We mustn’t let our ‘community immunity’ lapse

COVID-19
MGN

Free shots available through Vaccines for Children

What is more eagerly anticipated than the next Avengers movie and Beyoncé album, combined? The drop of the latest…vaccine.

COVID-19 has infected over 13.5 million worldwide, causing over 585,000 deathswhile shutting down businesses, schools, professional sports leagues and large events in its wake. To be able to safely return to any sense of what was normal before COVID-19, it is clear we will need a vaccine, and we will need a lot of people in our community getting the vaccine to stop the spread of this devastating disease.

However, as people have been told to stay home and avoid going to clinics, especially early in the outbreak this has resulted in fewer people seeing their doctor for their usual checkups. This has been a big problem for what are called “well child checkups” that kids should get regularly starting at birth.

It is at these checkups that kids receive their recommended vaccines or “shots” to help protect them and our community from other infectious diseases. Shots work best when enough people in a community have gotten theirs, preventing a disease from spreading from one person to the next.

Community immunity

This concept is called “herd” or “community” immunity. If enough people have gotten their shots or become immune by surviving an infection, then those who are too young, old or unable to get a shot are still protected. When this herd immunity drops due to not enough people getting their shots, we see outbreaks of infectious disease pop up.

This happened recently in Minnesota during our measles outbreak in 2017 and whooping cough outbreak in 2012. Those are two vaccine-preventable illnesses that are highly contagious.

This is what concerns me as a pediatrician and medical director of Minnesota’s Medicaid program at the Department of Human Services. When looking at data about the number of shots ordered and given in April, after the COVID-19 public health crisis was officially declared, researchers in Minnesota and around the country found that there has been a 70% drop in measles shots given compared to the same time last year.

Shots were down across the board in their report. Even with the gradual re-opening of parts of our state, we continue to see immunization rates below expectations.

A recent survey of pediatricians in Minnesota estimated that they were still seeing a 35% decline in immunizations for young children and a 45% decline in immunizations for teenagers.All of these drops are concerning, but drops in shots for measles is of greatest concern given how easily it is spread.

Measles

Measles is a virus that most often causes a rash and a fever with cough and congestion or runny nose. However, measles is much more than a rash. Of those children who are infected with measles, one in 20 will get pneumonia and one in 1,000 will get a rare complication called encephalitis, or inflammation of the brain.

Both complications can require hospitalization, can result in long-term damage, and can be fatal. In the United States, of every 1,000 children who get measles, one or two will die.

Measles is highly contagious and is spread in the air when people who have it cough or even just breathe. Protection from measles is given in the MMR shot, which stands for measles-mumps-rubella. Children get their first MMR shot at their 12-month well child check and a booster shot with their “kindergarten shots,” usually at age four or five years.

Well child checks

Most children get their shots at their well child checkups. These are the recommended doctor visits that start from birth where we look at a child’s growth, diet, sleep and teeth. We ask about how they are developing in activities like walking, talking and playing with others.

As they get older we check their hearing and vision or see if they may be dealing with anxiety or depression. We refer them to specialists so they can get the help they need to stay healthy and reach their full potential.

For children who get their health coverage through Medicaid (called MA or Medical Assistance in Minnesota) or MinnesotaCare, these visits are fully covered and part of our Child and Teen Checkup program. Since COVID-19, clinics have been taking extra precautions to make sure that, when children come in for these important checkups, the risk of their and their parents’ exposure to COVID-19 is very low.

Some clinics will have appointments for well child checks only in the morning so there are no sick children being seen at the same time. Some have moved all sick children and adults to specific clinics, away from where children are getting their well child checks.

Other steps providers are taking include wiping down their rooms thoroughly between patients, screening patients and families for signs of COVID-19 before they come in, and asking questions to see if anyone at home has had COVID-19 symptoms.

In many ways, going to your clinic may be safer than going to the grocery store. Talk to your clinic, as they may be offering new services like in-home visits, drive-up clinics, or mobile vaccination vehicles that come to you. Don’t hesitate to ask questions about how your clinic is preventing COVID-19 and what changes families need to make when they attend appointments.

Cost shouldn’t be a barrier

Children who don’t currently have health insurance still need their shots. They can get them for free or low cost through the Vaccines for Children program.

This program provides vaccines for 50% of children in the United States and provides free or low-cost vaccines to children who don’t have health insurance or whose insurance does not cover the cost of vaccines. Most pediatric clinics in Minnesota participate in this program, so just ask your provider or visit the website below.

Our Black and Indigenous communities are already feeling the impact of COVID-19 more than others in our state. We have a higher infection rate and a higher death rate when you take into account our overall life expectancy.

So the last thing we need is to suffer an outbreak like measles, whooping cough or the flu during COVID-19, especially when it can be prevented by catching up on our shots. Social distancing and hand hygiene will help with reducing the spread of all three, but the best medication science has given us to keep us healthy and around for our families and community has been vaccines.

Which makes me think the release party for the COVID-19 vaccine will be epic. Let’s make sure we and our children do what we can to make it to that celebration.

Visit www.health.state.mn.us/people/immunize/basics/howpay.html to learn more.

Dr. Nathan T. Chomilo is medical director for the State of Minnesota’s Medicaid/Medical Assistance & MinnesotaCare programs and practices as a general pediatrician in Brooklyn Center with Park Nicollet. He is a board member of the Minnesota Chapter of the American Academy of Pediatrics and an adjunct assistant professor of pediatrics at the University of Minnesota Medical School. He lives in Minneapolis with his wife and son.

About Nathan T. Chomilo, MD, FAAP

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