Update on Children’s COVID-19 and Routine Vaccination Trends Heading into Winter and as Respiratory Viruses Surge

In current 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 diminished inhabitants immunity headed into this years’ flu season, particularly amongst younger youngsters who’ve by no means been uncovered to or vaccinated in opposition to 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 delicate, this isn’t at all times the case, and kids are notably susceptible to flu and RSV. The mixture of all three may have extra severe ramifications for youngsters and in addition has the potential to overwhelm hospitals. Vaccination in opposition to COVID-19 and flu can present safety; nevertheless, COVID-19 vaccination charges have stalled and stay low for youthful youngsters and different routine vaccination charges could have been impacted by the pandemic. This coverage watch describes current developments 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 kids beneath age 5 and 31.8% of kids ages 5-11 had accomplished their primary series, which is the preliminary doses of a COVID-19 vaccine, mostly two pictures of a mRNA vaccine however can differ 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 have 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 Might 2021. It was approved for 5-11 year-olds in November of 2021 and at last, for youngsters beneath age 5 in June of 2022. Nevertheless, a few of it displays parental views and issues. KFF’s COVID-19 Vaccine Monitor from September 2022 reported that over half (53%) of oldsters of kids beneath 5 and over a 3rd (35%) of oldsters of kids ages 5-11 stated they’ll “undoubtedly not” get their little one vaccinated.  KFF surveys from July 2022 discovered dad and mom of younger youngsters have been involved in regards to the newness of the vaccine and never sufficient testing or analysis, unwanted side effects, and worries over the general security of the vaccines.

Bivalent boosters have been lately authorized for youngsters 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 (now not authorized) have been low. As of November 2nd, 5.3% of kids ages 5-11 and 18.2% of kids ages 12-17 had received their first booster dose. Completion of the first collection a minimum of two months earlier is required to obtain the brand new bivalent booster; thus, low major collection charges, particularly amongst youngsters ages 5-11, means fewer youngsters are eligible for the brand new booster. As of November 2nd, 0.5% of kids ages 5-11 and a pair of.6% of kids ages 12-17 have received an up to date (bivalent) booster dose. Whereas youngsters often have extra delicate COVID-19 instances, some youngsters do develop extreme sickness and a few have shown signs of lengthy COVID following prognosis. Boosters fight waning immunity and may help reduce the chance of an infection and onward transmission.

The pandemic has additionally led to declines in youngsters’s flu vaccinations, although the impression of the pandemic on different routine vaccinations stays unsure. Whereas youngsters’s flu vaccination rates from final 12 months’s flu season (2021-2022) have been much like the earlier 12 months (2020-2021), they have been virtually 6 share factors decrease than in 2019-2020, proper earlier than the pandemic started. Flu vaccination charges amongst youngsters differ broadly by state and seem 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 little one immunizations, and one study discovered elements impacting COVID-19 vaccine uptake might be impacting flu vaccine uptake. As well as, vaccination charges for different routine childhood vaccines additionally declined early within the pandemic, and the CDC experiences vaccination protection of all state-required vaccines for youngsters in kindergarten (MMR, DTaP, and varicella) declined barely by 1% within the 2020-2021 faculty 12 months (the primary full-pandemic faculty 12 months) in comparison with the earlier faculty 12 months. Some states and local areas have extra lately reported seeing diminished childhood immunization charges. Nevertheless, CDC information for the newest two faculty years usually are not but out there, and the general impression on childhood routine vaccination charges stays unclear presently.

There are particular coverage considerations for vaccinating younger youngsters, and a few states have developed profitable methods for growing vaccination charges amongst youngsters. States with the very 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 dad and mom to vaccinate their younger little one. Faculty vaccine mandates can be used as a device to extend COVID-19 vaccine uptake amongst youngsters, however presently, just a few states have COVID-19 vaccine mandates for varsity employees or college students. Preventive care appointments are additionally an vital component when addressing routine vaccination charges, as some dad and mom could not encounter a proposal of a vaccine till they go in for a routine go to to a pediatrician and pediatricians are considered extremely trusted sources of data by dad and mom. Not too long ago, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted so as to add the COVID-19 vaccines to the beneficial pediatric immunization schedule that features the opposite routine vaccines for youngsters relying on age. That is a part of an everyday, annual course of through which ACIP meets to vote on including newly beneficial vaccines to the kid and grownup immunization schedules.

As a result of Medicaid covers four in ten youngsters within the U.S., this system can play an vital role in facilitating entry to COVID-19 and different routine vaccines for youngsters, particularly those that are low-income. To extend COVID-19 vaccine uptake, state Medicaid packages and Medicaid managed care plans have undertaken numerous initiatives, together with monetary incentives for managed care plans that meet vaccination targets. Different current federal actions may help improve routine vaccination charges extra broadly. Data for youngsters 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 recent legislation to bolster Medicaid’s Early and Periodic Screening, Diagnostic and Therapy (EPSDT) profit may help extra Medicaid-covered youngsters obtain all beneficial screenings and providers, which incorporates routine vaccinations. Additional, the Child Core Set measures, designed to enhance the standard of care for youngsters in Medicaid and CHIP, will turn into obligatory to report in 2024 and track state-level immunization charges for youngsters and adolescents.

Kids will nonetheless be capable to entry wanted COVID-19 vaccines free of charge following the top of the COVID-19 PHE and even when federal provides of vaccines run out. Whereas the top of the PHE in addition to the depletion of federally-purchased provide may curtail access to some COVID-19 countermeasures like assessments and coverings, COVID-19 vaccines, together with boosters, will proceed to be out there free of charge to all children 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 youngsters 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 charge an administrative price. Kids who’re uninsured could also be eligible free of charge or diminished price 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 higher than traditional for the time of 12 months, 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 could have additionally declined because the pandemic started. Whereas most kids have delicate COVID-19 instances, vaccines can supply safety for youngsters 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.

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