The DOI matches its Crossref record; 2 of the 2 references it cites were found in a registry or an index; none of the 1 sources its claims cite is checked for support yet.
Decline in child vaccination coverage during the COVID-19 pandemic—Michigan Care Improvement Registry, May 2016–May 2020.
Open accessAbstract
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).
Overview
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
Cites
Statistics
Verification
Claims the paper makes
7 Own result · 1 Not checked yet
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Vaccination coverage declined in all milestone age cohorts, except for birth-dose hepatitis B coverage, which is typically administered in the hospital setting (Figure ).”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 2
- Probably not a substantial claim. 1
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Such strategies might result in decreased accessibility to routine immunization services, leaving children at risk for vaccine-preventable diseases and their complications (3).”
What the sources say
- Not checked yetcites [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
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
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.”
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?
The cited source says what the claim attributes to it.
In the citing paper
“After the March 2020 declaration of the COVID-19 pandemic in the United States, an analysis of provider ordering data from the federally funded Vaccines for Children program found a substantial decrease in routine pediatric vaccine ordering (1), and data from New York City and Michigan indicated sharp declines in routine childhood vaccine administration in these areas (2,3).”
Citations
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Changes in Influenza Activity and Circulating Subtypes During the COVID-19 Outbreak in China
Zheng, L., Qi, J., Wu, J., et al. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.829799 · Cited by 36
Abu-rish, E. Y., Bustanji, Y. K., & Abusal, K. (2022) · International Journal of Clinical Practice · doi:10.1155/2022/7918604 · Cited by 35
“Several early reports described a decline in vaccination coverage during the pandemic in Pakistan [2], England [3], USA [4], Saudi Arabia [5], Canada [6], and many other countries [7, 8].”
InfluentialCOVID-19 pandemic impact on childhood vaccination coverage in Quebec, Canada
Kiely, M., Mansour, T., Brousseau, N., Rafferty, E., Paudel, Y. R., Sadarangani, M., Svenson, L. W., Robinson, J. L., Gagneur, A., Driedger, S. M., et al. (2021) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2021.2007707 · Cited by 32
“Similar to Bramer et al.(8) we observed a reduction in VC for all milestone age cohorts less than two years in May 2020.”
MethodHong, K., Zhou, F., Tsai, Y., et al. (2021) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7007a4 · Cited by 35
Impact of the 2020 COVID-19 Pandemic on Ambulatory Hepatitis C Testing
Sperring, H., Ruiz-Mercado, G., & Schechter‐Perkins, E. M. (2020) · Journal of Primary Care & Community Health · doi:10.1177/2150132720969554 · Cited by 34
Cancelled routine vaccination appointments due to COVID-19 pandemic in Germany
Schmid-Küpke, N., Matysiak‐Klose, D., Siedler, A., Felgendreff, L., Wieler, L. H., Thaiss, H. M., & Betsch, C. (2021) · Vaccine X · doi:10.1016/j.jvacx.2021.100094 · Cited by 32
Changes in childhood vaccination during the coronavirus disease 2019 pandemic in Japan
Aizawa, Y., Katsuta, T., Sakiyama, H., Tanaka‐Taya, K., Moriuchi, H., & Saitoh, A. (2021) · Vaccine · doi:10.1016/j.vaccine.2021.05.050 · Cited by 31
School closures were over-weighted against the mitigation of COVID-19 transmission
Tan, W. (2021) · Medicine · doi:10.1097/md.0000000000026709 · Cited by 33
Influenza Vaccine Uptake in the United States before and during the COVID-19 Pandemic
McGovern, I., Bogdanov, A., Cappell, K. A., et al. (2022) · Vaccines · doi:10.3390/vaccines10101610 · Cited by 34
COVID-19 vaccination and governance in the case of low, middle and high-income countries
Lupu, D., & Țigănașu, R. (2023) · BMC Public Health · doi:10.1186/s12889-023-15975-3 · Cited by 34
Mandatory Infant Vaccinations in France During the COVID-19 Pandemic in 2020
Taine, M., Offredo, L., Drouin, J., et al. (2021) · Frontiers in Pediatrics · doi:10.3389/fped.2021.666848 · Cited by 33
Mitchell, T., Dalal, W., Klosovsky, A., Yen, C., Phares, C. R., Burkhardt, M., Amin, F., Froes, I., Hamadeh, A., Lynn, S. A., et al. (2020) · Vaccine · doi:10.1016/j.vaccine.2020.10.047 · Cited by 24
Public health management of pertussis in adults: Practical challenges and future strategies
MacIntyre, C. R., de Sousa, J. C., Heininger, U., Kardos, P., Konstantopoulos, A., Middleton, D. B., Nolan, T. M., Papi, A. A., Rendón, A., Rizzo, A., et al. (2024) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2024.2377904 · Cited by 40
“71,72 Conversely, for Tdap vaccination in pregnancy, coverage has been maintained or showed no pronounced decline in developed countries.”
