The surge of viruses that caused pediatric hospitals across the nation to reach a breaking point and exceed their capacity has filled the national news this fall and winter. As pediatric residents in Tennessee, we, along with other frontline health care workers, have witnessed firsthand the burden this has placed on our hospitals and clinics. Over the past one to two years of our training, we have seen how several viruses can impact and cripple the health care system the children of Tennessee rely on for routine and emergency care. Whether it’s respiratory syncytial virus (RSV), flu, or COVID-19, numerous viruses have tested the limits of the pediatric care our state can safely provide.
With our hospital systems already stretched thin, this is the worst time to have a resurgence of vaccine preventable childhood illnesses. For generations, the children of our state have been protected from illnesses such as measles, polio, and many others with the help of vaccines. Sadly, Tennessee vaccination rates have fallen dramatically in recent years.
A quick internet search about these viruses may bring an initial sense of relief, as symptoms described are often mild, such as fevers, cough, runny nose, and rash. What is less commonly discussed are severe complications including pneumonia, blindness, and sometimes lifelong consequences or even death. While vaccines have greatly decreased the death toll seen prior to widespread immunization, this may have lured us into a false sense of security. For some reasons that are not entirely clear, an increasing number of children are unvaccinated or undervaccinated, which leaves our most vulnerable patients open to what could be fatal infections.
Fortunately, each vaccine goes through a rigorous approval process that ends with the FDA approving the vaccine. Once a vaccine is approved, it is closely monitored by various entities to ensure its continued safety. In an era of ever increasing distrust, we urge Tennessee parents to have an open discussion about vaccines with their child’s health care practitioners and encourage providers to do the same.
Information from the Kindergarten Immunization Compliance Assessment shows that for the 2021-22 school year only 45% of Tennessee counties reported up-to-date vaccination rates for children entering kindergarten to be above 95% (the level needed to achieve herd immunity). That percentage is down from 67% in 2020-21, 76% in 2019-20, and 74% in 2018-19. Tennessee is not alone when it comes to low kindergarten immunization rates. Numbers are down in the majority of U.S. states, according to data collected by the CDC. Tennessee had a measles outbreak of seven cases in 2016 that was fortunately contained, but if we continue to have vaccination rates at the level of the year 2021-22 the likelihood that we have another larger outbreak of a vaccine preventable disease will increase with each subsequent year.
Several states have had outbreaks of vaccine preventable diseases in recent years and the majority of cases occur in unvaccinated children. For example, in the year 2000, measles was declared eliminated in the United States, nearly 40 years after the public introduction of a two-part vaccine series targeting the virus. The World Health Organization made this declaration after a 12-month period with no reported cases in the entire country. However, as of early December, Columbus, Ohio, now has 73 confirmed cases of measles in children that are partially or completely unvaccinated (71 of the total cases).
As both international and domestic travel becomes more routine, the risk of bringing vaccine preventable diseases back to under-immunized communities within the U.S. and beyond increases. With fewer children protected, all children within our state are at increased risk of facing a resurgence of illnesses that have not been seen in generations.
What can we do to prevent outbreaks and protect our children from preventable illnesses? Being up to date with routine vaccines is our best shot. As the Kindergarten Assessment shows, we have fallen behind on our immunization rates. Whether this is due to the pandemic, lack of access, or overall hesitation, our children are facing the consequences. Have a conversation with your trusted providers about routine and catch-up vaccinations at your child’s next well child check. We can keep our children safe and healthy through proven immunizations, potentially saving a life, by working together with our children in mind.
Meghan Ghanayem is a MD PGY-2 at Vanderbilt University School of Medicine, Nashville. Cole Atkins is a MD, MS PGY-2 at the University of Tennessee College of Medicine, Chattanooga. Rebecca England is a MD, MS PGY-2 at University of Tennessee College of Medicine, Memphis. Heeyun Kim is a DO PGY-2 at East Tennessee State University.