Assessing the completeness of infant and childhood immunizations within a provincial registry populated by parental reporting: A study using linked databases in Ontario, Canada

Wilson, Sarah E.; Wilton, Andrew S.; Young, Jacqueline; Candido, Elisa; Bunko, Andrean; Buchan, Sarah A; Crowcroft, Natasha S.; Deeks, Shelley L.; Guttmann, Astrid; Halperin, Scott A.; Kwong, Jeffrey C.; Wilson, Kumanan; Tu, Karen

doi:10.1016/j.vaccine.2020.06.003

Cited by 6 publications

(4 citation statements)

References 15 publications

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Section: Methodsmentioning

confidence: 99%

“…In Ontario, immunizations for children under two years old are usually administered by primary care providers, including family physicians, during regular well-baby visits [22] , [32] and documented in the children’s medical record. EMR data from family physicians’ clinics has been previously used and validated to study childhood immunization coverage in Ontario [32] , [33] , [34] . Ontario’s Publicly Funded Immunization Schedule [35] recommends six different vaccines in the first 24 months of life ( Table 1 ), including diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (DTaP-IPV-Hib) vaccine, pneumococcal conjugate (PCV13) vaccine, rotavirus (Rota) vaccine, meningococcal conjugate (Men-C-C) vaccine, measles, mumps, and rubella (MMR) vaccine, and varicella (Var) vaccine.…”

Section: Methodsmentioning

confidence: 99%

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Impact of the COVID-19 pandemic on routine immunization coverage in children under 2 years old in Ontario, Canada: A retrospective cohort study

Piché‐Renaud

Apajee

et al. 2022

Vaccine

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Background The COVID-19 pandemic has caused a disruption in childhood immunization coverage around the world. This study aimed to determine the change in immunization coverage for children under 2 years old in Ontario, Canada, comparing time periods pre-pandemic to during the first year of the pandemic. Methods Observational retrospective open cohort study, using primary care electronic medical record data from the University of Toronto Practice-Based Research Network (UTOPIAN) database, from January 2019 to December 2020. Children under 2 years old who had at least 2 visits recorded in UTOPIAN were included. We measured up-to-date (UTD) immunization coverage rates, overall and by type of vaccine (DTaP-IPV-Hib, PCV13, Rota, Men-C-C, MMR, Var), and on-time immunization coverage rates by age milestone (2, 4, 6, 12, 15, 18 months). We compared average coverage rates over 3 periods of time: January 2019-March 2020 (T1); March-July 2020 (T2); and August-December 2020 (T3). Results 12,313 children were included. Overall UTD coverage for all children was 71.0% in T1, dropped by 5.7% (95% CI: −6.2, −5.1) in T2, slightly increased in T3 but remained lower than in T1. MMR vaccine UTD coverage slightly decreased in T2 and T3 by approximately 2%. The largest decreases were seen at ages 15-month and 18-month old, with drops in on-time coverage of 14.7% (95% CI: −18.7, −10.6) and 16.4% (95% CI: −20.0, −12.8) respectively during T2. When stratified by sociodemographic characteristics, no specific subgroup of children was found to have been differentially impacted by the pandemic. Conclusion Childhood immunization coverage rates for children under 2 years in Ontario decreased significantly during the early period of the COVID-19 pandemic and only partially recovered during the rest of 2020. Public health and educational interventions for providers and parents are needed to ensure adequate catch-up of delayed/missed immunizations to prevent potential outbreaks of vaccine-preventable diseases.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Impact of the COVID-19 pandemic on routine immunization coverage in children under 2 years old in Ontario, Canada: A retrospective cohort study

Piché‐Renaud

Apajee

et al. 2022

Vaccine

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View full text Add to dashboard Cite

show abstract

“…Our main outcome measures included overall rates of primary care visits (in person and virtual) to a pediatrician or family physician (Appendix 1, Table S2). We further examined visits by type, including well-child visits (periodic health visits with or without vaccinations) 17,18 and sick visits (all other non-well-child visits).…”

Section: Primary Outcome Measuresmentioning

confidence: 99%

Pediatric primary care in Ontario and Manitoba after the onset of the COVID-19 pandemic: a population-based study

