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Minnesota doctors see worrisome reduction in childhood immunization rates during pandemic

“The message we are trying to get out there is that our offices are safe, that ill and well children are being separated,” said Dr. Sheldon Berkowitz. “We’re taking all the needed precautions: masking, gowning, wearing face shields.” 

MMR vaccine
REUTERS/Rebecca Naden
Summer is usually a busy time at pediatricians’ offices, with parents bringing their children in during the less-scheduled, school-free months.
When Zena Aminzade’s daughter Matilda turned 4 in April, the last thing on her mind was calling the pediatrician to schedule her preschooler’s annual well-child visit. 

“Normally we’re really up on those things,” Aminzade said. “But that was toward the beginning of the quarantine and we were pretty much just staying at home back then. We’ve been up to date on all of her other well-child visits, but we just weren’t concentrating on it then. It was just such a wild time.”

And even if Aminzade had remembered to schedule Matilda’s checkup this spring, she doesn’t think she would’ve felt comfortable actually visiting the doctor’s office. 

“At that point I wasn’t going anywhere,’ Aminzade said. “I would have been nervous taking her in. Definitely.” 

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Aminzade isn’t the only parent who’s put off her child’s regular physician’s appointment. Sheldon Berkowitz, M.D., president of the Minnesota chapter of the American Academy of Pediatrics, said that in a recent poll conducted by his organization, pediatricians across the state reported a significant decline in routine well-child visits.

An estimated 35% decline in childhood immunizations

“One of their greatest concerns is worsening immunization rates among their patents,” Berkowitz said of the more than 100 physicians who responded to the poll. “They are estimating a 35 percent decline in childhood immunization and a 45 percent decline in adolescent immunizations during this time.”

Immunizations against common childhood illnesses are an important part of most well-child visits, Berkowitz said. While he understands why parents were concerned about taking their child to the doctor’s office at the beginning of the pandemic, he now wants to let them know that pediatricians — just like other physicians — are taking extra precautions to keep their patients and their families safe from COVID-19. 

Sheldon Berkowitz
Dr. Sheldon Berkowitz
“There is a lot of parental fear and anxiety about bringing their child into the office,” Berkowitz said. He explained that he understands why some parents are nervous about bringing their children in: “But the message we are trying to get out there is that our offices are safe, that ill and well children are being separated. We’re taking all the needed precautions: masking, gowning, wearing face shields. It is not only important but it is also safe to bring your child in for routine care.” 

Summer is usually a busy time at pediatricians’ offices, with parents bringing their children in during the less-scheduled, school-free months, said Keith Stelter, M.D., president of the Minnesota Medical Association. 

“At this time of year, normally there would be many well-child visits, with children getting up-to-date on their vaccines,” Dr. Keith Stelter said. “But that isn’t happening as much this year. We’ve seen a serious drop-off in routine vaccinations.” 

Parents who have put off routine appointments for their children should feel comfortable letting their pediatrician know about their concerns, Berkowitz said. 

“I suggest that they make a call, ask to talk to their clinician directly, have that dialog with them, say, ‘I’m anxious about bringing my child in.’ Don’t just assume it is not safe to come in. Pediatricians all recognize the issue and we’re all working hard to help families feel safe coming back in to see us.” 

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Other diseases still a risk 

Even with all the distraction of COVID-19, life somehow goes on. And part of ordinary life is childhood illness and disease, Berkowitz said. 

“It is really important to get our kids in for their routine visits. Even during a pandemic, all of the diseases we are immunizing against are still a risk for children.” 

A large percentage of the U.S. population hasn’t had exposure to vaccine-preventable childhood diseases like whooping cough, measles or meningococcal meningitis. “That’s because our vaccines have been so good at reducing the rate of these diseases,” Berkowitz said. 

Maybe because most parents have no experience with these once-common childhood illnesses, they don’t realize that they can have serious — and even deadly — consequences for children who contract them, Berkowtiz said.  

Keith Stelter
Dr. Keith Stelter
“Children can die of measles. They can die of pertussis. These are not insignificant illnesses that only happen in other countries. They happen in our country. If people keep not bringing their children in for immunizations, we could start to see a big increase in all of these diseases again.”

Minnesota has seen measles outbreaks in recent years, Stelter said. The MMR vaccination, which protects children against measles, mumps and rubella, usually included in routine 12-15 month well-child checkups, with a booster between ages 4 and 6, is particularly essential, he added. 

