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Thursday October 25, 2018

A Troubling Sign: Number of Unvaccinated Toddlers Increases


Most children in the United States receive all or at least some of the scheduled vaccinations listed by the U.S. Centers for Disease Control and Prevention. But a new report by the CDC highlights reason for concern: The number of children who receive no vaccinations whatsoever, though tiny, has increased fourfold since 2001.

Back then, it would have been extremely hard to find a completely unvaccinated child ages 19 months to 35 months; only 0.3 percent fit that description, which means three children in a thousand. Now, the CDC said, the number is 1.3 percent. Still very small, but nonetheless, chances are that if you went to a toddler gymnastics center or other facility where 100 young preschoolers might be gathered, you would find at least one child who had never been vaccinated against measles, polio, tetanus, rotavirus and so forth.

It is of course natural to assume that anti-vaccine sentiment, or parental fears about vaccines based on myths that circulate on social media, might play a large part in the increase. According to a report by the Washington Post, CDC officials are concerned that about that possibility, especially after low vaccination rates among the Somali community in Minneapolis led to a measles outbreak that hospitalized dozens of children. Measles vaccination rates are up among that community, the local public-radio station recently reported, but still have reached only 58 percent, a very dangerously low level. The rate among the non-Somali community is 91 percent.

But it could be a mistake to make any assumptions. The CDC survey on vaccination rates did not look at causes. In addition, it found that vaccination rates were much lower in rural areas and among families who lacked insurance or who were on Medicaid, indicating that lack of access to vaccinations – or at least perceived lack of access – may have played an important role.

Children who lived outside a metropolitan area – in other words, a largely rural population – were about half as likely to have been vaccinated, the CDC reported. And low-income children were disproportionately represented among the unvaccinated group.

“Vaccination coverage differences by insurance status are concerning,” the CDC report, especially considering that uninsured children and those on Medicaid qualify for the Vaccines for Children program, which provides vaccination for free. “However, other issues, such as unfamiliarity with the VFC program and how to access it, transportation, child care, and convenience of clinic hours might also need to be addressed if the goals of this important element of the immunization safety net are to be fully realized. Lack of geographic proximity to vaccination providers, including those who participate in the VFC program, can be a barrier to vaccination. The shortage of health care providers, especially pediatricians, might partially explain the lower coverage among children living in rural areas.”

In other words, there might be plenty of parents who would love to give their children the important protection of immunization, if ways around the barriers of transportation, time and perhaps shortage of health care providers were implemented.

As with the Somali measles outbreak, the CDC said, the problem is less the overall vaccination rate, but the likelihood that there are many other pockets were the rates of unvaccinated children are much higher, especially in rural and low-income areas, creating a public-health hazard.

“Variation in coverage by health insurance and (rural vs. urban) status and the increasing percentage of unvaccinated children raise concerns about possible pockets of susceptibility in which children are not as well protected as national coverage estimates might indicate,” the report warned.



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