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In Illinois, routine childhood vaccinations against diseases such as measles, polio and whooping cough slipped during the pandemic — a drop that comes amid the reemergence of polio on the East Coast, and one that pediatricians blame on missed appointments and increased vaccine hesitancy.
About 89% of Illinois kindergartners were reported as vaccinated against measles, mumps, polio, rubella, chickenpox, diphtheria, tetanus and pertussis during the 2020-2021 school year, according to Illinois State Board of Education data obtained by the Tribune through Freedom of Information Act requests. That’s down from about 94% to 96% during each of the previous four school years.
In the 2020-2021 school year, vaccine data was submitted for 124,701 kindergartners in Illinois, meaning if 89% were vaccinated, it’s possible that nearly 14,000 were not.
“It’s really concerning,” said Dr. Kathy Shepherd, a pediatrician at Kids First Pediatric Partners in Skokie. “We’ve all seen, as pediatricians, kids who’ve been affected by vaccine preventable diseases. Sometimes, I think people get a false sense of security with their kids’ health where they don’t think it could happen to them.”
Illinois State Board of Education spokeswoman Jackie Matthews also called the dip “very concerning,” saying, in an email, “Routine childhood vaccinations protect students from preventable illnesses that can lead to serious complications and even death.”
The slide is part of a national and global trend amid the pandemic. In the 2020-2021 school year, the percentage of kindergartners across the country who got routine childhood vaccinations declined by about 1 percentage point, according to the Centers for Disease Control and Prevention.
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Across the world, 25 million children missed one or more doses of the vaccine that protects against diphtheria, tetanus and pertussis in 2021 — the largest sustained backslide in childhood vaccinations in a generation, according to the World Health Organization and UNICEF.
Pediatric health leaders warn that the consequences could be dire.
“We do not want to see major childhood outbreaks across the country, especially in light of these capacity issues,” said Dr. Frank Belmonte, chief medical officer at Advocate Children’s Hospital, referring to surges of kids with respiratory illnesses filling children’s hospitals that are also often struggling with staff shortages. “If we can prevent things, we should prevent them and not be dealing with them after the fact.”
‘We’ve lost patients to vaccine preventable diseases’
Bucktown parent Anne Judge knew she wanted to vaccinate her 1-year-old son James at his recent physical.
He cried as he received five jabs in his thighs, one right after the other, for hepatitis A; the flu; a shot for measles, mumps and rubella; a pneumococcal vaccine; and a vaccine to protect against chickenpox. But Judge felt it was worth it.
A couple of months earlier, James was rushed to the hospital after he had a febrile seizure, which is when a child convulses because of a fever. He ended up being just fine, but the experience reinforced Judge’s desire to have her son vaccinated, whenever possible.
“You go through something like that as a parent, and you’re like, ‘All right, I’m going to do everything I can to make sure I’m never back in this hospital again,’ ” she said. “If that includes getting vaccinated and having 30 seconds of my kid being uncomfortable, so be it.”
She worries about parents who are making different decisions.
“It’s not only putting your kid at risk, it’s my putting my kid at risk,” she said.
Many people may think that diseases such as polio, measles and whooping cough are relics of the past. But this summer, an unvaccinated person in Rockland County, New York, developed paralytic polio, and poliovirus was found in wastewater there and other New York counties.
“The generation that remembers polio is much older now. Without that lived experience, it’s maybe hard to appreciate what these viruses can do,” said Carol Pandak, director of PolioPlus at Evanston-based Rotary International, which aims to eradicate polio around the world.
Measles also still sporadically pops up in the Chicago area, as some parents have resisted vaccinating their kids against it. In 2019, nine cases of measles were reported in Illinois, including in Cook County. Measles can lead to complications, including pneumonia and brain swelling. It can be spread through the air when a person coughs or sneezes or through contact with mucus or saliva from an infected person.
Some vaccine preventable illnesses are far more common, and lead to deaths each year, even in the U.S.
About half of babies who get whooping cough need to be hospitalized, and up to 20 babies a year in the U.S. die of the illness. Children are supposed to receive doses of the vaccine that protects against whooping cough at 2 months, 4 months, 6 months, 15 to 18 months, and between 4 to 6 years of age, and then another immunization against it at 11 to 12 years of age.
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At least 200 children in the U.S. died of the flu during the 2019-2020 flu season. Children can begin receiving flu shots once they’re 6 months old.
