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Drop in routine childhood vaccinations during pandemic raises risk of outbreaks in a fourth of Tennessee counties

A medical professional gives a shot in the arm to a child in a red t-shirt.

More than 95% of Tennessee kindergarteners received their routine vaccinations last school year, but not all counties achieved that vaccination rate, according to the state health department.

Emily Elconin for Chalkbeat

At least a fourth of Tennessee counties risk outbreaks of diseases like measles, mumps, and whooping cough because more children missed their routine vaccinations during the early months of the coronavirus pandemic, data shows.

They include urban counties based in Nashville, Knoxville and Chattanooga, as well as a large swath of rural counties, especially in East Tennessee. 

Memphis-based Shelby County was the only urban area to achieve at least a 95% kindergarten vaccination rate, the international threshold for preventing outbreaks of vaccine-preventable communicable diseases that also include diphtheria, hepatitis A and B, and chicken pox.

The concerning trend was highlighted to county health directors this fall in a communication from Dr. Paul Peterson, director of emergency preparedness for the Tennessee Department of Health.

In an Oct. 7 email, which Chalkbeat obtained through a public records request, Peterson encouraged health officers to examine the state’s latest report on kindergarten immunizations “so that we can work together to catch up on immunizations and help minimize vaccine preventable diseases.”

The report is the most complete data thus far about the status of Tennessee’s routine childhood vaccinations during the pandemic, when the number of shots dropped dramatically nationwide as regular doctor’s appointments and preventative health care were derailed to avoid coronavirus exposure.

Tennessee also trails most of the United States to get shots against COVID in the arms of children, teens, and adults. And the divide is especially wide for kids ages 5 to 11, with less than 7% in that age group fully vaccinated.

For routine vaccinations, Tennessee requires that children be immunized when enrolling in kindergarten. Other vaccinations are mandatory when enrolling in child care, pre-school, or pre-K, as well as the seventh grade.

The state’s immunization report for the 2020-21 school year shows 95.2% of all public and private school kindergartners were fully vaccinated.

However, the state’s analysis of county-by-county data showed that only 72 of Tennessee’s 95 counties reached the rate needed to achieve herd immunity in public schools, 15 fewer counties than the prior year. 

Even fewer counties achieved herd immunity when factoring in kindergartners from private schools, which last year added more students and went from 4% to 5.2% of the state’s total kindergarten enrollment.

Dr. Morgan McDonald, deputy commissioner for population health for the department, said Tennesseans should be concerned about the vaccination lag.

“When a community drops below a 95% vaccination rate, we know their risk for outbreaks is significant,” McDonald said in an interview with Chalkbeat.

“These vaccine-preventable diseases are highly contagious. A case of measles can spread incredibly rapidly among individuals who are not vaccinated,” she said.

Measles was declared eradicated in the U.S. in 2000 thanks to widespread vaccination, but outbreaks have occurred in recent years in pockets of unvaccinated people.

In 2016 in Memphis, a measles outbreak infected seven people, six of whom had not been vaccinated. A 2017 outbreak in Minnesota sickened 79 people.

Measles is especially dangerous for young children and can lead to pneumonia, swelling of the brain, and death.

While vaccine hesitancy has been a national issue in the fight to tame COVID, the latest data on routine vaccinations suggests pandemic-related disruptions to preventative health care is the bigger issue, McDonald said.

Last school year among students who were not fully immunized, less than one-tenth of 1 percent received a medical exemption. Religious exemptions, which nearly doubled to 1.8% from 2015 to 2018, have hovered at that rate over the last three years.

Public health officials hoped for a rebound in routine vaccinations as most children returned to in-person classes this fall. In June, the American Academy of Pediatrics called on parents to get their children up-to-date.

However, in Tennessee, vaccination outreach was dialed back during the critical summer months over pushback from conservative GOP lawmakers about the state’s public health role during the pandemic. Fewer school systems offered back-to-school vaccination events in the aftermath, and the state has yet to replace its top vaccination official who was fired by Health Commissioner Lisa Piercey during the controversy. Peterson is the state’s interim director over immunization work.

Piercey has maintained the state’s immunization program was not disrupted — and that children have access to their routine vaccinations through their local health departments.

McDonald said the state has been working with the Tennessee Academy of Pediatrics, the state education department, and other community partners to ensure vaccine availability and to get the word out.

School nurses are part of that process.

