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

Annika M Hofstetter; Eileen J Klein; Bonnie Strelitz; Rangaraj Selvarangan; Jennifer E Schuster; Julie A Boom; Leila C Sahni; Natasha B Halasa; Laura S Stewart; Mary Allen Staat; Chelsea Rohlfs; Peter G Szilagyi; Geoffrey A Weinberg; John V Williams; Marian G Michaels; Heidi Moline; Sara A Mirza; Christopher J Harrison; Janet A Englund

doi:10.1016/j.vaccine.2024.126455

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

Vaccine. 2024 Oct 30;42(26):126455. doi: 10.1016/j.vaccine.2024.126455. Online ahead of print.

Authors

Annika M Hofstetter¹, Eileen J Klein², Bonnie Strelitz³, Rangaraj Selvarangan⁴, Jennifer E Schuster⁵, Julie A Boom⁶, Leila C Sahni⁷, Natasha B Halasa⁸, Laura S Stewart⁹, Mary Allen Staat¹⁰, Chelsea Rohlfs¹¹, Peter G Szilagyi¹², Geoffrey A Weinberg¹³, John V Williams¹⁴, Marian G Michaels¹⁵, Heidi Moline¹⁶, Sara A Mirza¹⁷, Christopher J Harrison¹⁸, Janet A Englund¹⁹

Affiliations

¹ Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA. Electronic address: [email protected].
² Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA. Electronic address: [email protected].
³ Seattle Children's Research Institute, Seattle, WA, USA. Electronic address: [email protected].
⁴ University of Missouri at Kansas City School of Medicine, Kansas City, MO, USA; Children's Mercy, Kansas City, MO, USA. Electronic address: [email protected].
⁵ University of Missouri at Kansas City School of Medicine, Kansas City, MO, USA; Children's Mercy, Kansas City, MO, USA. Electronic address: [email protected].
⁶ Texas Children's Hospital, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. Electronic address: [email protected].
⁷ Texas Children's Hospital, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. Electronic address: [email protected].
⁸ Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: [email protected].
⁹ Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: [email protected].
¹⁰ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Infectious Diseases, Cincinnati Children's Hospital, Cincinnati, OH, USA. Electronic address: [email protected].
¹¹ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Infectious Diseases, Cincinnati Children's Hospital, Cincinnati, OH, USA. Electronic address: [email protected].
¹² Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA; Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA, USA. Electronic address: [email protected].
¹³ Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA. Electronic address: [email protected].
¹⁴ Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA. Electronic address: [email protected].
¹⁵ Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA. Electronic address: [email protected].
¹⁶ National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: [email protected].
¹⁷ National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: [email protected].
¹⁸ University of Missouri at Kansas City School of Medicine, Kansas City, MO, USA; Children's Mercy, Kansas City, MO, USA. Electronic address: [email protected].
¹⁹ Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA. Electronic address: [email protected].

PMID: 39481240
DOI: 10.1016/j.vaccine.2024.126455

Abstract

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.

Keywords: COVID-19 pandemic; Children; Disparities; Vaccination.