In latest weeks, instances of respiratory syncytial virus (RSV) in youthful youngsters have surged, and the Facilities for Illness Management and Prevention (CDC) has reported seeing early will increase in seasonal flu instances. The CDC notes that the previous two years have seen low flu exercise, probably that means lowered inhabitants immunity headed into this years’ flu season, particularly amongst younger youngsters who’ve by no means been uncovered to or vaccinated towards the flu. Winter may additionally carry a rise in COVID-19 instances, because the climate will get colder and actions transfer indoors. Whereas youngsters’s instances of COVID-19 are often gentle, this isn’t at all times the case, and kids are significantly weak to flu and RSV. The mix of all three may have extra severe ramifications for kids and likewise has the potential to overwhelm hospitals. Vaccination towards COVID-19 and flu can present safety; nonetheless, COVID-19 vaccination charges have stalled and stay low for youthful youngsters and different routine vaccination charges might have been impacted by the pandemic. This coverage watch describes latest tendencies in youngsters’s COVID-19 and routine vaccinations and explores methods to extend vaccination charges amongst youngsters as we head into the winter season.
COVID-19 vaccine uptake amongst youngsters has stalled and vaccination charges stay low for younger youngsters. As of November 2, 2022, 3.2% of youngsters below age 5 and 31.8% of youngsters ages 5-11 had accomplished their main sequence, which is the preliminary doses of a COVID-19 vaccine, mostly two pictures of a mRNA vaccine however can range by age, immune standing, and vaccine product (Determine 1). Uptake is increased amongst these ages 12-17, at 61.1%. A few of this variation in uptake displays the period of time since COVID-19 vaccines had been approved by the FDA for various age teams. The vaccine was first approved for 16 and 17 year-olds in December 2020 and for 12-15 year-olds in Could 2021. It was approved for 5-11 year-olds in November of 2021 and eventually, for kids below age 5 in June of 2022. Nonetheless, a few of it displays parental views and issues. KFF’s COVID-19 Vaccine Monitor from September 2022 reported that over half (53%) of fogeys of youngsters below 5 and over a 3rd (35%) of fogeys of youngsters ages 5-11 mentioned they’ll “positively not” get their youngster vaccinated. KFF surveys from July 2022 discovered mother and father of younger youngsters had been involved in regards to the newness of the vaccine and never sufficient testing or analysis, negative effects, and worries over the general security of the vaccines.
Bivalent boosters had been not too long ago approved for kids ages 5 and older, however it’s unclear what number of youngsters will get the brand new booster. Kids’s vaccination charges for the primary booster (not approved) had been low. As of November 2nd, 5.3% of youngsters ages 5-11 and 18.2% of youngsters ages 12-17 had obtained their first booster dose. Completion of the first sequence not less than two months earlier is required to obtain the brand new bivalent booster; thus, low main sequence charges, particularly amongst youngsters ages 5-11, means fewer youngsters are eligible for the brand new booster. As of November 2nd, 0.5% of youngsters ages 5-11 and a pair of.6% of youngsters ages 12-17 have obtained an up to date (bivalent) booster dose. Whereas youngsters often have extra gentle COVID-19 instances, some youngsters do develop extreme sickness and a few have proven signs of lengthy COVID following analysis. Boosters fight waning immunity and can assist scale back the danger of an infection and onward transmission.
The pandemic has additionally led to declines in youngsters’s flu vaccinations, although the influence of the pandemic on different routine vaccinations stays unsure. Whereas youngsters’s flu vaccination charges from final yr’s flu season (2021-2022) had been much like the earlier yr (2020-2021), they had been nearly 6 share factors decrease than in 2019-2020, proper earlier than the pandemic started. Flu vaccination charges amongst youngsters range extensively by state and look like correlated with COVID-19 vaccination, that means states with increased uptake of flu vaccination final season even have increased uptake of COVID-19 vaccination, and vice versa (Determine 2). Some public well being leaders have expressed concern that COVID-19 vaccine hesitancy could also be spilling over to routine youngster immunizations, and one examine discovered components impacting COVID-19 vaccine uptake may very well be impacting flu vaccine uptake. As well as, vaccination charges for different routine childhood vaccines additionally declined early within the pandemic, and the CDC stories vaccination protection of all state-required vaccines for kids in kindergarten (MMR, DTaP, and varicella) declined barely by 1% within the 2020-2021 college yr (the primary full-pandemic college yr) in comparison with the earlier college yr. Some states and native areas have extra not too long ago reported seeing lowered childhood immunization charges. Nonetheless, CDC knowledge for the latest two college years usually are not but out there, and the general influence on childhood routine vaccination charges stays unclear at the moment.