“We’ve lost patients to vaccine preventable diseases,” Shepherd said. “When you have that kind of loss it makes you really take it seriously.”
Skipped appointments, vaccine hesitancy
Pediatricians say the dip in recent vaccinations could be because families skipped appointments during the early months of COVID-19. Many parents were afraid or unable to bring their healthy children to doctors’ offices for non-urgent issues, such as annual checkups, which is when routine vaccinations are typically given.
The vaccine percentages may look better in future years, as kids catch up on their vaccines.
It’s also possible some families are now avoiding routine childhood immunizations because of increased vaccine hesitancy. Even before the COVID-19 vaccine, some parents were wary of immunizations.
When COVID-19 vaccines were released, their safety, development and effectiveness became a national topic of conversation and debate. It prompted many people to think deeply about vaccines for the first time, and, it made some people uneasy.
“A lot of the vaccine efficacy and vaccine safety came into question and came into the public eye, and it created a lot more mistrust of vaccines in general,” said Dr. Panorea Mathews-Kukla, a pediatrician and department chair of pediatrics at Duly Health and Care.
Before COVID-19, Mathews-Kukla typically signed one or two religious exemptions a year for parents who didn’t want to get their kids vaccinated.
Since the pandemic, Mathews-Kukla has been getting about one religious exemption request a month.
Illinois law requires that students be immunized against certain diseases, such as measles, whooping cough, and chickenpox or provide proof of an allowed exemption, such as for religious or medical reasons by Oct. 15 of each year, or an earlier date set by their school district. If they don’t, they’re not supposed to go to school until they meet the requirements.
When parents worry about vaccinating their children, Mathews-Kukla does her best to answer their questions. She tries to keep in mind that parents are trying to do the best they can for their children.
“In my own practice, I do accommodate people who don’t want to be vaccinated,” Mathews-Kukla said. “I think it’s much more important to partner with the parents and take care of these kids and not turn them away from medical care.”
Other pediatric practices take a different approach. Shepherd’s practice, Kids First Pediatric Partners in Skokie, doesn’t work with families that reject routine vaccinations.
“We think it’s dangerous,” Shepherd said. “We’re a practice that’s happy to talk with families about questions and concerns they may have about the vaccine, but if they ultimately decide they don’t want to vaccinate their kids we would direct them to find another pediatrician because we don’t think we’re a good match for them.”
She said her practice has a lot of medically fragile patients.
“I think our families like knowing that we’re a vaccinating practice, that they’re not going to be exposed to other families that have unvaccinated kids,” she said.
For many routine vaccinations during the 2020-2021 school year, about 1.2% of kindergartners in Illinois had religious exemptions; less than 1% had medical exemptions; and more than 4% were unvaccinated without an approved reason. About 4% were not compliant with vaccine or physical exam requirements, but were going to school remotely because of COVID-19 concerns. It’s possible some of those 4% were vaccinated, but didn’t have a required physical exam.
During the previous school year, similar percentages of kindergartners had religious and medical exemptions, but the percentage of kids who were unvaccinated without an approved reason was about 3%, and there was no data tracking how many kindergartners were not compliant but remote.
Catching up
Doctors hope to see improved numbers for the 2021-2022 school year, once that data is available.
Dr. Nina Alfieri said pediatricians and families are in a “period of trying to catch up.” Many pediatric practices allow parents to make appointments just for vaccinations if they missed shots and don’t want to wait until their children’s next annual checkups to catch up.
“Most families, with going back to school and most places being unmasked, most families are being very vigilant about coming in for their checkups and catching up on any missed vaccines,” said Alfieri, a pediatrician at Lurie Children’s.
Doctors say kids who’ve missed vaccinations should come back for them as soon as possible. Vaccines are supposed to be given on a schedule, but “it’s better to be vaccinated” than not vaccinated at all, Mathews-Kukla said.
Elmhurst mother Heidi Rahn recently took her 1-year-old son for five vaccinations at his one-year checkup. He cried during the pokes, and Rahn gave him Tylenol after the appointment for any lingering pain or discomfort.
But he slept well, and was playing normally the next day.
“Vaccinations, for us, have always been something that — the traditional ones and the COVID ones — that’s a really simple way for us to do our part and keep ourselves safe, but also keep our community safe as well,” she said.