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May 12, 2020

Sharp Drop in Routine Vaccinations for US Children Amid COVID-19 Pandemic

Author Affiliations
  • 1Consulting Editor, JAMA Health Forum and JAMA
JAMA Health Forum. 2020;1(5):e200608. doi:10.1001/jamahealthforum.2020.0608

The immunization rates for all recommended childhood vaccines plummeted in the United States in March and April in the weeks following the March 13 declaration of a national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic, according to a new study led by researchers from the US Centers for Disease Control and Prevention (CDC).

“The identified declines in routine pediatric vaccine ordering and doses administered might indicate that US children and their communities face increased risks for outbreaks of vaccine-preventable diseases,” the authors noted.

To gauge the pandemic’s effect on pediatric vaccination in the United States, the report, published in the Morbidity and Mortality Weekly Report on May 8, used 2 data sources: vaccine purchase order data for the Vaccines for Children Program, which provides federally purchased vaccines to about half of US children from birth to age 18 years, and vaccine administration data from the Vaccine Safety Datalink (VSD), a collaborative project between CDC’s Immunization Safety Office and 8 US health care organizations that serve publicly and privately insured patients.

The researchers compared orders for all routine noninfluenza childhood vaccines for the period of January 6 through April 20 of this year to January 7 through April 21 in 2019. They found a decline of approximately 2.5 million doses from last year, with most of the drop beginning a week after the national emergency declaration. This included a decline in orders for about 250 000 doses of vaccines providing protection against measles.

The investigators also specifically tracked the number of measles vaccine doses administered to children each week at VSD sites this year, showing a drop starting the week of March 16. The data indicate that the downturn in measles vaccinations was somewhat less pronounced among children 2 years or younger compared with older children and adolescents aged 2 to 18 years.

Although the number of measles vaccine doses given to the older age group remained a fraction of the number of weekly doses administered at the beginning of the study period, measles vaccinations in the younger group began to gradually increase beginning in late March.

This increase in vaccine administration to the younger age group beginning in late March “might reflect early success of strategies implemented by VSD health care organizations to promote childhood vaccinations in the context of the pandemic, including outreach to patients overdue for vaccinations and changing office workflows to minimize contact between patients,” the authors suggested.

The global community has also raised alarms about the potential consequences of delayed immunizations of children because of disruptions related to the COVID-19 pandemic. The Measles & Rubella Initiative, a consortium whose members include the American Red Cross, the CDC, the United Nations Children’s Fund, the United Nations Foundation, and the World Health Organization, warned in mid-April that the measles immunization campaigns in 24 countries had already been delayed and that more will be postponed.

“As COVID-19 continues to spread globally, over 117 million children in 37 countries may miss out on receiving life-saving measles vaccine,” the group said.

Measles cases were already on the rise in some places even before emergence of the COVID-19 pandemic. Last year, the United States reported 1282 measles cases, its highest in more than 25 years. Globally, according to statistical modeling by the WHO, there were 9 769 400 estimated measles cases and 142 300 estimated deaths in 2018, the last year for which international figures have been compiled, compared with 7 585 900 estimated measles cases and 124 000 estimated deaths in 2017.

A statement issued by the American Academy of Pediatrics, noting the CDC’s finding on the recent sharp decline in childhood immunizations, “urges all parents to contact their pediatrician to schedule a visit to catch up on vaccines or for a well-child check-up.” The academy noted that it had just published new guidance on pediatric well visits “to guide pediatricians in managing visits safely and effectively.”

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