Though rates of routine childhood vaccinations have significantly rebounded after dropping precipitously amid the early days of Covid-19, they are still far short of pre-pandemic levels—and, if not addressed, could pose "a serious public health threat," according to a recent Morbidity and Mortality Weekly Report from CDC.

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Routine vaccinations drop

For the report, CDC looked at vaccination rates in 10 jurisdictions that closely monitor the rates of routine childhood vaccinations, eight of which imposed some form of stay-at-home order during spring 2020. Specifically, they compared rates of common childhood vaccinations between March and May 2020 and the same period in 2018 and 2019.

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According to the researchers, when comparing the 2020 period to the 2018 and 2019 periods, the rates of:

• Diphtheria, tetanus, and acellular pertussis (DTaP) vaccines dropped by a median of 15.7% among children under 24 months, and by 60.3% among children 2 to 6 years old;
• Measles, mumps, and rubella (MMR) vaccines dropped by a median of 22.4% among children 12-23 months, and by 63.1% among children 2 to 8 years old;
• Tetanus, diphtheria, and acellular pertussis (Tdap) vaccines decreased by more than 60% among children 9 to 17 years old; and
• Human papillomavirus (HPV) vaccines declined by nearly 64% in children 9 to 12 years old and by 71% among adolescents 13 to 17 years old.

The researchers added that while vaccination rates rebounded significantly between June and September 2020, with some even surpassing pre-pandemic levels, they still remain insufficient to "achieve the catch-up vaccination needed to address the many months when children missed routine vaccination."

For example, rates of MMR vaccines among children 2 to 8 years old dropped a median of 11.3% from June to September 2020 when compared to the same period in 2018 and 2019. Similarly, rates of HPV vaccines among adolescents 13 to 17 years old dropped "a median of 12.2% and 28.1%, respectively" in June to September 2020 when compared to the same period in 2018 and 2019.

'A serious public health threat'

In the report, CDC noted the drop in routine childhood vaccinations poses "a serious public health threat that would result in vaccine-preventable disease outbreaks, especially in schools that have reopened for in-person learning."

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The agency noted that "[e]ven a transient decline in vaccination coverage can compromise herd immunity and result in the propagation of outbreaks." And these potential outbreaks "have the potential to derail efforts to reopen schools" in the fall, CDC said.

For instance, Jason Terk, a pediatrician in Texas, cited the measles outbreak that affected Rockland County, New York, and nearby counties in the 2018-2019 school year. At the time, the measles vaccination rate in the affected schools was just 77%—well below the 93% to 95% rate needed to establish herd immunity.  

To help address the issue, CDC in May changed its guidance to allow Covid-19 vaccines to be administered at the same time as other vaccinations and is encouraging health care providers to do so, the Washington Post reports.

Similarly, the American Academy of Pediatrics (AAP) last week also encouraged parents to get their children's vaccinations done before schools resume in the fall.

"We understand many families understandably delayed visits to their doctors during the pandemic," Yvonne Maldonado, chair of AAP's committee on infectious diseases, said in a statement. "We urge families to get their children caught up with their routine immunizations now. States have begun opening up, and as families move about in their community, we are concerned that we could see outbreaks of measles, whooping cough, and other life-threatening diseases that could spread rapidly."

Separately, Todd Wolynn, CEO of Kids Plus Pediatrics, said the drop in HPV vaccinations is very concerning to him, because HPV can take a long time to develop into different types of cancer.

"That's a disease that's going to take a decade" or more to show up, Wolynn said. Most strains of the virus don't develop into cancer or produce any symptoms, but "you just don't know who the 10% are" that will develop cancer, he said (Fernandez, Axios, 6/11; Sun, Washington Post, 6/10; Rabin, New York Times, 6/10).