“One of the most important vaccines we have is the measles vaccine. Measles is a very, very contagious illness, which we’ve seen recently in some outbreaks in Minnesota. Right now, a number of children in our state are going without that vaccination — or having it delayed. If we don’t catch up, that could have some serious consequences down the road if another measles outbreak were to occur.”

It’s not just young children who need to keep up on their vaccinations, Berkowitz  added. Adolescents also need the disease protection that immunizations provide: “There’s this second meningococcal vaccine that’s due at age 16 that parents often don’t think about. People are usually good at  getting their adolescents in to the pediatrician up to 7th grade, but it falls off after that. And in this time of COVID, it’s easy for  parents to think it is OK to put off their teenagers’ checkups.” 

In autumn, parents will have other concerns, including the start of school. Statewide, schools require students to be up to date on their vaccination schedule to attend, and physicians’ offices may be busy with parents trying to get their children’s immunizations in before the start of school. 

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“Depending on what happens with schools, if they are going to be opening up as we are hoping, there will be families trying to catch up at the last minute, trying to get their kids immunized so they can get back to school,” Berkowitz said. “That is going to create another burden to our health care system.” 

Stelter also encourages parents and other caregivers to make sure that everyone in their family gets a flu shot this year. 

“When the flu season comes this year, our offices will already be so much more crowded with other respiratory illnesses,” Stelter said. Though it may be hard to imagine now, when most Minnesotans are focused on fighting Coronavirus, “Those other illnesses are also going to happen. We want people to use the opportunity they have now during the summer to get caught up before we head into flu season in September-October.” 

‘I feel like times have changed’

Though Minnesota has yet to defeat COVID-19, the state is beginning to open up many of the businesses and services that were closed during quarantine. 

Aminzade, a hairdresser, knows this firsthand. She finally went back to her salon at the beginning of July. The experience of being in the working world after so many months with her family at home has helped her to think differently about bringing her daughter in for her checkup.

Zena Aminzade, right, shown with her daughter Matilda, 4.
Courtesy photo
Zena Aminzade, right, shown with her daughter Matilda, 4.
“Of course there’s still a concern,” she said, “but I went back to work. I feel like things have changed since this spring.” While she thinks Minnesotans still have to be diligent about protecting themselves and others from the virus, she also realizes that she has to get back to real life — at least as much as she can. 

“I’m going to wear a mask,” she said. “I’m going to be clean. I’m really careful. But I can’t live if I have that mindset of every time someone comes within 6 feet of me I’m going to be worried.”

As she sees other people going back to work, and taking cautious steps toward ordinary life, the idea of taking Matilda back in for her checkup doesn’t seem quite so daunting, Aminzade said. 

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Berkowitz hopes that other parents will soon start to feel the same way. 

Pediatricians, like other physicians, he said, are working hard to let the public know that clinic staffs are doing everything possible to limit the spread of infection among patients and families. In his own clinic at Children’s Hospital in Minneapolis, healthy children in for well-child checkups are separated from those who are ill. 

‘We ask about fever, cough, other symptoms’

“Before a patient comes in, the scheduler asks them a series of questions,” Berkowitz explained. “We ask about fever, cough, other symptoms. We also ask about exposure to COVID. If they respond positively to those questions, it doesn’t mean we don’t see them. We just schedule them to see a clinician who is seeing patients at risk for COVID-19.”  

Families that still don’t feel safe coming to the clinic can have many aspects of a well-child visit conducted via telemedicine, Stelter said. 

“If a family chooses to do some of their well-child visit through telemedicine,” Stelter said, “Maybe they could visit the clinic for a quick, five-minute in-and-out for the vaccinations. Or maybe clinics could innovate wildly and offer drive-up vaccines for scheduled families.” 

Berkowitz suggests that concerned parents contact their pediatrician’s office to inquire about drive-up vaccines. “They just need to check in with their clinician to see if their office is making that option available,” he said.  

Aminzade — who explained she is “definitely not an anti-vaxxer; I would get a COVID vaccine in a second if it meant I could see my loved ones” — said she’s planning to call the doctor’s office to make an appointment for Matilda’s 4-year-old checkup. 

But first she’ll have some questions for the clinic. 

“I will make an appointment, especially if there is a vaccination scheduled this year,” she said. “But if there isn’t one this visit, maybe I won’t schedule quite yet. She’s a healthy kid. Maybe we can push it off a little bit more. I just want to do the right thing for everybody.”