Fewer Pa. children are fully vaccinated, raising concerns about measles outbreaks

• David Wenner/PennLive
  BioRecent Stories

  

  David Wenner has worked for The Patriot-News/PennLive since 1999 and has won numerous awards for his reporting. He often writes about health care as well as breaking news. He appreciates knowing about any important, troubling or otherwise newsworthy situation in central Pennsylvania. He can be reached at dwenner@pennlive.com or 717-255-8172.

Vaccination rates among Pennsylvania kindergartners fell again last year, with measles vaccinations dipping below the level doctors say is needed to prevent outbreaks, according to new data from the Pennsylvania Department of Health.

“All of these things that we’ve been doing for decades, that we’re going away from, that is very concerning,” said Dr. Shawn Safford, the medical director of pediatric services for UPMC in central Pennsylvania.

Rates for all vaccinations required to begin school in Pennsylvania have fallen steadily compared to 2018-19, the last full school year before the COVID-19 pandemic. As of last school year, the rates for four of the five vaccines needed to begin school have fallen below 95% — the general target for preventing outbreaks.

And mirroring a national trend, the number of children receiving religious, philosophical or medical exemptions also has risen substantially since before the pandemic, with more than 4% of Pennsylvania kindergartners now exempted from at least one vaccine.

Much of the decline is attributed to politicization and misinformation surrounding vaccines, which has intensified since the pandemic. Declining rates are blamed for recent outbreaks in the U.S. involving measles — a disease capable of causing brain damage and even death that had all but disappeared in the United States because of vaccination.

For the 2022-23 school year, Pennsylvania’s rate for the MMR vaccine, which covers measles, fell to 94%, down from more than 96% before the pandemic. Doctors say a measles vaccination rate of 95% or more is needed for “herd immunity” — when so many people are immune that a disease can’t spread.

No vaccine is 100% effective, Safford explains, meaning that some vaccinated children can still get the disease. In addition, some children can’t be vaccinated because of medical conditions. But when the vast majority of people are vaccinated, the vulnerable children are protected.

“The whole reason vaccines work so well is if the majority of people get vaccinated, and that vaccine is 85-90% effective, it keeps that spread of disease from occurring. When you drop below those critical levels, it keeps the vaccines from working like they’re supposed to,” he said.

Measles is one of the most contagious diseases. A rate below 95% can enable it to “take off like wildfire,” Safford said.

Other diseases Pennsylvania students must be vaccinated against, such as polio and rubella, aren’t as contagious, and doctors are less specific regarding the rate needed to prevent outbreaks.

In general, public health officials push for rates of 95% or more for the vaccines required to attend school, and which protect against diseases including polio, mumps, rubella, whooping cough, chickenpox and tetanus.

Doctors say the falling vaccination rates, being seen all over the country, can allow the return of diseases held in check for generations.

“I find it very concerning because we haven’t seen these diseases for decades and now, with reduced vaccination rates, we’re seeing diseases that we thought were mostly eradicated or, if they occurred, they’d occur in one or two people,” Safford said.

Dr. Katherine Shedlock, a pediatrician at Penn State Health Children’s Hospital, believes lower vaccination rates are partly due to parents underestimating the dangers of illnesses that had become so rare. Because they’ve never had or seen the illnesses, they assume the vaccines are no longer needed. Yet the diseases have the potential to put a child in intensive or even cause death, she stressed.

“It may not seem like a big deal, but actually it is, and we’re fortunate we don’t see these illnesses on a day-to-day basis — that’s because we have vaccines to prevent them,” she said.

She further believes COVID-19 vaccine, and the rare but sometimes serious side effects, have fueled new hesitancy about routine vaccinations given to children. At the same time, social media videos can “spread a lot of misinformation in a very memorable way” compared to the impression from reading an evidence-based article.

Safford believes the declining rates reflect “a lot of misunderstanding about what vaccines do and why we get them.” Some of it stems from “what we hear in the media, which is all over the place depending on which side of the channel you’re listening to.”

Safford draws a distinction between COVID-19 vaccine, which is based on a relatively new technology, and the routine vaccines for children, which use a different technology and have a long record of being safe and effective.

Like virtually all doctors, he considers COVID-19 vaccine safe, with benefits far outweighing the rare side effects. Still, he believes the current COVID-19 vaccine is more of an individual choice, based on someone’s own circumstances and discussion with their doctor.

It’s different with childhood vaccines, according to Safford. “We’ve been doing this for 50 years. It’s very well-established vaccines. We don’t want to see diseases come back that we thought were gone,” he said.

Nationally, the level of vaccine exemptions among kindergartners has reached 3% — the highest ever, according to federal data. In ten states, 5% or more kindergartners are exempted from at least one vaccine. Idaho has the highest percentage at 12%, while New York has the lowest, 0.1%. Pennsylvania’s 4.1% exemption rate translates to 5,025 kindergartners, according to the state data.

The good news, health experts say, is the vast majority of parents continue to vaccinate their children.

As for reversing the decline, Safford believes the key involves better discussions between parents and pediatricians.

“We need to get back to talking to our primary care doctors, talking to our pediatricians, expressing our concerns and having open conversations,” he said. “I love health care because it strips away politics. I get to take care of people regardless, and we need to get back to just talking openly and honestly about our concerns.”