pandemic.
From Feb. 16 to April 12, there was a 19.8% decrease in DTaP vaccinations, a 29.1% decrease in MMR vaccinations and a 40.2% decrease in HPV vaccinations, according to data provided by PCC. The decline in vaccination rates was first reported by The New York Times.
Healio spoke with AAP President Sara H. Goza, MD, FAAP, about the impact that the pandemic is having on vaccination rates and the care of pediatric patients. In a recent letter to HHS in which she requested emergency funds to help keep pediatric practices open, Goza noted the critical role pediatricians play in vaccinating children. – by Ken Downey Jr.
Question: How concerned are you?
Answer: This has really been on our mind since we started seeing the numbers of patients drop in the office because this is the time of year that we as primary care pediatricians would see a lot of check-ups for camp physicals, school physicals and then just the ongoing visits from children needing their vaccines. As we see those numbers drop, we know people are not coming in for their check-ups. It’s hard because they are scared, and we've been telling them to stay home, that it's not safe to go out and all of that. We’re trying to make sure that people understand that those check-up visits are still so important for a lot of different reasons. If you're seeing a 40% to 50% drop in the number of patients coming to your office, you're going to see probably a corollary drop in vaccines close to that.
We [have seen anecdotal data that] there was about a 40% to 50% drop in the last month in the number of vaccines. We have been concerned.
Q: How should pediatricians be counseling parents about vaccinations?
A: I think that we have been doing the same counseling that we have always done. In studies, vaccines are always safe and effective. They save lives, which is kind of our mantra. If we see the number of vaccinations drop around the country and even around the world, that means that people are more susceptible to those diseases. So, it's even more important for people to get those vaccines. We know measles is rampant around the world, including outbreaks in the United States. Whooping cough is another one; our babies could get that if people aren't vaccinated. And we have vaccines for meningitis for children under 2 years of age; if those children aren’t getting vaccinated they could be more susceptible to those infections as well. I find that in the day before those vaccines were out, we used to do a lot of admissions for what we call rule-out meningitis, and I really don't want to go back to seeing that happen.
Q: Should parents still be scheduling well visits for their children?
A: Because every community is different as to where they are in this pandemic, my recommendation to parents is if their children are due for a well visit, call their pediatrician’s office and see what they're doing — whether they are doing virtual visits; or bringing them in for vaccines; whether they're still seeing patients in an office and having different sides for sick and well patients; whether they're doing well visits in the morning and sick visits in the afternoon. Pediatricians have been very innovative in trying to do what we can to make sure that we have [situations] where we to make sure we have offices where we don’t mingle sick and we’ll children, so I would recommend that parents call their pediatricians and ask them what they're doing and work with them on what they should do.
Q: Are there any alternatives being explored to provide on-time immunizations?
A: Like I said, innovations are coming up everywhere. There are some places where they are doing the well visits virtually and then having patients come in. They're actually doing it outside, weighing and measuring and doing a quick physical exam and getting them back into the car. There are places that have tents set up, where they will do the vaccination in the tent. We are making sure that we do everything that we can to make sure these patients are getting vaccinations as close to on-time as possible.
Q: Are there other areas of patient care that the pandemic has complicated?
A: There are. We are very concerned with children being out of school, parents being home with their children 24/7, children not being in day care or going to visit grandparents or over to friends. Who has their eyes on the children? We know that routine illnesses are still going to happen, injuries are going to happen, developmental issues are going to show up in children. Those are not going to slow down just because of a pandemic. Then there are mental health issues, including anxiety and depression.
I just saw some patients today and I was asking the young children, “How are you dealing with being at home all the time?” The parents were amazed when their children talked about being sad or being upset. One mom said, “His temper is really flaring at times. Do you think it's due to being stuck at home and not being around his friends?” The little boy and I talked about it, and that's exactly what it was.
There is a lot that goes on that parents might not pick up on. Regarding our teenagers, we have to be very cautious about them missing a lot of life events. Depression can set in. Then we are very concerned that there could be cases of child abuse happening because the teachers don't have their eyes on their children. I had a teacher come in today with her child. She tries to communicate with her students on video chat at least once or twice a week. We are very concerned about that problem, but there is not much we can do other than having our eyes on them and trying to help them get through it as much as we can.
Q: Is there anything that we have not discussed?
A: My biggest thing is just communicating that pediatricians are here, subspecialist are here. So are mental health care professionals, for follow-up or for medications. They're also doing virtual visits and seeing some patients in person. We're here. We want to have our eyes on these children. We want to do what we can to help parents get through this crisis. We are willing to see children in person, virtually, or through phone consultations. Do not delay care for your children if you think something is wrong. Call your pediatrician. We will figure out where you need to go to get the right care at the right time at the right place.
Disclosure: Goza reports no relevant financial disclosures.