There are particular coverage issues for vaccinating younger youngsters, and a few states have developed profitable methods for growing vaccination charges amongst youngsters. States with the best COVID-19 vaccination charges amongst youngsters ages 5-11 used incentives, school-based vaccination clinics, parent-friendly web sites, and the media to encourage mother and father to vaccinate their younger youngster. College vaccine mandates can be used as a instrument to extend COVID-19 vaccine uptake amongst youngsters, however at the moment, just a few states have COVID-19 vaccine mandates for college employees or college students. Preventive care appointments are additionally an vital part when addressing routine vaccination charges, as some mother and father might not encounter a suggestion of a vaccine till they go in for a routine go to to a pediatrician and pediatricians are thought-about extremely trusted sources of data by mother and father. Just lately, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted so as to add the COVID-19 vaccines to the advisable pediatric immunization schedule that features the opposite routine vaccines for kids relying on age. That is a part of a daily, annual course of wherein ACIP meets to vote on including newly advisable vaccines to the kid and grownup immunization schedules.
As a result of Medicaid covers 4 in ten youngsters within the U.S., this system can play an vital function in facilitating entry to COVID-19 and different routine vaccines for kids, particularly those that are low-income. To extend COVID-19 vaccine uptake, state Medicaid applications and Medicaid managed care plans have undertaken varied initiatives, together with monetary incentives for managed care plans that meet vaccination targets. Different latest federal actions can assist enhance routine vaccination charges extra broadly. Knowledge for kids enrolled in Medicaid and CHIP confirmed a 9% decline in all routine vaccinations when evaluating the COVID-19 public well being emergency (PHE) interval (March 2020 – April 2022) to a pre-PHE interval (January 2018 – February 2020), with the most important declines for HPV, hepatitis A, and flu vaccines. Provisions included in latest laws to bolster Medicaid’s Early and Periodic Screening, Diagnostic and Therapy (EPSDT) profit can assist extra Medicaid-covered youngsters obtain all advisable screenings and companies, which incorporates routine vaccinations. Additional, the Baby Core Set measures, designed to enhance the standard of care for kids in Medicaid and CHIP, will turn out to be necessary to report in 2024 and monitor state-level immunization charges for kids and adolescents.
Kids will nonetheless be capable to entry wanted COVID-19 vaccines at no cost following the tip of the COVID-19 PHE and even when federal provides of vaccines run out. Whereas the tip of the PHE in addition to the depletion of federally-purchased provide may curtail entry to some COVID-19 countermeasures like exams and coverings, COVID-19 vaccines, together with boosters, will proceed to be out there at no cost to all youngsters even when there is no such thing as a longer any federally-purchased provide remaining or PHE protections in place. As soon as the availability of government-purchased vaccines runs out, the Vaccines for Kids program (VFC) will present entry to COVID-19 vaccines for kids who’ve Medicaid, who’re uninsured or underinsured, or determine as American Indian or Alaska Native. Whereas vaccines are free by way of the VFC program, taking part well being care suppliers can cost an administrative payment. Kids who’re uninsured could also be eligible at no cost or lowered value off vaccine administration by way of a group well being heart.
As we head into the winter season, RSV and different respiratory viral infections are surging in younger youngsters, flu infections are increased than normal for the time of yr, and COVID-19 instances are additionally anticipated to rise. At identical time, youngsters’s COVID-19 vaccination charges have stalled and stay low, and different routine youngsters’s vaccinations might have additionally declined for the reason that pandemic started. Whereas most youngsters have gentle COVID-19 instances, vaccines can provide safety for kids and households as travelling and gatherings ramp up for the vacation season. Numerous instruments, together with incentives, outreach, and the media, can be utilized to extend youngsters’s COVID-19 vaccination charges in addition to routine vaccinations extra broadly.