BackgroundVogt, T. M., Zhang, F., Banks, M., Black, C. L., Arthur, B. C., Kang, Y., Lucas, P., & Lamont, B. (2020) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6927a2 · Cited by 32
Bechini, A., Garamella, G., Giammarco, B., Zanella, B., Flori, V., Bonanni, P., & Boccalini, S. (2020) · Journal of preventive medicine and hygiene · doi:10.15167/2421-4248/jpmh2020.61.2.1626 · Cited by 32
“[10], who used Michigan Care Improvement Registry (MCIR) data in order to evaluate the status of vaccinations of multiple cohorts of children (between 1 and 24 months) and to compare the period May 2016-May 2019 and the period JanuaryApril 2020.”
MethodCourtney, J. G., Chuke, S. O., Dyke, K., Credle, K., Lecours, C., Egan, K. B., & Leonard, M. (2021) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7005a2 · Cited by 29
Recommendations for Prevention and Control of Influenza in Children, 2023–2024
O’Leary, S. T., Campbell, J. D., Ardura, M. I., Banerjee, R., Bryant, K. A., Caserta, M. T., Frenck, R. W., Gerber, J. S., John, C. C., Kourtis, A. P., et al. (2023) · PEDIATRICS · doi:10.1542/peds.2023-063773 · Cited by 35
Tuppin, P., Lesuffleur, T., Constantinou, P., et al. (2022) · BMC Family Practice · doi:10.1186/s12875-022-01792-x · Cited by 28
The indirect health impacts of the COVID-19 pandemic on children and adolescents: A review
Oostrom, T. G., Cullen, P., & Peters, S. A. E. (2022) · Journal of Child Health Care · doi:10.1177/13674935211059980 · Cited by 29
Chelo, D., Nguefack, F., Enyama, D., et al. (2021) · Archives de Pédiatrie · doi:10.1016/j.arcped.2021.05.006 · Cited by 27
Parent Attitudes Towards Childhood Vaccines After the Onset of SARS-CoV-2 in the United States
Opel, D. J., Furniss, A., Zhou, C., et al. (2022) · Academic Pediatrics · doi:10.1016/j.acap.2022.06.014 · Cited by 26
Impact of the COVID-19 pandemic on pediatricians’ clinical activity in Cameroon
Enyama, D., Chelo, D., Njinkui, D. N., Kouam, J. M., Puepi, Y. F. D., Nkwele, I. M., Ndenbe, P., Nguefack, S., Nguefack, F., Koum, D. K., et al. (2020) · Archives de Pédiatrie · doi:10.1016/j.arcped.2020.09.004 · Cited by 25
Eiden, A. L., DiFranzo, A., Bhatti, A. A., Wang, H. E., Benčina, G., Yao, L., Saxena, K., Chen, Y.-T., & Kujawski, S. A. (2023) · Expert Review of Vaccines · doi:10.1080/14760584.2023.2217257 · Cited by 26
Delays in Children’s Preventive Health Services During the COVID-19 Pandemic
Nguyen, K. H., Nguyen, K., Lekshmi, D., et al. (2022) · Family Medicine · doi:10.22454/fammed.2022.922801 · Cited by 25
McNally, V. V., & Bernstein, H. H. (2020) · Pediatric Annals · doi:10.3928/19382359-20201115-01 · Cited by 24
Faktor yang Memengaruhi Penurunan Cakupan Imunisasi pada Masa Pandemi Covid-19 di Jakarta
Mukhi, S., & Medise, B. E. (2021) · Sari Pediatri · doi:10.14238/sp22.6.2021.336-42 · Cited by 31
Sindoni, A., Baccolini, V., Adamo, G., et al. (2021) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2021.1950505 · Cited by 24
“In the United States, for example, vaccination coverage has decreased for most vaccinations except for those administered in the hospital setting.(32) In England, MMR vaccination coverage in 2020 was 19.”
