Routine vaccinations dropped off among children and adolescents in the early days of the Covid-19 pandemic in 2020—and, while rates did eventually pick up, vaccinations did not bounce back far enough to catch up those who missed out, according to a CDC analysis.
Routine pediatric vaccine orders saw a substantial decrease after the March 2020 declaration of the Covid-19 pandemic in the U.S., and areas such as New York City and Michigan reported massive drops in vaccine administration, Bhavini Patel Murthy, MD, and colleagues from the CDC explained in Morbidity and Mortality Weekly Report. In order to better understand the pandemic’s impact on routine pediatric immunizations for non-Covid diseases, Murthy and colleagues analyzed data on vaccine administration from March through September 2020 from 10 U.S. jurisdictions with high-performing immunization information systems—Idaho, Iowa, Louisiana, Michigan, Minnesota, New York City, North Dakota, Oregon, Washington, and Wisconsin.
The data showed that “administered doses of routine childhood and adolescent vaccines were substantially lower during March–May 2020 compared with the average administered during the same period in 2018 and 2019. This decline, which is consistent with other data sources indicating a similar decrease in routine pediatric vaccine ordering, corresponded to the enactment of stay-at-home orders in many jurisdictions. Although vaccine administration rebounded during June–September 2020, approaching prepandemic levels in most jurisdictions, this increase was not sufficient to achieve the catch-up vaccination needed to address the many months when children missed routine vaccination.”
Murthy and colleagues warned that the lag in catch-up vaccination “might pose a serious public health threat that would result in vaccine-preventable disease outbreaks, especially in schools that have reopened for in-person learning.”
They added that rebounding from the disruption of routine medical care caused by Covid-19 will require “a consolidated and coordinated effort among multiple partners to promote catching up and staying up to date on routine vaccinations for children of all ages. Health care providers should assess the vaccination status of all pediatric patients, including adolescents, and contact those who are behind schedule to ensure that all children are fully vaccinated.”
For their analysis, Murthy and colleagues measured the number of vaccine doses administered weekly for two time periods, March-May 2020 and June-September 2020—many of the included jurisdictions implemented and then lifted stay-at-home orders during those periods. For all 10 jurisdictions, they calculated the weekly percent change between number of vaccine doses administered in 2020 compared to those administered in 2018 and 2019.
The analysis included vaccinations for:
- Diphtheria, tetanus, and acellular pertussis (DTaP) for kids ages 0-23 months and kids ages 2-6 years.
- Measles, mumps, and rubella (MMR) for kids ages 12-23 months and kids ages 2-8 years.
- Human papillomavirus (HPV) for kids ages 9-12 years and adolescents ages 13-17 years.
- Tetanus, diphtheria, and acellular pertussis (Tdap) for adolescents ages 13-17 years.
Murthy and colleagues found that vaccine doses administered decreased dramatically for all vaccines across all jurisdictions from March through May 2020 compared to the same time period in 2018 and 2019.
“Among children aged <24 months and children aged 2–6 years, DTaP doses administered declined an overall median of 15.7% and 60.3%, respectively, across all jurisdictions compared with the same period during 2018 and 2019,” they found. “During March–May 2020, MMR doses administered to children aged 12–23 months and children aged 2–8 years declined a median of 22.4% and 63.1%, respectively. Among children aged 9–12 years and adolescents aged 13–17 years, HPV doses administered declined a median of 63.6% and 71.3%, respectively during March–May 2020 compared with doses administered during the same period in 2018 and 2019. Doses of Tdap administered during this period in 2020 decreased a median of 66.4% among children aged 9–12 years and 61.4% among adolescents aged 13–17 years compared with 2018 and 2019.”
As for the June-September 2020 time period, after the majority of stay-at-home orders were lifted, “the number of weekly routine pediatric vaccine doses administered increased initially, approaching or even surpassing baseline prepandemic levels in most of the 10 jurisdictions, with some differences by jurisdiction, vaccine type, and age,” they wrote.
However, none of the jurisdictions saw a sustained or prolonged increase in weekly administered doses above prepandemic levels, “which would be necessary to catch up children and adolescents who missed routine vaccinations,” they added.
For the June-September 2020 period, compared to 2018 and 2019 rates:
- DTaP: Declined 9.1% for ages <24 months and 6.7% for ages 2-6 years.
- MMR: Declined 8.8% for ages 12-23 months and 11.3% for ages 2-8 years.
- HPV: Declined 12.2% for ages 9-12 years and 28.1% for ages 13-17 years.
- Tdap: Declined 21.3% for ages 9-12 years and 30.0% for ages 13-17 years.
Murthy and colleagues posited that the lag in catch-up vaccinations likely stemmed from a number of factors, including fear of contracting Covid-19 in health care facilities or the community while seeking pediatric care; differences in the duration or enforcement of stay-at-home orders or the prevalence of Covid-19 cases in a given area; and a rapid transition to virtual learning during the pandemic that might have resulted in a lack of enforcement of immunization requirements for school attendance.
To combat this lag in immunizations, the study authors recommended that physicians consider co-administering Covid-19 vaccines with other routinely recommended vaccines as Covid vaccinations become more readily available in pediatric populations. Even transient declines in vaccination coverage can compromise herd immunity and result in viral outbreaks, they argued—and, as health care systems are already overburdened by the ongoing pandemic and schools are attempting to reintroduce in-person learning, vaccine-preventable diseases pose a major public health risk.
Study limitations include limiting the analysis to 10 jurisdictions, compromising generalizability; a lack of vaccination corroboration from other surveillance programs; and that the specific reasons behind declines in vaccine rates in March-May 2020 and the subsequent increases from June-September 2020 could not be determined.
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Administered doses of routine childhood and adolescent vaccines were substantially lower during the early months of the Covid-19 pandemic in 2020 compared with the average administered during the same period in 2018 and 2019.
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While vaccination rates rebounded during June–September 2020, this increase was not sufficient to achieve the catch-up vaccination needed to recover from declines from March-May 2020.
John McKenna, Associate Editor, BreakingMED™
The study authors had no relevant relationships to disclose.
Cat ID: 138
Topic ID: 85,138,730,933,31,926,138,44,192,561,925,934
