- For the first time in decades, the nation's childhood vaccine schedule is changing: the CDC dropping the number of vaccines routinely recommended for all children from 18 to 11.

Now, measles is surging across the country, and our region is feeling the impact.

Tonight on "Health Matters," what parents need to know and what our doctors are recommending.

(subtle bright music) Good evening, I'm Aaron Luna.

Washington State is choosing a different path, not following the federal government's new vaccine guidance.

Joining us tonight to break it all down, Dr.

Kristi Rice, pediatrician with Providence, Kayla Myers, program coordinator for immunization at Spokane Regional Health District, Dr.

Brian Simmerman, division lead for general pediatrics at Providence, And Dr.

Gretchen LaSalle, family medicine physician with MultiCare.

Let's start with the basics.

Dr.

Rice, for those who may not be familiar, what is the childhood vaccine schedule and who creates it?

- In the past, the schedule has been created by a group from the CDC called the ACIP.

and it had a board full of members that was appointed, a lot of them physicians and pediatricians and people who had studied vaccines for years.

And they created this vaccine schedule that we had followed, we as the American Academy of Pediatrics and Pediatricians.

And that's changed, because that board was replaced and the vaccine schedule has been changed.

- And what happens if parents don't follow the vaccine schedule?

- The schedule is set up so that we protect kids against illnesses that may either kill them or land them in the hospital, make them very ill.

So if they don't follow that schedule and there are more children who are not vaccinated, then more children will get those illnesses and be sick or hospitalized.

- And Kayla, why is it important to have a recommended schedule, and why is it important to have it consistent?

- So for individuals, it protects you at specific times, because that is when you're usually most susceptible to the disease.

As a community, it protects us from spreading the disease to others.

And it helps keep you out of the hospital and having severe outcomes from a disease.

And so that's why these vaccines were made in the first place.

- On January 5th of this year, the acting director of the CDC signed a decision memorandum overhauling the childhood vaccine schedule for the first time in decades.

This following a presidential directive to compare US practices with peer nations.

Dr.

LaSalle, let's walk through what actually changed.

The new CDC schedule now splits vaccines into three categories: universally recommended, recommended for high-risk groups only, and a third category, shared clinical decision-making.

Can you explain that schedule a little bit deeper for us?

- It's a little bit hard to explain.

There wasn't any really new science that dictated this change.

And so from our perspective, the professional societies, professional medical societies, it is difficult to explain what brought that about.

We are a different nation than Denmark, which is the country that the current CDC has tried to model our new schedule after.

We're a much larger nation.

We do not have universal healthcare.

And our populations are quite different.

We're not as homogenous of a group.

We have people from all over the world here.

And so following that, that schedule based on another country's population doesn't make sense for us.

It's hard to explain why that decision was made.

- And if it's confusing for you and your peers, how does that translate to patients?

- It's really confusing for patients.

In the past, we have, all of us patients and professionals, medical professionals and scientists alike, put our faith in the CDC.

The CDC had the Advisory Committee on Immunization Practices; the ACIP has decades of experience, and the people on that committee had been working with vaccines for years: that was their life's passion, their life's work.

They had tons of experience, historical knowledge.

And it was a group that also was forward-thinking, what's coming down the pike?

What are we gonna be encountering next?

And that group was sort of wholesale replaced with other individuals that don't have that experience.

And so it's now confusing to patients, it's confusing to providers as to what we should be doing.

We as providers are more confident in what the previous guidelines were.

And so the large professional society is the American Academy of Pediatrics, the American Academy of Family Physicians, College of Obstetricians and Gynecologists, Infectious Disease Society of America, we all agree with the previous schedule.

And Washington State is following suit.

- The other piece too, I think, why providers are confused, is because it normally goes through a very rigorous testing type, presentation type.

It's called like evidence to recommendation.

So experts, like she was talking about, will come and present why these changes should be made with lots of evidence, lots of data, and it's publicly broadcasted.

Nobody got to see that.

So that's why it's really hard to understand why those changes were made.

- That makes total sense.

And when you're dealing with patients, are they looking at this too?

Or what would you say the percentage of your patients go to the CDC to get some sort of directive before they see you in the... - Good question.

I'm not sure how many actually go to the CDC.

I'm sure maybe there are a few.

but some of them probably have read something that may be referencing CDC changes.

And then patients definitely are coming in over the last number of weeks, since this has occurred, with questions: What's going on?

