CoChat
Sign Up
Cited by 297Vaccine Coverage and HesitancyCOVID-19 and healthcare impactsCOVID-19 epidemiological studies

Decline in child vaccination coverage during the COVID-19 pandemic—Michigan Care Improvement Registry, May 2016–May 2020.

Open access
Bramer, Cristi A., Kimmins, Lynsey M., Swanson, Robert, Kuo, Jeremy, Vranesich, Patricia, Jacques-Carroll, Lisa A., Shen, Angela K.·2020·MMWR. Morbidity and Mortality Weekly Report
DOI 10.15585/mmwr.mm6920e1
Open this paper in CoChat — free accountOpen PDF

Abstract

On March 13, 2020, the United States declared a national state of emergency to control the pandemic spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1). Public health response measures to mitigate the pandemic have centered on social distancing and quarantine policies, including shelter-in-place and stay-at-home orders. Michigan implemented a stay-at-home order on March 23, 2020, to facilitate social distancing (2). Such strategies might result in decreased accessibility to routine immunization services, leaving children at risk for vaccine-preventable diseases and their complications (3). To evaluate whether vaccination coverage has changed during the pandemic, data from the Michigan Care Improvement Registry (the state's immunization information system) (MCIR) were analyzed. Changes in vaccine doses administered to children and the effects of those changes on up-to-date status were examined for vaccinations recommended at milestone ages corresponding to the end of an Advisory Committee on Immunization Practices (ACIP) recommendation period for one or more vaccines (4).

AI snapshot

Written from the paper’s full text.

TL;DR

Using Michigan’s immunization information system, this report found declines in child vaccination coverage across most milestone age cohorts during the COVID-19 pandemic, with a notable drop at age 5 months and fewer noninfluenza vaccine doses administered in early 2020. Coverage was lower among Medicaid-enrolled children than among children not enrolled in Medicaid.

Key findings

  • Vaccination coverage declined in all milestone age cohorts except birth-dose hepatitis B coverage, which is typically administered in the hospital setting.
  • Among children aged 5 months, up-to-date status for all recommended vaccines fell from approximately two thirds during 2016–2019 (66.6%, 67.4%, 67.3%, and 67.9%, respectively) to 49.7% in May 2020.
  • In the 16-month cohort, measles-containing vaccination coverage decreased from 76.1% in May 2019 to 70.9% in May 2020.
  • Noninfluenza vaccine doses administered and reported to MCIR decreased 21.5% for children aged ≤18 years and 15.5% for children aged ≤24 months during January–April 2020 compared with averages for the same periods in 2018 and 2019.
  • In May 2020, up-to-date series coverage was lower for Medicaid-enrolled children than for children not enrolled in Medicaid; the largest difference was at age 7 months, where 34.6% of Medicaid-enrolled children were up-to-date versus 55.0% of children not enrolled in Medicaid.

Methods

  • The study analyzed data from the Michigan Care Improvement Registry (MCIR), Michigan’s immunization information system.
  • Vaccination status was assessed for milestone age cohorts of children at ages 1, 3, 5, 7, 16, 19, and 24 months, with an average sample size of 9,269 for 2016–2019 and 9,539 for 2020.
  • Up-to-date status was assessed at a point in time in May 2020 and compared with 1-month age cohort assessments in May 2016–May 2019; noninfluenza vaccine doses administered and reported to MCIR for children aged ≤18 years and ≤24 months were examined during January–April 2020 compared with averages for the same period in 2018 and 2019.

Limitations

  • The paper does not include an explicit limitations section.
  • Evident from the design: this is an observational analysis using a single state’s immunization registry, with point-in-time comparisons and no causal inference.
  • Evident from the design: the analysis compares May 2020 with prior May assessments and January–April 2020 with 2018–2019 averages, without adjustment for potential confounders.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.15585/mmwr.mm6920e1

Cites

2 of 2 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 1 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § Decline in Child Vaccination Coverage During the COVID-19 Pandemic -Michigan Care Improvement Registry, May 2016-May 2020

    Noninfluenza vaccine doses administered to children aged ≤24 months decreased 15.5% during January-April 2020 relative to the average of the same periods in 2018 and 2019.

    “the number of noninfluenza vaccine doses administered and reported for children aged ≤18 years decreased 21.5%, and the number of doses administered to children aged ≤24 months decreased 15.5% during January-April 2020, compared with the same averaged periods in 2018 and 2019.”
    Quote in the paperSubstantial claim
  • Findingown data
    § Decline in Child Vaccination Coverage During the COVID-19 Pandemic -Michigan Care Improvement Registry, May 2016-May 2020

    In May 2020, up-to-date series coverage for each milestone age cohort (1, 3, 5, 7, 16, 19 and 24 months) was lower among Medicaid-enrolled children than among children not enrolled in Medicaid.

