Keeping Up with Immunizations is More Critical Than Ever

Whether it’s in person or online, it’s back-to-school time. Making sure children receive the required immunizations before the first bell rings has always been on parents’ to-do list. Pandemic or not, that hasn’t changed. In fact, making sure vaccinations are up-to-date is more important than ever. 

“Even with everything happening with COVID, the usual diseases are still in existence. They’ve not gone anywhere,” explains Deepa Sharma, D.O., a family medicine physician with Baptist Health Primary Care, Family Medicine Center at West Kendall Baptist Hospital.

Kids aren’t the only ones who need to stay on top of their immunizations, says Jonathan Fialkow, M.D., deputy medical director, chief of cardiology and a certified lipid specialist at Miami Cardiac & Vascular Institute and chief population health officer for Baptist Health South Florida. “The (U.S.) Centers for Disease Control and Prevention considers vaccinations to be an essential medical service for children, adolescents and adults, including pregnant women,” says Dr. Fialkow. “That means they should not be delayed because of the COVID-19 pandemic.”

A recent episode of the Baptist HealthTalk podcast, hosted by Dr. Fialkow, took on the subject of vaccines with Dr. Sharma and Lillian Rivera, Ph.D., a former public health officer and administrator for the Florida Department of Health. Some highlights of their conversation appear in the Q&A below. 

You can access this and other Baptist HealthTalk podcast episodes on your computer or smartphone, or via Apple Podcasts and Google Podcasts.

Dr. Fialkow:
“Back in May, the CDC reported that routine childhood vaccinations have decreased significantly since the start of the epidemic. Dr. Rivera, do you have any idea if this trend is still continuing?”

Dr. Rivera:
“The overall number of well-child office visits has been down about 50%. Manufacturers are reporting a decline in vaccine orders and doses distributed through what we call the Vaccine Children Program, which are the free vaccines that are given out throughout the nation and its territories have dropped significantly.… We do have a bit of good news. The vaccination levels are increasing in the state and the well-child office visits are increasing thanks to telemedicine.”

Dr. Fialkow:
“It’s a very troubling trend, as you said, from a public health standpoint, not having these routine vaccinations being done because of coronavirus concerns. Dr. Sharma, are you and your colleagues seeing the same type of situations?”

Dr. Sharma:
“Unfortunately, we are, in terms of what we see in the Family Medicine Center, where we see all ages from newborns to elderly. Well visits were certainly on the decline but fortunately, we are starting to see well visits come through the office.

“I think a lot of that has to do with community education for the importance of the routine healthcare measures and … sharing what the safety protocols are, how patients know that it is safe to come into the office.”

Dr. Fialkow:
“That’s actually encouraging. I want to also have you guys comment on the concept of catch-up vaccinations. So (if) I missed it or I didn’t get my child vaccinated is it too late or is there still a benefit to have your well visit?”

Dr. Sharma:
“Catch-up vaccinations are actually more common than people realize. Of course, we understand that life happens. So luckily, the Centers for Disease Control does have a catch-up vaccine schedule for providers and families to consult. We do recommend that depending on the vaccine, the age of the child, how many vaccines were administered, a little bit more information to guide us on the catch-up planning. But absolutely, catching up on vaccines is encouraged and recommended and we have available resources.”

Dr. Fialkow:
“Lillian, can you give us a few ideas of what are the types of diseases that we most routinely would vaccinate a child in order to protect against?”

Dr. Rivera:
“Absolutely. It’s very important that folks understand that there are different type of requirements that exist within the schedule recommendation of the Florida Department of Health in the state of Florida. We have age-appropriate childhood vaccinations. We have diphtheria, tetanus, pertussis. We have the polio vaccine, the measles, mumps, and rubella, which we call the MMR, very important vaccine. I know Dr. Sharma and I, before we leave, we have to talk about measles because measles, to me, is the most scary disease of all of them because it’s very, very contagious.”

Dr. Fialkow:
“You went through a list of disease states that I remember learning in medical school and, of course, I’ve never seen diphtheria or tetanus. But can you comment how these really were scourges in an age, in the day prior to vaccines?”

Dr. Rivera:
“These are all debilitating diseases and, unfortunately, also fatal. They could be fatal diseases. The good news is that we have a vaccine for these diseases. Right now, we’re in the midst of discussing a vaccine for COVID and when is it coming? We need it. Well, for a lot of these diseases that you, Dr. Fialkow, because you’re young, you haven’t seen. But I am older–”

Dr. Fialkow:
“Thank you for that. My bones don’t think so, but okay.”