What does this mean?

Can you help me understand what all that is and stuff.

So yeah, that definitely is happening.

- The following vaccines were moved out of universal recommendation into what's called shared clinical decision-making, meaning parents and doctors decide together: COVID-19, flu, rotavirus, hepatitis A, hepatitis B, and meningococcal vaccines.

Dr.

Rice, what should parents take away from this change?

- It is a change per their wording, but I feel like it's the same practice that I've been doing forever.

When I see patients, I recommend the American Academy of Pediatrics-endorsed vaccine schedule, and that's what we do in our office.

Then I go through each vaccine and why we give it and have a conversation.

So to me that's shared decision-making.

The way they brought this out was they were trying to pull different vaccines out that some people at the new ACIP deemed less necessary.

But we still feel they're necessary, and they should be part of the regular schedule.

So I do talk to the families about it.

- Has the wording impacted the questions people bring to the table?

Or is it still kind of one of those things that they're still finding out how to navigate?

- The patients have a lot more questions because they're confused.

Like, is this still necessary, and why have they made these decisions?

- When there's a universal recommendation, if I might interject, when there's a universal recommendation, meaning we recommend it for everybody, it lends a level of confidence to parents that this is important for my child and all children.

But when you introduce shared clinical decision-making, which is something that, like you said, Kristi, we all do that anyway.

Nobody's throwing darts at children as they walk out the door.

We're having a conversation about, you know, that patient's medical history, family history, pros, cons, is this the right time?

We're doing that anyway.

But when you add that sort of nomenclature to it, it just lends doubt, as in maybe I don't need this or maybe this isn't important for me.

And doubt is a lot of what we're seeing.

- And I'll add to that.

When we have routine recommendations, it makes it so that insurance plans are required to cover it as a preventative service.

And so when you move something into shared clinical decision-making, it can kind of sometimes make it difficult on maybe the billing side or something.

And you might end up with a bill.

So the state of Washington is working on remedying that before it becomes a problem.

But as of right now, all vaccines are covered until 2026, or at the end of 2026.

- Good to know.

And this has to highlight the importance of having that conversation with your doctor, or having an ongoing conversation with your healthcare provider.

- Yeah, and also part where you guys both said, like, my experience too is that when you change the language to shared decision-making, it sort of implies that perhaps that didn't exist before when it really did.

We were sitting there having these conversations with our parents and those families about their kids and their kids' health every day.

- Well, not to be the host, but do you guys hand out vaccine information statements?

- Absolutely.

- Exactly.

And that also covers a lot of that information of why all of us recommend it.

- And Dr.

Simmerman, let's talk about some of those specific vaccines.

Rotavirus was once something you saw kids in your office for pretty consistently.

What has that vaccine meant for children's health?

- So rotavirus is a virus that gives kids a significant and prolonged gastroenteritis, meaning they get sick to their stomach, they're nauseated, they throw up, they can't hold down fluids, and they get a lot of diarrhea.

And it's not the 24-hour version that maybe we all kind of think about.

It's like a few days of that.

And so it's a common reason why kids would get dehydrated and sometimes end up in the ER, and occasionally hospitalized.

- Pre-vaccine, took care of kids with rotavirus, gastroenteritis all the time.

It was a very common admission: sad, just dehydrated poor kids.

And now, with this vaccine, to be honest, I almost never see it.

And so it's changed what would've been a common childhood illness to almost something that doesn't exist for these kids anymore.

It's a miserable disease.

It's not a huge killer in the developed world.

They used to estimate, I think, between about 20 to 60 kids annually in the US would die of complications from rotavirus.

If it's your kid, it's a big killer, but looking at epidemiological numbers, not a huge, lethal type of infection, but it's a miserable infection that can be prevented.

- And hepatitis B, which is blood-borne and largely invisible because most people have been vaccinated, is there a long-term risk of pulling back that recommendation?

- Yes.

So the way we... Everybody's gonna have to jump in here, but yes.

So hepatitis B is a horrible disease.

It's a virus that causes a chronic hepatitis, and it's the world's leading cause of liver cancer.

And so it has horrible outcomes.

And when we developed a universal approach to how to treat hepatitis B in moms and babies, we dramatically reduced that in the United States.

So there is a big concern that by pulling back on that, and the way that healthcare works in America as opposed to some other health systems that exist in the world, that we will see bigger numbers of hepatitis B and complications of that.

