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
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Cites
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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
Cites
American Academy of Family Physicians
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Santoli, J. M., Lindley, M. C., DeSilva, M. B., Kharbanda, E. O., Daley, M. F., Galloway, L., Gee, J., Glover, M., Herring, B., Kang, Y., et al. (2020) · MMWR. Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6919e2 · Cited by 701
Cited by
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da Silva, T. P. R., Brandão, L. G. V. A., Vieira, E. W. R., et al. (2022) · Vaccine X · doi:10.1016/j.jvacx.2022.100156 · Cited by 17
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Sell, H., Paudel, Y. R., Voaklander, D. C., et al. (2023) · Vaccine · doi:10.1016/j.vaccine.2023.01.011 · Cited by 14
“This decline in coverage seen during the pandemic is consistent with previous literature on other routine immunizations internationally, including infant, [15–16] preschool, [7,15] and adolescent.”
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“However, strict adherence to home quarantine created a new problem that placed infants and children at a great disadvantage of missed evaluations by medical personnel (3, 4).”
BackgroundLetter: Impact of the COVID-19 pandemic on pharmacist-administered vaccination services
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“For example, this tool could be used to monitor unexpected events such as the COVID-19 pandemic disruption of routine vaccination administration [18].”
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HESITAÇÃO VACINAL DE PAIS E FAMILIARES DE CRIANÇAS E O CONTROLE DAS DOENÇAS IMUNOPREVENÍVEIS
Viana, I. D. S., Cursino, E. G., Miranda, P. D. S., da Silva, L. F., & Machado, M. E. D. (2023) · Cogitare Enfermagem · doi:10.1590/ce.v28i0.84290 · Cited by 22
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“La couverture vaccinale contre la rougeole assurée à l ́âge de 16 mois est passée de 76,1% en mai 2019 à 70% en mai 2020 [13].”
BackgroundChanges in parents' attitudes towards childhood vaccines during COVID ‐19 pandemic
Duran, S., Duran, R., Acunaş, B., & Şahi̇n, E. M. (2023) · Pediatrics International · doi:10.1111/ped.15520 · Cited by 10
“14,15 In the United States, after the declaration of the COVID-19, the total number of childhood vaccine doses decreased significantly.”
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Recommendations for Prevention and Control of Influenza in Children, 2024–2025: Technical Report
O’Leary, S. T., Campbell, J. D., Ardura, M. I., Bryant, K. A., Caserta, M. T., Espinosa, C. M., Frenck, R. W., Healy, C. M., John, C. C., Kourtis, A. P., et al. (2024) · PEDIATRICS · doi:10.1542/peds.2024-068508 · Cited by 11
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“Decreases in vaccination coverage are often related to a population’s socioeconomic status and geographic conditions(1,15-17), characteristics related to structural conditions and supply and access to health services in each location(6,16,18) and more recently the COVID-19 pandemic(19-20).”
BackgroundTemporal trends in vaccination coverage in the first year of life in Brazil
Neves, A. B. B., Silva, L., Amaral, G. M. C., et al. (2023) · Revista Paulista de Pediatria · doi:10.1590/1984-0462/2024/42/2023020 · Cited by 9
“28 The present findings align with previous research that shows a decline in the coverage of 90% of the vaccines offered to children under the age of 1 in comparison to previous years, including the year 2020, which was heavily impacted by the pandemic.”
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Vasireddy, D., Malayala, S. V., Atluri, P., et al. (2021) · Journal of Clinical Medicine Research · doi:10.14740/jocmr4403 · Cited by 7
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“Comparing the number of doses from one month to the next within the same year might be highly misleading when evaluating the impact of a pandemic on immunization rates [21, 33, 34].”
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Completion of multidose vaccine series in early childhood: current challenges and opportunities
Michels, S. Y., Daley, M. F., & Newcomer, S. R. (2024) · Current Opinion in Infectious Diseases · doi:10.1097/qco.0000000000001007 · Cited by 5
Liu, Y., Bai, Z., Yang, T., et al. (2024) · BMC Pediatrics · doi:10.1186/s12887-024-05082-6 · Cited by 5
“The American CDC reported a 21.5% decrease in childhood vaccination coverage in 2020 [31].”
