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Vaccination rates for children have dropped by 20% in parts of Canada, raising fears that the country may face a series of infectious epidemics while battling COVID-19.
As public health officials remove restrictions on coronaviruses, allowing Canadians to return to a form of pre-pandemic normalcy, pediatricians fear that children delayed on their immunization schedule may be at higher risk of contracting preventable diseases through vaccination, such as measles and bacterial meningitis.
The National Post has contacted a number of pediatric infectious disease specialists in recent days, and almost all have reported that immunization rates for children and infants are declining. They said the magnitude of this decline is unknown because most provinces and territories do not maintain updated data.
One of the few provinces that provided data to the Post, Manitoba, recorded a 25% drop in measles, mumps and rubella (MMR) vaccines for the months of March and April 2020, compared at the same time last year for children two years of age and under.
Manitoba also recorded a 21% drop in diphtheria, tetanus and pertussis (DTaP) immunizations in the same age group in March and April this year compared to 2019.
The Post contacted Dr. Jim Kellner, a Calgary-based pediatric infectious disease specialist who is also part of the federal government’s COVID-19 immunity task force. Kellner leaked a conversation he had with an anonymous public health doctor. The doctor estimated that Calgary experienced a 20% drop in overall immunizations in March and April, which means that parents delayed their children’s routine immunizations.
All the experts pointed out that COVID-19 restrictions implemented across the country were an unintended cause of lowered immunity in children and infants.
Some have raised the possibility that an imported case of measles can wreak havoc on vulnerable populations in which, to be fully protected, a vaccination threshold of 95% or more must be maintained. If this rate is not maintained, there is no collective immunity and outbreaks can occur with the slightest drop, said Dr. Caroline Quach-Thanh, pediatric infectious disease specialist in Montreal. Like Kellner, she also sits on the federal government’s COVID-19 immunity task force.
Kellner added that a measles epidemic is very worrying because measles is much more contagious than COVID-19 because of its routes of transmission; the former is suspended in the air while the latter is believed to infect largely via droplets that remain on surfaces. Measles mainly targets unvaccinated children, who may have flu-like symptoms and rashes. In rare cases, this can lead to death. With children who contract COVID-19, experts have so far discovered that they often suffer from a mild illness, with a significant portion remaining asymptomatic.
In 2018 alone, more than 142,000 people died – many of them children under the age of five – from measles and more than 9.7 million were infected worldwide., Estimates by the World Health Organization.
Although families largely followed the guidelines for social distancing and isolation established by public health officials during the pandemic, this does not guarantee that a baby or toddler is safe from harm. contracting a vaccine-preventable disease, warned pediatric infectious disease specialist Dr. Joan Robinson. in Edmonton.
What infectious disease should a parent be particularly concerned about? In Robinson’s mind, it’s bacterial meningitis.
“Most parents have never met a child with bacterial meningitis today – all because of the vaccines,” she said.
Despite months of social distancing, isolation within the family unit and staying largely at home, meningitis can infect young children because older children and adults can carry the disease for months without so many symptoms.
A child who has missed their routine meningitis vaccination, usually given for a while in college, may be more likely to get bacterial meningitis. Most people recover from it, but the disease can also cause lifelong problems such as learning disabilities, hearing loss and, in rare cases, death.
Follow the calendar
Across Canada, children follow a vaccination schedule in which, at two months, the first series of vaccines is administered. From there, every two months, the child receives a set of vaccines until the age of six months. The next series of vaccines is usually given at 12 months, then again at 18 months, two years, and four years. The vaccine a child receives depends on the province.
“It is especially important to get regular vaccinations for infants and toddlers because they are considered a” series of primary vaccinations, “wrote Dr. Vinita Dubey, an expert on immunizations and vaccine-preventable diseases in Toronto. Public Health.
“Without these vaccines, the child may not have complete protection against the diseases that the vaccine can prevent. In addition, vaccinations often require time to develop immunity and many doses are required during early childhood to obtain the best protection. Waiting for these vaccines can make a child vulnerable to infection with the disease. ”
One of the main factors delaying immunization and lowering immunity could be something as simple as a parent inadvertently forgetting, says Nova Scotia’s pediatric infectious disease specialist, Dr. Scott Halperin. get your child vaccinated.
