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Pediatricians across Virginia are reporting a decline in vaccination rates as the COVID-19 pandemic continues — a worrying trend that many fear will lead to future outbreaks of otherwise preventable infectious diseases.

A recent survey of more than 100 pediatric providers show that infant vaccination rates have decreased by 30 percent since early March, when Virginia reported its first known case of disease, said Dr. Sandy Chung, a Northern Virginia-based pediatrician and president of the state chapter of the American Academy of Pediatrics.

Adolescent vaccination rates are down 76 percent, Chung added. The state’s Department of Health has seen a similar decline in reports to the Virginia Immunization Information System, a statewide registry where physicians can enter vaccination data. From March 15 to April 23, vaccines reported to the system declined 45.7 percent compared to the same time period last year, according to Christy Gray, director of the department’s Division of Immunization.

As a result, many infants could be left vulnerable to diseases including whooping cough, bacterial meningitis and measles. Older children aren’t receiving routine boosters against tetanus and other bacterial illnesses, or scheduled immunizations against human papillomavirus, which can cause cervical, oral, and penile cancers.

“We’re worried that this could present problems on the other side of the pandemic,” said Dr. Paige Perriello, a pediatrician based in Charlottesville. “These are serious infections, and there’s concern that this is going to cause problems in the months to come.”

As coronavirus cases in Virginia continue to rise (with a total of 11,594 reported on Friday), Gov. Ralph Northam has extended measures to prevent the risk of transmission and preserve needed medical equipment. Many business closures have been extended through May 8. Virginia’s stay-at-home order remains active until June 10. And on Thursday, Northam announced that he would extend the state’s ban on elective surgeries for another week.

Medical providers say that the orders have led to confusion among some Virginians over what they can and cannot do during the pandemic. Emergency room utilization has declined across the state as more residents follow directions to stay at home. The decrease is partially due to a reduction in roadway crashes and other accidents, but there’s also concern that some people are avoiding treatment for heart attacks, appendicitis and other legitimate medical emergencies, Dr. Clifford Deal, president of the Medical Society of Virginia, said in an interview on Thursday.

The overall number of pediatric visits has also declined by 40 to 50 percent, Perriello estimated. Chung said that there have been fewer sick visits for some illnesses, such as seasonal flu and strep throat, as children stay home from school and day care centers. But wellness visits have also decreased, with some parents worrying that leaving the house could put their children at risk of contracting COVID-19. 

And while the governor’s stay-at-home order includes an exception for medical care, many families don’t know that, Perriello added.

“They’re confused because the executive order makes them feel like they can’t come in anymore,” Perriello said. 

A survey by the Virginia chapter of the American Academy of Pediatrics shows a steep decline in childhood vaccination rates since the beginning of the COVID-19 pandemic.

It’s a misunderstanding that many pediatricians are actively working to combat. Lauren Schmitt, the lobbyist for the state’s AAP chapter, said the group has reached out to the governor’s office and Virginia Department of Health in hopes that state officials will issue a clarifying statement on the stay-at-home order.

“We’re hoping they can give that kind of reassurance,” she said. “I think the issue is that no one was thinking about this — that people would be hesitant to bring their children in for medical appointments.” 

The academy is also in the process of drafting a letter for legislators to share with their constituents, Schmitt said. Other pediatricians have suggested reaching out to doctors in maternity wards and neonatal intensive care units to ensure mothers are being told it’s safe to bring their newborns in for immunization and wellness visits.

Both Chung and Perriello said that individual practices are also going to great lengths to protect their patients. Chung’s practice, Fairfax Pediatric Associates, has dedicated two of its locations  entirely to wellness visits and kept one reserved for sick visits.

Her doctors are also providing drive-through vaccination services, allowing caregivers and children to stay in their car while immunizations are administered. The office even rented a van for home visits, Chung added. While many parents have said they plan to defer scheduled vaccinations to the summer, she said she’s grown increasingly concerned by the delays as the pandemic drags on.

“We know this isn’t going to end by the summer,” Chung said. “So, now we have two-month-olds who should have gotten their shots at four months and now aren’t getting them until six to nine months. And if they’re exposed to a disease like pertussis, that can make them very, very ill.”

Like many other pediatricians, Perriello said her office disinfects examination rooms between every visit and asks patients to wait in their car until a room is ready, greatly reducing the risk of exposure in common waiting areas. 

After her office and other nearby practices reported shortages of personal protective equipment, Perriello also launched a grassroots movement to solicit donations and distribute them to doctors in the Charlottesville area. 

“What I would encourage is for people to call their pediatricians and find out what they’re doing to keep their babies and children safe,” she said. “Most offices have developed tight systems for bringing people in.”

Virginia has relatively high rates of compliance with school-required immunizations — a trend that many pediatricians are concerned about reversing, Schmitt added. Vaccine proponents, which include the vast majority of doctors, also scored a legislative win this year when the General Assembly voted to update the state’s immunization requirements for the first time since 2008.