Will Kenty, 8, pulls up his sleeve so Malissa Wildes, a medical assistant at Maine Medical Partners – Pediatrics, can give him a flu shot Friday. Public health experts say the number of children who aren’t getting vaccinations for infectious diseases remains dangerously high.  Brianna Soukup/Staff Photographer

Cases of chickenpox and whooping cough have declined dramatically in Maine this year, largely because of the social distancing, mask-wearing and other steps taken to reduce transmission of the virus that causes COVID-19.

But public health experts say the number of children who aren’t getting vaccinations for chickenpox, whooping cough and other infectious diseases remains dangerously high.

For the school year that ended in May or June, 5.6 percent of parents obtained religious or philosophic exemptions from vaccination requirements for their kindergarten-age children. That’s the same rate as the 2018-19 school year, when Maine had the fourth-highest exemption rate in the nation, behind Oregon, Alaska and Idaho, according to the U.S. Centers for Disease Control and Prevention.

National data isn’t available yet to show where Maine ranked in the 2019-20 school year, but the state likely remains among those with the highest exemption rates.

The rate is likely to plummet next year, when a new state law goes into effect that prohibits all but medical exemptions from school-based vaccination requirements. In Maine, only a relative handful of exemptions are issued for medical reasons; the overwhelming majority are based on philosophic objections.

Vaccines are a key public health prevention tool for dangerous infectious diseases like measles, mumps, chickenpox and pertussis – also known as whooping cough – and public health experts say that even though cases of two common vaccine-preventable diseases are low this year, vaccination should not be skipped.

Through August, Maine recorded 28 cases of varicella, or chickenpox, compared to a five-year-average of 143 cases for that period. Cases of pertussis this year stood at 29 through the end of August, well below the five-year average of 223 pertussis cases through the end of August.

Health care experts say a number of factors related to the coronavirus pandemic have led to the lower varicella and pertussis numbers, including schools closing in March, people wearing masks and social distancing, all of which reduced the risk of transmitting various types of viruses.

COVID-19 has caused more than 5,200 illnesses in Maine this year and 140 deaths, dwarfing the numbers of varicella and pertussis cases in a typical year. But varicella, pertussis, measles, mumps and a number of other diseases can be prevented by vaccines, so having hundreds of cases is an unnecessary public health threat, scientists say.

Malissa Wildes with a dose of this year’s flu shot at Maine Medical Partners – Pediatrics on Friday. Public health experts warn that hospitals could be deluged with both COVID-19 patients and flu patients if people do not get vaccinated.  Brianna Soukup/Staff Photographer

In 2019, there were already 314 cases of pertussis and 66 cases of varicella by the end of August. Year-end totals for 2019 were 383 for pertussis and 96 for varicella.

Last year, Maine had the second-highest pertussis rate in the nation – a per-capita rate more than five times the national average – and scientists say the high rate is connected to poor vaccination rates among schoolchildren.

Dr. Laura Blaisdell, a pediatrician from South Portland, said the efforts to limit the spread of COVID-19 clearly helped reduce infectious disease case counts.

“When children aren’t together they can’t spread disease,” she said. “Throughout the summer kids may have been seeing each other, but more in small groups and more outside.”

However, Blaisdell said she worries that parents may have been less likely to obtain school-required vaccines for the school year that just began, because people have avoided non-emergency medical care during the pandemic.

Some schools reported dangerously low levels of vaccination in 2019-20, including more than half the kindergartners opting out of vaccines at Fiddlehead School of Arts and Sciences in Gray, and about a third of kindergarten students at Denmark Elementary School and Maine Coast Waldorf School in Freeport. Next school year, those schools and others will have to enforce vaccinations in order for children to attend school in person.

Flu shots in the vaccine refrigerator at Maine Medical Partners – Pediatrics in South Portland. Brianna Soukup/Staff Photographer

Although the vaccination exemption rate for the current school year won’t be released until spring, there is cause for concern that parents have delayed immunization visits for their children during COVID-19. Vaccinations continued and were prioritized over other non-urgent medical procedures that were pushed back to limit human contact during the pandemic, but it’s not clear how many parents got that message.

“I fear our vaccine rates are quite low. Our community immunity has already been revealed to be very weak,” Blaisdell said, referring to the state’s sky-high pertussis rates and recent chicken pox outbreaks.

The federal government released data Thursday showing that all childhood immunizations – including for infants, toddlers and school-aged children – were down 20 percent through May. Recognizing that many parents may have put off vaccine appointments, the Maine Center for Disease Control and Prevention has run a series of “catch-up” clinics across the state where children can get free immunizations.

Jessica Shiminski, program manager for the agency’s Maine Immunization Program, said that from a July survey, only 2.1 percent of 13-year-olds in the program were behind on their booster shots. Data for younger children is not yet available.

John Suttie, superintendent for RSU 23 in Old Orchard Beach, said he has not seen a problem this school year with a larger number of children than usual being behind on their immunizations.

“We have made it a priority to remind parents to get up-to-date on their vaccinations, and letting them know that doctor’s offices are open and willing to see them,” Suttie said. “Parents have been pretty receptive.”

James Kenty, 6, winces as Malissa Wildes gives him a flu shot Friday. The federal government released data Thursday showing that all childhood immunizations were down 20 percent through May.  Brianna Soukup/Staff Photographer

Shiminski said in addition to the catch-up clinics, most pediatrician’s offices were making an extra effort to get children in for their vaccinations despite the pandemic. And she said school-based flu clinics will be taking place.

“Flu clinics are still happening this year,” Shiminski said. “It’s definitely very important to get the influenza shot.”

Public health experts warn that hospitals could be deluged with a “twin-demic” of COVID-19 patients and flu patients if people do not get vaccinated. However, there is also some hope that social distancing and wearing masks will also work to prevent the flu from spreading.

The new law ending non-medical vaccine exemptions next year did not get onto the books without a battle. Legislative hearings on the bill were marathon sessions that pitted public health experts and parents who support vaccines against other parents who believe vaccines can cause autism or other harms – even in the absence of credible scientific evidence to support those fears.

Opponents collected signatures to force a “people’s veto” referendum aimed at overturning the law, mounting a campaign that focused on parental rights as much as the public health issues at stake. But Maine voters supported the new vaccine standards at a referendum in March, just as the COVID-19 pandemic worsened.

It’s not clear how divisions over childhood vaccinations for infectious diseases might affect how Mainers respond to a vaccine to protect against COVID-19.

A national survey of 10,093 U.S. adults conducted Sept. 8-13 by Pew Research Center found that 51 percent of respondents said they would definitely or probably get a COVID-19 vaccine if it were available, and 49 percent said they definitely or probably wouldn’t.