The impact of COVID-19 on childhood immunizations

During COVID-19, routine preventive and non-emergency care has been a secondary priority in the minds of patients and physicians. With everyone being told to shelter-in-place, stay at home, and limit movement to essential activities, it is understandable that many parents delayed routine childhood immunizations due to possibly contracting COVID-19 at the doctor’s office. Luckily most COVID-19 cases in children have been mild, although reports of multisystem inflammatory syndrome may have scared parents to further delay well-child visits.

In May 2020, the Centers for Disease Control and Prevention (CDC) reported significant and concerning nationwide decreases in routine childhood vaccine ordering and administration due to COVID-19 in the United States. When comparing January to April of 2020 to 2019, childhood vaccines declined beginning the week after the national emergency declaration. Children younger than 24 months were less affected by missing immunizations than older children. From mid-March to mid-April 2020 in the U.S., there were 2.5 million fewer doses of routine non-influenza vaccinations ordered and 250,000 fewer doses of measles containing vaccines ordered when compared to 2019. This decrease in MMR administration in school-aged children is concerning. Internationally, the World Health Organization estimates that more than 100 million children could be currently vulnerable to measles.

A decline in vaccinations affects herd immunity and could spur outbreaks of other diseases, that, combined with COVID-19, would overwhelm healthcare systems. The CDC, American Academy of Family Physicians (AAFP), and American Academy of Pediatrics continue to recommend providing essential health services, including immunizations, during the COVID-19 pandemic. Normalizing and confirming the safety of vaccine administration is crucial given that a COVID-19 vaccine may be available soon and for the upcoming influenza season.

I have talked to many parents of healthy and sick children since the pandemic started. Many are scared of their child becoming sick from COVID-19 and think that the best way to protect them is to keep them at home. Parents have delayed treatment of serious etiologies because they are worried about disease transmission. Putting healthy children at risk for COVID-19 for the purpose of immunizations doesn’t seem intuitive to many parents, so education remains vital. If your practice doesn’t have a good system in place for immunization reminders, this is a great time to make this a primary focus.

Contact families whose children have missed vaccinations and encourage them to bring their child in for immunizations. Have patience and provide education as needed. Evidence has shown that community discussions, community meetings, and information campaigns may increase immunization uptake, so consider hosting a virtual forum for your patients. The AAFP has immunization resources, COVID-19 guidance for family physicians on preventive and non-urgent care during the pandemic, and a variety of practice tools that give advice on opening guidelines, expanding operations, and more. Proactively reassure patients of the steps your office has taken to maximize safety.

Continue to think outside of the box and share procedures you have developed to make childhood immunizations safe and convenient for patients. Have you continued seeing children up to age 24 months for an exam and immunizations? Did you implement virtual care visits for children older than 24 months and have them come in for parking lot vaccinations? Are you increasing the testing of your clinical staff to ensure they are not unknowingly spreading COVID-19? Many physicians are offering house calls to boost vaccinations or making these parking lot visits a reality. It is important to remain flexible and advocate for patients in a system where legislative or insurance rules can make navigation frustrating. Pioneering drive-through immunization clinics or having a drone deliver and administer a vaccine may seem like futuristic ideas, but may be increasingly feasible in this era of enhanced disease prevention precautions.

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Dr. Pyzocha is one of AFP's 2020-21 Jay Siwek Medical Editing Fellows.