CDC: Kids Born During the Pandemic Got Fewer Routine Vaccinations

Fewer children born during the first 2 years of the COVID-19 pandemic received recommended vaccines compared with those born in the 2 years before the pandemic, according to CDC data.

Compared with vaccine coverage during 2018 and 2019, estimated coverage for children born in 2020 and 2021 declined by 1.3 to 7.8 percentage points, depending on the vaccine, reported Holly Hill, MD, PhD, of the CDC’s National Center for Immunization and Respiratory Diseases, and colleagues in the Morbidity and Mortality Weekly Report.

The estimated differences in vaccine coverage by the age of 24 months for children born in 2018-2019 and those born in 2020-2021 were:

• Influenza vaccine, two or more doses: -7.8 percentage points
• Combined seven-vaccine series: -3.2 percentage points
• Rotavirus vaccine: -2.0 percentage points
• Diphtheria, tetanus, pertussis (DTaP) vaccine: -1.8 percentage points for three or more doses; -2.5 percentage points for four or more doses
• Haemophilus influenzae type b (Hib) conjugate vaccine: -2.2 percentage points for the primary series; -3.2 percentage points for the full series
• Pneumococcal conjugate vaccine: -1.8 percentage points for three or more doses; -2.7 percentage points for four or more doses
• Hepatitis A vaccine, one or more doses: -1.6 percentage points
• Measles, mumps, and rubella (MMR) vaccine: -1.7 percentage points
• Poliovirus vaccine: -1.5 percentage points
• Varicella vaccine: -1.3 percentage points
• Hepatitis B vaccine, three or more doses: -1.5 percentage points

“Analyses of [National Immunization Survey-Child] data for earlier birth cohorts have not revealed such widespread declines in routine childhood vaccination coverage,” Hill and co-authors wrote.

On a brighter note, despite the decreases, vaccine rates for poliovirus, MMR, DTaP, Hib, and hepatitis B remained above 90% for children born in 2020-2021.

However, only 56% of children nationwide received two or more doses of influenza vaccine in 2020-2021, down from 63% in 2018-2019.

The CDC’s Advisory Committee on Immunization Practices (ACIP) currently recommends routine vaccination against 15 potentially serious illnesses for children by age 24 months.

“Recent decreases in coverage with most of the ACIP-recommended childhood vaccines could lead to a resurgence of vaccine-preventable diseases such as measles, varicella, and rotavirus and their associated morbidity and mortality,” Hill and team noted, citing the recent surge in measles in the U.S. As of September 26, there have been 264 measles cases reported in the U.S. in 2024, and 88% of those were in people who were unvaccinated or with unknown vaccination status.

Separately, the CDC recently announced that cases of whooping cough (pertussis) this year exceed levels seen before the pandemic.

In their study, Hill and colleagues also found disparities in vaccine coverage by race and ethnicity for those born in 2020-2021. Black, Hispanic or Latino, and American Indian or Alaska Native children had lower vaccine coverage than white children for four or more doses of the DTaP vaccine, four or more doses of the pneumococcal conjugate vaccine, the rotavirus vaccine, and the combined seven-vaccine series. Influenza vaccine coverage with two or more doses was also lower among Black (43%) and Hispanic (53%) children than among white children (60%). Asian children had the highest levels of flu shot coverage, at about 71%.

Health insurance seemed to influence vaccine uptake, Hill and co-authors noted. For 2020-2021, children who were uninsured or covered by Medicaid or other non-private insurance had lower vaccine coverage than those with private insurance. Moreover, children living at or below the poverty line had lower coverage rates, ranging from 2.7 percentage points lower for the MMR vaccine to nearly 20 points lower for two or more doses of the flu shot.

Looking at birth cohorts in different U.S. HHS jurisdictions, nearly all coverage across eight vaccine measures decreased from 2018-2019 to 2020-2021.

“Because children born during or after the period of major disruption of primary care from the COVID-19 pandemic might have missed some vaccinations, providers should review children’s histories and recommend needed vaccinations during every clinical encounter,” Hill and colleagues wrote.

“Addressing financial barriers and other access issues along with vaccine hesitancy and misinformation concerns is important to increasing vaccination coverage and reducing disparities,” they added.

Higher provider participation in the Vaccines for Children program could help mitigate financial barriers by increasing access to no-cost vaccines, they pointed out. Several other recommended strategies to improve vaccine uptake include use of standing orders and other prompts, reminder/recall systems, strong physician recommendations to vaccinate, and giving vaccines in alternative settings.

The study relied on data from the National Immunization Survey-Child, a nationwide survey of U.S. parents or guardians of children ages 19 to 35 months. The researchers collected data during household telephone interviews and reviewed vaccination records from the children’s healthcare providers. Among sampled households, the response rate was 27% and adequate provider data were available for 48% of children with completed interviews. A total of 28,688 children were included in the analysis.

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