Impact of COVID-19 pandemic on routine childhood vaccinations

Differences in timeliness, completeness and drop-out rates of MMRV and DTP containing vaccines among Ultra-Orthodox Jews and others in a deprived Northern Israel city: an ecological study

BACKGROUND

The Ultra-Orthodox Jewish (UO) population has been affected by pertussis, polio, and measles outbreaks. Safed, a deprived, undervaccinated city in Israel's North, has a large UO population concentrated in specific neighborhoods. We determined whether in Safed UO population concentration was associated with DTP- containing and MMRV1 vaccines coverage, timeliness and drop-out rates.

METHOD

For each of Safed's statistical areas, we estimated UO population based on the proportion of votes for UO political parties in Israel's 2020 general elections. We determined whether this proportion was associated with timely and delayed MMRV1 and DTP vaccine coverage for children born 2017-2022 using simple linear regression. We compared DTP and MMRV1 coverage and drop-out rates in UO areas (> 50% vote for UO parties) to others, using chi-square tests.

RESULTS

All eligible 4385 children residing in Safed were included in the MMRV1 and DTP analyses. Vaccine coverage was significantly lower in UO areas compared to non-UO for all doses of DTP and MMRV1 at expected age (-11.8, -15.8, -16.6, -11.8 and - 7.1% points (pp) respectively, P < 0.005) - and at 36 months old (-0.5, -3.9, -6.2, -9.3 and - 2% points respectively, P < 0.005). Gaps narrowed more for MMRV1 (from 7.1 to2 pp), than for DTP4 (from 11.8 to9.3 pp). Increasing UO vote was associated with decreased timely coverage for DTP but not MMRV. DTP1-4 drop-out rates were larger in the UO areas than in non-UO areas (26.2% vs. 18%).

CONCLUSIONS

Vaccine coverage was lower in UO neighborhoods, even in a peripheral city where coverage in non-UO areas is already low. Coverage differences between UO and non-UO populations decreased with time for MMRV1 but not DTP. Our findings suggest timeliness should be considered alongside non-vaccination, and vaccination behavior may be vaccine-specific in the UO population.

Vaccine Hesitancy: Where Are We Now?

Vaccine hesitancy is the delay in acceptance or outright refusal of immunizations, which has evolved into a growing public health threat. In this article, we explore recent trends in vaccine hesitancy in the setting of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic, vaccine-specific variations, social media influence, and sociodemographic factors. During the coronavirus disease 2019 pandemic, the antivaccine movement gained increasing support and generated widespread conspiracy theories and mistrust. This highlighted the importance of enhancing communication between the health care field and general public. While the impact of antivaccine social media is widespread, physicians have also begun to use technology to spread factual information and increase vaccination uptake. There is a growing body of evidence regarding sociodemographic data, including the pervasive impact of medical racism on vaccine hesitancy, with additional studies on age, education, income, and more. Providers must serve as communicators and focus on presumptive language, strong recommendations, and tailored conversations with families who are hesitant about vaccines. [Pediatr Ann. 2025;54(5):e154-e159.].

Decline in Vaccination Coverage by Age 24 Months and Vaccination Inequities Among Children Born in 2020 and 2021 - National Immunization Survey-Child, United States, 2021-2023

Data from the National Immunization Survey-Child (NIS-Child) were analyzed to estimate coverage with childhood vaccines recommended by the Advisory Committee on Immunization Practices among U.S. children by age 24 months. Coverage with nearly all vaccines was lower among children born in 2020 and 2021 than it was among those born in 2018 and 2019, with declines ranging from 1.3 to 7.8 percentage points. Analyses of NIS-Child data for earlier birth cohorts have not revealed such widespread declines in routine childhood vaccination coverage. Coverage among children born during 2020-2021 varied by race and ethnicity, health insurance status, poverty status, urbanicity, and jurisdiction. Compared with non-Hispanic White children, coverage with four of the 17 vaccine measures was lower among non-Hispanic Black or African American children as well as Hispanic or Latino (Hispanic) and non-Hispanic American Indian or Alaska Native children. Coverage was also generally lower among those covered by Medicaid or other nonprivate insurance, uninsured children, children living below the federal poverty level, and children living in rural areas. Coverage varied widely by jurisdiction, especially coverage with ≥2 doses of influenza vaccine. Children born during 2020-2021 were born during or after the period of major disruption of primary care from the COVID-19 pandemic. Providers should review children's histories and recommend needed vaccinations during every clinical encounter. Addressing financial barriers, access issues, vaccine hesitancy, and vaccine-related misinformation can also help to increase coverage, reduce disparities, and protect all children from vaccine-preventable diseases. Strategies that have been found effective include implementation of standing orders and reminder and recall systems, strong physician recommendations to vaccinate, and use of immunization information systems to identify areas of lower coverage that could benefit from targeted interventions to increase immunization rates.