Michigan Children Fell Behind on Vaccines Early in the COVID-19 Pandemic, 2020

What happened

On March 13, 2020, the United States declared a national emergency over COVID-19, and Michigan issued a stay-at-home order on March 23. Measures like these can make routine vaccinations harder to get, leaving children open to vaccine-preventable diseases. Michigan's health department analyzed its immunization registry — the Michigan Care Improvement Registry — to see what changed.

How: vaccination status was checked in May 2020 for children at milestone ages — 1, 3, 5, 7, 16, 19 and 24 months, the ends of recommended vaccination periods — and compared with the same checks in May 2016–2019. Each age group averaged about 9,269 children in 2016–2019 and 9,539 in 2020. The number of non-flu vaccine doses given in January–April 2020 was compared with the same months of 2018 and 2019.

What was found

• Coverage fell in every age group except for the hepatitis B birth dose, which is usually given in the hospital.
• 5-month-olds: the share up to date on all recommended vaccines dropped from about two-thirds in 2016–2019 (66.6%, 67.4%, 67.3%, 67.9%) to fewer than half (49.7%) in May 2020.
• 16-month-olds: coverage with a measles-containing vaccine fell from 76.1% in May 2019 to 70.9% in May 2020.
• Doses given in January–April 2020 fell 21.5% for children 18 and younger and 15.5% for children 24 months and younger.
• Medicaid gap: in every age group, children on Medicaid were less often up to date. The widest gap was at 7 months: 34.6% of Medicaid-enrolled children versus 55.0% of others.

Michigan children vaccinated at milestone ages, May 2016–May 2020. Figure from the CDC report.

Why it matters

Falling coverage can leave young children and communities exposed to diseases such as measles: without 90%–95% measles vaccine coverage — the level needed for herd immunity — outbreaks can occur. Children behind on measles and other recommended vaccines need to catch up quickly.

Keeping vaccination going

Much well-child care moved to telemedicine, but vaccines require an in-person visit. Practices can:

• set aside separate clinics, rooms or buildings for sick and well visits;
• keep fewer patients on site at once, close waiting rooms, and let families check in by phone and be vaccinated in their cars;
• use health records and immunization registries to find children who've missed vaccines, schedule visits, and reassure parents about infection control.

Michigan continues to work with local health departments and providers to track coverage, promote reminder and recall tools, and educate providers and parents on the continued need for vaccination during pandemics.

Sources

Based on Cristi A. Bramer, Lynsey M. Kimmins, Robert Swanson and others (Michigan Department of Health and Human Services, the Immunization Action Coalition and Children's Hospital of Philadelphia), "Decline in Child Vaccination Coverage During the COVID-19 Pandemic — Michigan Care Improvement Registry, May 2016–May 2020," MMWR, Centers for Disease Control and Prevention; published by CDC and in the public domain; rewritten in hubnx's own words.