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With pandemic disruptions aplenty, fewer infants were left up to date (UTD) with their routine vaccinations through the fall of last year, and weekly vaccination rates remained depressed for several age groups as well, a large observational study found.

In the analysis involving 1.4 million children in each of the 2 years (2020 and 2019), infants ages 7 and 18 months were less likely to be UTD with their vaccinations by September 2020 versus a year prior (7 months: 74% vs 81%, respectively; 18 months: 57% vs 61%), reported Malini DeSilva, MD, MPH, of HealthPartners Institute in Bloomington, Minnesota, and colleagues.

Across most age groups, the proportion UTD was lowest among non-Hispanic Black children -- 61% at 7 months and 41% at 18 months. Meanwhile, Asian infants had the highest proportion UTD by these time points (88% and 76%, respectively).

"Disruptions to the timing of vaccine appointments in early infancy can lead to substantial delays in completion of vaccine series because of the required minimum intervals between vaccine doses and the need for additional health care visits to receive missed vaccines," wrote DeSilva and coauthors. "These data suggest that barriers to vaccination persisted after the opening of preventive care for all age groups."

As shown in , weekly vaccination rates were still reduced across most age groups in September 2020, after pandemic restrictions were relaxed and primary care was expanded, versus September 2019:

• <24 months (ratio of rate ratio [ROR] 0.96, 95% CI 0.93-0.98)
• 4 to 6 years (ROR 1.02, 95% CI 0.96-1.07)
• 11 to 13 years (ROR 0.81, 95% CI 0.76-0.86)
• 16 to 18 years (ROR 0.57, 95% CI 0.51-0.63)

"Despite the return to more typical levels of vaccination, the proportion of children with UTD vaccinations was lower among the 7-month, 18-month, and 13-year age groups while remaining stable for the 6- and 18-year age groups," noted Brian Jenssen, MD, MSHP, and Alexander G. Fiks, MD, MSCE, both of the University of Pennsylvania in Philadelphia, in an .

"The decreased vaccination coverage in young children parallels the declines in other pediatric medical services during the COVID-19 pandemic, including preventive well child care, screenings, dental visits, and lead testing," the editorialists added. "Health care system changes, such as reminding and offering vaccination in a variety of settings, and policy changes, such as vaccine mandates, will be essential in providing the impetus for families to re-engage with care and achieve timely and complete vaccination of children and adolescents."

For their study, DeSilva and colleagues evaluated 1,399,708 children in 2019 and 1,402,227 children in 2020 vaccinated at one of eight healthcare systems across six states (Minnesota, Washington, Wisconsin, Colorado, Oregon, and California). The systems were enrolled in CDC's Vaccine Safety Datalink () project.

Children of multiple age groups (<24 months, 15%; 4 to 6 years, 26%; 11 to 13 years, 29%; 16 to 18 years, 30%) were included if they were enrolled in the system from Jan. 5 to Oct. 3, 2020, or during the same time frame in 2019. Participants were evenly split between boys and girls, 32% were Hispanic, 32-33% were white, 12% were Asian, and 7% Black.

The study looked at the proportion of kids UTD on vaccination by age, and weekly vaccination rates during three 2020 periods: pre-pandemic (January 5 to March 14), age-limited preventative care (March 15 to May 16), and the expanded primary care period (May 17 to October 3), and then compared them to their respective 2019 rates. Vaccinations were in accordance with the Advisory Committee on Immunization Practices recommendations.

Researchers acknowledged several limitations with the analysis, including that VSD enrolls only insured patients at large integrated health centers, which limits the generalizability of the findings, and influenza and hepatitis A vaccinations were excluded. Also, the analysis used slightly variable age cutoffs, potentially overestimating UTD percentages.

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