May 08, 2020, 02:46 pm News Staff – The COVID-19 pandemic has transformed the way family physicians practice, giving many of them a crash course in caring for patients via telemedicine, among other changes. Through it all, FPs have worked tirelessly on the front lines to provide care to patients of all ages -- including, when possible, conducting in-office well-child visits that include administration of childhood immunizations.
A CDC Morbidity and Mortality Weekly Report Early Release published online May 8 examined the pandemic's effect on that latter aspect of practice. The report documented substantial decreases in the number of vaccines ordered and administered to children since the United States declared a national emergency in response to the COVID-19 pandemic on March 13, potentially leaving hundreds of thousands of children at increased risk for vaccine-preventable diseases.
"Family physicians know the importance of preventive care as well as anyone," said AAFP President Gary LeRoy, M.D., of Dayton, Ohio, "and this report from the CDC clearly shows the havoc COVID-19 is wreaking on childhood vaccinations in this country."
The report's authors analyzed data from two sources: the national Vaccines for Children program that provides federally purchased vaccines to about half of U.S. children 18 and younger and Vaccine Safety Datalink, a collaboration between the CDC's Immunization Safety Office and eight large health care organizations across the United States.
First, the authors tallied the number of cumulative doses of VFC-funded vaccines ordered at weekly intervals between two periods: Jan. 7, 2019, to April 21, 2019, and Jan. 6, 2020, to April 19, 2020. Then, for all noninfluenza vaccines the Advisory Committee on Immunization Practices recommends for children -- including the two measles-containing vaccines licensed for routine use -- they calculated the differences in weekly doses ordered between those two periods.
In a separate analysis, they compared counts of measles-containing vaccine doses administered each week at VSD sites during the 2020 time period among two age groups: children 24 months and younger and children older than 24 months through 18 years.
The researchers found sharp declines in orders for VFC-funded, ACIP-recommended vaccines in 2020 compared with the previous year. The declines started the week of March 16, accelerated the following week and continued through the end of the data period.
Analysis of VSD data showed that a similar decline in measles-containing vaccine administration also began the week of March 16. The decline was less prominent in children 24 months and younger, and vaccine administration in that younger age group quickly rebounded, increasing through the end of the data period.
In the report, the authors suggested that the increase in administration of measles-containing vaccines in very young children may have resulted from concerted efforts at VSD sites to promote childhood vaccinations in light of the ongoing pandemic.
LeRoy told AAFP News that he saw a similar opportunity for family physicians to talk about the importance of vaccines with parents.
"It would be natural for parents to be concerned about exposing their children to COVID-19 during a well-child visit or routine exam," LeRoy said. "But preventive care is at the heart of what family physicians do, and few forms of preventive care are more effective than childhood immunizations."
It's important to note that a number of states have already begun to loosen social distancing requirements, which could boost health risks. In those instances, LeRoy said, it's vital that FPs inform parents of the precautions they are taking to keep patients safe in their offices and remind them of the dangers posed by diseases other than COVID-19.
"Kids who don't have all of their vaccines will be more vulnerable to other highly infectious diseases such as measles," said LeRoy. "FPs need to be vigilant, and they should work with parents to get their children back on track and back on their regular immunization schedule.
"By giving kids the vaccines they need, we can help save lives. It's that simple."
The AAFP offers a wealth of immunization resources for members, as well as materials specifically focusing on this and other types of preventive care delivered during the pandemic.
Recently, for example, the AAFP Board of Directors approved the statement "COVID-19: Guidance for Family Physicians on Preventive and Non-Urgent Care," (no link yet) which includes guidance on immunizations. The statement notes that because of the pandemic, some FPs may not be able to provide preventive health care services, including administration of immunizations. If only limited well-child visits can be provided, FPs are encouraged to prioritize newborn care and vaccination of infants and young children (through 24 months) when possible.
In addition, the Academy has developed a variety of practice tools (no link yet) to give FPs guidance on office preparedness, considerations for reopening or expanding operations, and more.