Decline in vaccinations amid coronavirus pandemic may lead to measles outbreak, warns CDC
The reduction began the week after the national emergency declaration in the US
There has been a significant decrease in the number of children getting routine vaccinations in the US, potentially driven by concerns that they could be exposed to Covid-19 during their doctor visits. This could lead to outbreaks of measles and other vaccine-preventable diseases in the US, warn experts from the US Centers for Disease Control and Prevention (CDC).
“The ongoing Covid-19 pandemic is a reminder of the importance of vaccination. The identified declines in routine pediatric vaccine ordering and doses administered might indicate that US children and their communities face increased risks for outbreaks of vaccine-preventable diseases,” says the CDC in a new report. It adds, “Parental concerns about potentially exposing their children to Covid-19 during visits might contribute to the declines observed. To the extent that this is the case, reminding parents of the vital need to protect their children against serious vaccine-preventable diseases, even as the Covid-19 pandemic continues, is critical.”
On March 13, US President Donald Trump declared a national emergency in response to the coronavirus pandemic. With reports of laboratory-confirmed cases in all 50 states by that time, disruptions were anticipated in the US healthcare system’s ability to continue providing routine preventive and other non-emergency care, say researchers. Besides, many states and localities issued shelter-in-place or stay-at-home orders to reduce the spread of Covid-19, limiting movement outside the home to essential activities.
Accordingly, two data sources were examined to assess the impact of the pandemic on pediatric vaccination in the US: Vaccines for Children Program (VFC) provider order data from CDC’s Vaccine Tracking System, and Vaccine Safety Datalink (VSD) vaccine administration data.
VFC is a national program that provides federally purchased vaccines to approximately 50% of US children, up to 18 years of age. “Cumulative doses of VFC-funded vaccines ordered by healthcare providers at weekly intervals during two periods -- January 7, 2019-April 21, 2019 (period 1), and January 6, 2020-April 19, 2020 (period 2), were tallied, and differences in cumulative weekly vaccine doses ordered between period 2 and period 1 were calculated for all non-influenza vaccines,” says the report.
VSD is a collaborative project between CDC’s Immunization Safety Office and eight US healthcare organizations serving publicly and privately insured patients. The researchers compared aggregate counts of measles-containing vaccine doses administered each week at VSD sites during period 2 between two pediatric age groups: children aged 24 months or less, and those aged over 24 months through 18 years.
Based on data, the authors found a significant decrease in the number of childhood immunizations administered compared to previous years. Between March 13 to April 19, there was an over 2 million-dose decline in orders of regular childhood vaccines, not counting influenza vaccines. “Data indicate a notable decrease in orders for non-influenza childhood vaccines and for measles-containing vaccines during period 2 compared with period 1. The decline began the week after the national emergency declaration; similar declines in orders for other vaccines were also observed,” says the study.
Among children aged 2-18 years, the number of measles-containing vaccinations fell from more than 2,000 per week to only a few hundred over a two-week period and has remained at that level from mid-March through at least mid-April. The decrease was less dramatic for children under 2 years, and the number of vaccines for this age group has steadily rebounded, up to nearly 1,500 vaccinations by mid-April.
Gaps in vaccinations have already resulted in lower immunization rates last year: a total of 704 cases were reported during January 1-April 26 in 2019, the highest number of cases reported since 1994. Outbreaks in close-knit communities accounted for 88% of all cases, says the 2019 CDC report.
Based on the current findings, the experts recommend that assessment of state and local vaccination coverage is needed to quantify the impact among US children of all ages and prioritize areas for intervention. “As social distancing requirements are relaxed, children who are not protected by vaccines will be more vulnerable to diseases such as measles. In response, continued coordinated efforts between healthcare providers and public health officials at the local, state, and federal levels will be necessary to achieve rapid catch-up vaccination,” recommends the research team.