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Dr. Dennis Cunningham recalls a whooping cough outbreak in the late 1990s while he was a resident in Philadelphia. Some hospital staff had cracked ribs from coughing.
“It was terrible. Everyone was just hacking up all the time even though we were trying to wear the masks. It was a nightmare. It is not a benign illness, and it can be quite frightening,” said Cunningham, a pediatrician and director of infection control and Prevention for Detroit-based Henry Ford Health.
Cunningham spoke to reporters this week as students prepare or return to school to address Michigan’s decreasing childhood vaccination numbers, concerning because the state could see an outbreak of, for example, whooping cough or polio, preventable with widespread vaccination and largely eradicated for decades in the United States.
In the first quarter of 2022, 68.5% of Michigan children 19 to 35 months had received recommended doses of several routine vaccines, including diphtheria, tetanus and whooping cough; polio; measles, mumps and rubella; hepatitis B; haemophilus influenzae type b, which can cause meningitis; and chicken pox.
As of June, the rate was even lower in some parts of the state. In Detroit, 48% of children 19 to 36 months had received these shots. This fell to about 31% in Oscoda County in northeastern Michigan. Gladwin County, also in the northeast, Leelanau County in the northwest and Keweenaw County in the Upper Peninsula also had rates below 60%.
This is down from 74% at the end of 2019, before the COVID-19 pandemic, according to the state health department.
Among adolescents, 72.9% had received recommended inoculations as of the first quarter 2022. This rate was almost 74% at the end of 2019.
“If it was my kid’s report card, it would not be a pleasant evening in my house,” Cunningham said of the latest state vaccination report.
He does not wish to see in Michigan what is happening elsewhere in the country.
In July, a case of polio was reported in Rockland County, New York. The state health department then launched wastewater surveillance to check for signs of the virus. As of Aug. 12, analysis from the U.S. Centers for Disease Control and Prevention confirmed the presence of poliovirus in a total of 20 positive samples in Rockland and Orange counties, in the New York City area, genetically linked to the individual case, the first in the United States since 2013.
Michigan does not currently monitor for polio in wastewater; there is no commercial kit available to do such testing. So, it would have to go through the CDC or state labs would have to make a “homegrown” assessment, Chelsea Wuth, a public information officer for the Michigan Department of Health and Human Services, said in an email. The state hopes to quickly receive more guidance from the CDC, she said.
Michigan’s vaccination numbers are low enough that Cunningham said he is nervous about the consequences of a polio case in Michigan. “It really could spread quite quickly.”
It is best to have many people vaccinated and immune to disease, so the viruses do not circulate, he said.
When asked for possible reasons for declines in vaccine uptake, Dr. Michelle Day, a Henry Ford Health pediatrician, said a general disruption of routine, caused by the pandemic, led to interruptions in regularly scheduled visits. Some parents remain reluctant to return to doctors’ offices – in the last few months, she has seen a few families making their first visits in years, she said. Misinformation related to the COVID-19 vaccine has also led to hesitancy about other immunizations, even those routinely provided for decades, she said.
“There is distrust a little bit in what people read. Parents are worried about safety. Parents are worried about efficacy.”
At Henry Ford Health, staff administered more than 53,000 vaccines from January to June 2019. This number decreased by 20% in 2020, but is still down 10% since before the pandemic.
From the introduction of COVID to now, 13% of children are overdue for polio vaccines at Henry Ford Health. The CDC recommends four doses beginning at two months.
Usually, one of three polio viruses cause nonspecific illness in children. The symptoms could include fever, sore throat, stomachache or nausea, headache, and tiredness, Cunningham said.
A small percentage of kids, however, will suffer further complications, most commonly a viral infection of the spinal fluid and tissue around the brain. Some will develop paralysis, possibly lifelong, after they recover, Cunningham said.
Day encourages families to make appointments and see their pediatricians to ask questions. “Because nothing really can replace that face-to-face conversation with a pediatrician they trust.”
As well as the usual childhood vaccinations, Day encourages the COVID-19 vaccine, available now to all children 6 months and older.
“With going back to school, kids are going to be again in enclosed spaces, sitting together for circle time, working on projects,” she said.
Children are not the best at handwashing, at practicing good hygiene, she said. “It only takes one child to spread illness.”
Vaccine schedules are designed to protect children when they are most vulnerable to disease. However, there are catch-up timelines “It’s never to late to start getting up to date,” Cunningham said.