Missouri’s low vaccination rate leaves children vulnerable, experts say

October 11, 2010
by Alan Bavley
Kansas City Star

Missouri has fallen woefully behind the rest of the nation in vaccinating preschool children, which health experts say leaves the state’s children vulnerable to a resurgence of infectious diseases.

Just 56.2 percent of Missouri children 19 to 35 months old received all their recommended shots last year, according to new survey data from the Centers for Disease Control and Prevention.

That compares with a national rate of 70.5 percent. The highest level of full vaccination coverage — 78.1 percent — was in Missouri’s neighbor to the north, Iowa. The rate in Kansas, 71.7 percent, was statistically similar to the U.S. figure.

As recently as 2006, 80.6 percent of young children in Missouri had received all their shots. Since then, vaccination coverage has plummeted.

Experts cite these possible explanations for the decline: poorly funded public health programs, outdated state regulations and a growing number of parents reluctant to have their children vaccinated.

“It’s pretty obvious we’ve been sliding the last four years,” said Rex Archer, director of the Kansas City Health Department. “We could easily see an outbreak of measles or pertussis, any of these infectious diseases.”

Vaccinations protect more than the individuals getting the shots, Archer said.

When the overwhelming majority of people are vaccinated against a disease, it creates “herd immunity” that keeps the disease from spreading to people with weakened immune systems or to infants and others who haven’t received the vaccine.

“We’re getting to the point where we don’t have the herd immunity to keep outbreaks from happening,” Archer said.

Archer said Missouri’s low funding of public health impedes efforts to raise vaccination rates.

“If we had the resources, we know what to do,” Archer said.

For example, the Kansas City Health Department used to send personnel to doctors’ offices to sift through patient files looking for children who were behind on their immunizations. Money for that program dried up a couple of years ago, Archer said.

Only one state, Nevada, budgeted less per capita for public health last year than Missouri, according to a recent report by the advocacy group Trust for America's Health.

Missouri ranked 43rd among states in per capita public health funding from the CDC.

“It’s a little embarrassing,” Archer said. “But you get what you pay for, and you don’t get what you don’t pay for.”

Christopher Harrison, a Children’s Mercy Hospital specialist in infectious diseases, suggested another reason for the low vaccination rate: increasing “vaccine reluctance” among parents in Missouri.

Many parents incorrectly think there is a link between vaccines and autism in children, Harrison said.

“That idea has embedded itself in the psyche of our culture. Doctors deal with it every day. It ends up with children without the vaccines.”

Harrison worries that “pockets” of unvaccinated kids will develop in some communities.

“That’s the formula for outbreaks,” he said.

That’s what happened in the first half of 2008, when measles outbreaks in the U.S. sickened 131 people. The largest number of cases were among school-age children who were eligible for vaccination but whose parents chose not to vaccinate them, the CDC said.

Harrison hopes a new state rule will boost vaccination rates. While most states have mandated pneumococcal conjugate vaccine for children entering day care or preschool, Missouri didn’t have that requirement until July 1.

The vaccine protects against bacteria that can cause meningitis, blood infections and ear infections.

“We expect that (vaccination) mandate will increase the number immunized automatically,” said Jacqueline Lapine of the Missouri Department of Health and Senior Services.

Lapine said the health department will check the immunization records of least 10 percent of day care centers to make sure they are complying.

The health department also is going to make sure that every doctor who sees Medicaid patients also participates in Vaccines for Children, a federal program that provides shots free to children who are uninsured or on Medicaid.

And the health department is developing a Web-based immunization registry, called ShowMeVax, that will be able to track the number of vaccinations given and send reminders to doctors and parents when children are due for another shot.

“We want to get the word out that these vaccines are safe and they’re going to protect our kids,” Lapine said.

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