By CELIA LLOPIS-JEPSEN
Thousands of Kansas children and teens go without vaccines that could save their lives.
A series of policy changes, though, could protect more Kansans against everything from cervical cancer to swift-acting meningococcal disease.
The changes
(1) The meningococcal vaccine may soon join the list of immunizations required to attend school in Kansas. The Kansas Department of Health and Environment is going through regulatory steps for that potential change, which could take effect as early as the 2019-20 school year.
Outbreaks of meningococcal disease are rare but aggressive and scary where they occur. Nearly a third of patients suffer serious effects, such as brain damage, loss of limbs or even death.
Kansas would require the vaccine that protects against four types of the disease. A separate vaccine against another type seen in recent college campus outbreaks would not be required.
(2) Starting in July 2020, vaccination reports will all feed into a statewide database that clues physicians to patient needs. Today, not all providers use it. Eventually, if a parent takes her teen son to a new doctor within state lines, that doctor will have a reliable record. Maybe the teen got his first HPV shot, for example, but still needs one or two more.
The same change will help health officials better spot patterns and troubleshoot.
Take the question of access: It’s not even across the state. Not all doctors carry all recommended vaccines. Some may refer patients to county agencies many miles away. Others might vaccinate a privately insured patient but turn away one on Medicaid. Still others may do the exact opposite. Such scenarios hinge on nitty-gritty details like cost, batch size and vaccine stock.
“Like most things in public health, everything is local,” said Phil Griffin, who directs immunization efforts at the state health department. “There’s multiple layers of complications.”
(3) Kansas pharmacists can give children the flu shot as early as age six. As of 2017, however, they can also administer other recommended vaccines to kids as young as 12.
Since kids at that age generally don’t visit their doctors as often as when they are very young, public health experts hope families may at least drop by a local pharmacy to get vaccines and that that will gradually boost the state’s teen immunization rates.
Kansas vaccine rates
Federal data on the subject are far from perfect. But compared to other states, Kansas seems to have particularly low vaccine rates against meningococcal disease and against cancers caused by the nearly ubiquitous Human Papilloma Virus.
As for seven vaccines recommended for toddlers, including measles, Kansas hovers around the national average.
“Average” still means 30 percent of Kansas toddlers don’t complete those seven.
“It is dismal,” said Barbara Pahud, a Children’s Mercy pediatrician. “And it is sad.”
Low vaccination rates erode the herd immunity that protects people who can’t be inoculated because they are too young or have weakened immune systems.
Opposition to vaccines — either philosophical or based on debunked claims that the shots cause autism — have fueled the ongoing measles outbreak in the Pacific northwest.
In Kansas, hundreds of children catch vaccine-preventable diseases each year. (Or thousands, if you count the flu.)
Pahud, a professor affiliated with with the University of Missouri-Kansas City and the University of Kansas, says a small percentage of parents oppose all vaccines for religious or other reasons.
But that means many families not getting the vaccines don’t share that opposition — all the more incentive for researchers to home in on the obstacles.
Those obstacles likely vary by vaccine. Take these three recommended pre-teen/teen vaccines: For every 10 Kansas teens, nine get the Tdap shot against tetanus, diphtheria and whooping cough. Yet only seven get the meningococcal shot. Five start the HPV vaccine series. Fewer complete it.
“Really, if the kids are able to get the Tdap,” says Gretchen Homan, chair of the Immunize Kansas Coalition, “they should be able to get the other two.”
But so far, only Tdap has been required for school. Because it’s required for attendance, it’s easier to find at your doctor’s office.
What of the other two? Experts say some physicians don’t talk to families about vaccines that are recommended though not required at school. That sends parents the wrong message, says Homan, a pediatric professor at the KU School of Medicine-Wichita.
“To them,” she said, “if I don’t bring it up, it’s not important.”
The HPV vaccine, meanwhile, meets with resistance from parents who fear it leads to promiscuity. Studies have not found a link.
Nervousness about those parental concerns appears to deter some pediatricians from even recommending the vaccine, said Roy Jensen, head of KU’s Cancer Center. They fear offending parents and losing patients.
Yet, he said, researchers have found that a strong recommendation from a family’s doctor often overcomes parental concerns.
“If that recommendation is made,” he said, “then pretty much the HPV vaccine rates go up, and are more or less congruent with Tdap and the other early adolescent vaccines.”
The CDC says “almost every person who is sexually active will get HPV at some time in their life” without the vaccine. Most of the time, the infection simply clears up without problems. Other times it causes cancer, particularly of the cervix, vulva, vagina, penis, anus, or throat.
Kansas health officials want to prevent those cancers, but haven’t added HPV vaccine to the list of school requirements.
Doing so works better when vaccines already have a statewide reach of nearly 70 or 80 percent, state health officials say. Otherwise, it can cause a public backlash.
“Our ultimate goal,” said Griffin, from the state health department, “is that we have full herd immunity with every vaccine-preventable disease.”
Celia Llopis-Jepsen is a reporter for the Kansas News Service. You can reach her on Twitter @Celia_LJ.
