Childhood Vaccination Rates Continue to Decline Amid Measles Outbreak

This article discusses reasons for declining childhood vaccination rates and describes a current measles outbreak in Ohio.

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In recently released data by the CDC, vaccination rates for kindergartners declined for the second consecutive school year in 2022.

For the past three school years, state-required vaccination rates among kindergarten students have declined as follows(6):

  • 95% for the 2019-2020 school year
  • 94% for the 2020-2021 school year
  • 93% for the 2021-2022 school year (approximately)

The most recent vaccination rate means that there are approximately 250,000 kindergartners vulnerable to measles, mumps, and rubella (MMR)(6).

Measles is highly contagious. The CDC estimates that 90% of unvaccinated people who contact an infected person will contract measles. Due to measles' high contagiousness, immunization rates must reach 95% to protect communities from outbreaks(3).

The potential impacts of seemingly small, ephemeral changes in vaccination rates, can have profound impacts, or as the CDC stated

"Even a transient decline in vaccination coverage can compromise herd immunity"(4)

Why Have Childhood Vaccinations Declined?

Parental vaccine hesitancy

In recent years, parental vaccine hesitancy has increased. Some hesitancy stems from concerns about COVID-19 vaccines, and those concerns spillover to childhood vaccinations(3). Other reasons are:

  • mistrust of government, science, and research(2).
  • belief that vaccines are not necessary(1).
  • concern about vaccine ingredients(1).
  • parental confusion about vaccination schedules(1).
  • risk of adverse events(1).
  • concern about developing autism from vaccines(6).

To try and decrease the risk of adverse events, some parents go so far as to adjust their child's vaccination schedule(1).

COVID-19 disruptions to vaccination coverage

Routine vaccination programs were disrupted by COVID-19(6).

Clinics closed and appointments were missed. Due to COVID-19, well-child visits decreased significantly, which are important to maintain vaccination schedules.

Lack of healthcare access

Vaccination rates are lower in small rural communities(1). Rural areas face many barriers to accessing health services, including:

  • greater distance to providers(1).
  • lack of transportation and unreliable transportation(1).
  • provider shortages(1).

Gambel(3) also reports that children who lack health insurance and live below the federal poverty level are less likely to be vaccinated.

Misinformation

Some authorities believe false or misleading information is partially responsible for declining childhood vaccination rates.

"We are still trying to understand the extent to which misinformation around the COVID-19 vaccine has spread to misinformation about other childhood vaccines," said Dr. Sean O'Leary, as quoted on Reuters.

Misinformation and nurses

Here's a definition of misinformation from a policy brief issued by the NCSBN and seven other leading nursing organizations in 2021. The brief addressed misinformation about COVID-19, but nurses are encouraged to prevent misinformation about all health topics.

"For the purposes of this statement, misinformation is defined as distorted facts, inaccurate or misleading information not grounded in the peer-reviewed scientific literature and counter to information being disseminated by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).”(5)

"Nurses are urged to recognize that dissemination of misinformation not only jeopardizes the health and well-being of the public but may place their license and career in jeopardy as well.”(5)

When identifying themselves as nurses, nurses are professionally responsible for the information they provide to the public.

Measles Outbreaks

Thanks to vaccines, measles was declared eliminated in the United States In 2000(6). Recent years have seen outbreaks, however.

Measles outbreaks occur due to the following:

  • unvaccinated travelers who import cases(6).
  • communities with pockets of unvaccinated people(6).

Only one child needs to be infected to spread the disease. An outbreak can occur if a small number of children are undervaccinated in an area with high vaccination coverage(6).

In 2018-2019, there was a significant measles outbreak in New York.

On September 30, 2018, an unvaccinated child returning from Israel developed a rash. By July 15, 2019, a total of 649 cases of measles had been confirmed. Forty-nine children were hospitalized, with 20 of those admitted to the ICU(6).

Currently, Columbus, Ohio, is in the midst of an outbreak that started in November 2022. According to the Ohio Disease Reporting System, there are 85 cases as of January 18, 2023, and the spread has slowed.

Seventy-eight children were unvaccinated, and six were partially vaccinated (one dose). One child's vaccination status is unknown, and none were fully vaccinated.

Visit the CDC for a list of recommended childhood vaccinations.


References

1. Albers AN, Thaker J, Newcomer SR. Barriers to and facilitators of early childhood immunization in rural areas of the United States: A systematic review of the literature. Prev Med Rep. 2022 Apr 25;27:101804. doi: 10.1016/j.pmedr.2022.101804. PMID: 35656229; PMCID: PMC9152779. https://pubmed.ncbi.nlm.nih.gov/35656229/ Retrieved January 17, 2023.

2. Crescitelli, M. D., Ghirotto, L., Sisson, H., Sarli, L., Artioli, G., Bassi, M. C., ... & Hayter, M. (2020). A meta-synthesis study of the key elements involved in childhood vaccine hesitancy. Public Health, 180, 38-45. https://www.sciencedirect.com/science/article/abs/pii/S0033350619303476 Retrieved January 15, 2023.

3. Gambrell, A., Sundaram, M., & Bednarczyk, R. A. (2022). Estimating the number of US children susceptible to measles resulting from COVID-19-related vaccination coverage declines. Vaccine, 40(32), 4574-4579. https://www.sciencedirect.com/science/article/pii/S0264410X22007824 Retrieved January 15, 2023.

4. Murthy, B. P., Zell, E., Kirtland, K., Jones-Jack, N., Harris, L., Sprague, C., ... & Gibbs-Scharf, L. (2021). Impact of the COVID-19 pandemic on administration of selected routine childhood and adolescent vaccinations—10 US jurisdictions, March–September 2020. Morbidity and Mortality Weekly Report, 70(23), 840. https://www.CDC.gov/mmwr/volumes/70/wr/mm7023a2.htm?s_cid=mm7023a2_w Retrieved January 18, 2023.

5. National Council of State Boards of Nursing. (2021). Leading nursing organizations issue policy brief regarding nurses spreading misinformation about COVID-19. https://www.NCSBN.org/news/leading-nursing-organizations-issue-policy-brief-regarding-nurses-spreading-misinformation-about-covid19 Retrieved January 16, 2023.

6. Seither, R. (2023). Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten—United States, 2021–22 School Year. MMWR. Morbidity and Mortality Weekly Report, 72. https://www.CDC.gov/mmwr/volumes/72/wr/mm7202a2.htm?s_cid=mm7202a2_w Retrieved January 16, 2023.

7. Zucker, J. R., Rosen, J. B., Iwamoto, M., Arciuolo, R. J., Langdon-Embry, M., Vora, N. M., ... & Barbot, O. (2020). Consequences of undervaccination—measles outbreak, New York City, 2018–2019. New England Journal of Medicine, 382(11), 1009-1017. https://www.nejm.org/doi/full/10.1056/NEJMoa1912514 Retrieved January 18, 2023.

Hi! Nice to meet you! I especially love helping new nurses. I am currently a nurse writer with a background in Staff Development, Telemetry and ICU.

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