News & Views: Vaccines — Local? Societal? Both.
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Vaccine Update for Healthcare ProvidersPublished on
Vaccine Update for Healthcare ProvidersVaccinations are local. Regardless of whether your trip to the “office” lands you in a clinic in rural America or a country in west Africa, you are likely to recall examples that demonstrate the diverse nature of local populations and perhaps even have experiences related to how that diversity affects vaccine acceptance and uptake. Unfortunately, the pathogens that cause vaccine-preventable infectious diseases do not respect borders or diversity of populations, so societal protection is at the mercy of local protection. As stated by Thomas Reid, “The chain is only as strong as its weakest link, for if that fails the chain fails and the object that it has been holding up falls to the ground.”
This reliance on local protection for its role in societal protection means that the work of understanding the beliefs and attitudes of one’s own patient or community population as well as local barriers to vaccination is critical. It also means that we need a contextual understanding of the state of societal protection for how it may affect our own communities. With this in mind, four recently published reports are worth reviewing for their contributions to this unbreakable bond between local and societal protection:
The first two reports (NIS-Child and Kindergarten) offer a snapshot of U.S. vaccine coverage, including data by state and demographic. The third report, while focused on COVID-19, provides an understanding of attitudes among rural populations throughout the U.S., including examples that demonstrate the diversity across rural communities. The fourth report describes vaccine coverage by World Health Organization (WHO) region as well as between groups of countries with different economic classifications.
The children evaluated during the most recent NIS-Child survey were those born during 2019 and 2020. In good news, immunization coverage rates were similar to those found during the previous analysis (2017-2018 births) and included increased coverage with the birth dose of hepatitis B vaccine and at least one dose of hepatitis A vaccine. As such, more than 9 of 10 children had received at least three doses of polio and hepatitis B vaccines and one or more doses of measles, mumps, rubella (MMR) and chickenpox vaccines. And, the percent of children who were completely unvaccinated remained steady at 1%.
However, a few findings are important for our consideration of the relationship between local and societal protection:
The 2022-2023 school year evaluation of vaccine coverage among kindergarteners included children who became eligible to complete school-mandated vaccines during the pandemic. Previous surveys of pre- and post-pandemic vaccine coverage demonstrated about a 2% decline (from 95% to 93%), and the cohort in this year’s survey remained at 93%. However, more alarming were findings related to vaccine exemption rates, which increased in 40 states and the District of Columbia (DC), including 10 states where exemption rates topped 5% for at least one vaccine. According to the discussion section of the report, “The overall percentage of children with an exemption increased from 2.6% during the 2021–22 school year to 3.0% during the 2022–23 school year, the highest exemption rate ever reported in the United States.”
Likewise, coverage rates varied widely across states. For example, 12 states and DC had lower than 90% coverage for vaccines, such as MMR (2 doses), polio (4 doses) and chickenpox (2 doses), and 14 states and DC had less than 90% coverage with DTaP (5 doses). Given the contagiousness of diseases like measles, pertussis and chickenpox, the number of susceptible students in classrooms is concerning.
The “CDC’s State of Vaccine Confidence Insights Report,” published in September 2023, evaluated a series of data sources collected between 2017 and 2023 to understand vaccine confidence and uptake among rural populations throughout the U.S. The findings focused on three themes:
For each theme, the report highlighted the findings that contributed to them and presented questions to consider and actions that may be taken to address each concern. The report also contained links for more information and additional resources.
A few interesting highlights from this report:
This report evaluated vaccine coverage up to 2022, focusing in particular on progress toward decreasing the number of children who had yet to receive a single dose of diphtheria-tetanus-pertussis-containing (DTP-containing) vaccine (called “zero-dose children”) and increasing the number of those who had received at least three doses of DTP-containing vaccine. Neither of these measurements have returned to pre-pandemic (2019) levels, but both increased from where they were in 2021:
The authors made the point that while rates of vaccine coverage are rebounding, “progress was unevenly distributed, especially in low-income countries” (p. 555). For example, only 15 of 73 countries that had a 5% or greater decline in three-dose DTP-containing vaccine coverage have returned to pre-pandemic coverage levels. Coverage is also approaching, but not yet at, pre-pandemic levels for BCG, hepatitis B (3 doses), polio (3 doses) and rubella. Likewise, 115 of 194 WHO member states have yet to return to pre-pandemic coverage levels against measles. Indeed, according to a recent report focused on immunization recovery, it’s estimated that about 128,000 people died from measles in 2021; many of these were unvaccinated or partially vaccinated children younger than 5 years of age.
Because international travel is common and because our society is only as strong as our weakest local communities, it is important to understand that the risk for these diseases to enter the U.S. remains real.
Vaccinations are local, but infectious diseases are not. By focusing on understanding our own communities and figuring out ways to improve local vaccination rates, we can contribute to not only keeping our neighbors healthy but also ensuring that our community does its part when it comes to protecting our collective society.
Contributed by: Charlotte A. Moser, MS, Paul A. Offit, MD
Categories: Vaccine Update November 2023, News and Views About Vaccines
Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.
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