BackgroundRecommendations for Prevention and Control of Influenza in Children, 2022–2023
COMMITTEE ON INFECTIOUS DISEASES (2022) · PEDIATRICS · doi:10.1542/peds.2022-059275 · Cited by 26
O’Leary, S., & Frost, H. M. (2023) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2023.2180971 · Cited by 22
Kazi, A. M., Ahsan, N., Jamal, S., Khan, A., Mughis, W., Allana, R., Kazi, A. N., Kalimuddin, H., Ali, A., McKellin, W. H., et al. (2021) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2021.104600 · Cited by 20
Jimma, M. S., GebreEyesus, F. A., Chanie, E. S., et al. (2021) · Pediatric Health Medicine and Therapeutics · doi:10.2147/phmt.s306475 · Cited by 21
“Strategies like stay-at-home, social distancing results in decreased accessibility to routine immunization services and make children at risk for vaccine preventable-diseases and also its complications.(25) The mitigation measures adopted to control the COVID-19 pandemic threaten to undo the progress achieved in the c…”
BackgroundEmergency unemployment benefits and health care spending during Covid
Evangelist, M., Wu, P., & Shaefer, H. L. (2021) · Health Services Research · doi:10.1111/1475-6773.13772 · Cited by 20
Dong, A., Meaney, C. A., Sandhu, G., Oliveira, N. D., Singh, S., Morson, N., & Forte, M. (2022) · CMAJ Open · doi:10.9778/cmajo.20210084 · Cited by 20
“4,5 A large study, based at a multisite primary care network in Columbus, Ohio, reported declining vaccination rates from existing low rates at baseline.”
The Hidden Impact of the COVID-19 Pandemic on Routine Childhood Immunization Coverage in Cameroon
Saidu, Y., Mattei, P. D., Nchinjoh, S. C., Nnang, N. E., Nsah, B., Muteh, N. J., Ndoula, S. T., Abdullahi, R., Stein‐Zamir, C., Njoh, A. A., et al. (2023) · Vaccines · doi:10.3390/vaccines11030645 · Cited by 20
“Other studies reported a similar decline in immunization indicators during the pandemic [21,22].”
ResultMitigating the Impacts of COVID-19 on Global Child Health: a Call to Action
Garcia‐Prats, A. J., McAdams, R. M., Matshaba, M., Thahane, L., Butteris, S. M., Conway, J. H., Slutsker, M., Clair, N. E. S., & Haq, H. A. (2021) · Current Tropical Medicine Reports · doi:10.1007/s40475-021-00241-6 · Cited by 19
Effects of the COVID-19 pandemic on routine pediatric vaccination in Brazil
Santos, V. S., Vieira, S. C. F., Barreto, Í. D. D. C., de Gois-Santos, V. T., Celestino, A. O., Domingues, C. M. A. S., Cuevas, L. E., & Gurgel, R. Q. (2021) · Expert Review of Vaccines · doi:10.1080/14760584.2021.1990045 · Cited by 18
Chang, S. Y., Bisht, A., Faysman, K., Schiller, G. J., Uslan, D. Z., & Multani, A. (2021) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofab326 · Cited by 18
Measles and Rubella during COVID-19 Pandemic: Future Challenges in Japan
Shimizu, K., Teshima, A., & Mase, H. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18010009 · Cited by 19
Grabert, B. K., Heisler-MacKinnon, J., Liu, A. W. K., et al. (2021) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2021.1913965 · Cited by 18
Suárez-Rodríguez, G. L., Salazar-Loor, J., Rivas-Condo, J. R., Rodriguez-Morales, A. J., Navarro, J. C., & Ramírez-Iglesias, J. R. (2022) · Vaccines · doi:10.3390/vaccines10060857 · Cited by 21
Metadata
- 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
- Published
- 2020-05-22
- Volume
- 69
- Issue
- 20
- Pages
- 630-631
- ISSN
- 0149-2195 (ISSN-L)
- 1545-861X
- 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
- diamond
- doi.org
- 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
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