On-time childhood vaccination before and during the COVID-19 pandemic in seven communities: Findings from the New Vaccine Surveillance Network.

BACKGROUND

The COVID-19 pandemic raised unprecedented challenges to vaccinating children. This multi-center study aimed to compare on-time vaccination of children before and during the COVID-19 pandemic and identify key factors associated with on-time vaccination.

METHODS

This study was conducted among children aged 0-6 years enrolled in the New Vaccine Surveillance Network at seven geographically diverse U.S. academic medical centers. Children with acute respiratory illness or acute gastroenteritis were enrolled from emergency department and inpatient settings; healthy control subjects were enrolled from primary care practices. Vaccination data were collected and verified from patient medical records, immunization information systems, and/or provider documentation. On-time vaccination according to Advisory Committee on Immunization Practices recommendations was compared between pre-pandemic (December 2018-February 2020) and pandemic (March 2020-August 2021) periods using bivariate and multivariable analyses, adjusting for key demographic, clinical, and study characteristics.

RESULTS

A total of 24,713 children were included in the analytic sample (non-Hispanic 73.4 %; White 51.0 %; publicly insured 69.0 %). On-time vaccination declined between the pre-pandemic (67.3 %) and pandemic (65.4 %) periods (Adjusted Odds Ratio 0.89, 95 % CI 0.84-0.95). The largest declines were observed among children who were < 12 months, male, Black, publicly insured, or whose mothers had a high school-equivalent education or less. The pandemic impact also varied by vaccine type and study site.

CONCLUSIONS

This multi-center study revealed a relatively modest overall reduction in on-time vaccination, which may reflect multilevel efforts to address pandemic-associated challenges. However, some patient subgroups and sites experienced greater reductions in on-time vaccination, highlighting the importance of tailoring interventions to increase equitable vaccine delivery, access, and acceptance across populations and communities.

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Déclaration de conflit d'intérêts

Declaration of competing interest N.B.H.: Research funding from Sanofi, Quidel, and Merck. M.A.S.: Institutional funding from the Centers for Disease Control and Prevention, National Institutes of Health, and Cepheid for respiratory virus testing. Research funding from Merck. Funding from Up-To-Date for article preparation. Funding from the American Academy of Pediatrics for ID course preparation. G.A.W.: Received honoraria from Merck & Co for writing and editing chapters in the Merck Manual textbook. J.V.W.: Previously served within last 3 years on a Scientific Advisory Board for Quidel and Independent Data Monitoring Committee for GlaxoSmithKline. C.J.H.: Research funding from GSK, Pfizer, and Merck through June 30, 2022. J.A.E.: Institutional funding from AstraZeneca, Merck, GlaxoSmithKline, and Pfizer. Consultant for Abbvie, AstraZeneca, Meissa Vaccines, Moderna, Pfizer, and SanofiPasteur. The other authors have no financial relationships or potential conflicts of interest to disclose.