Impact of the COVID-19 pandemic on routine childhood vaccination in 9 U.S. jurisdictions

Abstract

Importance: Routine vaccinations are key to prevent outbreaks of vaccine-preventable diseases. However, there have been documented declines in routine childhood vaccinations in the U.S. and worldwide during the COVID-19 pandemic.

Objective: Assess how the COVID-19 pandemic impacted routine childhood vaccinations by evaluating vaccination coverage for routine childhood vaccinations for children born in 2016-2021.

Methods: Data on routine childhood vaccinations reported to CDC by nine U.S. jurisdictions via the immunization information systems (IISs) by December 31, 2022, were available for analyses. Population size for each age group was obtained from the National Center for Health Statistics' Bridging Population Estimates.

Main outcomes and measures: Vaccination coverage for routine childhood vaccinations at age three months, five months, seven months, one year, and two years was calculated by vaccine type and overall, for 4:3:1:3:3:1:4 series (≥4 doses DTaP, ≥3 doses Polio, ≥1 dose MMR, ≥3 doses Hib, ≥3 doses Hepatitis B, ≥1 dose Varicella, and ≥ 4 doses pneumococcal conjugate), for each birth cohort year and by jurisdiction.

Results: Overall, there was a 10.4 percentage point decrease in the 4:3:1:3:3:1:4 series in those children born in 2020 compared to those children born in 2016. As of December 31, 2022, 71.0% and 71.3% of children born in 2016 and 2017, respectively, were up to date on their routine childhood vaccinations by two years of age compared to 69.1%, 64.7% and 60.6% for children born in 2018, 2019, and 2020, respectively.

Conclusions and relevance: The decline in vaccination coverage for routine childhood vaccines is concerning. In order to protect population health, strategic efforts are needed by health care providers, schools, parents, as well as state, local, and federal governments to work together to address these declines in vaccination coverage during the COVID-19 pandemic to prevent outbreaks of vaccine preventable diseases by maintaining high levels of population immunity.

Keywords: Routine childhood vaccination; Vaccination.

Fig. 1.

Proportion of children up to date on all ACIP routinely recommended vaccines^a by two years of age as of December 31, 2022 among children born in 2016–2021 in 9 U.S. Jurisdictions^{b. a}Vaccination series included receiving all of the following: ≥4 DTaP, ≥3 doses polio, ≥1 MMR, ≥3 doses Hib, ≥3 Hepatitis B, ≥1 dose varicella, ≥4 doses pneumococcal conjugate. ^bIIS jurisdictions included: New York City, Iowa, Louisiana, Michigan, Minnesota, North Dakota, Oregon, Washington, and Wisconsin.

Fig. 2.

Overall routine childhood vaccination coverage for 9 U.S. jurisdictions^a as of December 31, 2022 for children born in 2016–2021 by selected vaccine types and age^b. ^aIIS jurisdictions included: New York City, Iowa, Louisiana, Michigan, Minnesota, North Dakota, Oregon, Washington, and Wisconsin. ^bFor a list of ACIP recommended routine childhood vaccinations by age, please visit: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html.