A drop in childhood immunization rates due to the pandemic looms as school starts back up.

As the school year begins – though still mostly virtual at this point – state and local public health officials are standing firmly behind immunization requirements, concerned because many Orange County youngsters have fallen behind on their shots during the pandemic.

The dropoff began in the spring, when parents were afraid to venture out during the shutdown and feared Coronavirus exposure in doctors’ offices. As a result, immunization rates for youth ages 0-18 in Orange County fell by as much as 41 percent in March, April and May.

Reduced immunization poses a threat even if students are at home, medical experts say; but perhaps more importantly, some schools have begun resuming in-person classes, and more are expected since Orange County was removed from the state’s watch list, setting in motion a possible return to campus en masse by mid-September.

“The line will be drawn when students come back to school,” said Pamela Kahn, president of the California School Nurses Organization and Coordinator of Health and Wellness at the Orange County Department of Education. Without strict enforcement, “We could have a whole influx of students whose immunizations got put off,” she said.

An outbreak of childhood disease during the Coronavirus crisis would be especially complex to treat and contain, experts say.

“This is not a good moment to have an epidemic of measles or mumps or whooping cough, and all this stuff is preventable,” said Dr. Ilan Shapiro, a pediatrician, spokesperson for the American Academy of Pediatrics, and Medical Director of Health and Wellness Education at AltaMed Health Services, which treats 300,000 patients in Orange and Los Angeles counties. “Measles is more contagious than Coronavirus.”

A small measles outbreak and fatal cases of whooping cough have occurred in recent years in California, and the state still draws visitors from around the world – all the more reason to take infectious childhood disease seriously, Shapiro said. He added that hospitals are currently at full capacity due to Coronavirus.

Meanwhile, the symptoms of childhood illnesses are similar to those of Coronavirus, which could cause confusion and stoke fear in schools, Kahn said, and illnesses that weaken immune systems might make a student more susceptible to Coronavirus.

Kahn said school nurses and state health officials were for a while uncertain about whether to relax immunization standards as long as kids were learning from home. But ultimately the school nurses she polled said they preferred to require compliance; whether schools will actually exclude non-compliant students from online classes remains to be seen, she said. For now, she is encouraging school nurses to be vigilant in reminding parents of students who haven’t gotten their shots to do so. Anecdotally, she is hearing that nurses are gaining the cooperation of parents, though the state won’t make vaccination rates public until next spring.

Public and private schools in California require proof of vaccination for new students, kindergarteners and students going into 7th grade. Incoming 7th-graders need to produce evidence of two varicella (chicken pox) doses and a booster of Tdap (Tetanus, Diphtheria, Pertussis). A vaccine for human papillomavirus, which can help prevent cancer, is recommended but not required.

Since 2015 when a state law made it harder for Californians to opt out of vaccine requirements, compliance has been high, Kahn said. 

And while recent vaccination rates have bounced back since they dipped in the spring, that decrease hasn’t been made up, she said: “There was a big dip, and we did see very large hole in immunization rates. Since then, levels have gone up to about normal, but we still have that hole.”

She said pediatricians have responded by extending their hours in some cases and circulating fliers to encourage parents to bring their kids in for shots.

AltaMed is among the practitioners engaged in outreach, Shapiro said. AltaMed clinics are communicating by radio and social media, and even staging drive-through childhood vaccinations in L.A. He said clinics have taken steps to make the doctor visit safe from Coronavirus transmission.

“We’re trying to send a message out there. Yes, we told you it was important to stay at home. But right now…the only way to protect your kids or community is actually to come to the office,” Shapiro said. “I can’t send shots by Amazon.”

Amy DePaul is Voice of OC Healthy Communities Editor and a lecturer in the University of California, Irvine Literary Journalism program. You can reach her directly at depaula@uci.edu.

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