Impact of the COVID-19 pandemic on routine immunization coverage in children under 2 years old in Ontario, Canada: A retrospective cohort study.

COVID-19 / epidemiology Cohort Studies Humans Immunization Immunization Programs Infant Male Ontario / epidemiology Pandemics Retrospective Studies SARS-CoV-2 Vaccination Coverage
COVID-19 Childhood immunization Family medicine Health services Immunization coverage Pediatrics Primary care Retrospective observational study

Journal

Vaccine
ISSN: 1873-2518
Titre abrégé: Vaccine
Pays: Netherlands
ID NLM: 8406899

Informations de publication

Date de publication:
15 03 2022
Historique:
received: 24 10 2021
revised: 31 01 2022
accepted: 01 02 2022
pubmed: 16 2 2022
medline: 11 3 2022
entrez: 15 2 2022
Statut: ppublish

Résumé

The COVID-19 pandemic has caused a disruption in childhood immunization coverage around the world. This study aimed to determine the change in immunization coverage for children under 2 years old in Ontario, Canada, comparing time periods pre-pandemic to during the first year of the pandemic. Observational retrospective open cohort study, using primary care electronic medical record data from the University of Toronto Practice-Based Research Network (UTOPIAN) database, from January 2019 to December 2020. Children under 2 years old who had at least 2 visits recorded in UTOPIAN were included. We measured up-to-date (UTD) immunization coverage rates, overall and by type of vaccine (DTaP-IPV-Hib, PCV13, Rota, Men-C-C, MMR, Var), and on-time immunization coverage rates by age milestone (2, 4, 6, 12, 15, 18 months). We compared average coverage rates over 3 periods of time: January 2019-March 2020 (T1); March-July 2020 (T2); and August-December 2020 (T3). 12,313 children were included. Overall UTD coverage for all children was 71.0% in T1, dropped by 5.7% (95% CI: -6.2, -5.1) in T2, slightly increased in T3 but remained lower than in T1. MMR vaccine UTD coverage slightly decreased in T2 and T3 by approximately 2%. The largest decreases were seen at ages 15-month and 18-month old, with drops in on-time coverage of 14.7% (95% CI: -18.7, -10.6) and 16.4% (95% CI: -20.0, -12.8) respectively during T2. When stratified by sociodemographic characteristics, no specific subgroup of children was found to have been differentially impacted by the pandemic. Childhood immunization coverage rates for children under 2 years in Ontario decreased significantly during the early period of the COVID-19 pandemic and only partially recovered during the rest of 2020. Public health and educational interventions for providers and parents are needed to ensure adequate catch-up of delayed/missed immunizations to prevent potential outbreaks of vaccine-preventable diseases.

Sections du résumé

BACKGROUND
The COVID-19 pandemic has caused a disruption in childhood immunization coverage around the world. This study aimed to determine the change in immunization coverage for children under 2 years old in Ontario, Canada, comparing time periods pre-pandemic to during the first year of the pandemic.
METHODS
Observational retrospective open cohort study, using primary care electronic medical record data from the University of Toronto Practice-Based Research Network (UTOPIAN) database, from January 2019 to December 2020. Children under 2 years old who had at least 2 visits recorded in UTOPIAN were included. We measured up-to-date (UTD) immunization coverage rates, overall and by type of vaccine (DTaP-IPV-Hib, PCV13, Rota, Men-C-C, MMR, Var), and on-time immunization coverage rates by age milestone (2, 4, 6, 12, 15, 18 months). We compared average coverage rates over 3 periods of time: January 2019-March 2020 (T1); March-July 2020 (T2); and August-December 2020 (T3).
RESULTS
12,313 children were included. Overall UTD coverage for all children was 71.0% in T1, dropped by 5.7% (95% CI: -6.2, -5.1) in T2, slightly increased in T3 but remained lower than in T1. MMR vaccine UTD coverage slightly decreased in T2 and T3 by approximately 2%. The largest decreases were seen at ages 15-month and 18-month old, with drops in on-time coverage of 14.7% (95% CI: -18.7, -10.6) and 16.4% (95% CI: -20.0, -12.8) respectively during T2. When stratified by sociodemographic characteristics, no specific subgroup of children was found to have been differentially impacted by the pandemic.
CONCLUSION
Childhood immunization coverage rates for children under 2 years in Ontario decreased significantly during the early period of the COVID-19 pandemic and only partially recovered during the rest of 2020. Public health and educational interventions for providers and parents are needed to ensure adequate catch-up of delayed/missed immunizations to prevent potential outbreaks of vaccine-preventable diseases.

Identifiants

DOI: 10.1016/j.vaccine.2022.02.008 PMID: 35164987 PMC: PMC8824235
pubmed: 35164987
pii: S0264-410X(22)00131-1
doi: 10.1016/j.vaccine.2022.02.008
pmc: PMC8824235
pii:
doi:

Types de publication

Journal Article Observational Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1790-1798

Informations de copyright

Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Auteurs

Catherine Ji (C)

Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Toronto Western Family Health Team, University Health Network, 440 Bathurst Street, 3rd Floor, Toronto, Ontario M5T 2S6, Canada. Electronic address: catherine.ji@uhn.ca.

Pierre-Philippe Piché-Renaud (PP)

Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8.

Jemisha Apajee (J)

Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada.

Ellen Stephenson (E)

Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada.

Milena Forte (M)

Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Mount Sinai Academic Family Health Team, 60 Murray Street, 4th Floor, Toronto, Ontario M5T 3L9, Canada.

Jeremy N Friedman (JN)

Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8; Division of Paediatric Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.

Michelle Science (M)

Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8.

Stanley Zlotkin (S)

Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8; Division of Paediatric Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Centre for Global Child Health and the SickKids Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, Ontario M5G 0A4, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada.

Shaun K Morris (SK)

Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8; Centre for Global Child Health and the SickKids Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, Ontario M5G 0A4, Canada.

Karen Tu (K)

Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Toronto Western Family Health Team, University Health Network, 440 Bathurst Street, 3rd Floor, Toronto, Ontario M5T 2S6, Canada; North York General Hospital, 4001 Leslie Street, Toronto, Ontario M2K 1E1, Canada.

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