In rural Haywood County near Memphis, district nurse supervisor Julie Taylor sent letters last week telling 19 families to get their kindergartners vaccinated over the holidays. If the families do not submit documentation showing vaccination, the children won’t be allowed to return to school, she said.

With 84% of its kindergarteners vaccinated last school year, Haywood County logged the state’s lowest kindergarten immunization rate.

Taylor is hopeful for improvement this year, but acknowledged the challenge.

“It all points back to COVID. It was a difficult year,” she said.

“We had a lot of COVID in households in Haywood County, and it was all-consuming for school nurses as we worked with our local health departments to provide contract tracing. We were just trying to hold on and keep our students safe and healthy from the pandemic,” Taylor said.

This year, there’s been a more concerted effort to catch students up on shots they may have missed, which Taylor said was more about pandemic-related logistical challenges than vaccine hesitancy.

“These parents aren’t bad parents. Things just fell through the cracks,” she said.

Use our table below to look up your county’s kindergarten vaccination rate.

Percentage of Tennessee public and private school kindergarten students fully immunized by county
County % fully immunized Total kindergarten students
ANDERSON 96.70% 828
BEDFORD 95.00% 624
BENTON 98.00% 153
BLEDSOE 97.20% 106
BLOUNT 94.30% 1,362
BRADLEY 91.30% 1,114
CAMPBELL 95.50% 374
CANNON 97.80% 134
CARROLL 96.80% 316
CARTER 94.70% 550
CHEATHAM 96.70% 459
CHESTER 93.20% 207
CLAIBORNE 97.30% 329
CLAY 92.50% 80
COCKE 98.40% 387
COFFEE 96.50% 636
CROCKETT 99.10% 214
CUMBERLAND 97.10% 488
DAVIDSON 94.00% 6,907
DECATUR 96.50% 114
DEKALB 95.60% 228
DICKSON 97.30% 562
DYER 98.30% 460
FAYETTE 95.00% 278
FENTRESS 90.70% 172
FRANKLIN 97.30% 400
GIBSON 95.40% 669
GILES 92.10% 290
GRAINGER 98.10% 209
GREENE 98.20% 609
GRUNDY 94.70% 131
HAMBLEN 95.10% 771
HAMILTON 91.60% 3,689
HANCOCK 91.70% 60
HARDEMAN 98.40% 257
HARDIN 99.30% 276
HAWKINS 96.90% 482
HAYWOOD 84.00% 194
HENDERSON 97.20% 326
HENRY 97.30% 296
HICKMAN 95.70% 230
HOUSTON 94.30% 87
HUMPHREYS 95.50% 220
JACKSON 88.80% 107
JEFFERSON 95.80% 481
JOHNSON 93.80% 129
KNOX 94.70% 4,716
LAKE 97.00% 66
LAUDERDALE 100.00% 237
LAWRENCE 93.90% 477
LEWIS 96.40% 137
LINCOLN 96.90% 327
LOUDON 96.50% 372
MACON 97.40% 386
MADISON 96.40% 995
MARION 98.10% 316
MARSHALL 98.90% 278
MAURY 93.00% 1,104
MCMINN 96.20% 526
MCNAIRY 96.90% 290
MEIGS 95.90% 123
MONROE 93.00% 471
MONTGOMERY 94.70% 2,820
MOORE 93.20% 59
MORGAN 93.00% 200
OBION 95.80% 385
OVERTON 96.10% 205
PERRY 90.00% 70
PICKETT 92.00% 50
POLK 92.30% 130
PUTNAM 92.60% 797
RHEA 94.80% 386
ROANE 92.60% 433
ROBERTSON 95.00% 906
RUTHERFORD 96.10% 4,257
SCOTT 99.00% 296
SEQUATCHIE 98.40% 124
SEVIER 96.90% 1,048
SHELBY 96.10% 11,465
SMITH 99.50% 213
STEWART 93.00% 128
SULLIVAN 96.10% 1,337
SUMNER 96.00% 2,123
TIPTON 97.90% 761
TROUSDALE 97.90% 97
UNICOI 97.70% 132
UNION 85.30% 401
VAN BUREN 84.70% 59
WARREN 97.20% 425
WASHINGTON 96.40% 1,197
WAYNE 96.90% 159
WEAKLEY 96.40% 278
WHITE 89.40% 302
WILLIAMSON 95.10% 3,035
WILSON 96.50% 1,734

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