Giving a vaccine

Cassandra Bersing, a registered nurse, right, demonstrates how to give a vaccine to Kenslee Bersing, 2, Friday, at Yakima Pediatrics.

Routine immunizations and wellness visits among Yakima County children remain below average going into the new school year, according to local health experts.

But trends might be moving in the right direction — and parents of children behind in the wellness checkups are encouraged to schedule appointments now.

Nationwide, immunizations among children dropped off dramatically when a state of emergency for COVID-19 was declared in mid-March, Centers for Disease Control and Prevention data shows.

The Vaccines for Children Program, a national effort that provides vaccines to roughly 50% of U.S. children, reportedly ordered roughly 2.5 million fewer doses of all routine non-influenza vaccines from mid-March to mid-April of this year, compared with the same period in 2019, as well as 250,000 fewer doses of measles-containing vaccines, CDC data shows.

Yakima County was no exception, with medical experts from organizations like Virginia Mason Memorial hospital and Community Health of Central Washington’s Yakima Pediatrics reporting a decline in wellness visits and immunizations.

“I would say overall we’re still seeing a lower volume of patients being seen face-to-face in-clinic, and that extends to our preventative health visits with children,” said Tanny Davenport, the physician executive of medical group operations for Memorial, who continues to practice as a family physician.

“As we move to the fall and as our (COVID-19) numbers go down in the community … I hope our families know that it’s safe to go to the clinics,” he said. “There are appropriate protocols in place with personal protective equipment. ... We can safely see them and do those wellness visits ... and complete the needed immunizations.”

The need for immunizations

Some diseases like measles require a 90-95% community vaccination rate to prevent an outbreak, since it is highly contagious, said Davenport. The CDC recommends two doses of the measles, mumps and rubella vaccine — at 12 to 15 months, and between ages 4 and 6.

Medical experts say that if immunization rates don’t rebound from the drop in the spring, it could make the U.S. or local population vulnerable to vaccine-preventable outbreaks.

“The ongoing COVID-19 pandemic is a reminder of the importance of vaccination,” the CDC said in a May report. The declines in vaccines “might indicate that U.S. children and their communities face increased risks for outbreaks of vaccine-preventable diseases.”

Locally, there’s concern that could place undue pressure on health care providers that are already working to keep COVID-19 under wraps.

“More than ever, it will be important to get vaccinated against influenza and other highly communicable but vaccine-preventable diseases that can lead to hospitalizations,” said Rishi Mistry, a pediatric nurse practitioner with Yakima Pediatrics, which cares for about 11,000 children throughout the Yakima Valley.

“COVID-19 alone has placed a significant strain on many hospitals around the country, including the facilities in our county and state,” said Mistry. “The fear from many public health officials and health care providers is that complications from other respiratory diseases like influenza (that vaccines) can prevent may further strain hospital capacity. So it’s crucial for children and families to get their influenza vaccines and other CDC-recommended vaccines.”

Mistry, Davenport and state Department of Health officials said some parents had expressed concern in the spring over whether it was safe to bring their children into medical facilities. But health care providers have taken measures to ensure their offices are safe for routine care, even while caring for COVID-19 patients.

At Yakima Pediatrics, for example, appointment times were lengthened, slots were dedicated for wellness visits, universal masking and COVID-19 symptom screening was implemented, and a car-side clinic was launched for potential COVID-19 exposures or symptoms,— further separating these patients from healthy ones.

Rebounding from spring

Yakima County has made significant strides in COVID-19 trends. In early May, the county had the highest case rate on the West Coast. Now, Gov. Jay Inslee has held it up as a model for the state, and new case counts have been below 50 for nearly two weeks.

“Immunizations are down,” said Davenport. “Now, when there is a lull in COVID activity, is the perfect time for people to schedule those preventive care visits and get those needs met now.”

And while the vast majority of schools in the county are starting the school year with remote learning, Davenport said it’s important for children to get immunizations so they’re ready when school does resume in-person, where they’re required to have up-to-date immunizations.

There has been a small and recent uptick in wellness visits, said Mistry, although it’s unclear if it’s a full rebound just yet.

The latest data on immunizations and exemptions available through the state Department of Health is for the 2018-19 school year. It shows that statewide, 88.8% of K-12 students had up-to-date immunizations, while 4.8% were exempt. Yakima County fared better, with 94.6% complete and 1.4% exempt.

Schools are reporting new data now, meaning an update will be available soon, said Frank Ameduri, a public information officer for the department.

“That said, the department is still concerned about immunization rates, but they are slowly increasing” from the spring, said Ameduri.

What’s also changed from the spring are the conversations around vaccinations, said Davenport. Ordinarily, conversations around immunization revolve around theoretical whooping cough or measles outbreaks. COVID-19 has given some people a new appreciation for disease prevention — from hand-washing to wearing a mask or getting a shot, he said.

“It’s made the conversation really different,” said Davenport. “I would say COVID has changed how immunizations will be viewed forever in this generation, because they’ve seen what an infectious disease can do to a community, a nation and to a world.”

What you need to know

Small new changes to immunization rules went into effect statewide Aug. 1. They include requiring medically verified immunization records for school and child care entry and pushing back the Tdap immunization requirement from sixth-to-12th grades to seventh-to-12th.

Examples of accepted medical records include a Certificate of Immunization Status signed by a doctor or health care provider; a CIS filled out by a parent or guardian with medical records attached; a printed CIS from MyIR.net; or a CIS printed from the state immunization system by a health care provider or school.

More details on immunization rule changes can be found through the state DOH website.

The exception to requirements is for students who have an exemption. In Washington state, students can get a medical or religious exemption, something allowed in 45 states nationwide, according to the National Conference of Legislatures.

Until last year, personal belief exemptions were also allowed in Washington, but they were removed after an outbreak of measles in Washington state contributed to the greatest national outbreak of the illness since 1992. Just 15 states have that allowance now.

Reach Janelle Retka at jretka@yakimaherald.com or on Twitter: @janelleretka