Routine childhood vaccinations dropped dramatically during the early months of the coronavirus pandemic, and although they began rebounding last summer as families rescheduled doctors’ visits, many children and adolescents are behind on their shots, according to a federal health report released Thursday.
The 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 school reopenings, according to the Centers for Disease Control and Prevention.
With health-care systems overburdened, the CDC is recommending that providers give 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 shots to be given at the same time as others.
The American Academy of Pediatrics also 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,” Yvonne Maldonado, who chairs the group’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 data from 10 jurisdictions provides further evidence of the pandemic’s impact on routine childhood and adolescent vaccination rates, which was documented last year as parents across the country canceled well-child checkups to avoid coronavirus exposure.
Researchers found that shots for children and teens between March and May 2020 were substantially lower for routine vaccinations, including for DTaP (diphtheria, tetanus and acellular pertussis), measles, and HPV, across all age groups, compared with the same three-month period in 2018 and 2019.
Among children younger than 24 months old and children 2 to 6 years old, doses of DTaP fell a median of almost 16% and 60%, 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% and 63%. Among children 9 to 12 years old and teens ages 13 to 17, doses of the human papillomavirus vaccine (HPV) fell almost 64% and 71%, 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, which 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 any symptoms or cancer, and disappear on their own, “you just don’t know who the 10% 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 pre-pandemic levels, 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 email. 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. In 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.
The latest CDC data confirms what immunization and health experts have heard from various sources about dangerously low vaccination rates during the pandemic, said Erica DeWald, director of strategic communications for Vaccinate Your Family, an immunization advocacy group.
A Blue Cross Blue Shield analysis in late 2020 found a 26% drop in vaccinations among children since the pandemic began. And 40% 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. Teens and adults missed more than 26 million doses of recommended vaccines last year, including 8.8 million missed adolescent doses and 17.2 million missed adult vaccine doses.
The CDC is working to monitor progress since September 2020, according to Bhavini Patel Murthy, a medical epidemiologist and lead author of the report.
“We hope to share the findings as soon as they become available,” she wrote in an email.