Toolkit to increase Well-Child Visits and Vaccinations in School-Aged Youth

The CDC’s public sector immunization ordering data show a 14% drop in 2020-2021 compared to 2019, and measles immunization is down by more than 20%. According to the American Academy of Pediatrics, the immunization rates have varied significant from state to state. Based on recent census data 2021, there are states that have significantly stronger universal childhood healthcare programs and have larger networks of providers who take public insurance. The JAMA Pediatrics study found that immunization rates were significantly lower across all pediatric age groups as the pandemic first surged in the US. The proportion of those who were up to date on their routine immunizations was lower for most age groups in September 2020 compared to September 2021, and coverage also varied significantly by race and ethnicity. Overall, only 74% of infants under 7 months were up to date on their immunizations in 2020, an 81% drop from 81% in 2019. Only 57% of 18-month-old infants were up to date in 2020, which is 61% down from 2019. The proportion of children who were up to date on immunizations were lowest among black youth. This is relevant information for our school districts, because disruptions to the timing of immunization appointments in early infancy can lead to substantial delays in completion of immunization series as youth enter the school systems, because of the required minimum intervals between immunization doses and the need for additional health care visits to receive missed immunizations. It is key to note that immunization rates for routinely recommended immunizations have historically been low in our most underserved, minority communities. The COVID-19 pandemic has only exacerbated the problem. As related to well child visits, a recent Centers for Medicare & Medicaid Services (CMS) report shows worrisome downtrends in health care utilization during the COVID-19 pandemic for the nearly 40 million children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). Data reflect a sharp decline in children’s engagement in both primary and preventive care, driven by stay-at-home orders in states across the nation. For children, particularly those from low-income households, the lack of primary and preventive health services can potentially impact physical health, as well as mental health, social-emotional development, and academic outcomes. Routine well child visits and immunizations are one of the best ways to ensure that kids can return to school successfully and engage in the parts of life that students love –playing with friends, participating in sports, and connecting with their teachers. Well-child visits are an opportunity for parents to support the whole child, both their physical and behavioral wellbeing. Caregivers can ask questions about nutrition and safety and their child can be screened for developmental delays or behavioral and mental health concerns. Immunizations not only protect the individual receiving the immunization, but also the community preventing the spread of these diseases. While there are no federal laws regarding the requirement of immunizations, all 50 states have legislation requiring children attending public school to be vaccinated against diphtheria, tetanus, and acellular pertussis (DTaP); polio (IPV); measles and rubella (MMR); and varicella (chickenpox). All states and the District of Columbia, however, allow medical exemptions for children who have a medical condition preventing them from receiving an immunization. Schools and healthcare providers have an opportunity and responsibility to advance health equity and assure that every child has a fair chance to reach their potential. During the pandemic, African American and Latinx/Hispanic children missed well-child visits at rates greater than their white counterparts (33% and 35%, compared to 27%, respectively). We all have an opportunity to do better. Our public health partners and local community organizations can all play a part in reaching families with the services that they need. These are challenging times, but we have the power to help our youth and families. Working together, schools and healthcare providers to bring high quality healthcare to our youth and ensuring they receive an annual well-child visit and recommended immunizations is one of the best things you can do to protect your child and community from serious diseases that are easily spread. The health care of our students is a national priority, and school-based health care plays a critical role in this goal. Youth are more likely to succeed educationally if they are healthy and in school. Caregivers/guardians, educators, and healthcare workers all want the best for children and adolescents. Positive health outcomes support improved educational outcomes by reducing or eliminating nonacademic barriers to learning.