Health experts: Drop in Michigan immunizations during COVID crisis could lead to outbreaks

Karen Bouffard
The Detroit News

As the novel coronavirus raged across Metro Detroit this spring, Dr. David Obudzinski watched well-child visits to his Bingham Farms-based pediatric practice plummet, leaving scores of his tiniest patients unvaccinated.

"There was a lot of fear out there," Obudzinski said. "There are some that I was told the mom made the appointment and then the dad said, 'Nope, you not going.'

"More didn’t talk about it. They just called and canceled."

Two-year-old Khloe Sitto, from Farmington Hills, plays on the phone of her mother Karleen before receiving a hepatitis A vaccination at Beverly Hills Pediatrics, in Bingham Farms, May 26, 2020.

Obudzinski's observations come as Michigan vaccination rates have dramatically fallen during the COVID-19 crisis, according to a study published by the federal Centers for Disease Control and Prevention this month — a development that has public health officials worried about future outbreaks of vaccine-preventable diseases in the state. The diseases range from measles, mumps and rubella to diphtheria, tetanus and pertussis, or whooping cough.

Vaccination rates overall for children 18 and younger dropped by more than 20%, the study found. Measles vaccinations dropped from just over 76% among 16-month-olds, to just over 70%, leaving communities vulnerable to outbreaks, according to the report. 

"The observed declines in vaccination coverage might leave young

children and communities vulnerable to vaccine-preventable

diseases such as measles," the study concluded, noting that 90% to 95% vaccine coverage is required to establish herd immunity to measles and avoid outbreaks

The study compared the vaccination status of children at various ages during May of this year, with those of their cohorts during the previous four years. There were double-digit declines in immunizations this year, which has alarmed state health experts and local doctors.  

"I’m extremely concerned that anytime we see a drop-off in our vaccine rates that it does leave the door open for a potential outbreak," said Bob Swanson, director of the division of immunization at the Michigan Department of Public Health. 

"We worry about things like measles or pertussis or mumps. Those types of diseases, we really could see resurge when we see a decrease in the rates."  

Results of the study, co-written by researchers at the state health department and the St. Paul, Minnesota-based nonprofit Immunization Action Coalition, and vetted by the CDC, likely reflect what's happening around the rest of the country where parents are keeping kids at home during the pandemic, Swanson said.

"It’s absolutely a national trend," he said. "There’s been a lot of concern on conference calls I’ve been on with other states, with their rates dropping due to this outbreak. They’re putting together plans on how they can increase rates and try to get back to where we were — at least, if not beyond."

Two-year-old Khloe Sitto, from Farmington Hills, receives a hepatitis A vaccination from certified medical assistant Dijonn Adams while being held by her mother Karleen at Beverly Hills Pediatrics, in Bingham Farms, May 26, 2020.

'A lot of fear out there'

Researchers used data from the Michigan Care Program Registry, which tracks immunizations across the state, to compare how many kids were vaccinated this May compared with the average of May rates from 2016-19. 

Fewer than half of babies who were 5 months old this May were up-to-date on their immunizations, compared with two-thirds of 5-month-olds in the prior years.

The rates were lowest in southeast Michigan, which was worst-hit by the surge in COVID-19 cases that began in mid-March, Swanson said.

More than 55,100 coronavirus cases have since occurred and more than 5,260 deaths — with 63% of the cases and 78% of the deaths occurring in Macomb, Oakland and Wayne counties.  

The number of children with up-to-date vaccinations was lowest among children covered by Medicaid, the federal health insurance program for low-income people. Fewer than 35% of babies who were 7 months old in May had received the recommended series, compared with 55% not enrolled in Medicaid.

"There is a greater number of Medicaid clients in southeast Michigan, especially in the Detroit area," said Swanson, noting that Medicaid covers the cost of vaccinations. 

Obudzinski, the pediatrician, said parents started canceling their appointments in March. That month, Gov. Gretchen Whitmer issued stay-home and other emergency orders that prohibited elective and other non-emergency surgeries at Michigan hospitals. But she did not ban parents from visiting doctors' offices for vaccinations. 

Obudzinski's practice, Beverly Hills Pediatrics, posted the safety precautions it takes on its website, such as having separate clinic hours for children who are sick. But parents still didn't bring in their kids. The practice has remained open throughout the pandemic, though it was forced to reduce its hours of operation at its Sterling Heights location due to a lack of patients.

"My fear is that we're going to have a group of kids who are not protected at an age where they need to have the protection," Obudzinski said. 

"Whooping cough is still there in the population; we have outbreaks from time to time. Kids are given vaccines at 2, 4 and 6 months to protect them from that, and at under a year of age, it can be quite devastating — risk of death is there. So I always tell parents: You want to get three doses in before six months."

In the past three years, Michigan has experienced a decline in whooping cough from 761 cases in 2017 to 543 cases in 2019, according to the Michigan Department of Health and Human Services. 

But the respiratory disease remains a persistent concern. Last year's whooping cough cases occurred widely across the state and were reported in 49 of the state's 83 counties or almost 60% of them, state health department spokesman Bob Wheaton said.

Mumps experienced a spike to 81 cases in 2018 before falling to 29 cases last year, according to the state. They included five that were confirmed, 20 that were considered probable and four were suspected cases, Wheaton said.    

Two-year-old Khloe Sitto, from Farmington Hills, receives a hepatitis A vaccination from certified medical assistant Dijonn Adams while being held by her mother Karleen at Beverly Hills Pediatrics, in Bingham Farms, May 26, 2020.

In 2019, Michigan had its largest outbreak of measles since 1991 with 46 cases reported. It was more than double the 19 cases in 2018, while the state only reported two cases in 2017 and one case in 2016.

Forty-two cases of measles last year were part of a single outbreak in Southeast Michigan that was centered in Oakland County, with four other isolated cases.

A national uproar ensued after an outbreak of measles linked to California's Disneyland quickly spread to people in at least 14 states in early 2015, including one case in Oakland County.

Health officials blamed the re-emergence of the highly contagious disease, which had been eradicated from the United States in 2000, on parents refusing to vaccinate children out of fear that immunizations can cause autism — a theory that has been widely debunked by the scientific community.  

The symptoms of measles are usually mild, including a fever, a cough, runny nose, body aches and a loss of appetite. But the symptoms can be deadly in babies, who cannot be immunized until they’re a year old, according to health officials.

"Science is really behind us — we know that vaccines are safe, and they’re effective," said Swanson with the Michigan health department's immunization division. "They’re the best thing we have to try to protect our population from these vaccine-preventable diseases.

"So we need to be sure that everybody gets caught up on their immunizations that they may have fallen behind on so that we can assure that everybody is protected from vaccine-preventable diseases."

Twitter: @kbouffardDN