    “Up-to-date series coverage for each age cohort (1, 3, 5, 7, 16, 19, and 24 months) assessed in May 2020 was lower for Medicaid-enrolled children than for those children not enrolled in Medicaid.”
    Quote in the paperSubstantial claim
  • Findingown data
    § Decline in Child Vaccination Coverage During the COVID-19 Pandemic -Michigan Care Improvement Registry, May 2016-May 2020

    In Michigan, vaccination coverage declined in every milestone age cohort assessed in May 2020 except birth-dose hepatitis B coverage.

    “Vaccination coverage declined in all milestone age cohorts, except for birth-dose hepatitis B coverage, which is typically administered in the hospital setting (Figure ).”
    Quote in the paperSubstantial claim
  • Findingown data
    § Decline in Child Vaccination Coverage During the COVID-19 Pandemic -Michigan Care Improvement Registry, May 2016-May 2020

    Among Michigan children aged 5 months, up-to-date status for all recommended vaccines fell from roughly two thirds in May 2016-2019 (66.6%, 67.4%, 67.3%, 67.9%) to 49.7% in May 2020.

    “Among children aged 5 months, up-to-date status for all recommended vaccines declined from approximately two thirds of children during 2016-2019 (66.6%, 67.4%, 67.3%, 67.9%, respectively) to fewer than half (49.7%) in May 2020.”
    Quote in the paperSubstantial claim
  • Findingown data
    § Decline in Child Vaccination Coverage During the COVID-19 Pandemic -Michigan Care Improvement Registry, May 2016-May 2020

    In the 16-month age cohort, measles-containing vaccination coverage fell from 76.1% in May 2019 to 70.9% in May 2020.

    “For the 16-month age cohort, coverage with all recommended vaccines declined, with measles-containing vaccination coverage decreasing from 76.1% in May 2019 to 70.9% in May 2020.”
    Quote in the paperSubstantial claim
  • May combine two claims. 2
  • Classified as probably not a substantial claim. 1

  • May combine two claims.

    Findingown data
    § Decline in Child Vaccination Coverage During the COVID-19 Pandemic -Michigan Care Improvement Registry, May 2016-May 2020

    In the 7-month cohort assessed in May 2020, 34.6% of Medicaid-enrolled children were up-to-date for the recommended series, compared with 55.0% of children not enrolled in Medicaid.

    “The largest difference was in the age 7 months cohort assessed in May 2020; in that cohort, 34.6% of Medicaidenrolled children were up-to-date for their recommended series, compared with 55.0% of children not enrolled in Medicaid.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § Decline in Child Vaccination Coverage During the COVID-19 Pandemic -Michigan Care Improvement Registry, May 2016-May 2020

    Pandemic mitigation strategies such as social distancing and stay-at-home orders might reduce access to routine immunization services, putting children at risk of vaccine-preventable diseases and their complications.

    “Such strategies might result in decreased accessibility to routine immunization services, leaving children at risk for vaccine-preventable diseases and their complications (3).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Santoli, 2020, Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration—United States, 2020, MMWR Morb Mortal Wkly Rep source

      Not checked in the free run.

2 of 2

  • The paper relies on this without support.

    Measles vaccination coverage of 90%-95% is the level needed to establish herd immunity.

    “If measles vaccination coverage of 90%-95% (the level needed to establish herd immunity) is not achieved, measles outbreaks can occur.”

  • The paper relies on this without support.

    Measles outbreaks can occur when measles vaccination coverage falls below 90%-95%.

    “If measles vaccination coverage of 90%-95% (the level needed to establish herd immunity) is not achieved, measles outbreaks can occur.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Bramer, C. A., Kimmins, L. M., Swanson, R., Kuo, J., Vranesich, P., Jacques-Carroll, L. A., & Shen, A. K.
Corresponding author
Bramer, Cristi A.
ORCID
Shen, Angela K.
Venue
MMWR. Morbidity and Mortality Weekly Report
Publisher
Centers for Disease Control MMWR Office
Published
2020-05-22
Volume
69
Issue
20
Pages
630-631
ISSN
  • 0149-2195 (ISSN-L)
  • 1545-861X
DOI
10.15585/mmwr.mm6920e1
OpenAlex
W3024637813
Semantic Scholar
ee9b1379e7e406be53e9ecc26d29d2ad5303301c
Cited by
297
References
2
Citations by year
2026: 5 · 2025: 17 · 2024: 26 · 2023: 43 · 2022: 46 · 2021: 109 · 2020: 51
FWCI
34.42
Type
journal article
Language
en
Open access
Locations
  • MMWR Morbidity and Mortality Weekly Report (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
  • Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
  • Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
Keywords
childhood vaccination coverage, COVID-19 pandemic, vaccine-preventable diseases, stay-at-home orders, social distancing, immunization information systems, Michigan
MeSH terms
Vaccination Coverage, COVID-19, Child, Preschool, Humans, Infant, Michigan, Pneumonia, Viral, Registries, Coronavirus Infections, Pandemics, Quality Improvement

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review