Children and teens need up-to-date shot records to start the new school year, and the doctors at Cook Children’s are eager to help get students caught up on their routine immunizations.

Alice Phillips, M.D. at Cook Children’s Pediatrics Cityview said vaccines can prevent contagious diseases such as hepatitis, measles and mumps from spreading through the classroom and to family members at home.

“We can look back at history and see stories about polio and whooping cough and the toll that that took on our kids and on our society. We do not want to go back to that,” Dr. Phillips said. “Vaccines are safe. They work. And they are tried and true and proven over many decades.”

But the latest annual immunization report by the Texas Department of State Health Services identified a drop in overall vaccination coverage among kindergarteners during the 2021-2022 school year. The report also cited a high number of seventh-graders behind on shots for meningitis and Tdap (tetanus, diphtheria and pertussis).

In the report, the COVID-19 pandemic was listed as the main reason more children missed out on their required vaccines last year. Additional barriers to immunization include lack of transportation, missed opportunities, lengthy wait, and lack of culturally appropriate educational materials, according to the state health department.

Dr. Phillips pointed out that only 85% of Fort Worth Independent School District kindergarten students were current with their measles shots last school year. To reach herd immunity, and limit transmission, the rate should be 90-95%, she said.

Many families were afraid to come to the pediatrician for their child’s annual checkup during the early months of the pandemic in 2020, Dr. Phillips said. Most of her patients have since received any overdue vaccines.  

Heather Miller, M.D. at Cook Children’s Neighborhood Clinic Northside also saw a trend of families not making appointments -- or canceling, or not showing up -- for well-child visits because of COVID-19 concerns during the past two years. To make up for the shots they missed, some 6-year-olds are now coming in for vaccines normally given at age 4.  

Dr. Miller has good news for children and teens who fell behind: There are combination vaccines that can be given in most cases, meaning “fewer pokes,” as she puts it.

Most of the patients that Dr. Miller and her colleagues see at the Neighborhood Clinic Northside are on Medicaid or the Children’s Health Insurance Program (CHIP), which is available to those who can’t afford private health coverage. She wants parents to know that the Texas Vaccines for Children Program provides vaccines to eligible children from birth through age 18.

Dr. Miller says getting back-to-school vaccinations will help protect children from potentially serious complications from those diseases. “That’s why we’re here,” she said, “to help keep children healthy.”

Cook Children’s families can go to the MyCookChildren’s patient portal to schedule an appointment or access the immunization records needed for school registration. Dr. Miller said the staff at the neighborhood clinics can help their families navigate the portal or print out a copy of immunization records. 

In addition to the delays the pandemic caused, Dr. Phillips believes vaccine hesitancy also played a role in the 2021-2022 drop in the immunization rate.  She invites parents to ask questions and talk to the doctor about any concerns.  

“Let me discuss with you what I know – the science, the data – to tell you why these vaccines are safe for your child and why they are effective at preventing illness for not only your child but all of their friends and the community,” said Dr. Phillips, who describes a team partnership of trust between the physician and patient families working together to keep kids healthy.

“I truly believe after 25 years of doing this, that what’s absolutely best for their child is to be fully immunized and protected, because these diseases are still out there,” Dr. Phillips said.

Vaccines Checklist

Because many vaccines are typically given in the first 12-18 months of life, an incoming kindergartner might not have received a vaccine since her first birthday. Between the ages of 4-6, these additional vaccines are due:

• MMR (measles, mumps and rubella)
• DTaP (diphtheria, tetanus and pertussis)
•  IPV (inactivated poliovirus)
•  Varicella (chickenpox)

And an incoming seventh-grader might not have received a vaccine since he was a preschooler. Between the ages of 11-12 years, these additional vaccines are due:

• MCV4 (meningitis)
• Tdap (tetanus, diphtheria and pertussis)
• HPV (human papillomavirus)

A booster of the meningitis vaccine is also recommended at age 16.