- And I'd like to clarify, it's also, it's not just blood-borne but it's body fluids, which includes things like tears and saliva and things that children are swapping in daycares all the time.

And they are often exposed from adults in their life as well who don't know they have hepatitis B. Most adults who have hep B don't know it.

And so they can't protect against it.

You know, a binky drops on the ground, you stick it in your mouth to clean it off and stick it in the kid's mouth.

Or somebody chews up food to soften it for a child, and they can transmit hepatitis B that way.

A teenager borrows a friend's razor; you can have hepatitis B transmission.

Somebody's playing sports and has a cut on their skin and bumps into another kid playing sports with another cut, and you can have hep B transmission.

So it doesn't take this, people think of it as a high-risk sexual activity or, you know, drug use.

It really doesn't take high-risk activity.

And if kids are exposed in infancy, they are much more likely to become chronically infected and to go on to develop, like 90% of those kids will become chronically infected and develop liver disease.

So it's really important to catch them early.

- And meningitis is another one on the shared decision-making list now, a disease that's known to be highly contagious as well.

And on many college campuses, the vaccine is required.

What questions should parents be asking, specifically for parents of teenagers heading to college or summer camps?

- Oh, happy to jump in.

- When can I get it?

(all laughing) - Right.

Exactly.

= Can I get that vaccine now?

- So meningococcal disease is a horrible disease.

It's not as common as some of the other things that we may talk about, but it has little pockets or outbreaks.

And it is close to about, I I believe the mortality rate is close to 20%; So about one in five that get sick with it will probably not make it.

- And that's with treatment.

- And that's with treatment.

And those that make it have horrible outcomes.

They often end up with severe neurological sequelae.

They may end up with amputations because of the clotting dysfunction that occurs while you're actively sick with this.

So it is just a horrid, horrid disease.

This is an example of a vaccine that's created not because it's such a frequent infection, but because it's such a horrible and severe infection.

- And when it happens, it happens really fast.

People that die from that disease, usually it's within 48 hours.

And these are, you know, high-risk times are like camps, military, college dorms where kids are in close quarters.

and these are times when kids are not really, you know, they're sharing drinks with other kids, they're kissing; this is how you transmit meningococcal disease.

And they're on their own.

And, you know, if you get treatment, if you catch it early, one in five, what is it, one in every six to 10, I think, is the statistic, will die from it.

But kids don't always pay attention to early symptoms, and they're on their own trying to figure this out.

- They get sick fast.

- They get sick really fast.

And so, you know, when I sent my kids off to college, vaccinated them for sure, because they're on their own when there's an outbreak; they're handling it on their own.

- And it's fairly prevalent.

It sounds like it's fairly easy to come in contact with.

- Yeah.

And there's some people who carry it.

So it's always in the population.

- There is one change to that schedule that deserves its own conversation, and that is HPV.

The CDC now recommends just one dose of the HPV vaccine for kids ages 11 and 12.

That's down from two or three doses depending on age.

Dr.

Rice, this is a different kind of change than the others.

Why was this recommendation specifically adjusted?

- We're not sure.

We don't really have the data yet.

There are studies being done to look at is one dose going to be enough?

But in all the data we have so far, it shows that it may protect for like 10 to 12 years for females for cervical cancer.

But we don't have the data on the boys and all of the other cancers.

So HPV protects against head and neck cancers as well as cervical and penile cancer.

So we want to make sure that whole population is protected.

So the American Academy of Pediatrics, Family Practice Association, we all recommend that we still use the current guidelines of two doses of the vaccine if you start before 15 and three after.

- And what is current research on that looking like?

- It's so good.

It's so effective.

- [Kristi] The vaccine, yes.

Yeah.

Oh, very good.

- I mean, rates of cervical cancer have plummeted.

We don't have as much screening, we don't have any screening, really, that we do for things like throat cancer or penile cancer.

So we don't have as much data on other noncervical cancer, HPV-related cancers.

But we're seeing decreased incidents, generally speaking.

And it's one of the most effective vaccines, I think, we've ever had.

It's a cancer prevention.

Who doesn't want to prevent cancer?

And I've seen, as a family physician, I see people from all ages from birth through death.

And so I've seen people, adults, struggle with head and neck cancers or rectal cancer, penile cancer, and it's devastating.

And so I would never want anybody to have to go through that.

And this is an easy and safe vaccine.

- Well, because the HPV vaccine targets a sexually transmitted disease, what do you tell parents who may view it as unnecessary for their child?

