Amid the coronavirus outbreak, many parents have been understandably hesitant to take their kids to their health care provider for routine health care, such as vaccines and health screenings. But pediatricians worry that this trend could open the door to outbreaks of other types of childhood illnesses, such as measles and whooping cough.
We recently spoke with Dr. Louis Vernacchio, a pediatrician with the Pediatric Physicians’ Organization at Boston Children’s Hospital (PPOC), to learn more about these concerns and what parents can do to help.
What are the risks when kids miss scheduled vaccines?
Getting childhood vaccines at scheduled intervals is the best way to develop immunity and prevent disease. And when overall vaccine rates drop below a certain threshold for herd immunity (when a large number of the population is immune to an illness through vaccination or previous exposure), there’s a higher risk of outbreaks in the community. We’ve seen that happen recently with measles in certain parts of the country. So there’s a concern that if enough children miss vaccines, these outbreaks could happen on a wider scale and with other diseases, like whooping cough.
Is maintaining the vaccine schedule more important for certain age groups?
Yes, it’s most crucial for infants, who are receiving what we call the primary vaccine series. This is because the vaccines are given on a fairly tight schedule, starting at about 2 months of age, which gives them the best chance for good immunity against illness. With babies, the more months they fall behind, the greater the chance that we’ll see outbreaks.
What about schedules for older kids?
For children ages 4 and older, the windows are much wider. For example, there is a set of what we call “pre-kindergarten” vaccines, which are recommended for children between ages 4 and 6. As long as they are given within that window, they work well and there’s a good chance the children will be adequately protected. So there’s less of a concern with these kids falling behind and risking disease, as long as we can track them and get them in within the next year or so.
How do pediatricians keep track of which kids are behind?
At Boston Children’s, we’re using our electronic health record to track any child that’s fallen behind on their vaccines and trying to reach out to parents proactively. We think it’s helpful to create a systematic method so we don’t have to rely on a paper trail.
Are there other types of screenings kids are missing?
Yes. While telemedicine has been a great tool for us during this time, there are some screenings we simply can’t do over video. For example, infants and toddlers should have a lead poisoning screening as well as hearing and vision screenings. Kids ages 3 and older need annual blood pressure screenings and teens should get screened for sexually transmitted diseases. I also worry that there will be children with treatable conditions, such as asthma that are missed when these visits are put off.
Are PPOC pediatricians taking any extra steps keep families safe?
Yes, we’re taking many such steps in my practice at Longwood Pediatrics and sharing best practices with other providers in the PPOC. These include:
- Cohorting patients. This means keeping patients with possible COVID-19 symptoms in a different area from patients who are coming in for well visits. At our Longwood office, we are able to keep these patients separated on different floors. Some offices may separate patients by having sick visits and well visits at different times of the day.
- Providing personal protective equipment (PPE) for all staff. This is not only to keep staff safe, but also protects patients and families.
- Removing items like toys and books that could spread germs from waiting rooms.
- Following strict disinfecting procedures for waiting rooms and procedure rooms in between patients.
Some practices are also finding creative ways to minimize patients’ time in the office. For example, some are having patients check in by text from their cars and then wait in their car until a room is ready. I’ve also heard some practices are pairing a virtual visit with an in-person visit. In this case, the doctor or nurse practitioner does the health counseling portion of the visit through a virtual visit, and then the patient comes into the office for their screenings and vaccines. It’s a neat way to keep patients’ time in the office to a minimum.
Do you have any suggestions for parents who feel uneasy about an office visit?
I would suggest they have a conversation with their pediatrician about their concerns. Together, they can discuss the risks versus benefits of an office visit based on their child’s individual health needs. For most kids who need vaccines and other screenings, we do feel that the benefits outweigh any risks. But there may be circumstances when a child’s doctor feels it’s best to delay an office visit based on that child’s health history.
Get more answers about Boston Children’s response to COVID-19.
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