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
Cites
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Effectiveness of a vaccine recovery plan after the COVID-19 pandemic. Results of one year follow-up.
Contarino, F. M., Pietro, E. D., Randazzo, C., Bella, F., & Contrino, M. L. (2023) · Journal of preventive medicine and hygiene · doi:10.15167/2421-4248/jpmh2023.64.3.3001
McGrath, E. J., Dwaihy, M., Smitherman, L. C., Behar, M. G., Benjamins, L. J., Cockern, N., Meade, J. A., Smith, J., Marshall, S. P., Youngman, C., et al. (2023) · Clinical Pediatrics · doi:10.1177/00099228231218160
“16,23,26 However, as the Expo was not a true intervention at the population level, but, instead, focused on engaging individual children, adolescents, and their families, the theory from Loren Eiseley’s “Starfish Story” may be invoked, namely, “We made a difference to that one!””
Preis, J. I. (2023) · International Journal of Clinical Case Reports and Reviews · doi:10.31579/2690-4861/349
Silva, Í. D. S., de Lira, M. L. A., de Souza, A. E. B., et al. (2023) · Revista Ciência Plural · doi:10.21680/2446-7286.2023v9n3id29226
Measles is an Important Disease to Recognize: Case Series
Gürlevik, S. L. (2023) · Çocuk Enfeksiyon Dergisi/Journal of Pediatric Infection · doi:10.5578/ced.20239680
“These factors include vaccine hesitancy, interruptions in routine child healthcare visits during the COVID-19 pandemic, the presence of immigrants from regions with healthcare system challenges, and the effects of climate change (6,7,10,11).”
Luvisaro, B. M. O., da Silva, T. P. R., Gusmão, J. D., et al. (2024) · Research Square · doi:10.21203/rs.3.rs-3909483/v1
Koura, R., & Davis, C. (2024) · Proceedings of Singapore Healthcare · doi:10.1177/20101058241270882
“11,21 37 While there was a signi fi cant decrease in clinic attendance and increase in default rates at the start of DORSCON yellow, there was no further signi fi cant changes after escalation to DORSCON orange.”
Bertoldo, S. O. L., & Correia, L. L. (2024) · Gestão & Cuidado em Saúde. · doi:10.70368/gecs.v1i1.13289
Tosyalı, M., & Koç, F. U. (2024) · Pakistan Journal of Medical Sciences · doi:10.12669/pjms.41.1.9689
Pereira, C. M., Soares, A. D. S., & Schuelter‐Trevisol, F. (2024) · Arquivos Catarinenses de Medicina · doi:10.63845/982s9z56
Gedamu, T. E., Assemie, A., Aleye, L. T., Woldemariam, M. T., Argago, T. G., & Buda, A. S. (2025) · Frontiers in Pediatrics · doi:10.3389/fped.2025.1566443
“Our results align with previous studies (33, 34), suggesting similar trends in vaccination coverage.”
Boot camp translation: A novel method to increase human papillomavirus (HPV) vaccination uptake
O’Leary, S. T., Skenadore, A., Mosley, B. S., Severson, R. L., Rice, J. D., Simpson, M., & Brewer, S. E. (2025) · Vaccine · doi:10.1016/j.vaccine.2025.127683
Fatores associados aos desafios da adesão vacinal infantil: Percepção de profissionais de saúde
de Sousa, D. K. B., Arruda, L. P., Lopes, R. E., Aguiar, F. A. R., & Pimenta, A. D. F. M. (2025) · Research Society and Development · doi:10.33448/rsd-v14i9.49439
Asraoui, A., & Soulaymani, A. (2025) · Research Square · doi:10.21203/rs.3.rs-7641363/v1
Ishimori, S., Nishimura, A., Tamura, A., et al. (2025) · Journal of Infection and Chemotherapy · doi:10.1016/j.jiac.2025.102875
Impact of the COVID-19 Pandemic on National Pediatric Inpatient Vaccine Delivery
Mihalek, A. J., Schafenacker, A. M., Andreeff, K., Aguilar, R., Bryan, M. A., & Singh, J. (2026) · Hospital Pediatrics · doi:10.1542/hpeds.2025-008730
Secundino, T. S., & Fonseca, C. E. S. (2026) · RCMOS - Revista Científica Multidisciplinar O Saber · doi:10.51473/rcmos.v1i1.2026.2547
Bryan, M. A., Mihalek, A. J., Torres, R., Desai, S., Wu, S., Avondet, E., Solstad, R., McFadden, V. C., Kasick, R. T., Banker, S. L., et al. (2026) · PEDIATRICS · doi:10.1542/peds.2025-075278
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
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.
A language model drew the claims from the paper on 2026-10-08, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-08 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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.
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