Impact of the COVID-19 pandemic on the provision of routine childhood immunizations in Ontario, Canada

Piché-Renaud, Pierre Philippe; Ji, Catherine; Farrar, Daniel; Friedman, Jeremy; Kitai, Ian; Burey, Sharon; Feldman, Mark; Morris, Shaun K.

doi:10.1016/j.vaccine.2021.05.094

Cited by 33 publications

(27 citation statements)

References 27 publications

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“…A study using data from four academic medical centers in the United States revealed younger versus older children were less likely to have a large decrease in well visits [ 2 ]. This is consistent with a Canadian sample in which there was little change in well-child visits among infants less than 18 months old during the early phase of the COVID-19 pandemic as compared to 2019 utilization rates [ 7 ]. In contrast, a Santoli and colleagues study [ 5 ], using the United States Vaccines for Children Program data, revealed decreased use of immunization and well visits in March 2020 and increased utilization the following month among children under 2 years of age; however, visits for older children did not demonstrate a similar rapid increase during this same time frame.…”

Section: Introductionsupporting

confidence: 87%

Infant, pediatric and adult well visit trends before and during the COVID-19 pandemic: a retrospective cohort study

Salas

Hinyard

Cappellari

et al. 2022

BMC Health Serv Res

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Background Adult well visits declined during COVID-19, but literature is inconsistent in regard to whether childhood well visits declined. We determined if the COVID-19 pandemic was associated with a change in well visits among infants, children, adolescents and adults before, compared to during the COVID-19 pandemic, including through the emergence of the Delta variant. Methods De-identified electronic health care data came from a multi-state Midwest health care system. Eligible patients (n = 798,571) had ≥ 1 well visit between 7/1/2018 and 6/30/2021. Trends in well visits per month for children (< 1, 1–4, 5–11, 12–17 years) and adults (18–39, 40–64, ≥ 65 years) over 3-years were assessed using Joinpoint regression models and monthly percent change (MPC). Results Well visits remained stable for infants (< 1 year of age) (MPC = -0.1; 95% CI = -0.3, 0.1). For children 1–4 years and all adults, visits were stable prior to 2020, decreased from 1/2020 to 4/2020 (MPC range -20 to -40), increased from 4/2020–7/2020 (MPC range 30 to 72), and remained stable after 7/2020. Children 5–17 had seasonal variation in visits where low points occurred in Jan/Feb 2019 and high points in Aug 2019 (start of school year); however, the low point in 2020 occurred in April 2020 and the seasonal variation normalized after this. Conclusions In a large Mid-western health care system, infant well visits did not decline at the onset (3/1/2020) of the COVID-19 pandemic. Although well visits for all other ages decreased to a low point in 4/2020, a rapid return to pre-pandemic utilization rates occurred by 7/2020. The brief decrease in preventive care may have had little impact on health.

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Section: Introductionsupporting

confidence: 87%

Infant, pediatric and adult well visit trends before and during the COVID-19 pandemic: a retrospective cohort study

Salas

Hinyard

Cappellari

et al. 2022

BMC Health Serv Res

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“…In May 2020, Canada’s National Advisory Committee on Immunization recommended prioritizing primary immunization series up to 18-months old during the pandemic [20] , which may have encouraged the increase in coverage rates seen in our results starting in June 2020. However, given lower rates persisted until the end of our observation period in December 2020, more education and support should be put forward for healthcare providers and parents [21] .…”

Section: Discussionmentioning

confidence: 92%

“…In response to these concerns, international and Canadian public health and governmental institutions have recommended that routine immunizations are essential health services that should not be deferred, especially the primary series and booster doses for children aged less than two years [18] , [19] , [20] . Some studies have nonetheless reported on parents avoiding medical care facilities, clinics not providing in-person services due to the perceived risk of COVID-19 transmission, and school immunization programs being suspended [21] , [22] . There is currently limited data to quantify the impact of the pandemic on pediatric immunization coverage in Canada, and whether the pandemic has impacted access to vaccination differentially for specific groups of children.…”

Section: Introductionmentioning

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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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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“…A state-wide survey from Canada reported greater disruption of RI in a pediatrician’s office as compared to that of a primary care physician. [ 38 ] This suggests greater responsibility and a bigger role for primary care physicians and family medicine practitioners in restoring RI services during a pandemic. In addition, linking RI campaigns with the COVID-19 vaccine sessions, could prove beneficial.…”

Section: Findings and Discussionmentioning

confidence: 99%

Magnitude and causes of routine immunization disruptions during COVID-19 pandemic in developing countries

Sharma

Singh

et al. 2021

Journal of Family Medicine and Primary Care

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The ongoing pandemic of COVID-19 is a threat to various routine healthcare services. India’s routine immunization (RI) campaign is one of largest ever known. In this review, we discuss the magnitude of disruption of RI activities due to COVID-19 pandemic, various causes of it and recommend ways to reduce the disruptions. Prominent literature databases were searched till April 30, 2021 for articles reporting disruptions of RI due to COVID-19. One study from India and numerous from outside India reported significant declines in the vaccine coverage rates during the lockdown period, which ranged from March 2020 till August 2020 in different regions of the world. Some reported disruptions for all vaccines, while a few reported sparing of birth doses. Shortage of healthcare workers due for them being diverted to patient care services and their reduced movement due to lockdowns and non-availability of public transport were prominent causes. Parents avoided RI sessions as they feared them or their children getting infected. They also faced travel restrictions, just like the healthcare workers. Children of school entry age and those from poorer socio-demographic profile appeared to miss the doses more frequently. Ministry of Health and Family Welfare, India has issued guidelines for conducting fixed and outreach RI sessions while following COVID-appropriate behavior. Promptly identifying missed out children and scheduling catch-up sessions is required to sustain the gains made over the decades by the immunization program of India.

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Impact of the COVID-19 pandemic on the provision of routine childhood immunizations in Ontario, Canada

Cited by 33 publications

References 27 publications

Infant, pediatric and adult well visit trends before and during the COVID-19 pandemic: a retrospective cohort study

Infant, pediatric and adult well visit trends before and during the COVID-19 pandemic: 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

Magnitude and causes of routine immunization disruptions during COVID-19 pandemic in developing countries

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