Saunders

Guttmann

Brownell

et al. 2021

cmajo

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Primary health care is essential to maintaining the health of individuals and populations, and the functioning of a health care system. For children in particular, primary care is the cornerstone for monitoring growth and development, providing anticipatory guidance and delivering vaccinations for vaccine-preventable diseases. A good primary care system is associated with more equitable health in populations. 1,2 Delays in or failure to access regular and timely primary care can lead to service gaps during a period of critical development for children and can further widen health inequities.In March 2020, the COVID-19 pandemic was declared by the World Health Organization. 3 Many primary care provider offices closed or functioned at reduced capacity alongside broader shutdowns including nonurgent health care. 4,5 Care providers reported difficulty keeping offices open owing to multiple factors including lack of personal protective equipment and fear of infection. 6 To mitigate the challenges to providing care imposed by the shutdown, and to facilitate and maintain isolation, the Ontario and Manitoba ministries of health introduced new virtual care fee codes. 7 Virtual care is a well-established modality for care delivery, especially for mental health care. Its integration into pediatric primary care for those with a medical home is supported by the American Academy of Pediatrics. 8 For children, however, for whom growth monitoring, vision screening and vaccinations require in-person visits, needed care may only partially be provided virtually. Virtual care may not be optimal for families with lack of access to a reliable Internet or telephone

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Section: Settingmentioning

confidence: 99%

Impact of the COVID-19 pandemic on routine immunization coverage in children under 2 years old in Ontario, Canada: A retrospective cohort study

Piché‐Renaud

Apajee

et al. 2021

Preprint

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BackgroundThe COVID-19 pandemic has caused a disruption in childhood immunization coverage around the world. This study aimed to determine the change in immunization coverage for children under 2 years old in Ontario, Canada, comparing time periods pre-pandemic to during the pandemic.MethodsWe conducted an observational retrospective open cohort study, using primary care electronic medical record data from the University of Toronto Practice-Based Research Network (UTOPIAN) database, from January 2019 to December 2020. Children under 2 years old who had at least 2 visits recorded in UTOPIAN were included. We measured up-to-date (UTD) immunization coverage rates, overall and by type of vaccine (DTaP-IPV-Hib, Pneu-C-13, Rot, Men-C-C, MMR, Var), and on-time immunization coverage rates by age milestone (2, 4, 6, 12, 15 and 18 months). We compared average coverage rates over 3 periods of time: January 2019-March 2020 (T1); March-July 2020 (T2); and August-December 2020 (T3).Results12,313 children were included. Overall UTD coverage for all children was 71.0% in T1, dropped by 5.7% (95% CI: -6.2, -5.1) in T2, slightly increased in T3 but remained lower than in T1. MMR vaccine UTD coverage slightly decreased in T2 and T3 by approximately 2%. The largest decreases were seen at ages 15-month and 18-month old, with drops in on-time coverage of 14.7% (95% CI: -18.7, -10.6) and 16.4% (95% CI: -20.0, -12.8) respectively during T2. When stratified by sociodemographic characteristics, no specific subgroup of children was found to have been differentially impacted by the pandemic.ConclusionChildhood immunization coverage rates for children under 2 years in Ontario decreased significantly during the early period of the COVID-19 pandemic and only partially recovered during the rest of 2020. Public health and educational interventions for providers and parents are needed to ensure adequate catch-up of delayed/missed immunizations to prevent potential outbreaks of vaccine-preventable diseases.

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Assessing the completeness of infant and childhood immunizations within a provincial registry populated by parental reporting: A study using linked databases in Ontario, Canada

Cited by 6 publications

References 15 publications

Impact of the COVID-19 pandemic on routine immunization coverage in children under 2 years old in Ontario, Canada: A retrospective cohort study

Impact of the COVID-19 pandemic on routine immunization coverage in children under 2 years old in Ontario, Canada: A retrospective cohort study

Pediatric primary care in Ontario and Manitoba after the onset of the COVID-19 pandemic: a population-based study

Impact of the COVID-19 pandemic on routine immunization coverage in children under 2 years old in Ontario, Canada: A retrospective cohort study

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