- That it's still necessary.

It's a vaccine that prevents cancer.

And we don't know when kids will become sexually active, and it doesn't just mean sexual intercourse; it's different types of sexual activity too.

So we need to protect early.

And the earlier you protect, the better protection that kids get.

- And there's even some theory that deep kissing can transmit HPV, that your nose and throat physicians are studying and scientists are studying that.

And we don't consider that really a high-risk activity.

And this is a virus that's so prevalent in the community.

About 80% of us are exposed at some point in our sexual lives.

So it doesn't take high risk.

It could be the first sexual partner you ever have.

And I tell parents, you know, you may know your child, and your child may be, you know, really good and they're gonna wait until marriage, but you don't know that child's first partner's history.

And so it's just best to protect them.

- And that's sometimes the advice I'll give families.

Like, your child may not have any contact until they're 26 and getting married, but if their future spouse potentially had picked that up at some point, it still puts them at risk.

So cancer's bad.

- Better safe than sorry.

- Yeah.

And Dr.

Rice, let's make sure parents know what has not changed.

The CDC still universally recommends vaccines for 11 diseases: that includes measles, polio, whooping cough.

Why did those stay on the list and some came off?

- We're still trying to understand that.

I don't think I can answer that question.

We feel that all of them are still recommended, and we recommend all of them.

And we should keep them on the same schedule we've always had.

- Yeah, and again, because that transparent meeting didn't happen, where they're presenting the evidence behind their decisions, it's really difficult to determine where they got that information from.

- Hence the confusion.

- Yeah.

And we are seeing outbreaks now of measles nationwide.

We've got outbreaks of measles like we haven't had in decades.

Whooping cough we had the last year or two.

I'd never seen whooping cough in my whole career until this last year.

And so these things are coming back.

And I think there was some acknowledgement of that.

Even though measles, you know, might not be the favorite vaccine of certain people, I think they acknowledged that it's a current problem.

And so didn't want to take that off the table.

- And I want to get to that measles topic here in just a second.

But real quick, here in Washington State, the local and state health officials have taken a different position than the federal government.

Can you explain where things stand here, and kind of do that compare and contrast?

We've done it a little bit.

- Yeah, well, basically, Washington State and the West Coast Health Alliance are all agreed that we should be following the previous schedule.

Along with they are putting their confidence in the professional societies, the medical professional societies who believe that we should be following the previous schedule.

And so they have taken steps to ensure that we can still provide the vaccines that we know are important for our families.

- And I'll jump in.

It's very reminiscent to COVID.

If you remember, there, the recommendations would come out from CDC.

And then we had, like, it was called the Western Scientific Group.

There's more words.

And so it was another like checkpoint because people were concerned.

And so adding that additional review isn't a bad thing.

So if we can see that there's evidence, and if the AAP, AAFP, or ACOG see that the evidence stands and that it should be changed, then we will.

But it hasn't occurred yet.

- Now let's talk measles.

In 2000, measles was declared effectively eradicated in the United States.

Now cases are appearing across the country and in Spokane.

And how did that happen?

(guests laugh) - So unfortunately, when we see immunization rates declining, and they've been declining kind of slowly.

And we're just getting to a threshold now where it's allowing more spread.

We're also having more imported cases.

So like from other countries, people visit and come back with them.

There's also just pockets of communities that choose not to vaccinate with measles-rubella vaccine.

And so generally that is where we're seeing most of the spread.

So it's kind of what we talk about a lot, is if we can't maintain certain levels, then we're gonna see it again.

And we're gonna see it circulating more and more as less people get vaccinated.

- And one thing with measles, it's very contagious.

So you can have a drop in vaccine rates, just a slight drop, and it's spread way faster.

- So the effects of low, like you were saying, fewer people getting the vaccine, you're gonna see higher numbers pretty instantaneous.

- Yeah.

- Yeah, like a great example is I work very closely with our epidemiology team.

So as we are seeing the cases around the state and planning and meeting and preparing, we are just pulling data about like school data.

So how many schools are at 95% for MMR vaccination and above?

Those are the schools that we're very confident we won't see spread.

But if we are in the 90 to 94%, we will probably see spread, but it won't be rampant.

It'll still have like some sort of barrier, probably.

Anything under 90%, we're concerned.

So we've already pulled all that information, and we're like sharing it with the schools.

