Routine childhood vaccinations are down in Indiana, boosting concerns as schools resume

More than a third of Indiana’s youngest kids are behind on routine vaccinations, prompting renewed efforts by public health officials to boost immunization rates, especially in the aftermath of the COVID-19 pandemic.

Only 58% of Hoosier children aged 19-35 months have completed what is known as the 4:3:1:3:3:1:4 immunization series, which is recommended to prevent diseases like polio, measles, hepatitis and chickenpox, according to the Indiana Department of Health (IDOH). The vaccines are later required to enter the state’s K-12 schools.

The fully-vaccinated rate decreased from 61% in 2021, and 70% in 2020.

Health experts largely attribute the 10% drop in vaccinations to the COVID-19 pandemic that kept kids from visiting doctor’s offices for checkups, when most routine childhood shots are administered.

The downward trend extends beyond Indiana — the World Health Organization and UNICEF reported the largest backslide in global childhood vaccination rates in the last 30 years happened during the pandemic.

Still, Indiana has historically recorded low vaccination rates compared to other states. With the state’s youth already headed back to in-person classes, there’s even more urgency to boost immunizations for the youngest Hoosiers, said Patrick Glew, operations coordinator for the Indiana Immunization Coalition.

“Earlier in the pandemic, doctor’s offices were closed down or had much more limited hours and kids just couldn’t get in. In some cases, parents lost jobs and didn’t have health insurance,” Glew said. “Unfortunately, the lower rate does also align, in some cases, with certain political positions or just general concern about vaccines.”

Indiana immunizations historically lower

Before entering kindergarten, children in Indiana are required to receive the DTaP (diphtheria, tetanus and pertussis), polio, MMR (measles, mumps, and rubella), Hepatitis A, Hepatitis B and varicella (chickenpox) vaccines. 

By the sixth and twelfth grades, additional MCV4 (meningococcal) and Tdap (tetanus, diphtheria and pertussis) immunizations are needed.

As of the 2021-22 school year, roughly 81% of kindergarten students were in compliance with state-required immunizations. That number dropped to about 74% for sixth graders, 66% for those in grade 12.

For the early childhood vaccine series, specifically, most Indiana counties record between 50% and 71% of kids have received all necessary doses as of this year.

Northern Indiana’s LaGrange County reported the state’s lowest rate of compliance, with only 35% of kids completely immunized. LaGrange County is known for a large Amish population. Warrick County, in the southwestern part of the state, reported 77% of kids vaccinated — the most in Indiana.

Marion County 53% of children aged 19-35 months have completed the routine childhood vaccine series recommended by state health officials. Allen County reported 43% of kids have completed the series. In Vanderburgh County, the completion rate is 74%.

Indiana ranks below most other states in the country when comparing routine childhood immunization rates for kids, according to the Centers for Disease Control (CDC). While the state ranked near the bottom of the nationwide list before the pandemic, preliminary federal data suggests the state has dropped even lower since 2020.

What’s allowed in Indiana

Students in all grades — including children attending special education programs, childcare, or preschool within a school building — are required to meet the minimum immunization requirements laid out by the IDOH.

State law allows schools to grant a noncompliant student with a 20-day waiver to allow time to get the required vaccines. Students who don’t get the shots in time risk not being able to attend school, unless they receive an exemption.

A medical exemption can be issued by a physician, indicating that a particular immunization may be detrimental to the child’s health. 

Indiana is one of 44 states to additionally allow objections to immunizations based on religious grounds. 

Those objections must be in writing, signed by the child’s parent, and delivered to the school. There is no requirement of proof, according to state guidelines. 

During the 2021-22 academic year, 2.32% of kindergartners — equal to 1,453 students – were exempt from Indiana’s vaccine requirements. Of those, 106 exemptions were for medical reasons, while 1,347 were religious objections.

Among older school-aged kids, another 2,763 exemptions were recorded by the IDOH. The state health department indicated that 399 students required a medical exemption, and 2,364 students were not in compliance with vaccine requirements on religious grounds.

Complications from COVID-19

Across all age groups in Indiana, routine vaccination numbers dropped during the pandemic, according to IDOH data. State health officials have expressed the greatest concern about those who are school-aged, however.

A May letter to school nurses and administrators from Indiana Health Commissioner Dr. Kristina Box emphasized that the COVID-19 pandemic “has presented numerous health challenges for schools and students. She added that it’s critical that Hoosier kids are protected against vaccine preventable diseases so they can stay healthy in schools.

“This puts our students at greater risk for diseases such as measles, mumps, chicken pox, and many others,” Box said, noting the 10% reduction in childhood vaccination rates among Indiana in the last two years.

Before the start of the 2022-23 school year, IDOH sent letters to the homes of roughly 540,000 kids between the ages 5 and 18 who are behind on vaccines. The effort was intended to encourage students and their families to visit their doctor, or attend one of the numerous vaccination clinics hosted by the state and local health departments.

Public health experts say the dip in vaccinations also amplifies concerns about the rate at which Hoosier youth receive COVID-19 vaccines.

The COVID-19 vaccine is recommended by the CDC and IDOH for all students five years of age and older, but it’s not required.

As of Friday, approximately 135,000 children in Indiana between the ages of 5 and 11 had received at least one COVID-19 vaccine dose, according to state data. That represents about 22% of the approximately 609,000 children in this age group in Indiana.

The COVID-19 vaccination rate increases to 44.6% among 12 to 17 year olds.

When faced with questions about COVID-19 vaccines in the state legislature earlier this year, lawmakers were adamant against making those shots required for anyone in the state — including students.

Adopted during the 2022 legislative session, HEA 1001 addressed COVID-19 vaccine mandates by employers and requires that employees be allowed to opt out of immunization requirements for medical or religious reasons, as well as if they can show proof of immunity from COVID-19 based on a prior infection. 

An earlier draft of the measure would have prevented required vaccines for schools, but was amended to keep current state guidelines for childhood vaccines in place.

What will it take to get more kids vaccinated?

Dr. Avery August, an immunology professor and member of the American Association of Immunologists, cautioned that both children and adults are more susceptible to preventable illnesses when they aren’t up-to-date on routine vaccines.

“As vaccination rates go down, we see the emergence of infections that would normally have been kept at bay,” he said. “That’s because immunizations protect us from the debilitating effects, in some cases, of the infection and they protect against symptoms of those infections.”

Missing even one dose in the childhood vaccine series can keep someone from being in full-compliance.

Firm data on routine childhood vaccinations for students entering school in the 2022-23 academic year won’t be recorded until sometime in February 2023, according to the IDOH.

In the meantime, Box said state and local health officials are working in tandem to notify parents and students about immunizations still needed and opportunities to get vaccinated.

Glew, with the Indiana Immunization Coalition, said the statewide coalition is part of that effort, hosting mobile vaccine clinics around Indiana, including at K-12 schools, colleges and universities.

All vaccines are provided by the group at clinics. Shots are free for those who are uninsured.

“Part of this comes from knowing that the vaccine rates are going down, but in the absence of that, we want to do this because we know there’s a lot of underserved Hoosiers,” he said. “This is still a tricky time — people will probably have feelings all across the board right now. But routine vaccines have been around for decades and are really important for protecting us.”

This story was reported with support from the Education Writer Association’s New to the Beat program.