New Hampshire

Health leaders push for vaccines as student vaccination rates drop

The number of Granite State students who are educated on the various vaccines the state requires for school attendance is headed in the wrong direction, health experts say. The trend continues nationally, too, the Centers for Disease Control and Prevention reported earlier this month.

Experts say even a small drop in vaccination rates that New Hampshire has seen increases the likelihood of communicable diseases spreading within a school and beyond. Specifically for measles, the CDC said the 93.5 percent immunization rate among the nation’s preschoolers still puts 250,000 of their peers at risk of infection.

Vaccine hesitancy that hampered COVID-19 vaccine uptake plays a role, but it’s hardly the driver, health experts said. Neither did religious exceptions, which so dominated last session’s legislative debates that lawmakers made it easy for parents to get one.

Religious exemptions for all students have fallen to 1 percent this year from the 2019-2020 school year, when 2.5 percent of parents requested one, according to the Department of Health and Human Services. (The COVID-19 vaccine has driven the change in exemption requests, but is not required to visit schools and childcare facilities.)

dr Erik Shessler, chair of general pediatrics and associate medical director of Dartmouth Health Children’s and vice president of the New Hampshire chapter of the American Academy of Pediatrics, says two other culprits are behind the drop in vaccination rates: staff shortages and the pandemic making it difficult for children to get their Receive annual check-ups where providers update vaccines and review a child’s overall mental and physical health. And some families aren’t prioritizing postponing those missed visits.

“One of the things that we’ve had to do statewide and nationwide is get a little bit of cheerleading back, like, ‘No, no, it’s a big deal to get screened regularly,'” Shessler said. “As with any kind of pandemic or disaster, people expected the sky to come down, and when the sky didn’t come down, it was like, ‘Well, I’ll get to that, but not right away. I’ll get there when I get there.’ ”

Shessler and other public health experts are urging parents to reschedule missed appointments as soon as possible. But they warn that falling vaccination rates will not be immediately reversed as providers grapple with a surge in flu and RSV cases while trying to reschedule adults and children who have delayed care during the pandemic to plan.

“We’re behind, and you add up their delay plus our delay, and you end up defaulting on vaccines,” Shessler said.

State laws require children to receive multiple vaccinations to attend private or public schools or child care facilities: diphtheria, mumps, whooping cough, poliomyelitis, rubella, rubella, and tetanus. The Department of Health and Human Services, which can also mandate vaccines, requires hepatitis B and chickenpox vaccines, as well as a vaccine that protects against meningitis, epiglottitis and pneumonia.

The Department would lose its power to mandate vaccines under House Bill 557, which would only allow lawmakers to make changes. Sponsor Rep. Jim Kofalt of Wilton said that while the department is “very reluctant” to add new vaccines, he is concerned that a future Commissioner of Health and Human Services will add any CDC-recommended vaccine or the COVID-19 vaccine would.

“That should be decided by the legislature, not the person running the agency,” he said.

Health and Human Services spokeswoman Laura Montenegro said the percentage of students in public and private schools who are up to date on mandatory vaccines has dropped from 95 percent to 93 percent. According to department records, vaccination rates tend to be 2 to 4 percent lower among private school students. Private students also have higher rates of religious exemptions. In the final school year, the latest available period, 4 percent of students were exempt from mandatory vaccines for religious reasons, twice the number of public school students.

Outside the public health world, a two percentage point drop might seem minor, especially if rates remain above 90 percent. But for some vaccines, a drop below a rate in the high 80s poses a risk that herd immunity public health experts say is necessary to prevent an outbreak

“We don’t want to lose our fantastic immunization rates in the state and now we’re suddenly dealing with outbreaks of measles or whooping cough and hospitalizing a lot of babies,” Shessler said.

According to the CDC, measles was declared “eradicated” in the United States in 2000 thanks to high vaccination rates. That’s no longer true.

In 2019, 1,274 cases were reported. The number fell during the pandemic as people masked and socially distanced, but has risen again, from 49 in 2021 and 121 cases last year. A measles outbreak in November in Ohio infected 85 college students, 72 of whom had not received the combined mumps, measles, and rubella vaccine.

“It’s about putting the community in the right light,” said Ryan Tannian, head of the Department of Health and Human Services’ Office of Infectious Disease Control. “We have seen examples across the country of outbreaks of vaccine-preventable diseases. And you know, our goal is to keep kids in school and not have to close a school because of a vaccine-preventable disease.”

Tannian said schools in the state have been forced to close due to outbreaks of influenza, a disease with no required vaccine in New Hampshire. It has not reported any outbreaks of disease with mandatory vaccines, he said.

Like Shessler, Tannian said the decline in childhood immunization rates has expanded the department’s immunization reach beyond supporting communities by making vaccines readily available in schools or local clinics.

“We’re trying to make sure people choose to vaccinate their children,” Tannian said. “And then in the meantime, we want to make sure that anyone who has missed or hasn’t had access to or hasn’t been able to get those routine shots and is kept up to date.”

Henniker’s Hali Wilkins is not among those who missed the chance to have her 3-year-old daughter Jovie vaccinated. She and her husband chose not to vaccinate her.

Wilkin’s opposition to all vaccines began with a miscarriage unrelated to vaccines. Instead, Wilkins began questioning all medical recommendations, including vaccination, after concluding that an internal ultrasound had killed her baby a few weeks into the pregnancy.

Before her second pregnancy with Jovie, Wilkins and her husband Cody discussed postponing recommended childhood vaccinations. They eventually decided to forego all vaccinations. She has shared her research with others through Facebook groups and her company, Jovial Birth and Postpartum Services, which focuses on natural childbirth and care.

“The day I had[my daughter]I just looked at her and was like, ‘Whoa, I could never let someone inject her if I risked hurting her or killing her,'” he said Wilkins. “So I figured, let’s sit down and look at every single shot and what it’s supposed to protect against, quote-unquoted.”

None, they decided, was worth the risk for Jovie and their second baby along the way.

Shessler and Tannian said it’s impossible to know how many parents choose not to vaccinate their children because of health concerns about the vaccine or religious objections.

“There is a large population that makes every vaccine that we could give. There is a small and vocal population that is not doing any of the vaccines,” Shessler said. “And then there’s a big section in the middle where you hear the term ‘vaccination refusal’. We’re trying to move people from one side of this spectrum to another to increase their confidence in vaccination. And having a trusted source for that information is incredibly important.”

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