Addressing the Drop-off in Pediatric Immunization Rates

How COVID-19 Has Impacted the National Healthcare System

CDC-recommended pediatric vaccinations include HepA and B, RV, DTaP, Hib, PCV, IPV, MMR, influenza, and varicella, among others.1 A drop-off in immunization rates occurs nationally during the toddler years, leaving many children vulnerable to preventable diseases.2 These rates may be at further risk due to the impact of COVID-19 on the healthcare system, requiring additional education of parents on the importance of completing the pediatric vaccination series.

Consider these percentages of vaccinated children aged 19 to 35 months (2019)1:

Although DTaP and Hib incidence rates are low in the United States, these diseases have not disappeared, and, therefore, it is important to ensure patients complete their full vaccination series to help provide continuous protection, especially during the COVID-19 pandemic.3

aIncludes vaccinations received by age 24 months (before the day the child turns 24 months), except for ≥2 HepA doses by 35 months and Hib Primary series by 19 months. For all vaccines the Kaplan-Meier method was used to estimate vaccination coverage to account for children whose vaccination history was ascertained before age 24 months (35 months for ≥2 HepA doses, 19 months for and Hib Primary series).

bIncludes children who might have been vaccinated with diphtheria and tetanus toxoids vaccine or diphtheria, tetanus toxoids, and pertussis vaccine.

cHib primary series: receipt of ≥2 or ≥3 doses, depending on product type received; full series: primary series and booster dose,which includes receipt of ≥3 or ≥4 doses, depending on product type received.

See Data Below to Learn How COVID-19 Has Impacted DTaP and Hib Vaccination Opportunities in Your State

DTaP Vaccination Coverage by Age 24 Months, 20191

DTaP 3+ Doses
National Estimate 93.3% Indicator
DTaP 4+ Doses
National Estimate 80.6% Indicator
DTaP 3+ Doses to
4+ Doses Drop-offa

DTaP Drop-off Ratea Comparison by State1


Hib Vaccination Coverage by Age 24 Months, 20191

Hib Primaryb
National Estimate 91.4% Indicator
Hib Full
National Estimate 79.9% Indicator
Hib Primary to
Hib Full Drop-offa

Hib Drop-off Ratea Comparison by State1


aDrop-off is the difference between 3rd to 4th DTaP dose and primary to full series of Hib for children aged 19 to 35 months (2019). In some cases confidence intervals may overlap at the state level resulting in data that may not be statistically significant.

bIncludes vaccinations received by age 19 months for Hib Primary series by 19 months. The Kaplan-Meier method was used to estimate vaccination coverage to account for children whose vaccination history was ascertained before age 19 months for Hib Primary series.

National COVID Impacts

As a result of the COVID-19 pandemic, there has been a national increase in telehealth appointments. Additionally, job loss has resulted in lower rates of national insurance coverage. These factors have resulted in fewer in-office wellness visits in 2020, contributing missed opportunities for vaccination4,5.

National pediatric wellness visits in children aged 0-2 years have decreased by up to 50% in 2020 and have not recovered to typical annual rates4

Pediatric wellness visits decreased by over 50%4,a

Medicaid and Children’s Health Insurance Program (CHIP) enrollment participation increased by 7 million5,b

aData from January–December 2020.
bData from February–October 2020.

DTaP Claims, 2019 vs 20206,a

DTaP Vaccine Claims in 2019 vs 2020

*Reflects private insurance claims only.

The impact of the COVID-19 pandemic on routine pediatric wellness visits may have contributed to the decline in DTaP vaccine orders in last year. Therefore, many children could be behind on this vaccine series and lack full protection from preventable disease.

COVID-19 continues to impact .
Here are the latest statistics7:

COVID-19 Newly Diagnosed Cases and Change by Month

Percentage Change in Medicaid and CHIP Child Enrollment 2019 vs 20205,a

aMedicaid child enrollment data unavailable.

Average Mobility (by Month)4a
Compared to January 2020 baseline

*Mobility trends for each month are estimated as the average daily relative volume of Apple Maps directions requests per state compared to a baseline volume on January 13, 2020. Data for May 11-12, 2020 and March 12, 2021 is not available, therefore not included.

Data available as of 06/2021.

References: 1. 2016-2017 Childhood Vaccination Coverage Combined Birth Year Dashboard. Centers for Disease Control and Prevention. Updated September 28, 2020. Accessed May 13, 2021. 2. Mbaeyi SA. Maintaining and strengthening routine childhood vaccination during the COVID-19 pandemic. Centers for Disease Control and Prevention. Published August 4, 2020. Accessed February 13, 2021. archives/20/downloads/8_4/Sarah_Mbaeyi.pdf 3. Mbaeyi SA, Bozio CH, Duffy J, et al. Meningococcal vaccination: recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep. 2020;69(9):1-41. 4. The impact of COVID-19 on outpatient visits in 2020: visits remained stable, despite a late surge in cases. The Commonwealth Fund. Published February 22, 2021. Accessed May 13, 2021. 5. Corallo B and Rudowitz R. Analysis of recent national trends in Medicaid and CHIP enrollment. Published January 21, 2021. Accessed February 22, 2021. coronaviruscovid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/ 6. Data on file, IQVIA claims. 7. COVID data tracker. Accessed May 13, 2021.