Dr. Rivera:
“I am older and I have seen diphtheria and I have seen tetanus. I actually had a patient, took care of a patient that died of tetanus. These diseases are very, very scary. Polio, we all know about one of our presidents who had polio. I still think some people remember that. So, these are diseases that definitely can cause a lot of sequela, what I mean (is) harm to the different organs in the body. It could cause blindness. It could cause lack of hearing. It could cause even death.

“But the good news is that we have a vaccine to take careof them. But vaccines only work if you use them, if you get them administered.If you don’t, then we have a problem.”

Dr. Fialkow:
“It’s not necessary for everyone to remember what these vaccinations are and when to give them. That’s the caregiver’s, the provider’s role. I will tell you, a year and a half ago, I was traveling to a country where measles had had an outbreak. I was tested and even though I had my MMR when I was young, I did not have measles titers. So, I had to be re-vaccinated.”

Dr. Sharma:
“Yeah. It’s great you mentioned that because it’s not just the children and young adults that need vaccines. Adults do as well. Vaccines are usually addressed at the annual preventative physical exam for most adults.  We learned, as you mentioned, Dr. Fialkow, that with time, some folks lose their immunity to MMR. So, it’s pretty common that for a certain age group, we might do blood work to see if there’s immunity there, and then give a booster if needed.”

Dr. Fialkow:
“I want to switch gears for a second and I’m going to ask both of you this. When we talk about safety, unfortunately in recent years, there’s been a lot of incorrect information. It’s spread on the Internet. It’s spread in soft informational channels about the safety of vaccines. We clearly don’t have time to debunk all the misinformation. But Deepa, can you tell us what are the most common questions you hear from parents that are related to misinformation about vaccines and how you handle it?”

Dr. Sharma:
“Misinformation is a bigger issue than ever. I always tell parents and family members who ask me about vaccines, first of all, thank you for asking. Because asking your doctor is already taking the first step in looking to a reliable source of information. I credit folks who are motivated to learn about information. So instead, I like to empower them by giving them the sources that we rely on.

“So, I do tell parents like, ‘Listen, check the CDC.Check the Florida Department of Health website. Check UpToDate, which is aphysician and patient portal of information and medical information. BaptistHealth has information for patients. Look at your sources that your doctorrecommends and then use that data to make your decision.’ That way you can kindof guide away from misinformation.”

Dr. Fialkow:
“And Lillian, similarly, what have your experiences been?”

Dr. Rivera:
“In my experience, most of the parents are confident in the safety and effectiveness of vaccines. They are. There is a group of parents that they need the right information. Misinformation is out there… We definitely sit down with the parents or sit down with the patient and just explain to them exactly where– like the doctor said, go to the CDC website. These are the reliable sources that you could use for information. Usually, we do turn patients around.”

Dr. Fialkow:
“One of the things we really want to impress upon people is the flu vaccine and that influenza is not COVID. We want to really make sure, especially as the flu season begins, that people don’t neglect that or not get it based on any fear. So again, Deepa, can you just comment on, please, the importance of the flu vaccine?”

Dr. Sharma:
“Yeah, absolutely. I’m glad you brought that up. The flu vaccine is very, very important now more than ever. If I may say, I’ve been pretty happy to hear in the last few months from my patients that they’re eager for the flu vaccine. They realize what the importance is and they’re asking, ‘Hey Doc, this is a good year for me to get it, right?’ And my answer is, ‘Absolutely.’ So I think folks are realizing that that vaccine this year is more important than ever, but I do want to encourage everyone to pursue that vaccine.”

Dr. Fialkow:
“And if you see a loved one, if you have an elderly parent or something, you want to make sure not only are you vaccinated, but you also want to help people around you get vaccinated as well. Can you talk a little bit about those types of recommendations, Lillian?”

Dr. Rivera:
“This is going to be very challenging for all of us as healthcare providers and for public health, the flu, because it’s also a respiratory illness. So, we’re going to have to see how serious our flu season is going to be. Hopefully, there will be more acceptance of the flu vaccination….I know that the CDC has been working on a possible diagnostic test that will test you for COVID and it will test you for the flu. It’s not out there yet, but they are working on it. Hopefully, we’ll have one test that could test for both.  But again, the flu vaccine is going to be of utmost important in terms of protecting ourselves during this flu season.”

Dr. Fialkow:
“So that’s great information, guys. Any final comments or any final points you want to make? We’ll start with Deepa.”

Dr. Sharma:
“Yep. Just remember that prevention is better than cure.”

Dr. Rivera:
“We should not be distracted by COVID-19. We cannot neglect our general health, (it’s) very important. Immunization should be routine, and we need to be immunized.”