Despite the challenges and disruptions caused by the COVID-19 pandemic, it is important to ensure that children get the vaccines they need to be protected against serious and sometimes deadly diseases. Late summer is usually a time when many families begin preparing to send their children back to schools and early care and education programs. To help children return safely to school in the fall, healthcare providers will need to ensure that children are up-to-date on their routine vaccines and have received recommended COVID-19 vaccines. This is a crucial time when healthcare providers need to communicate with families to add routine childhood and COVID-19 vaccines to their back-to-school checklist.
How have the routine childhood vaccination rates been impacted by COVID-19?
Due to the COVID-19 pandemic, some parents have faced disruptions in healthcare services and barriers to scheduling well-child appointments, which in turn has impacted the administration of routine childhood vaccines. Although healthcare services have largely been restored in recent months, vaccine distribution and claims data demonstrate an ongoing deficit in childhood vaccination.
During the 2020-2021 school year, vaccination coverage for required vaccines among kindergartners nationwide dropped a full percentage point, from 95% to below 94%. This might not sound like much, but it amounts to at least 35,000 more children across the United States entering kindergarten without documentation of complete vaccination. Moreover, nearly 400,000 fewer children entered kindergarten than expected. Those children also might not be up-to-date on their routine vaccination, which provides further evidence of how pandemic-related disruptions to healthcare and education could have lingering consequences for school-age children.
Children need to get back on schedule with their well-child visits for many reasons, including to ensure that they are up-to-date with routine vaccines to protect themselves, their families, and their classmates when they return to school and early care and education programs this fall.
Why is it important to encourage families to vaccinate children 6 months and older against COVID-19?
Many parents and caregivers continue to falsely believe that COVID-19 is not a serious threat to children. That is not the case, and children of all ages can get COVID-19, spread the virus to others, and become seriously ill. There is no way to tell in advance whether a child will get a severe or mild case. Since the beginning of the pandemic, there have been more than 20,000 hospitalizations and 200 deaths among children ages 6 months through 4 years, and more than 45,000 hospitalizations and 600 deaths among children and teens ages 5 through 17 years. Children with underlying medical conditions or who have a weakened immune system — for example, children with asthma or chronic lung disease, diabetes, obesity, or sickle cell disease — are more likely to get severely ill from COVID-19. However, those without underlying medical conditions can also experience severe illness. In fact, approximately 1 in 3 children younger than 18 years of age hospitalized with COVID-19 have no underlying conditions. It is critical that the impact of COVID-19 on children continue to be communicated to parents and caregivers.
Children and teens infected with COVID-19 can also experience a wide range of new, returning, or ongoing health problems. These post-COVID conditions include physical and mental health complications that may occur 4 or more weeks after initial infection and affect quality of life. Symptoms that children and teens may experience after COVID-19 can include fatigue, cough, muscle and joint pain, headache, trouble falling or staying asleep, and trouble concentrating.
In addition, children and teens who get COVID-19 can develop multisystem inflammatory syndrome in children (MIS-C), a condition in which different body parts, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs, become inflamed. Since the beginning of the pandemic, thousands of cases of MIS-C in children have been reported. Vaccination reduces the likelihood of MIS-C in children ages 12-18 years by 91%.
In the setting of this unprecedented pandemic and ongoing community transmission, vaccinating children is the single best way to protect them from severe illness associated with COVID-19. Because masks are not recommended for use in children younger than 2 years of age, vaccination can help provide much-needed protection for this very young population. COVID-19 vaccination is also a critical opportunity to help protect those disproportionately impacted by COVID-19, such as children from certain racial and ethnic minority groups and children with disabilities and underlying medical conditions. COVID-19 vaccination among children can also help decrease the strain on the healthcare system and give families more confidence in having their children participate in childcare, school, and other activities with less risk for serious COVID-19 illness.
What can healthcare providers do to help get children caught up on routine vaccinations and get vaccinated against COVID-19?
Healthcare providers should be encouraged to use every visit — including well-child checks, sports physicals, and other appointments — as an opportunity to administer COVID-19 vaccines, as well as other vaccines that are due or might have been missed because of pandemic-related disruptions. This is recommended even if it means puncturing a multidose vial of COVID-19 vaccine without having enough people available to receive each dose.
To help improve vaccination coverage, health systems and providers can:
Send reminders to families whose children are behind on visits and routine vaccination.
Notify families when COVID-19 vaccines are available and share with parents where they can find COVID-19 vaccines for their children if not offered in the office or clinic.
Implement protocols to review vaccine history at every visit.
Flag medical records when a child is behind or due for vaccination.
Make strong recommendations and have standing orders for vaccines.
