On October 22, 2020, CDC released the results of the 2019 National Immunization Survey-Child (NIS-Child), “Vaccination Coverage by Age 24 Months Among Children Born in 2016 and 2017 – National Immunization Survey-Child, United States, 2017-2019”.

The NIS-Child monitors coverage with vaccines recommended for children age <24 months to protect against 14 potentially serious illnesses. Overall report findings indicate that national coverage for many recommended vaccines remains high and stable, and there has been some increase for several vaccines among children born during 2016-2017. Data also indicate that large coverage disparities by health insurance coverage and poverty status persist. These survey findings highlight the disruption in routine medical care caused by the COVID-19 pandemic. CDC noted that extra effort will be needed to achieve and maintain high immunization coverage for routinely recommended childhood vaccines, and this is especially important for the seasonal influenza vaccine to mitigate the effect of cocirculation of two serious respiratory viruses.

CDC provided the below highlights and recommendations:

• Key Findings:
  • National coverage by age 24 months remained stable and high, with over 90 percent getting the recommended vaccines that prevent measles, mumps, and rubella (MMR), polio, hepatitis B and varicella.
  • Coverage with two doses of flu vaccine by age 24 months was higher for children born during 2016-2017 (58.1%) compared to those born during 2014-2015 (53.8%), but was the lowest among all vaccines studied.
  • Only 1.2% of children had received no vaccinations by age 24 months.
  • CDC’s analysis also highlighted access-related hurdles, such as health insurance status, that keep some parents from getting their children vaccinated.
    • The prevalence of being completely unvaccinated was highest among uninsured children (4.1%), lower among those enrolled in Medicaid (1.3%), and lowest among those with private insurance (0.8%).
  • Disparities in coverage were also observed by race/ethnicity, poverty level, and metropolitan statistical area status.
  • Considering the disruptions to healthcare provider operations caused by the COVID-19 pandemic, extra effort will be required to achieve and maintain high levels of coverage with routine childhood vaccinations.
    • This is particularly critical among uninsured children and those insured by Medicaid.
  • Parents and providers should use the visit at which a flu vaccine is administered as an opportunity for the child to receive other recommended vaccinations that are due or might have been missed due to COVID-related disruptions.

• Call to Action to Parents:
  • During the COVID-19 outbreak, it’s important to stay on track with your child’s routine vaccinations to avoid preventable, and sometimes deadly diseases like measles and whooping cough.
    • Ask your doctor about ways they safely offer well-child visits during this outbreak.
    • When your child receives a flu vaccination, ask your doctor about other recommended vaccinations that are due or may have been missed this year.
  • This year, flu vaccination is particularly important to help protect people from flu and its potentially serious complications, as well as to alleviate stress on the healthcare system during the COVID-19 pandemic.
  • New CDC data shows that less than 60 percent of children received their recommended doses of flu vaccine by 24 months.
    • Because of their age, children younger than 5 are at high risk of serious flu complications, even if they are otherwise healthy.
    • There were 189 pediatric deaths reported to CDC last season, which is the highest recorded number for pediatric flu deaths reported during a regular flu season.
      • The majority of children who have died in recent seasons were unvaccinated, so this is a tragic reminder of how deadly the flu can be.
    • Children 6 months through 8 years getting vaccinated for the first time, and those who have only previously gotten one dose of vaccine, should get two doses of vaccine this season.
  • For parents who recently lost their insurance or whose insurance no longer covers vaccines, CDC’s Vaccines for Children (VFC) Program helps provide vaccines at no cost to children whose parents or guardians may not be able to afford them.
    • Talk to your doctor about how to make sure your child stays up to date on his/her vaccinations regardless of your financial circumstances.

• Call to Action to Providers:

• • Health care providers are a valued and trusted source of health information – and can serve as a key influencer in decisions by patients to get vaccinated.
  • Due to the COVID-19 pandemic, there was a dramatic decrease earlier this year in outpatient medical visits, including well-child visits, as well as a reduction in administration of routine childhood vaccines.
  • Services have largely been restored, yet vaccine distribution and claims data demonstrate an ongoing deficit in childhood vaccination.
    • Reductions were less and recovery was greater for vaccines administered to infants, so the remaining gaps are greater among older children.
    • Extra effort will be required to achieve and maintain high levels of vaccine coverage.
  • Providers should use every opportunity to safely administer recommended vaccines to children during the COVID-19 pandemic, with particular attention to flu vaccination this fall and winter.
    • If you are administering a flu vaccine to a child, talk to the parents or guardian about catching up on other recommended vaccines that are due or might have been missed due to COVID-related disruptions.
    • Health systems can send reminders to families whose children are behind on visits to help improve vaccination coverage.
  • Despite challenges caused by the COVID-19 pandemic, we must remain vigilant in efforts to ensure that children get the vaccines they need to protect against serious and sometimes deadly disease.

Visit CDC’s webpage to view the full Morbidity and Mortality Weekly Report (MMWR). View the American Immunization Registry Association’s (AIRA) webpage for additional guidance in interpreting and communicating vaccination coverage data from IIS and NIS-Child.