Wide World of Vaccines

Alarming Drop in Childhood Vaccination Rates Since 2020

Column Author: Christine Symes, MSN, APRN, CPNP | Division of Infectious Diseases

Column Editor: Angela Myers, MD, MPH | Director, Division of Infectious Diseases | Professor of Pediatrics, UMKC School of Medicine | Medical Editor, The Link Newsletter

COVID-19 has disrupted almost every aspect of our lives over the preceding two and a half years. Lockdowns, disruptions of global health care delivery and delays in well-child visits due to pandemic precautions have had a dramatic impact on vaccination rates in children in the U.S. and around the world.

In July, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) raised the alarm and reported the largest sustained decline in childhood vaccinations in 30 years in the time period from 2019 to 2021. As a marker of pediatric vaccines, the primary series of diphtheria-tetanus-acellular pertussis (DTaP) completion rate fell by 5%, with 25 million children worldwide missing at least one dose and 18 million of those receiving zero doses. The rate of children receiving their first dose of measles vaccine fell to 81% in 2021. This drop accounts for 24.7 million children missing their first measles dose in 2021 and 14.7 million more failing to receive their second dose. It is estimated that 6.7 million more children also missed the third dose of polio vaccine in 2021 than in past years. According to Catherine Russell, UNICEF Executive Director, “This is a red alert for child health. We are witnessing the largest sustained drop in childhood immunization in a generation. The consequences will be measured in lives. … We need immunization catch-ups for the missing millions, or we will inevitably witness more outbreaks, more sick children and greater pressure on already strained health systems.”¹

With lockdowns being lifted and in-person medical visits resuming, it was anticipated in 2021 that the backlog of children who had fallen behind on vaccines would start to be caught up. Instead, DTaP coverage was set back to its lowest level since 2008, in conjunction with declines in coverage for other basic vaccines. As a result, the world has been pushed off track to meet global childhood immunization goals.

Similarly, the U.S. Centers for Disease Control and Prevention has reported a fall in vaccination rates. Data from the Michigan Care Improvement Registry (the state’s immunization information system) was analyzed in May 2020 and compared to the same months in the years 2016-2019. The vaccination status of children at ages 1, 3, 5, 7, 16, 19 and 24 months was assessed. Vaccination rates fell in all age groups, except for the birth dose of hepatitis B vaccine. The rate of 5-month-old infants current per Advisory Committee on Immunization Practices recommendations fell from the May 2019 rate of 67.9% to 49.7% in May 2020. Missouri schools self-reported vaccination rates of children entering kindergarten and those fully vaccinated for DTaP fell to 91.5%, for polio 91.9%, MMR fell to 91.6%, hepatitis B to 94%, and varicella to 91.1%. These percentages of fully vaccinated are down 4% on average from previous years, prior to 2019.² The fall in vaccination rates may leave young children and communities vulnerable to vaccine-preventable diseases. As an example, if measles vaccination rates fall below 90%, measles outbreaks can occur. In addition to a decline in up-to-date status in almost all age cohorts, the number of noninfluenza vaccine doses administered and reported for children aged ≤18 years decreased 21.5%, and the number of doses administered to children aged ≤24 months decreased 15.5% during January-April 2020, compared with the same averaged periods in 2018 and 2019.³

Primary care clinicians provide a medical home to children and are best positioned to engage in conversations that highlight the importance of recommended vaccines to their patients and families while answering questions and providing reassurance. The use of electronic health records and immunization information systems can help identify children not current on vaccines and clinicians can work with families to schedule in-person appointments to provide catch-up immunizations. A concerted effort from all pediatric health care clinicians will be needed to improve immunization rates and provide protection to children of all ages from vaccine-preventable diseases. The WHO and the American Academy of Pediatrics recommend that immunizations should be offered at every health care encounter. This recommendation is especially important in the wake of the COVID-19 pandemic.

References:

1. https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades
2. https://health.mo.gov/living/wellness/immunizations/schoolrequirements.php/September15
3. Bramer CA, Kimmins LM, Swanson R, et al. Decline in child vaccination coverage during the COVID-19 pandemic — Michigan Care Improvement Registry, May 2016–May 2020. MMWR Morb Mortal Wkly Rep. 2020;69:630-631. doi:http://dx.doi.org/10.15585/mmwr.mm6920e1