Wisconsin children are behind other states in vaccinations, according to an Oct. 17 report released by the Centers for Disease Control and Prevention. The Wisconsin Department of Health Services is also monitoring a sharp increase in pertussis cases, commonly called whooping cough, in the state this year.  

Door County has a higher overall childhood vaccination rate than most of the rest of the state, but the data still shows fewer children are being vaccinated than in the past. There has also been an increase in pertussis cases in Door County this year, according to Door County Public Health. 

At least one of those cases spurred a local school district to send out letters to families, alerting them that their children may have had close contact with pertussis. Brett Stousland, Gibraltar School District superintendent, confirmed a letter was sent out to elementary school families on Oct. 17, after an active case was confirmed in the district. 

Immunization by the numbers

According to the most recent data from DHS, in 2023, 79 percent of infants up to 2 years old received DTaP vaccinations in Door County. Those rates have fallen from 2013 when they were 85 percent.

Statewide, infant DTap vaccination rates were 77 percent in 2013, down to 72 percent in 2023. 

When a child receives the entire official childhood vaccination series set by the CDC, it is called “4:3:1:3:1:4”. The numbers refer to four doses of DTaP; three doses of polio; one dose of measles, mumps and rubella (MMR; three doses of Haemophilus influenza (Hib); three doses of Hepatitis B; one dose of varicella (chickenpox); and four doses of pneumococcal (pneumonia) vaccine. 

The rate of Door County children under age 2 who have received the full childhood vaccination series went from 82 percent in 2013 to 76 percent in 2023. 

Flu and Covid vaccination rates are tallied separately and Door County’s rates are lower than the Wisconsin rates overall. The latest data for Door County, updated Oct. 31, shows about 14 percent of children under 4 receiving flu vaccines, and only 1.4 percent receiving Covid vaccines. About 10 percent of children age 5 to 17 received flu shots, while 1.2 percent of them received Covid shots. 

Wisconsin children under 5 are vaccinated against flu at a 15 percent rate, and Covid at a 2.5 percent rate. Older children in the state are at vaccination rates of 11 percent for flu and 2.5 percent for Covid. 

In a press release dated Sept. 19, DHS highlighted MMR vaccination rates and noted that 85 percent of Wisconsin kindergarteners are up to date on their MMR vaccine, while nationally 93 percent of children have received it. 

Door County has some of the highest MMR vaccination rates in the state, however, and is one of nine other counties with 85 percent of all children up to 18 years old vaccinated against MMR. At least 21 other Wisconsin counties fall below 75 percent. 

The pertussis vaccine is administered with two others, diphtheria and tetanus. Called DTaP, the combination vaccine is given in a series of three shots to children starting at 2 months old until they are 6 months old. 

Childhood disease rates increasing

Not only are childhood vaccination rates in Wisconsin falling below the rest of the country, according to the CDC and DHS, but rates of communicable diseases are rising in the state. 

In the case of pertussis, the numbers are increasing sharply. According to CDC data from as recently as Oct. 26, Wisconsin has had 1,434 pertussis cases reported so far in 2024. In 2023, there were 35 cases.

About 46 percent of the pertussis cases reported this year were for children aged 11 to 18 years old, and 59 cases were in infants. Nine of those infants were hospitalized and no deaths have been reported. 

A pertussis case total for Door County was not available at the time of publishing, but there have been enough confirmed cases here recently that Public Health sent a notice to providers about pertussis’ presence in the community, according to Katie VanLaanen, a Door County Public Health nurse. 

She cautioned that confirmed case counts are not accurate reflections of how many cases there actually are. “These are the ones that are tested,” she said. “Not everyone is interested or able to get tested.” 

Many healthcare providers do not think to test for pertussis, especially if they have not seen a case of it before, she added. Public Health sent information to local providers on Oct. 29, asking them to test patients with coughs for pertussis, as it is active in Door County right now. 

Whether or not declining vaccination rates are linked to the rise of diseases like pertussis is unclear, VanLaanen said. Pertussis is a cyclical disease, meaning every decade or so there is a surge in cases, she said. 

However, Wisconsin pertussis cases are over pre-pandemic rates, according to Jennifer Miller, a spokesperson for DHS.  

“The exact cause isn’t known. We sometimes do have years where there is an uptick in cases, though admittedly 2024 case counts have proven to be very high,” said Miller via email.  

What is clear, according to VanLaanen, is that the best defense against pertussis and other highly contagious diseases like measles, are vaccines. 

As to why vaccination rates are on the decline, VanLaanen said the Covid-19 pandemic is a factor. 

“People were at home, not going to the doctor, the health department stopped our weekly immunization clinics,” she said. “Our main focus was Covid cases and contact tracing.” 

Families may have fallen behind in their children’s vaccination schedules, she said. She and Miller encouraged parents and caregivers to check their family’s vaccination records on the Wisconsin Immunization Registry, to see what immunizations family members still may need.  

The pertussis vaccine may wane after several years, Miller added, so people can talk to their provider to see if they might need the vaccine again.

A cough apart

“I really worry about babies,” VanLaanen said. Babies under 2 months old cannot get their DTaP vaccine yet, and will not receive the full vaccination series until they are at least 6 months old. 

Infants under 1 year old, pregnant women, medically vulnerable and immune-compromised people, especially those with asthma, and people who have close contact with those populations are the most in need of protection from pertussis, she said. 

Fits of coughing can be so prolonged and severe that they can lead to vomiting and apnea, she said, or being unable to breathe. This is especially true for babies, she added, and the disease can result in hospitalization and can be fatal. 

Pertussis is a Category 1 communicable disease, VanLaanen explained, meaning providers are required to report a confirmed case to their local public health department immediately. 

Patients are contagious up to seven days before symptoms begin and the disease has an 80 percent rate of contagion, she said. Additionally, there is a population that may contract the disease and not get the characteristic “whooping” sound in their cough, she added, making it harder to diagnose them. 

Door County Public Health follows up on all reported cases as soon as possible, and they recommend that all close contacts of confirmed cases receive prophylactic antibiotics because pertussis is so contagious. 

None of the reported pertussis cases in Door County this year were in infants under 1 year old, VanLaanen said, however Public Health has recommended prophylactic antibiotics for infants that were close contacts of cases. 

Public health resources

As a result of recent outbreaks, Door County Public Health has pertussis vaccines available for no cost, regardless of insurance status, for ages 11 and up, VanLaanen said. 

For individuals 18 years old and younger who are on Badgercare, Medicaid, are uninsured or have insurance that does not cover vaccines, Public Health provides free vaccinations for childhood diseases like pertussis and measles, as well as seasonal flu and Covid vaccines. 

Additionally, people can make vaccination appointments with Public Health through its online scheduling system or call (920) 746-2234 for more information.