BackgroundInfluentialAlves, Y. M., Berra, T. Z., Tavares, R. B. V., et al. (2024) · Vaccines · doi:10.3390/vaccines12121434 · Cited by 5
COVID-19 and Completion of Select Routine Childhood Vaccinations
DeSilva, M. B., Haapala, J., Vazquez‐Benitez, G., et al. (2025) · PEDIATRICS · doi:10.1542/peds.2024-068244 · Cited by 5
A história da vacina e seus benefícios
Santos, V. A. R., & de Almeida, M. E. F. (2024) · Research Society and Development · doi:10.33448/rsd-v13i1.44652 · Cited by 13
Vaccine Coverage at 36 Months and 7 Years by Parental Birth Country, Washington State
Tasslimi, A., Bell, T. R., Moore, T. P., et al. (2024) · PEDIATRICS · doi:10.1542/peds.2023-064626 · Cited by 5
Is it time to reconsider measles, mumps, and rubella immunisation strategies?
Boccalini, S., & Bechini, A. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30519-3 · Cited by 5
The role of epidemiology in informing United States childhood immunization policy and practice
Carter‐Pokras, O., Hutchins, S. S., Gaudino, J. A., et al. (2020) · Annals of Epidemiology · doi:10.1016/j.annepidem.2020.09.017 · Cited by 5
Vaksin SARS-CoV-2: Tinjauan Kepustakaan
Husada, D. (2020) · Journal Of The Indonesian Medical Association · doi:10.47830/jinma-vol.70.10-2020-254 · Cited by 5
Jayaraj, J., Ganesan, S., & Geminiganesan, S. (2023) · International Journal of Community Medicine and Public Health · doi:10.18203/2394-6040.ijcmph20232050 · Cited by 5
Place of distancing measures in containing epidemics: a scoping review
Chebil, D., Hassine, D. B., Melki, S., Nouira, S., Rebai, W. K., Hannachi, H., Merzougui, L., & Abdelaziz, A. B. (2022) · Libyan Journal of Medicine · doi:10.1080/19932820.2022.2140473 · Cited by 4
Perinatal Hepatitis B Prevention: Eliminating Disease and Disparity
Chung, E. K., & Enquobahrie, D. A. (2021) · PEDIATRICS · doi:10.1542/peds.2020-037549 · Cited by 4
Atkinson, K. M., Ntacyabukura, B., Hawken, S., et al. (2022) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2022.2158005 · Cited by 4
High coverage and timeliness of vaccination of children under 6 years of age in Risaralda, Colombia
Machado‐Alba, J. E., Machado‐Duque, M. E., & Vargas-Zambrano, J. C. (2023) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2023.2257424 · Cited by 4
“…to the difficulty of access to vaccines during quarantines and other situations occurring during the pandemic, which are not yet fully established, 40–43 These findings highlight the importance of continued investment in vaccination programs to improve health outcomes and reduce economic burden…”
BackgroundDisparities in Unmet Health Care Needs Among US Children During the COVID-19 Pandemic
Pampati, S., Liddon, N. C., Stuart, E. A., Waller, L. A., Mpofu, J. J., Lopman, B. A., Adkins, S. H., Guest, J. L., & Jones, J. S. (2024) · The Annals of Family Medicine · doi:10.1370/afm.3079 · Cited by 4
Closson, K., Karim, M. E., Sadarangani, M., et al. (2020) · Vaccine · doi:10.1016/j.vaccine.2020.10.033 · Cited by 4
Theiß, K., Simon, A., Graf, N. M., et al. (2021) · Monatsschrift Kinderheilkunde · doi:10.1007/s00112-021-01125-9 · Cited by 4
COVID-19 y coberturas de vacunación del calendario regular del Paraguay, efecto de la pandemia
Araya, S., Perez, T., Troche, A. V., et al. (2021) · Pediatría (Asunción) · doi:10.31698/ped.48032021003 · Cited by 4
Factors Influencing Maternal Antepartum Tdap Vaccination
Bernstein, H. H., Tong-Miller, S., Cleary, S. S., et al. (2022) · Maternal and Child Health Journal · doi:10.1007/s10995-022-03557-5 · Cited by 4
“With the notable impact of COVID-19 on childhood vaccinations it is more important than ever to ensure that all pregnant women are receiving the antepartum Tdap vaccine with each pregnancy so that infants are protected from pertussis infection (Bramer et al., 2020; Rowe, et al., 2021; Santoli et al., 2020).”
