Childhood Vaccinations Dropped When COVID-19 Arrived, Spring 2020

On March 13, 2020, the President declared a national emergency over COVID-19. Cases had been confirmed in all 50 states, many places issued stay-at-home orders, and routine and preventive care was expected to suffer. On March 24, CDC stressed that well-child visits and vaccinations must continue, especially for children 24 months and younger, when many vaccines are due.

How it was measured

Coverage takes time to measure, so CDC looked at two faster signals:

• Vaccine orders from the Vaccines for Children (VFC) program, which supplies federally bought vaccines to about half of U.S. children aged 0–18. Weekly cumulative orders from January 6 to April 19, 2020, were compared with January 7 to April 21, 2019, for all recommended non-influenza childhood vaccines and, as an example, measles-containing vaccines.
• Doses given, from the Vaccine Safety Datalink, a project of CDC and eight U.S. health care organizations: weekly measles-containing doses for children 24 months and under versus those older than 24 months through 18 years.

What happened

• Orders fell sharply for VFC childhood vaccines and for measles-containing vaccines, starting the week after the emergency declaration; other vaccines showed similar drops.
• Measles doses given fell from the week of March 16, 2020.
• The drop was smaller for children 24 months and under than for older children, and when doses began to rise again in late March, they rose more among the youngest.

Weekly changes in Vaccines for Children provider orders and Vaccine Safety Datalink doses given for routine childhood vaccines, January 6–April 19, 2020. CDC / MMWR

The smaller drop and earlier rebound in babies and toddlers suggest health systems were prioritizing their well-child care and vaccinations — for example by reaching out to families overdue for shots and changing office routines to limit contact between patients.

Why it matters

Fewer vaccinations mean U.S. children and communities may face a higher risk of outbreaks of vaccine-preventable diseases. Parents' worries about exposing children to COVID-19 at checkups may have played a part — so it is vital to remind them that protection against serious diseases still matters. As social distancing relaxes, unvaccinated children will be more exposed to diseases such as measles. Health care providers and public health officials at every level will need to work together on rapid catch-up vaccination, and state and local coverage must be assessed to find where to act.

Sources

Based on Santoli JM, Lindley MC, DeSilva MB, et al., "Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020," MMWR Morbidity and Mortality Weekly Report, volume 69, first posted May 8, 2020, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The report's summary graphic, built on a photograph, is not reproduced.