A new school year is nearly here. Cases of COVID-19 are already rising, and more germs are coming.

However, it’s a new era. In the age of misinformation and declining vaccination rates, public health officials in Maryland are concerned that students will head into the fall without important protections, in part because of shifting guidance at the federal level.

Maryland has historically had higher-than-average vaccination rates, and the General Assembly also passed legislation earlier this year to ensure that people would have no disruption in insurance coverage.

But officials are still worried, holding clinics, advertising vaccines’ benefits and urging students and their families to get not just required immunizations for diseases like measles and chickenpox now, but extra ones for flu and COVID in the fall.

They point to a continuing measles outbreak and rising COVID cases. Maryland has had just a few measles infections, but there were 76 people hospitalized for COVID as of Aug. 11. That’s double from earlier in the month though still below the peak this time last year of 260.

There are fewer tools to monitor for COVID, and a whole lot less testing, which can cloud the view of how widespread any virus surge may be.

From testing that was done, the rate of infections in Maryland has increased by 40% from July 28 to Aug. 11, according to available state figures. And in statewide wastewater samples taken earlier this month, a high level of virus was found in Montgomery and Anne Arundel counties. Overall, these increases mirror a rise in cases nationally.

Even though state health officials said the numbers were still lower than typical for the peak respiratory season, “the best advice is to get a vaccine if you are eligible for a vaccine,” Dr. Manisha Juthani, president-elect of the Association of State and Territorial Health Officials, said during a recent news conference.

Juthani and others urged the public to speak with their doctors and other trusted health care professionals now, especially about school vaccines.

To enter kindergarten in Maryland, students need vaccines against measles, mumps and rubella; diphtheria, tetanus and pertussis; polio; hepatitis B; and chickenpox. Students in the seventh grade need the combination tetanus vaccine and a meningococcal shot.

After a 20-day grace period, schools will bar unvaccinated students from classes, but local health department officials say they are contacting families needing immunizations.

Parents can also check with their doctors, on their providers’ online portals or request vaccine records from a state database called ImmuNet. The state no longer contracts for online access to the popular records site MyIR.

Health departments like the one in Howard County, where vaccination uptake is typically high, are holding back-to-school clinics. Erin Anderson, assistant director of nursing, showed off a cooler with vaccines designated for uninsured and underinsured children, though she said anyone can get a shot at a clinic.

“We had a drop-off during the pandemic because people were staying home, but it really ramped back up,” said Anderson.

With no mandates, COVID and flu vaccination rates remain low despite continuing waves of infections.

Fewer than half of children got the flu shot last year during a particularly severe season with more than 200 pediatric deaths, including four in Maryland.

The CDC recommends that everyone over age 6 months get the flu vaccine ahead of the October-to-May season. Doses should be available in the fall in drug stores, doctors’ offices and health departments. Those age 2 to 49 can now also order FluMist for use at home this year for a shipping fee.

For COVID, summer and winter surges have become the norm, said Dr. David A. Schwartz, a medical epidemiologist and member of the College of American Pathologists.

Schwartz said schools should emphasize hand washing, as well as covering your cough and keeping sick kids home to avoid seasonal infections — and getting vaccines, typically given in the fall.

Federal health officials, however, sharply cut their recommendation of those who they say need COVID vaccinations. They have said the shots are only recommended for those over age 65 or with a health condition such as cancer or diabetes, a concerning rollback to some public health officials.

Still, it is possible for healthy kids to get the vaccine if health care providers recommend it, so parents may have to ask.

Guidance could still change for the 2025-2026 COVID vaccine from from the CDC’s advisory panel, which Secretary Robert F. Kennedy Jr. replaced with his own picks last month.

Insurers are required to cover recommended vaccines, and there are programs to provide them to those who can’t afford them called Vaccines for Children.

New laws in Maryland require insurance plans to cover any vaccine recommended by the end of 2024. The Maryland Insurance Administration says this applies to those who bought insurance through the state health exchange and other companies with fully insured workers. But most people in Maryland work for larger companies not covered by the new law, meaning employees will have to rely on their company’s insurance policies.

CVS Pharmacies, among the nation’s largest drug store chains, said it will accept insurance for all recommended vaccines. If they are not covered, out-of-pocket fees for flu shots range from about $75 to $126, and COVID shots are about $199.

For its part, CareFirst BlueCross BlueShield, the state’s largest insurer, said it expects most members to have coverage for school vaccines, as well as flu, COVID and RSV, or respiratory syncytial virus, at in-network pharmacies or doctors’ offices.

The state is hoping to counter any confusion or hesitancy about vaccines with a bilingual social media campaign through August that local health departments and schools can share, along with resources and clinics.

Maryland Health Secretary Dr. Meena Seshamani singled out Washington County for its efforts to work the phones and steer parents of unvaccinated children to clinics held on Fridays.

Tia Taylor, communicable disease program manager for the Washington County Health Department said the calls are paying off. “They were not aware students needed a vaccination until we called,” Taylor said.