AAP urges vaccination as rates drop due to COVID-19

Editor's note: For the latest news on COVID-19, visit  https://www.aappublications.org/news/2020/01/28/coronavirus.

Childhood vaccinations plummeted in mid-March after COVID-19 was declared a national emergency, leaving many children vulnerable to preventable diseases, according to a new report.

AAP President Sara “Sally” H. Goza, M.D., FAAP, called the findings “incredibly worrisome” and urged pediatricians and families to schedule visits to catch up on immunizations and other vital services using new AAP guidance.

“The COVID-19 pandemic is giving all of us a real-time education in what … vulnerability feels like,” Dr. Goza said in a statement. “Fortunately, we have vaccines to protect children and teens against 16 different diseases.”

The new findings come from a Centers for Disease Control and Prevention report containing data on vaccine ordering through the Vaccines for Children (VFC) program.

The data show from mid-March to mid-April, doctors in the VFC program ordered about 2.5 million fewer doses of all routine non-influenza vaccines and 250,000 fewer doses of measles-containing vaccines compared to the same period in 2019.

The number of doses of measles-containing vaccine administered at Vaccine Safety Datalink sites also dropped in mid-March, especially among older children. Administration of these vaccines started to pick up again among children 2 years and under, but remained lower than before the emergency declaration.

“The fact it has dropped so significantly in such a short period of time across the U.S. is really concerning because of the potential for outbreaks,” said Sean T. O'Leary, M.D., M.P.H., FAAP, a member of the AAP Committee on Infectious Diseases.

Authors of the report said stay-at-home orders and parents’ fears about contracting COVID-19 at a doctor’s office may have kept them from scheduling visits. Skipping visits has repercussions beyond vaccines.

“I’m also concerned that children who have missed vaccines have also missed other health care that occurs during those visits, including physical exams, developmental screenings and other important care that should not be delayed,” Dr. Goza said.

To facilitate these services, the AAP released new guidance today on providing well-child care and the use of telehealth during the pandemic .

In-person visits should occur whenever possible and are necessary for vital services like comprehensive physical exams; laboratory testing; hearing, vision and oral health screenings; fluoride varnish and immunizations.

Pediatricians can take precautions like scheduling well and sick visits at different times of the day, physically separating patients in different locations and rigorously sanitizing their offices. They should make families aware of these steps so they feel comfortable going to the office.

“Medical offices are among the safest places you can be right now given the really extensive measures they’ve taken to prevent spread of COVID-19 both to themselves and their patients,” Dr. O’Leary said. “Parents shouldn’t be afraid to go to their doctor.”

When appropriate, some elements of the well exam can be conducted via telehealth with in-person follow-up, according to the AAP guidance. Referrals should continue to be made for specialty care, and pediatric medical subspecialists and pediatric surgical specialists also may use telehealth.

The guidance also stated that payers should pay for telehealth at parity with in-person visits regardless of the patient’s age or whether the visit is for well child, acute or chronic care.

“While we wait for scientists and doctors to develop a vaccine for coronavirus,” Dr. Goza said, “let’s work together to protect our children in every way that we can, today.”