Impact of stay-at-home measures on vaccination


Social distancing measures may have helped slow the spread of COVID-19 in the early days of the pandemic, but an investigation indicates an unintended and potentially problematic consequence: a decline in vaccination.

When the country shut down to slow the spread of COVID-19, one of the biggest changes for pediatricians was a move to telemedicine visits and fewer in-person visits. Even when the country started to reopen, there were still many families who were hesitant to come into the office due to fear of becoming infected. One of the major concerns about this shift was that vaccinations were not occurring, which could lead to later issues. An investigation in Colorado examined how the pandemic impacted the vaccination rates in the state.1

The investigators used data from the Colorado Immunization Information System, which receives reports from 87.5% of health care professionals who immunized. Every child aged younger than 6 years has an immunization record in the system. A vast majority of the immunizations administered to children aged 0 to 18 years are reported to the system within a day of being administered. Age categories used in the system were 0-2 years, 3-9 years, and 10-17 years and the 3 vaccines looked at were Haemophilus influenzae type b; 13-valent pneumococcal conjugate; and measles, mumps, and rubella vaccines. They used data from January 5, 2020, to May 2, 2020, and the measures to prevent the spread of COVID-19 began on March 15, 2020.

In the period before the lockdown, the average number of vaccines given to children aged 0 to 2 years was 23,523 (2181); for children aged 3 to 9 years, it was 6148 (1049); and for children aged 10 to 17 years, it was 8318 (933). Following the measures, the average number of vaccine doses used for the same age groups was 16,146 (1648), 1330 (408), and 1529 (623), respectively. This change in immunization meant that the decline in average immunization rate was 31% for individuals aged 0 to 2 years, 78% for those aged 3 to 9 years, and 82% for those aged 10 to 17 years. Most significant was that all of the age groups saw a large decrease in immunizations immediately after the measures started, with immunizations in children aged 0 to 2 years dropping by 4581 (95% CI, 2965-6196) immunizations per week (P < .001); for children aged 3 to 9 years, it dropped by 2486 (95% CI, 568-4408) immunizations per week (P > .99); and in children aged 10 to 17 years, the rate dropped by 4060 (95% CI, 2156-5965) immunizations per week (P < .001).

The researchers concluded that vaccine administration had significantly declined in Colorado following the implementation of measures meant to slow the spread of COVID-19. To avoid adding to the burden of the already stretched health care system with vaccine-preventable diseases, they recommend clinicians use reminders and recalls to inform parents of missed vaccinations.


1. O'Leary S, Trefren L, Roth H, Moss A, Severson R, Kempe A. Number of Childhood and adolescent vaccinations administered before and after the COVID-19 outbreak in Colorado. JAMA Pediatr. December 7, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.4733

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