When a parent has a newborn baby, it occurs to him that at two months of age, the baby needs his first vaccines. If a baby reaches almost six months of age with COVID-19 restrictions in place, it may take a few more months for the child to receive the necessary vaccines.
It’s not because there are restrictions in place that prevent the child from getting the vaccine, said Kellner. In fact, most public health clinics and many pediatricians continued to administer vaccines throughout the closings.
Instead, the parent, due to strong public health messages to avoid doctor visits, may confuse the message and not bring the child for routine vaccination for fear of contracting COVID-19. In reality, the only public immunization programs that were discontinued were the school immunization clinics, which means that children who would otherwise have received vaccines in school may not have done so.
A Toronto pediatrician said his clinic had suspended allowing children to get regular vaccinations until the end of April because he was unsure of the impact of COVID-19 on children. Understanding the danger of delaying early childhood vaccinations, however, Dr. Daniel Flanders started a drive-through clinic so that parents can bring their kids for injections. Before setting up the drive-thru service, Flanders said it had noticed that the children who came to get the vaccine had dropped by about half.
Most parents today have never met a child with bacterial meningitis – that’s all because of the vaccines
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All doctors contacted by the Post said it was important that parents stick to their child’s immunization schedules. These are designed to ensure that a child has developed sufficient immunity before he is most at risk of contracting the infectious disease.
If the timetable is waived, communities lose their immunity and their protection against vaccine-preventable diseases. Unlike measles, where 95% or more of the population must be vaccinated for adequate coverage, most jurisdictions strive to achieve vaccination rates of 90% or more for other infectious diseases for which there is a vaccine.
Before COVID-19, the last available data, from 2017, showed that the use of vaccination across the country did not meet public health objectives, as published by the National Survey on Immunization Coverage of children.
In Canada, 90% of two-year-olds had received at least one dose of the measles vaccine and 76% of two-year-olds had received the four recommended DTaP vaccines.
The Post contacted each province and territory, requesting data on childhood and infant immunization rates for the months of January to April 2020 and for the same period in 2019.
Aside from Manitoba, the only other province to return to the Post with data from January to April 2020 was Saskatchewan, which did not experience huge fluctuations in whooping cough and measles vaccines in children enrolled in the provincial immunization database.
Toronto pediatrician Flanders voiced concerns about the data from Saskatchewan.
“It seems strange to me that the COVID situation has no impact on immunization rates,” he said in Saskatchewan, while Manitoba – a province next door – fell 20%.
While immunizations for children two and under dropped by about a fifth for measles and a quarter for whooping cough in Manitoba in March and April this year, children aged two to 17 declined much larger during the same period.
Administrations for MMR vaccine fell by more than 60% and administrations for DTaP vaccine decreased by 55%.
A provincial spokesperson said the preliminary data are likely due to the COVID-19 epidemic.
British Columbia, Prince Edward Island, Nova Scotia and the Yukon did not respond to the Post’s request for data. Ontario, the Northwest Territories, New Brunswick, Newfoundland, Nunavut and Quebec all reported not having the requested data. Alberta did not provide monthly breakdowns, but rather January-April vaccination rates combined.
“We do not know the magnitude of the problem of delayed immunization during the pandemic,” said Halperin, a Nova Scotia specialist.
“We suspect from what we hear that children are delaying vaccination, but we do not know to what extent. If someone is delayed, it is a concern. ”
Quach-Thanh assumed that in Quebec, those responsible for monitoring vaccination rates in the province were largely displaced to focus on the government’s response to the coronaviruses.
A spokesperson for the Quebec Ministry of Health confirmed that the province collects immunization surveillance every two years and that the province had started working on the report for 2018 before interrupting it due to requests from COVID- 19.
Quach-Thanh noted that the lack of available data on population immunity is “absolutely” a concern. It echoed the position put forward by the National Advisory Committee on Immunization, which urged Canadians to stick to vaccination schedules.
The committee and the doctor acknowledged government efforts to limit non-essential stresses on the health system, but strongly stated that vaccinations, especially early vaccinations, are considered essential.
Quach-Thanh pointed to the United States, a country experiencing a dangerous drop in immunization rates, as reported by the New York Times in April).
In the United States, nationwide, MMR vaccine administration dropped 50% between mid-February and early April.
“What is happening in the United States is happening here,” she said.