Cook Children’s follows the vaccine schedule adopted by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

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For 10 key facts about immunizations, including why it’s important to follow a vaccination schedule, go to Vaccine and Immunization (cookchildrens.org)

To view the recommended ages for shots from birth through the teen years, go to cook-childrens-vaccinefacts2.pdf (cookchildrens.org)

Meet Heather Miller, M.D.

Dr. Miller’s desire to become a doctor took root as she grew up in the Piney Woods of East Texas. She earned a Bachelor of Arts in Biology from the University of Texas at Austin, then attended the University of Texas Medical Branch for medical school and residency. Along the way she proudly served in the U.S. Air Force for three years as a General Medical Officer at Lackland Air Force Base in San Antonio. After fulfilling her military commitment and completing pediatric residency training, she started her career at Cook Children’s Northside Clinic in 2002. Then came a 10-year journey following other career opportunities in San Antonio, Mississippi and New Mexico.

With a happy heart, this native Texan returned to Fort Worth and rejoined the Northside Neighborhood Clinic. Reconnecting with Cook Children’s has been a wonderful homecoming. She feels blessed to have this opportunity to provide care for the children and families of North Texas once again. Her special interests in pediatric care include safety and prevention as well as behavior and development

With her husband Steven and son Andrew, Dr. Miller enjoys exploring the world and taking trips by train.

Learn more about Dr. Miller here.

This is the fourth case of measles confirmed in North Texas this year and the fourteenth in the state. Health officials say the patient recently traveled internationally to an area that has seen an uptick in measles and this case is not related to any previous infections reported in North Texas. 

“This is an important case to take note of because we already know that Tarrant County is a hot spot for potential outbreaks of diseases like the measles,” said Jason Terk, M.D, a Cook Children’s pediatrician and a nationally known advocate for vaccines. “Even though this is an imported case, we are more likely to have a wider outbreak of measles in our area because of the number of unvaccinated people and especially the people who are unvaccinated and live in unvaccinated clusters.”

Currently, there are no recommendations for early vaccination for babies who are not traveling to other countries.

"The scale of the problem is vastly different in other countries than these scattered cases here," Dr. Terk said. "Right now, and always, people need to make decisions based upon a thoughtful conversation with their doctor. We are seeing a signal of the problem we have been warning about. Even in the larger outbreaks in places like Washington, there are no recommendations for early vaccination for babies under 12 months of age. The health department follows this closely and will make formal recommendations if needed for any changes in vaccine schedule."

Peter Hotez, M.D., who is director of the Texas Children’s Hospital Center for Vaccine Development, co-authored a study in 2018 on vaccine exemptions published by the Public Library of Science Journal of Medicine.

Texas is one of 18 states that allows non-medical exemptions for vaccines and the report named Tarrant County and Fort Worth specifically as national “hot spots” for a potential outbreak.

In an editorial in the Star-Telegram, Dr. Hotez urged parents to provide immunization for their children, warning that “we are extremely vulnerable to a measles outbreak in Texas.”

Measles was declared eliminated from the United States in 2000 by the Centers for Disease Control and Prevention thanks to a highly effective vaccination program.

But as more parents are refusing vaccines for their children, despite scientific proof that they are safe and effective, measles has made a comeback. The CDC reports that there are more than 260 measles cases in 12 states with exemption rates continuing to rise.

Earlier this week, Collin County confirmed its second case of measles and Denton County confirmed a case in February.

Measles is an airborne disease spread by coughing and sneezing. It causes a reddish rash, high fever, cough, runny nose and watery eyes. It usually lasts one to two weeks. The rash begins on the face and head and then proceeds downward and outward to the hands and feet. It fades in the same order it began, from head to feet.

Measles is a vaccine-preventable disease. Adults who have received a measles vaccine series are considered immune. Those who have not been immunized against measles, or have never had measles, should contact their healthcare provider. Residents considering foreign travel should always check their health status beforehand.

Most people born in 1957 or after should have documentation of at least one dose of MMR (Measles, Mumps and Rubella) vaccine or other evidence of immunity to measles. The U.S. Centers for Disease Control and Prevention recommends two doses of the vaccine. The first dose should be given at 12 months of age and the second between the ages of 4 to 6 years.