Be prepared to answer families' questions about COVID-19 vaccination using resources such as CDC's Quick Conversation Guide on COVID-19 Vaccines for Children.
Offer vaccination-only appointments or hold vaccination clinics.
Administer COVID-19 vaccines at the same time as other routinely recommended vaccines, if recommended and appropriate.
What should healthcare providers tell parents and caregivers about routine and COVID-19 vaccines?
We know that many families are seeking and receiving a lot of information to help make decisions about both routine and COVID-19 vaccination for their children. Parents and caregivers look to healthcare providers as their most trusted source of information and as key influencers in vaccination decisions, but others in their social networks and community can influence their decisions as well. Often mis- and disinformation shared on social media or through other sources can lead to hesitancy about vaccination, and even parents who previously have been supportive of routinely recommended pediatric vaccination may now be more hesitant. It is critical, therefore, that healthcare providers feel empowered to use their role to improve and reinforce vaccine confidence, which is the belief that vaccines are safe and effective and made available to them by a trustworthy regulatory process and medical system. Strong community-level confidence in the COVID-19 vaccines leads to increased vaccination coverage and fewer preventable illnesses, hospitalizations, and deaths.
Here are some key facts that healthcare providers can share with families to help build confidence in recommended vaccines.
Key Messages Encouraging Routine Childhood Vaccination
We know that many parents and guardians have experienced increased stress due to the COVID-19 pandemic, which disrupted both in-person learning and delayed routine well-child visits for many families over the past 2 years.
Routine vaccination and well-child visits or checkups are all key to helping keep children safely in school, childcare, and participating in other activities.
With most schools now back to in-person learning, it is critical that parents and caregivers catch up children who missed vaccination to ensure that coverage is sufficiently high to protect their children, their families, and their communities against vaccine-preventable diseases.
Now is the time to catch up on recommended vaccinations to avoid preventable diseases like measles and whooping cough, which are extremely contagious and can be very serious, especially for babies and young children.
Vaccines are safe and effective for children to receive at the recommended age, and at the recommended dose and interval.
Check out CDC's easy-to-read Child and Adolescent Immunization Schedule to see the vaccines recommended for each age and the diseases they prevent. If recommended vaccinations have been missed, use CDC's Catch-up Immunization Schedule to help catch children up as soon as possible.
Did you know that children may be eligible for free vaccines? CDC's Vaccines for Children (VFC) program helps provide free vaccines to children who qualify.
Parents and caregivers have the power to help protect their children's health through vaccination. Parents and caregivers can plan to ensure that their children get back on track and stay on track with recommended vaccines so they are ready for school and play.
Key Messages Encouraging COVID-19 Vaccination for Children
Parents make decisions every day to protect their children, and now COVID-19 vaccines are available to protect all children 6 months and older.?
Vaccinating everyone, including children 6 months and older, provides the best defense against serious outcomes related to COVID-19.
Just like adults, children can become severely ill from COVID-19, be hospitalized, and even die. Children can experience short- and long-term health complications from COVID-19 that can affect their mental and physical health and quality of life.
There is no way to predict whether a child will develop a severe or mild case of COVID-19. Even healthy children without underlying medical conditions can get severe COVID-19 or suffer from long-term health complications.
Vaccinating children helps lessen the strain on families by providing more confidence in having children participate in childcare, school, and other activities.
Children who have previously had COVID-19 should still get vaccinated, as vaccination offers added protection.
Clinical trials and ongoing safety monitoring show that COVID-19 vaccines are safe for children 6 months and older.
Just like for routine childhood vaccines, CDC monitors the safety of all COVID-19 vaccines after they are authorized or approved for use, including the risk for myocarditis and other potential adverse events.
After getting a COVID-19 vaccine, children may have some side effects that are mild, temporary, and similar to those experienced after routine vaccination. Some children have no side effects.
Serious health events, like myocarditis, after COVID-19 vaccination in children and teens are rare, and when they are reported, they occur most frequently within a few days after vaccination.
The known risks of COVID-19 and its related, possibly severe complications — such as long-term health problems, hospitalization, and even death — outweigh the potential risks of having a rare adverse reaction to vaccination.
COVID-19 vaccines and other vaccines can be given at the same visit.
Parents and caregivers are encouraged to use or create their own account to register their children for v-safe as a way to share how their child is feeling after vaccination. V-safe uses confidential text messaging and web surveys to provide personalized health check-ins following COVID-19 vaccination.
Pediatric COVID-19 Immunizations
Information for parents and caregivers:
Lead image: DigitalVision/Getty Images
Public Information from the CDC and Medscape
Cite this: Add Routine and COVID-19 Vaccination to the Back-to-School Checklist - Medscape - Jul 28, 2022.