COVID-19 Fears Tied to Dangerous Drop in Child Vaccinations

Diana Swift

May 12, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The social distancing and sheltering in place mandated because of the COVID-19 pandemic are keeping parents and kids out of their doctors' offices, and that has prompted a steep decline in recommended routine vaccinations for US children, according to Centers for Disease Control and Prevention (CDC) researchers.

Pediatric vaccinations dropped sharply after the national emergency was declared on March 13, suggesting that some children may be at increased risk for other serious infectious diseases, such as measles.

The researchers compared weekly orders for federally funded vaccines from January 6 to April 19, 2020, with those during the same period in 2019.

They noted that by the end of the study period, there was a cumulative COVID-19–related decline of 2.5 million doses in orders for routine noninfluenza pediatric childhood vaccines recommended by the CDC's Advisory Committee on Immunization Practices, as well as a cumulative decline in orders of 250,000 doses of measles vaccines.

Although the overall decrease in vaccinations during the study period was larger, according to CDC spokesperson Richard Quartarone, the above figures represent declines clearly associated with the pandemic.

The weekly number of measles vaccines ordered for children aged 24 months or older fell dramatically to about 500 during the week beginning March 16, 2020, and fell further to approximately 250 during the week beginning March 23. It stayed at that level until the week beginning April 13. By comparison, more than 2500 were ordered during the week starting March 2, before the emergency was declared.

The decline was notably less for children younger than 2 years. For those children, orders dropped to about 750 during the week starting March 23 and climbed slightly for 3 weeks. By comparison, during the week of March 2, about 2000 vaccines were ordered.

The findings, which were published online May 8 in the CDC's Morbidity and Mortality Weekly Report, stem from an analysis of ordering data from the federal Vaccines for Children (VFC) Program, as well as from vaccine administration data from the CDC's Vaccine Tracking System and the collaborative Vaccine Safety Datalink (VSD).

The VFC provides federally purchased vaccines at no cost to about half of persons aged 18 years or younger. The VSD collaborates on vaccine coverage with the CDC's Immunization Safety Office and eight large healthcare organizations across the country. Vaccination coverage is the usual metric for assessing vaccine usage; providers' orders and the number of doses administered are two proxy measures, the authors explain.

"The substantial reduction in VFC-funded pediatric vaccine ordering after the COVID-19 emergency declaration is consistent with changes in vaccine administration among children in the VSD population receiving care through eight large US health care organizations," write Jeanne M. Santoli, MD, and colleagues, of the CDC's Immunization Services Division, National Center for Immunization and Respiratory Diseases. "The smaller decline in measles-containing vaccine administration among children aged ≤24 months suggests that system-level strategies to prioritize well child care and immunization for this age group are being implemented," they state.

Santoli, who is an Atlanta-based pediatrician, and associates stress the importance of maintaining regular vaccinations during the pandemic. "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," they write. "Parental concerns about potentially exposing their children to COVID-19 during well child visits might contribute to the declines observed." Parents should therefore be reminded of the necessity of protecting their children against vaccine-preventable diseases.

In 2019, a Gallup survey reported that overall support for vaccination continued to decline in the United States.

The researchers predict that as social distancing relaxes, unvaccinated children will be more susceptible to other serious diseases. "In response, continued coordinated efforts between health care providers and public health officials at the local, state, and federal levels will be necessary to achieve rapid catch-up vaccination," they conclude.

The authors have disclosed no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. Published online May 8, 2020. Full text

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