The Pennsylvania Department of Health quietly announced late last month that it was temporarily suspending requirements for children’s immunizations, a move that could send mixed signals to parents about the importance of preventing disease, and could mark a return for vaccine-preventable diseases like measles, doctors fear.

The coronavirus pandemic has made it difficult for families to make scheduled checkups. In Philadelphia, routine immunizations have fallen substantially since March. As a result, many children in Pennsylvania may not have the required immunizations to enter and attend school this fall.

Under Pennsylvania regulations, children who do not meet the list of required immunizations for their grade — which includes but is not limited to measles, mumps, and whooping cough (pertussis) — should be excluded from school activities, and schools are required to verify that children obtain their vaccinations, except in cases of medical exceptions. Furthermore, children enrolled in a child-care program must maintain updated immunizations.

However, these regulations are suspended for a two-month period after the beginning of the school year or the beginning of enrollment in an early childhood education program, according to a Health Department news release.

Amber Tirmal, manager of the Philadelphia Immunization Program in the Philadelphia Department of Public Health, said the decision was “appropriate.”

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“It’s going to take time to catch everyone up, and we don’t want to hold back children because they’re not up-to-date within five days” after starting school,” Tirmal said.

However, some pediatricians are concerned about the repercussions of the suspension, including the potential for further immunization delays.

“I lived through the measles outbreak in the 1990s. It was devastating,” said Trude Haecker, a pediatrician and president of the Pennsylvania chapter of the American Academy of Pediatrics.

Diseases including measles and pertussis are highly contagious, and even small declines in vaccination rates can set the stage for outbreaks that affect children and their families.

“I was surprised to see [the suspension]. We have immunizations to prevent certain infectious diseases, but I fear they will come back again,” Haecker said.

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The state Health Department said that the suspension is only in response to the impact of the coronavirus pandemic on the availability of immunizations before the start of the school year. But providers say they are prepared to see families for these visits.

“We’re able to ramp up and see patients again. We have a need to catch children up, especially at a time when practices are opening up and people are starting to trust their pediatricians again,” Haecker said.

While some families shied away from pediatricians’ offices because of concerns about contracting the coronavirus — and non-emergency health care services were suspended for the same reason — many practices now have appropriate precautions in place, including hand washing, masking, social distancing, sanitizing, and reduced scheduling. Pediatricians are urging families to set up appointments.

“Right now, there’s not much of a wait at all. We have a lot of availability to catch people up on vaccinations that might have fallen behind because of the pandemic,” said Jonathan M. Miller, chief of the division of general pediatrics at Nemours/Alfred I. duPont Hospital for Children in Wilmington. “We can get caught up before the school year starts, and I don’t want families to wait until September for vaccinations that we can be doing now.”

The seasonal flu vaccine, while not required for school, is also especially important for children during a pandemic. Flu symptoms – fever, coughs, runny nose, difficulty breathing – overlap with those of the coronavirus. And the flu vaccine, even if not 100% effective, does reduce the severity and duration of symptoms due to the influenza virus.

The suspension “is only two months, but two months is precious for flu vaccinations. September is a peak time for kids to get their flu vaccines,” Haecker said.

While the Department of Health’s suspension announcement stresses the importance of childhood immunizations, some experts think it’s sending a message that can easily be misunderstood or even used to argue against vaccination in general.

“It suggests that vaccination can take a back seat to other things right now. But that’s not the case,” said Neal D. Goldstein, an assistant professor of epidemiology at the Drexel University Dornsife School of Public Health. “I appreciate that it’s a temporary suspension, but I think this order could be damaging to our public health messaging. It’s easy to see an anti-vaccination group using this as ammunition for [their] message.”

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In Philadelphia, the School District recently announced that students will attend school virtually through at least Nov. 17, which reduces the chance of vaccine preventable outbreaks. Still, school isn’t the only place children congregate.

“It seems like the extension coupled with virtual school means that most students should be up-to-date and caught up whenever they go back to school in-person,” said Tirmal, of the city health department.

However, Goldstein suggested the state’s message might have been more effective it was communicated a different way: “We should ensure to the best of our ability that the greatest number of children are vaccinated.”

Experts recognize the well-intentioned, yet sometimes conflicting, information can make it difficult for families to decide what is best for their children. Recommended vaccine schedules can be found on the U.S. Centers for Disease Control and Prevention’s website.

“Above all, reach out to your primary care provider – make sure your children are on track and get what is needed,” said Cameron M. Rosenthal, professor of pediatrics at the University of Florida.