Routine childhood vaccinations dropped dramatically during the early months of the pandemic, and although those began rebounding last summer, many children and adolescents are still behind on shots, according to a federal health report released Thursday.
That lag might pose "a serious public health threat" of outbreaks of vaccine-preventable illnesses such as measles and whooping cough that have the potential to derail efforts to reopen schools, according to the Centers for Disease Control and Prevention.
With health care systems and other social institutions already overburdened by the pandemic, the CDC is recommending that providers consider giving coronavirus vaccines on the same day as other vaccines, especially when children and teens are behind or in danger of falling behind on recommended shots. The CDC changed its guidance last month to allow for coronavirus vaccinations and other shots to be given at the same time.
The data from 10 jurisdictions provide further evidence of the pandemic’s impact on routine childhood and adolescent vaccination rates that was documented last year as parents around the country canceled well-child checkups to avoid coronavirus exposure.
A Blue Cross Blue Shield analysis in late 2020 found a 26 percent drop in vaccine doses among children since the pandemic began. And 40 percent of parents surveyed by Blue Cross said their children missed shots because of the pandemic. A claims analysis released this week that was commissioned by GlaxoSmithKline and conducted by Avalere Health showed a sustained drop in immunization rates for recommended vaccines among teens and adults from January through November 2020.
The American Academy of Pediatrics called on parents Thursday to get their children up to date on routine shots as families prepare for the return of in-person classes in the fall.
"We understand many families understandably delayed visits to their doctors during the pandemic, and children may be behind in their vaccination schedule," Yvonne Maldonado, who chairs the AAP's committee on infectious diseases, said in a statement. "We urge families to get their children caught up with their routine immunizations now. States have begun opening up and as families move about in their community, we are concerned that we could see outbreaks of measles, whooping cough and other life-threatening diseases that could spread rapidly."
The CDC found that shots for children and teens between March and May 2020 were substantially lower for routine vaccinations, including DTaP, measles, and HPV, across all age groups, compared with the same three-month period in 2018 and 2019, in the 10 jurisdictions studied.
Among children under 24 months old and children 2 to 6 years old, doses of DTaP (diphtheria, tetanus, and acellular pertussis) fell a median of almost 16 percent and 60 percent, respectively, across all jurisdictions, compared with the same period in 2018 and 2019.
Doses of the measles, mumps, and rubella vaccine (MMR) given to children 12 to 23 months and 2 to 8 years old fell a median of 22 percent and 63 percent. Among children 9 to 12 years old and teens 13 to 17, doses of human papillomavirus vaccine (HPV) fell almost 64 percent and 71 percent, compared with doses administered in the two previous years.
The drop-off in HPV vaccinations worries pediatricians such as Todd Wolynn, chief executive at Pittsburgh-based Kids Plus Pediatrics. Unlike diseases such as measles that show up immediately, HPV infections can take years, even decades, to develop into cancer of the cervix, vagina, and penis, according to the CDC.
“That’s a disease that’s going to take a decade” or more to show up, Wolynn said. Even though most strains of the virus do not produce cancer or any symptoms, and disappear on their own, “you just don’t know who the 10 percent are” who will develop cancer, he said.
By last summer, after some stay-at-home orders had been lifted, the number of weekly routine pediatric vaccine doses increased in most of the 10 jurisdictions, even surpassing baseline levels before the pandemic, the CDC report said. But the rebound "was not sufficient to achieve the catch-up vaccination needed to address the many months when children missed routine vaccination," it said.
“We have been playing catch-up for the last year, and we still see patients coming in who have not seen us in more than 18 months, which means many of them are behind on vaccines,” said Jason Terk, a pediatrician in Fort Worth, Texas, part of a physician network that includes more than 100 primary care doctors.
“I absolutely share the concerns about increased risks for” vaccine-preventable outbreaks, Terk said in an e-mail. For extremely contagious diseases such as measles — far more infectious than the coronavirus — even the smallest decline in vaccination coverage can compromise herd immunity and lead to outbreaks, he said. From 2018 to 2019, a measles outbreak occurred in Rockland County, N.Y., and nearby counties; measles vaccination coverage in schools in the affected area was only 77 percent, far below the 93 to 95 percent needed for herd immunity.