Childhood Vaccinations Plunged, Then Rebounded, in New York City During COVID-19

Health officials worried early in the COVID-19 pandemic that routine childhood vaccination was falling — a special concern in New York City, which had just had a large measles outbreak in 2018–2019. The city’s Department of Health and Mental Hygiene tracked the effect through its Citywide Immunization Registry, which holds 2.7 million records for New Yorkers aged 0–18 and receives reports from about 1,600 immunization sites. It compared weekly vaccine doses in 2020 with the same weeks of 2019 (excluding flu vaccine and doses given in pharmacies and hospital nurseries).

The plunge

Doses began to fall the week of March 8, 2020, a week after the city’s first confirmed COVID-19 case, and fell further after the state’s “PAUSE” stay-at-home order took effect on March 22. The low point came the week of April 5–11:

The number of sites giving any vaccine fell too — by 46% for children under 24 months (from 900 to 488) and by 78% for ages 2–18 (from 1,238 to 275).

Weekly routine childhood vaccine doses and reporting facilities, New York City, 2019 and 2020. Image from CDC’s page.

The response

The health department:

• sent three letters and a Health Alert Network notice to providers between March and June stressing that routine immunization must continue;
• posted messages in the registry’s vaccine-ordering system from May urging providers to order enough vaccine to catch children up;
• promoted the registry’s reminder and recall tools for finding children overdue for shots;
• made childhood vaccination the subject of a widely covered mayoral press conference on May 20; and
• held a webinar for pediatric providers on June 17.

The rebound

Vaccination of children under 24 months began rising the week of April 19–25 as new COVID-19 cases declined, and was back to 2019 levels by the week of May 17. By late June, 825 sites were vaccinating young children, up 69% from the low point.

For ages 2–18, doses began rising the week of April 26–May 2 and kept climbing, but by June 21–27 were still 35% below 2019 (17,947 against 27,405), though the number of sites vaccinating older children had grown to 950.

Lessons

The rebound shows the importance of health departments working with providers. A ready way to reach providers quickly, a strong immunization registry to find unvaccinated children, and the Vaccines for Children program’s network of providers and vaccine distribution all mattered — and would be critical, the authors noted, for distributing COVID-19 vaccines once available. The department kept up its work through public service announcements, letters, guidance and webinars on helping parents catch their children up.

Sources

Based on Langdon-Embry M, Papadouka V, Cheng I, Almashhadani M, Ternier A, Zucker JR, "Notes from the Field: Rebound in Routine Childhood Vaccine Administration Following Decline During the COVID-19 Pandemic — New York City, March 1–June 27, 2020," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; written by the New York City Department of Health and Mental Hygiene and rewritten in hubnx’s own words.