Talk to patients about immunizations

Jen Tinguely, MD, MPH
President, South Dakota State Medical Association

October 1, 2024

While it may feel that more and more patients are receiving their healthcare advice from social
media sources, it is heartening to know that a recent survey of South Dakota residents showed that 73% of respondents trust their primary care provider when receiving information about vaccinations. Only 35% of respondents trust their family and friends when it comes to receiving information about vaccines which demonstrates the vital role we play as physicians in educating our patients about the importance of vaccines and preventative care. Primary care providers also exceeded government organizations like the Centers for Disease Control or the South Dakota Department of Health in this area with 55% of those respondents saying they trust those organizations when it comes to vaccine information. This means that if we can get patients into their primary care providers on a regular basis, there is a reliable avenue for patients to receive information on vaccine recommendations. This is especially important for our young children whose vaccine completion rates fell to\ the lowest levels in decades during the COVID-19 pandemic and have yet to return to pre-pandemic levels per data from the 2022-23 school year.

For the 2022-23 school year, South Dakota was lower than the national average for vaccine completion rates for incoming kindergartners with our state’s rate at 92.5% and  the national average at 93%. All states require incoming kindergartners to have a certain set of vaccinations which provide protection against measles, mumps, rubella, diphtheria, tetanus, pertussis, polio and varicella but all states also allow for medical exemptions for these vaccines. Forty-five states, including South Dakota, also allow for religious exemptions to vaccines for incoming kindergartners and 15 states take it even further and allow for “personal objection” to vaccines. Three of those 15 states that allow for personal objection to vaccines for kindergarten entry are our neighbors (North Dakota, Nebraska and Minnesota). It should come as no surprise, then, that Minnesota is seeing an outbreak of measles cases in 2024 with over 40 reported cases thru mid-September 2024. Most of these cases are occurring in unvaccinated children in Minneapolis.

In 2023, the number of exemptions for kindergarten vaccines reached an all-time high across the nation. This is concerning and we continue to see legislative efforts to allow for more vaccine exemptions in our state. It is my hope that I won’t have to write about this again in a few months once the legislative session starts but if the past is indicative of what to expect in the future, we can plan on seeing more bills regarding vaccine exemptions. One data point that I found very concerning in the survey of South Dakota residents mentioned above is that 37% of respondents would support legislation to loosen vaccine requirements. As a medical society, we should be ready to oppose any legislative efforts to make our community less safe from preventable diseases.

Moving on from kindergarten vaccines, our state’s HPV vaccination rate has historically been quite good compared to all the other states but, like what was seen in most other states, we saw a decline in the percentage of children and adolescents initiating this vaccine series in 2022. Currently, 62.6% of adolescents ages 13-17 across the country have completed their HPV series. In South Dakota, that percentage is higher at 68.3%. Of course, this still means that over 30% of our state’s teenagers do not have the protection from cervical, anal and throat cancers that is offered by the HPV vaccine. The Healthy People 2030 goal is to increase the percentage of adolescents who receive the recommended doses of the HPV vaccine to 80% which means we definitely have work to do! We should take advantage of the fact that middle school entry in South Dakota requires another round of vaccinations with an updated Tdap and one dose of MCV4. While HPV vaccination is not required for middle school entry, knowing that all students will be coming into the doctor’s office for their middle school shots, we should not miss the opportunity to educate on the importance of the HPV vaccine and get it done along with the other two required vaccines. It’s best practice to get the patient scheduled back with a nurse for the second dose as the HPV vaccine is a two-shot series if it is started before age 15. Don’t count on busy parents to remember to get the second dose done…just schedule it on the way out the door!

Skipping over a generation and moving into our older patient population, I would like to finish by talking about the new RSV vaccines. These are relatively new on the market and are available to patients over the age of 60. The guidance on these vaccines says that anyone over the age of 75 should receive the RSV vaccine but patients with certain medical conditions should receive the vaccine once they turn 60 years old. Many medical conditions are included in this group such as diabetes, COPD, asthma, coronary artery disease, chronic liver disease, BMI > 40 and residence in a nursing home. This vaccine, along with so many other adult vaccines, is available in the pharmacies so it gives patients another opportunity to get protected against this relatively common but potentially dangerous respiratory illness. We have added information about the RSV vaccine at sdsma.org (under Advocacy – Current Topics) as this is a relatively new vaccine and we are about to head into everyone’s favorite time of year…cold and flu season! Please take good care of yourself, get your own vaccines updated and remember that you are a trusted source of vaccine information for your patients. Take the time to talk to them about the vaccines they are eligible for and give them space to share their concerns and ask questions. Vaccine hesitancy has become a much larger issue for healthcare providers over the past four years but if we take the time and talk with our patients, I think we will find that they follow through on the recommendations we give them.