Childhood Vaccination Coverage Declines During COVID-19 Pandemic

Childhood vaccination coverage has declined sharply during the coronavirus 2019 (COVID-19) pandemic, according to a review of the Michigan Care Improvement Registry.

For the study, highlighted recently in the US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, investigators from the Michigan Department of Health and Human Services, the Immunization Action Coalition and Children’s Hospital of Philadelpha reviewed the vaccine up-to-date status for a point in time in May compared with points in time in May 2016-May 2019.

“The biggest takeaway is that coverage for childhood vaccines have gone down and this leave a number of children under- and un-vaccinated,” Angela Shen, ScD, MPH, retired captain with the US Public Health Service and visiting scientist at Children's Hospital of Philadelphia told Contagion^®. “Vaccines are an essential part of the well-child visit and should continue while local and state public health implement measures to manage COVID-19. While the vaccination uptake will rebound again, albeit slowly, it is important to maintain immunization services and get your children vaccinated amid this pandemic.”

Stay-at-home orders, such as that ordered in Michigan on March 23 to mitigate the spread of the novel coronavirus SARS-CoV-2, have hampered accessibility to routine vaccination services. Telehealth has become more prominent avenue for addressing many health care needs during the pandemic, but the drop in vaccination coverage highlights the need to accommodate in-person visits for those health care services that can’t be provided remotely.

“Providers should use their electronic health records and immunization information systems to identify children who have missed recommended vaccinations, work with families to schedule in person appointments, and assure parents that strict infection control practices are in place,” Shen said.

The study found vaccination coverage declined for all age milestones except the hepatitis B vaccine given at birth, which is typically administered in the hospital.

Fewer than half (49.7%) of infants age 5 months were up-to-day on all recommended vaccines in May, compared with about two-thirds (66.6%, 67.4%, 67.3%, 67.9%) during the past four years. At age 16 months, measles-containing vaccination coverage declined to 70.9% from 76.1% a year ago.

“The concern is there is now a population of disease-susceptible children, and as the country opens back up they will need to make up those appointments in an already-stressed health care system,” Shen said. “You don’t want to get behind on the primary immunization series. Once children fall off, it’s hard to catch up.”

The total number of non-influenza vaccine doses administered for children age 18 or younger fell by 21.5% during the first four months of this year, compared with 2018 and 2019. Among children 24 months or younger, the decrease was 15.5%. Fewer children enrolled in Medicaid were up-to-date with their recommended vaccinations in May (34.6%), compared with children not enrolled in Medicaid (55%).

“It is important to get children vaccinated at recommended times, otherwise we run the risk of outbreaks in the community,” Shen stated. “It is also important for everyone 6 months of age and older, who are not contraindicated, to get a flu vaccine this fall. It will reduce the number of respiratory illnesses that need to be managed and reduce the strain on the health care system which is currently under siege by COVID-19 response.”

Even before the pandemic, health care providers faced challenges with childhood vaccination coverage as vaccine hesitancy and misinformation pushed the number of parents seeking vaccine exemptions up in recent years, leading to increases in vaccine-preventable diseases followed by state legislation aimed at limiting exemptions.

Efforts to combat vaccine hesitancy and misinformation have been ongoing. Investigators in Italy recently completed an updated review of the safety, efficacy and adverse events associated with the MMR vaccine, with the finding supporting the continued use of the vaccines for mass immunizations.