CDC Report Confirms Kids Are Still Behind on Routine Vaccinations

The rates of routine vaccination among children and teens dropped significantly in 2020, but even after stay-at-home orders were lifted, vaccination rates didn’t catch up to pre-pandemic levels, according to a new CDC report released June 11.

The report found that from March to May of 2020, rates for some pediatric vaccinations fell by over 60%. More children and teens received their shots between June and September, but overall vaccination rates were still well below 2018 and 2019 levels. This confirms CDC data from last year that raised the alarm over similar concerns.

"As a pediatrician I’m very concerned about how many children have missed other important vaccines during the pandemic, including for diseases like measles and whooping cough which can be deadly," Lisa Costello, MD, a pediatric hospitalist at West Virginia University Medicine Children’s Hospital, tells Verywell.

Falling Vaccination Rates

Looking at 10 different districts—Minnesota, Iowa, Idaho, Louisiana, New York City, North Dakota, Michigan, Oregon, Wisconsin, and Washington state—the CDC report took stock of vaccination rates across four different vaccines and age ranges. 

Vaccination Rates in Younger Children

For young children, the CDC collected data on diphtheria, tetanus, and acellular pertussis (DTaP) vaccinations, and measles, mumps, and rubella (MMR) vaccinations. In the early part of the pandemic, DTaP vaccination rates fell by almost 16% for kids under 2, but by over 60% for kids ages 2–6. Later on, in the summer and fall, data showed that DTaP fell by about 9% for kids under 2 and almost 7% for ages 2–6 compared to pre-pandemic levels. 

MMR vaccinations had a similar pattern. In children up to 23 months, MMR vaccination rates dropped by 22% between March and May, and by almost 9% between June and September. Those numbers were even higher—63% and 11% respectively—for kids 2–8 years old. 

Vaccination Rates in Older Children

The CDC found that vaccination rates for older children and teens also took a dive. The human papillomavirus (HPV) vaccination rates in spring 2020 fell by nearly 64% compared to 2018 and 2019 levels for kids 9–12 years old. For teens 13–17 years old, that number was 71%.

From June to September, rates never fully recovered—the median decrease was 12% for the preteens and 28% for the teens.

The tetanus, diphtheria, and acellular pertussis (Tdap) shot normally administered to the same age ranges also saw drastic declines. Kids between 9–12 years old were being vaccinated at rates 66% lower between March and May, and 21% lower between June and September. For teens 13–17 years old, the CDC found Tdap vaccination rates had dropped by 61% and later 30% respectively.

Possible Causes and Explanations

The June 11 CDC report says a number of possible factors influenced low vaccination rates in 2020. Stay-at-home orders and fear of contracting COVID-19 in a healthcare facility likely kept many families away. 

The CDC also suggests that the rushed transition to online learning played a role. The organization says that some schools may have been more lax when it came to enforcing vaccination requirements while children were taking classes from home.

Some older kids and teens may not be going to the pediatrician as often as they should, Costello says, which also impacts who gets vaccinated and who doesn’t. 

“We know that earlier in life, you have more trips to your pediatrician where [it] involves checking your growth and your development, and we also do the important job of providing immunizations to protect against those diseases that we're able to protect against,” Costello says. “As we get older we don't maybe as frequently go to the pediatrician or to the doctor as much as we should.”

Though not mentioned in the report, vaccine hesitancy has also played a role in declining rates of routine vaccinations for kids in recent years. A nationwide survey conducted in February 2019 found that just over 6% of parents were hesitant about routine vaccinations, meaning they either had concerns about getting their kids vaccinated or opposed it entirely. Vaccine hesitancy was also named a global health threat by the World Health Organization in 2019, Costello adds.

“There's a continuum of vaccine confidence, whether that's for the COVID-19 vaccine or for other vaccines,” Costello says. “And so I think that we as healthcare professionals need to continue to start from a place of listening and empathy, and make sure that our patients are able to ask the questions that they may have.”

Herd Immunity Is Not Just a COVID-19 Goal

With the exception of tetanus, which is spread through direct contact with bacteria in our local environments, all of the other vaccine-preventable diseases named in the June 11 CDC report are highly infectious. That’s why the report’s authors are so concerned with keeping pediatric vaccination rates as close to 100% as possible. 

Herd immunity has become a COVID-19 buzzword in the past few months, but it’s an important measure to keep up for any and all communicable diseases. The higher the number of children vaccinated against infectious diseases like HPV, diphtheria, measles, mumps, and more, the less likely infection is to spread. 

For a disease like measles, herd immunity is only achieved when at least 93% to 95% of the population is vaccinated, according to the CDC report. In 2019, there was an outbreak of measles in some communities that had larger populations of unvaccinated people. The 1,282 reported cases were the highest number since 1992. So far in 2021, only two cases of measles have been reported thus far, a win for public health.

However, if vaccination rates don’t recover as people return to public life, cases could increase. A 2017 report warns that even a 5% decrease in MMR vaccinations among children 2–11 years old could cause a three-fold spike in measles cases.

“We’ve had outbreaks of these diseases recently, and so it's not far-fetched to believe that we could see another one, especially if we don't get children and teens caught up quickly on these vaccines,” Costello says. 

The CDC report stresses that without herd immunity for many of these vaccine-preventable diseases, infections could hinder school reopening efforts this fall. Even worse, they could strain an already overwhelmed healthcare system and put the entire community at risk. 

Making Pediatric Vaccines a Priority

Luckily, getting children vaccinated against these diseases is simple. Pediatricians are responsible for helping get kids and teens vaccinated, and the CDC strongly suggests that healthcare providers, parents, schools, and local governments work together to make sure that kids and teens are staying up to date with all routine vaccinations.

To start, Costello says it’s as easy as parents giving their healthcare providers a call to see if their children are overdue on any immunizations.

"It's going to be incredibly important to do the education, make sure we're doing the outreach to get children and teens updated on their vaccinations so that we don't have outbreaks of these preventable diseases that we are able to prevent through vaccination," Costello says. 

The CDC report also recommends that pediatricians administer the COVID-19 vaccine alongside the routine vaccinations kids might be behind on, as it becomes available. Currently, the COVID-19 vaccine is available for all children and teens over the age of 12, though clinical trials are underway for the Moderna and Pfizer vaccines for kids as young as 6 months.

Usually, getting children vaccinated is a low- or no-cost endeavor for parents and caregivers. The Department of Health and Human Services provides information for vaccine cost based on insurance-status, state, and more.