And just making sure that nurses and the administrative people who make decisions are aware of where their schools are at before we see it again here.

- Yeah, a small threshold right there.

Dr.

LaSalle, for families who are worried about measles right now, what are you telling them about protection?

And for communities where measles is actively spreading, what extra measures are being considered or should be considered?

- Well, for children, we have pretty good records on their vaccines.

And so if they're not vaccinated or if they're the age of which, you know, at which we would want to be vaccinating, I'm strongly encouraging that.

Where there's a little more doubt is in adults, because most of us don't have our vaccine records.

If we were born before 1957, typically you're considered immune; that was before a vaccine was available, and so you probably had measles as a kid, which offers lifelong protection, typically.

But after that, then it's questionable.

And so if you have any doubts about, you know, were you immunized or were you immunized adequately, you should talk to your provider.

We can either immunize, if we're unsure; it's safe to immunize, as long as someone is not an immune-compromised person.

And/or we can test titers and see if they've had protection in the past.

And if not, then we'd get them caught up.

We had a mumps outbreak in 2017, and so a lot of people actually ended up getting an MMR vaccine at that time to protect against mumps in the setting of an outbreak.

So we do have adults who have had recent vaccines as well.

- [Brian] And the MMR vaccine is really effective.

- Highly.

Highly.

= It works so well.

Like one MMR, 93% effective at making you immune to measles; you get your second one a few years later: 97% effective.

So very, very few people, I mean, that's better than every other one of our vaccine.

I don't think there's anything else that comes close to 93 to 97%.

- And you guys jump in if I say something wrong.

So for the people that are immunocompromised that maybe can't get the MMR vaccine, there are some resources available for you to know, like updated exposure locations on the Department of Health website.

They've created a map where you can go in and just, you know, maybe you're someone who needs to check that before you go somewhere, if you're unable to get the vaccine.

Also, advocate for yourself and ask the people around you to get the vaccine to protect you and cocoon you.

- And even before the CDC changes, vaccination rates were already declining.

What are we seeing in data in Spokane County and across Washington State with those numbers?

- So in Spokane County, we've kind of always had lower vaccination rates than the Western side.

But we are continuing to see small declines, especially in the school immunization data.

So again, I know I mentioned MMR specifically in the school data, but there's a data dashboard on the Department of Health where anyone can go look at it; and you can even drill it down to school building.

So you can even see which school your child goes to and how many kids have all the recommended vaccines.

- [Aaron] A great way to arm yourself with information.

- [Gretchen] That's an excellent resource.

- Dr.

Simmerman, there's a real concern that moving these vaccines to, once again, shared decision-making will cause more parents to skip them; not because they've decided against the vaccine, but because the extra step creates a barrier there.

You know, we talked about this a little bit earlier.

Is that something you're seeing, or is that something you're worried about?

- Well, I have concerns that, you know, creating any more confusion makes it a little bit harder to clarify for families, to understand what we're recommending.

I don't think, as we spoke earlier, that labeling shared decision-making for me so far has created issues, because we already have those conversations.

And so I'm hopeful that as we go forward, that we'll still be able to communicate in the same way with our families.

But I do anticipate we'll have some that will have a few questions.

And we'll just handle those and try to answer them to the best of our ability.

- What is the real-world public health cost if vaccination rates continue to drop, both in the short term and years, or maybe even decades from now?

And I'll have to make this one quick 'cause we're running out of time.

- Well, so there's data that shows that, on average, every dollar spent for vaccinating saves $54 of societal cost and individual cost.

So if a vaccine costs $200 per dose, we're saving $10,800 with just that one dose given.

And with our healthcare system and how expensive things are, it could even be more than that.

And some families don't have the ability to do that.

And vaccinating just keeps you from having those severe symptoms and from hospitalization.

- And it also pulls resources.

If people aren't vaccinated, they end up in the hospital or utilizing doctors' offices; it pulls resources away from other people with other illnesses or needs.

- If you have questions, of course, talk to your physician.

And that's all we have time for tonight.

Thank you, Dr.

Rice, Dr.

Simmerman, Dr.

LaSalle, and Kayla Myers for being here to help our community navigate this important topic.

If you have questions, once again, talk to your doctor.

And if you're worried about access, reach out to the Spokane Regional Health District, or visit srhd.org.

You can share this episode with your friends and family: just go to ksps.org.

Stay healthy.

Have a good night.

(subtle bright music) (subtle bright music ends)