COVID-19 and Routine Childhood Vaccinations—Identifying Gaps and Informing Solutions

Abstract

On March 11, 2020, the World Health Organization declared COVID-19 a global pandemic. The United States declared a national emergency and, on March 18, 2020, the American Academy of Pediatrics issued guidance advising pediatricians to restrict preventive care visits to younger children requiring immunizations. Pediatric primary care visit volumes precipitously declined. A growing literature is helping to define this impact and raise questions about how best to address the consequences of that lost care.In this issue of JAMA Pediatrics, DeSilva et al 1 address the critical issue for the pediatric community of declining vaccination rates during the COVID-19 pandemic. The study team used data from the Vaccine Safety Datalink, a collaborative effort between the US Centers for Disease Control and Prevention's Immunization Safety Office and 8 integrated health care organizations across 6 US states. Using this data set, the study team conducted a retrospective observational study with a prepost control design, examining both weekly routine childhood vaccination rates and the proportion of children in key age groups with up-to-date (UTD) vaccinations as of February, May, and September 2020. The study team then compared these rates with comparable 2019 time periods. Analyzing the data for approximately 1.4 million children in each year, the study team identified substantially lower rates of weekly vaccine administration across age groups during the early months of the COVID-19 pandemic, followed by an increase to near prepandemic levels from summer into fall 2020. Despite the return to more typical levels of vaccination, the proportion of children with UTD vaccinations was lower among the 7-month, 18-month, and 13-year age groups while remaining stable for the 6-and 18-year age groups.In all, the data presented by the study team describe a situation that is both reassuring and concerning regarding the impact of the COVID-19 pandemic on childhood vaccinations. Vaccine administration rates in health care systems, after an initial decline, have essentially returned to prepandemic levels. However, as has been observed in other studies, there are lingering effects of the pandemic, as the proportion of children with UTD vaccinations has declined over time. 2 The COVID-19 pandemic also has increased health disparities in a range of settings. 3,4 For pediatric vaccination, the study team examined and found wide disparities in the proportion of children with UTD vaccinations by race and ethnicity. These differences preceded the pandemic, and, for some age cohorts, the disparity may have widened. For example, rates of UTD vaccination for the 7-and 18-month age groups varied widely by race, with rates highest in Asian children and low-5. Daley MF, Shoup JA, Newcomer SR, et al. Assessing potential confounding and misclassification bias when studying the safety of Opinion

Do we need to vaccinate every child against COVID-19: What evidence suggests—A systematic review of opinions

“…Condition is much worse in developing countries [e.g., In India, BCG and Pentavalent missed doses were 1 lakh and 2 lakh, respectively, in March 2020 ( 124 ), and in Pakistan, those who missed a dose of measles and polio were 40 and 50 million, respectively, during the same period] ( 125 ). Five articles ( 16 , 17 , 46 , 63 , 71 ) in the present review have shown the disruption of routine immunization or other health services as one of the negative factors/hindrances for universal childhood COVID vaccination.…”

“…The COVID-19 pandemic has caused a huge disruption of the healthcare delivery services since the beginning of the pandemic and COVID vaccination also caused extra stress on the already overburdened healthcare system which lacks sufficient manpower, resources, and logistics, especially for lower economic countries ( 46 , 55 , 63 , 71 , 123 ). It has been reflected by a report of UNICEF that in 2020 number of missed doses of routine vaccines was the highest globally since 2009 ( 123 ).…”

Effect of Outreach Messages on Adolescent Well-Child Visits and Coronavirus Disease 2019 Vaccine Rates: A Randomized, Controlled Trial

“…Some have advocated for converting sick visits to AWC visits, when possible. 10 Tiered approaches to outreach, including home visitation, may also be warranted. 21 …”

“… 4 , 5 , 6 Following the pandemic shut-down, thousands of AWC appointments were cancelled or delayed and vaccination administration rates declined. 7 , 8 , 9 Black and Latinx vaccination rates were found to be disproportionately worsening, 9 , 10 creating an imperative to address structural racism with intentional and deliberate intervention. 11 , 12 Additionally, increasing rates of obesity and depression have heightened the importance of AWC preventative services.…”

Adapting celiac immunity for the future: Addressing the immunization gap in children with celiac disease

“…However, vaccine hesitancy has also increased so the proportion of children who receive their primary vaccine series on schedule is declining. 13 Jang et al 7 highlight the importance of ensuring that children with CeD complete their routine childhood vaccinations, especially the pneumococcal series (PCV13/PCV15/PCV20). Furthermore, their data raises the question whether children with CeD are a population who should receive pneumococcal polysaccharide vaccine (PPSV23).…”