Immunization rates plateau in Virginia over recent years

Richmond Times-Dispatch - 3/20/2017

After working with the Virginia Department of Health since 1983, James Farrell is preparing to retire from his position as vaccination director - but he leaves with concerns.

Vaccination rates in Virginia have plateaued.

"We're not making any great advances, and we're not declining," he said.

According to the federal Centers for Disease Control and Prevention, the state's childhood immunization rates are not especially low on the nationwide scale, but neither is Virginia among the country's best performers.

In Virginia, according to the state Department of Health, the rate of children ages 19 months to 35 months who received their immunizations in 2015 was 64.4 percent, compared with the 72.2 percent national average.

But in 2014, Virginia's rate was 73.7 percent - above the national average of 71.6 percent.

Still, the state's rates have increased since 2010, when 55.2 percent of children 19 months to 35 months old received their recommended vaccinations.

According to the Virginia Department of Health's immunization survey, from 2011 to 2015, the immunization rate for the state's sixth-graders in public and private schools fell from 98.1 percent to 88.3 percent. But for kindergartners, the rate increased from 80.9 percent to 85.6 percent.

Earlier this month, the Henrico County Health District reported individual cases of mumps in three of the county's schools: Mills Godwin High, Douglas S. Freeman High and Tuckahoe Middle.

Laura Young, the health district's epidemiologist, declined to comment on how the students were doing last week, but she said symptoms of mumps typically resolve on their own and complications are rare.

Cases of mumps, Young and Farrell said, aren't uncommon, even in a well-vaccinated population. The vaccine is about 88 percent effective with the recommended two doses and 78 percent effective with one dose.

The number of sixth-graders in Henrico receiving religious exemptions from vaccine requirements - including the mumps vaccine - has increased during the past five years, though. In 2016, 65 students had religious exemptions, compared with 42 in 2015 and 24 in 2014, according to Department of Health data.

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The biggest challenge facing the Department of Health and child care providers as they work to get more children vaccinated, Farrell said, is the anti-vaccine movement.

"With the advent of the internet, any non-science-based information gets on the internet and, unfortunately, becomes gospel," he said.

Vaccine opponents claim they are advocating for choice and informed consent when it comes to whether or not a parent must have their child immunized.

Parents should not be forced to vaccinate their children, they claim. Others believe vaccines are dangerous. For Farrell, though - and many health care providers in Virginia, especially pediatricians - it's about protection from sometimes deadly diseases.

Vaccines are most efficient when a majority of the population receives them. If more parents become skeptical about their safety - despite the fact that all required vaccines have been approved by the U.S. Food and Drug Administration - the health of the population could be in danger.

In 2011, cases of whooping cough became more prevalent in the Richmond area and all over the state. The increase was associated with waning immunity, because fewer children were getting vaccinated.

In 2015, at least 70 people in six states and Mexico became ill with measles after visiting Disneyland, likely because they had not received their measles-mumps-rubella, or MMR, vaccine - some because they were too young, others because they opted out.

Unfortunately, Farrell said, one of the best ways to convince people that vaccines are important is through an outbreak. After the Disneyland outbreak, rates of MMR vaccination increased.

"We are suffering from our own success," he said. "We've had parents who never had communicable diseases because the vaccines have been so effective. Vaccines are the greatest public health success story there is."

Dr. Sofia Teferi, chief of pediatrics at Bon Secours Richmond Health System'sSt. Mary's Hospital, treats pediatric inpatients. She said she sees patients and parents refuse flu shots frequently because they are misinformed: They think the shot will cause them to get the flu, or they don't think it's necessary.

After a flu outbreak in the early 2000s, she recalled, patients were far more willing to receive flu shots.

"People don't realize how successful we have been with eradicating and really changing the landscape of what people suffer from nowadays because of vaccines," she said.

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Farrell said that in order to boost vaccination rates in Virginia, state and federal agencies should support providers, who oftentimes are on the front lines when confronted with a parent worried about vaccine safety.

Dr. Sean McKenna, a pediatrician with the Children's Hospital of Richmond at VCU, said parents increasingly are exposed to misinformation.

"Parents understandably have a lot of questions when websites contain information that the doctors don't agree with and the American Academy of Pediatrics don't agree with," he said. "Parents are in a difficult position sorting through those facts.

"Once parents sit down and see the actual facts - what the data shows, the safety profiles - then I find no parents refuse immunizations," he said.

Teferi noted that sometimes infants will come in with whooping cough because they were too young to receive the vaccine and became infected because an adult family member was not vaccinated.

"We need to do a better job working with the private community and preparing physicians to deal with this onslaught of negative information that's going to come to them through parents by these anti-vaccine groups," Farrell said.

The Department of Health gets more than $6 million every year in grant funds through the CDC's Prevention and Public Health Fund for immunizations that local health departments give to their patients. The grant also funds educational and awareness campaigns.

But Congress soon might remove $1 billion from that fund, which was created through the Affordable Care Act, if the health law is repealed.

Educating those who are against vaccines likely is not a worthwhile endeavor, Farrell said, because they will not be persuaded by science.

"But there are parents that are concerned, and they have legitimate concerns," he said.

"The true answer is to overcome it by just providing good, solid information to parents and (educating) physicians on how to talk to parents who are hesitant about having their children immunized. That's the key."

kdemeria@timesdispatch.com

(804) 649-6813

Twitter: @katiedemeria

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64.4% - Rate of children 19 months to 35 months in Virginia who received immunizations in 2015. The national average was 72.2 percent.

88.3% - Immunization rate for Virginia sixth-graders (public and private schools) in 2015. It was 98.1 percent in 2011.

65 - Students receiving religious exemptions in 2016. There were 42 in 2015 and 24 in 2014.