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Doctors across Canada say they are seeing a drop in the number of child vaccinations, fuelling concerns it could lead to an increase in preventable diseases while the country is still struggling with COVID-19.

Some parents appear to be avoiding routine vaccinations over fears that going to a health care facility could increase the risk of contracting COVID-19. In other cases, some doctors are choosing to postpone or cancel routine vaccinations because of clinic closings or because they don’t have enough personal protective equipment to see patients safely, according to infectious disease experts.

“We’ve heard from regular families who have found they can’t get into their family doctors,” said Joanne Langley, a pediatric infectious diseases physician at the IWK Health Centre and Dalhousie University in Halifax. “There shouldn’t be any interruption of children’s routine immunization schedule. It’s very important for maintaining their health and preventing life-threatening diseases."

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Experts are particularly concerned about children under the age of two, who are scheduled to receive their first critical doses of vaccinations to protect against illnesses such as whooping cough, chickenpox, measles, mumps and rubella. The fear is that missed vaccinations could lead to serious outbreaks down the road, yet another example of the collateral damage caused by COVID-19. Across the country, thousands of patients have had surgeries and treatments postponed as a result of the pandemic, while others appear to be avoiding going to the hospital because they fear contracting the illness there.

Most parts of Canada do not have a comprehensive registry to track vaccination rates. But emerging evidence and anecdotal reports suggest routine immunizations are down, which could spell problems – particularly as cities and schools reopen.

In British Columbia, where officials have current data, routine vaccinations in children under the age of two are down from 2 to 5 per cent in some regions, said Monika Naus, the medical director of the communicable diseases and immunization service at the BC Centre for Disease Control.

“We’ve definitely heard that parents have cancelled appointments because of concerns,” Dr. Naus said. “We have seen declines in on-time completion [of vaccination] in many of our regions.”

The decline prompted the province to launch a social media and advertising campaign to encourage parents to book their children for vaccinations.

Shaun Morris, a clinician scientist in infectious diseases at Toronto’s Hospital for Sick Children, said vaccination-related visits are definitely down.

“We’ve had families that have cancelled appointments because they’re concerned about COVID,” Dr. Morris said. “If a child misses a vaccine, there are risks with that.”

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The hospital’s immunization clinic works with unique cases, such as families who are resistant to vaccines, children who have had adverse reactions or those with compromised immune systems.

Dr. Morris said he has talked to care providers who have been hesitant to schedule visits because of shortages of masks and other personal protective equipment. He and his colleagues are launching a study that will survey primary care providers and parents on the issue of vaccination during the pandemic.

Concerns about a drop in rates prompted the Canadian Paediatric Society to issue a plea last month urging parents and health care providers to follow the vaccination schedule for children.

“Any delay or omission in scheduled vaccines puts children at risk for common and serious childhood infections such as pneumococcal disease, measles, and pertussis,” the CPS said in the statement.

Even though physical distancing means there’s less immediate danger of certain outbreaks, such as measles, which is only imported into Canada from international travel, there are other serious vaccine-preventable diseases that can be picked up during lockdowns, said Joan Robinson, a spokeswoman for the CPS and a pediatric infectious disease expert at the University of Alberta. For instance, children can get tetanus infections through cuts and scrapes from contaminated objects when playing outside. And older, vaccinated children can carry a dangerous type of bacteria that can cause meningitis in younger, unvaccinated siblings, Dr. Robinson said.

The CPS said health care providers can take steps to protect against COVID-19 transmission, such as screening patients over the phone for symptoms, eliminating the use of waiting rooms and reserving certain times of the day for vaccination appointments.

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In Ottawa, public-health officials created a special vaccination clinic after noticing a substantial decline in vaccination orders placed by primary care providers at the end of March and the beginning of April.

“We decided on the information that the decrease in vaccine distribution meant that we were likely seeing an actual decrease in needles going into arms in children in the community,” said Trevor Arnason, associate medical officer of health with Ottawa Public Health. “We decided that that group needed to be provided a safety net alternative.”

Ottawa Public Health worked with the Children’s Hospital of Eastern Ontario and other community partners to set up a stand-alone, referral-based clinic that caters specifically to families who couldn’t get their child immunized due to COVID-19. It opened late last month, runs three days a week and has seen fairly high levels of demand, said Anne Pham-Huy, a pediatric infectious diseases physician at the CHEO.

“The first week, even with no advertising, we had a couple of kids in the first day,” Dr. Pham-Huy said. Since then, “we’ve had almost full, if not full, clinics."

David Sibayeh Ngantchu was able to get two of his three children caught up with their vaccines at the new CHEO-based clinic. Mr. Sibayeh Ngantchu, who moved from Cameroon to Ottawa with his wife and children in January, doesn’t have a primary care provider and was worried about leaving his children unvaccinated. He hopes he can also get his third child caught up soon.

“I think it is important for every child to be vaccinated,” he said. “It provides security."

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