By Stefanie Cole, BSN, RN, MPH, Pediatric Immunization Nurse Educator, Michigan Department of Health and Human Services, Division of Immunization
Since 1994, the United States has recognized one week of the year as National Infant Immunization Week (NIIW) to highlight the importance of protecting infants from vaccine-preventable diseases and to celebrate achievements of immunization programs and partners in promoting healthy communities.1 While it is certainly important to have a dedicated time during the year to remember how vital vaccines are to protecting young children’s health, it’s even more important that pediatric healthcare providers put that into practice throughout the entire year. Infants are especially vulnerable to vaccine-preventable diseases and their associated complications. Luckily, we have vaccines available to help keep children healthy in those first important years of life.
Vaccines protect against 14 diseases by the age of 2 years. For best protection, healthcare providers should immunize their patients according to the Advisory Committee on Immunization Practices (ACIP) immunization schedules.2 Both the child/adolescent and adult immunization schedules are updated annually and were recently updated in February 2020. Vaccines should be administered at the recommended ages. Because so many vaccine series require multiple doses for full protection, if a child falls behind on the recommended schedule it can be difficult to get them caught back up in a timely manner.
According to Michigan Care Improvement Registry (MCIR) data as of November 2019, 84.1% of Michigan infants had received their first dose of hepatitis B vaccine by 1 month of age. Hepatitis B vaccine is recommended to be given to all infants shortly after birth (within 12 or 24 hours, depending on the mother’s hepatitis B status). Not only does this mean that about 16% of 1-month-olds are left completely vulnerable to hepatitis B during their first month of life, but it becomes that much harder once beginning the hepatitis B vaccine series to receive all the doses on time according to the schedule.
Furthermore, there is a concerning decline in the percentage of Michigan infants between 1 and 7 months of age who are completely vaccinated according to the recommended schedule. By age 7 months, only 54.2% of Michigan children are completely up to date with all recommended vaccines (excluding influenza). By age 2 years, only 52.5% of Michigan children are complete up to date with recommended vaccines. These data show that once children fall behind on their immunization schedule, they often do not get completely caught back up.
Again, these are alarming statistics because young children, especially those less than 2 years old, are at higher risk for acquiring and becoming very ill from vaccine-preventable diseases. Many vaccine-preventable diseases such as pertussis (whooping cough), varicella (chickenpox), and mumps circulate in Michigan every year.3 Although influenza affects more people than any other vaccine-preventable disease, many Michiganders go unprotected from flu. As of December 31, 2019, only 5.6% of Michigan children aged 6 months through 8 years recommended to receive 2 doses of flu vaccine for full protection during the 2019-20 season had received both doses.4
Other diseases we typically see less often in Michigan but are just a plane ride away. In 2019, there were 46 confirmed cases of measles in Michigan, more than the state has experienced since 1991.5 More than 1,200 cases of measles were confirmed in the U.S. in 2019, the greatest number of cases reported since 1992.6 Michigan’s large measles outbreak as well as the majority of the nation’s measles cases last year were associated with unvaccinated individuals who travel internationally and bring measles back home where it spreads in communities with pockets of unvaccinated people. Measles is currently a global public health threat with many countries around the world experiencing outbreaks. As of November 5, 2019, there were more than 413,000 confirmed cases reported to the World Health Organization.7 In the Democratic Republic of Congo alone, about 310,000 suspected measles cases have been reported since the beginning of 2019 with over 6,000 deaths.8 Remember there are situations where children should be vaccinated earlier than the routinely recommended age. Children aged 6-11 months who travel internationally should be vaccinated against measles and hepatitis A before departure.2 Refer back to the immunization schedules to ensure you fully protect your youngest patients from vaccine-preventable diseases. Keep them healthy by keeping them on the recommended vaccine schedule.
1 Centers for Disease Control and Prevention (2019). NIIW (National Infant Immunization Week). Retrieved from www.cdc.gov/vaccines/events/niiw/index.html on January 27, 2020.
2 Centers for Disease Control and Prevention (2019). Immunization Schedules. Retrieved from www.cdc.gov/vaccines/schedules/index.html on January 27, 2020.
3 Michigan Department of Health and Human Services (2020). Vaccine Preventable Diseases in Michigan – Annual Summaries. Retrieved from www.michigan.gov/mdhhs/0,5885,7-339-73971_4911_4914_6385-47024--,00.html on January 27, 2020.
4 Unpublished MDHHS data.
5 Provisional data.
6 Centers for Disease Control and Prevention (2020). Measles Cases and Outbreaks. Retrieved from www.cdc.gov/measles/cases-outbreaks.html on January 28, 2020.
7 World Health Organization. (2020). Measles – Global situation. Retrieved from www.who.int/csr/don/26-november-2019-measles-global_situation/en/ on January 28, 2020.
8 Center for Infectious Disease Research and Policy. (2020). As measles deaths top 6,000 in DRC, WHO calls for aid. Retrieved from www.cidrap.umn.edu/news-perspective/2020/01/measles-deaths-top-6000-drc-who-calls-aid on January 28, 2020.