BackgroundReducing the Risk of Vaccine Preventable Diseases During the COVID-19 Pandemic
Lutz, M. K., Hayney, M. S., Farraye, F. A., et al. (2020) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.08.011 · Cited by 4
“Similarly, data from a pediatric population in Michigan now indicate that less than half of children age 2 years and younger are up to date on immunizations.(5) Data in the adult population are only beginning to emerge.”
Advocacy Considerations for the Pediatric Pulmonologist in the Era of the COVID-19 Pandemic
Rao, D., Kopp, B. T., Kamerman‐Kretzmer, R., Afolabi, F., Liptzin, D. R., Balasubramaniam, V., & Sadreameli, S. C. (2021) · Annals of the American Thoracic Society · doi:10.1513/annalsats.202008-1022ps · Cited by 4
Tatsioni, A., Siountri, I., Tsamoulis, D., & Vafeidou, K. (2021) · European Journal of General Practice · doi:10.1080/13814788.2021.1986279 · Cited by 4
Escabí-Wojna, E., Alvelo-Fernández, P. M., Suarez, E. L., et al. (2024) · Vaccine · doi:10.1016/j.vaccine.2024.126584 · Cited by 3
The impact of the COVID-19 pandemic on vaccinations in United States primary care practices
Ataç, Ö., Peterson, L. E., & Waters, T. M. (2025) · PLoS ONE · doi:10.1371/journal.pone.0325934 · Cited by 3
Mohanty, N. (2022) · Telehealth and Medicine Today · doi:10.30953/thmt.v7.375 · Cited by 3
McGrath, E. J., Dalal, D., Smitherman, L. C., et al. (2021) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2020.1410 · Cited by 3
Kram, D. E., Tooze, J. A., Russell, T. B., & McLean, T. W. (2021) · Journal of Pediatric Hematology/Oncology · doi:10.1097/mph.0000000000002243 · Cited by 3
“Yes 7 (6) 2 (8) No 118 (94) 23 (92) Deaths during hospitalization NA Yes 0 0”
(2022) · Archivos Argentinos de Pediatria · doi:10.5546/aap.2022.39 · Cited by 3
Uso do Sistema de Informação de Imunização do Brasil: qual a realidade?
Rodrigues, S. B., Amaral, G. G., Silva, B. S., et al. (2022) · Revista CUIDARTE · doi:10.15649/cuidarte.2138 · Cited by 3
Disruption of Pediatric Emergency Department Use during the COVID-19 Pandemic
Sen, B., Brisendine, A. E., & Ghosh, P. (2022) · Southern Medical Journal · doi:10.14423/smj.0000000000001383 · Cited by 3
“Finally, our findings also are consistent with delays in other essential pediatric health services such as vaccinations, particularly for publicly insured children.(18,19) We acknowledge several limitations to our study.”
ResultVaccine hesitancy in families of children during the COVID-19 pandemic
Viana, I. D. S., Cursino, E. G., da Silva, L. F., et al. (2023) · Rev Rene · doi:10.15253/2175-6783.20232489253 · Cited by 3
“Public health measures to mitigate the effects of the pandemic revolve around the adoption of social distancing and quarantine(7), but these strategies had an influence on the reduced access to vaccination services(8).”
Gusmão, J. D., da Silva, T. P. R., Velásquez-Meléndez, G., Mendes, L. L., Pessoa, M. C., Lachtim, S. A. F., Felisbino-Mendes, M. S., Santos, L. C., Rodrigues, G. J. C., Vimieiro, A. M., et al. (2023) · BMC Infectious Diseases · doi:10.1186/s12879-023-08549-6 · Cited by 3
Silver, E. R., Fink, L., Baylis, K. R., Faust, R. A., Guzman, K., Hribar, C., Martin, L., & Navin, M. C. (2024) · Vaccine · doi:10.1016/j.vaccine.2024.07.045 · Cited by 3
Outcome of Coronavirus Disease 2019 on School Vaccination Policies for 2020-2021
Barraza, L. F., Reeves, C. M., & Campos-Outcalt, D. E. (2020) · JAMA Health Forum · doi:10.1001/jamahealthforum.2020.1018 · Cited by 3
Impact of Covid-19 on the Outcomes of Basic Immunization in Health Facilities
Iswati, R. S., & Nuraini, I. (2020) · Jurnal Profesi Medika Jurnal Kedokteran dan Kesehatan · doi:10.33533/jpm.v14i2.2170 · Cited by 3
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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