"This leaves many children, especially younger ones, at risk of serious illness from vaccine-preventable diseases, like measles and whooping cough."

The pandemic put many major life events on hold: weddings, proms, graduations, but also the minor, more mundane ones: in-person meetings, playdates, doctors' appointments. And though calendars are starting to fill again, it feels like we're still catching up—rescheduling all those missed appointments, trying to make up for lost time.

But one significant downside of all those delayed doctors' appointments? A sharp decrease in routine childhood vaccinations.

Kids across the country missed out on their routine immunizations between 2020 and 2021 thanks to the pandemic—not getting the measles, mumps, rubella (MMR) shot, the chickenpox (varicella) vaccine and many others.

Recent data from the Centers for Disease Control and Prevention (CDC) show a 12.9 million dose gap in recommended childhood vaccines in 2020 to 2021 as compared to 2019. That's 12.9 million fewer doses administered to children around the country in an effort to prevent childhood diseases.

"This leaves many children, especially younger ones, at risk of serious illness from vaccine-preventable diseases, like measles and whooping cough," says Melinda Wharton, MD, Associate Director for Vaccine Policy at the CDC. "As children return to in-person school and activities, it is critical they get caught up on routine vaccinations."

Catching up now is especially important, as there's a potential link that routine vaccinations received in childhood may provide some protection for kids against Covid.

Missed vaccinations leave kids vulnerable

Covid-19 caused so many disruptions last year—and this year too. "Understandably, many parents may have missed or delayed well-child checkups during the pandemic," says Dr. Wharton. But missed or late shots can mean children are vulnerable for longer than necessary to highly contagious diseases, which can be even more serious for younger children and babies. "In recent years, there were outbreaks of measles, especially in communities with low vaccination rates," Dr. Wharton notes. And now that kids have resumed in-person schooling and daycare across the country, it's even more likely that disease can spread.

"With the lifting of mask mandates, we have seen a rise in common childhood infections," says E.R. Chulie Ulloa, MD, MSc, Assistant Professor, UC Irvine School of Medicine, Department of Pediatrics. "I anticipate this number to increase in the fall/winter."

The American Academy of Pediatrics (AAP) also recommends that kids get a flu shot before Halloween this year, in an effort to prevent a potential "twindemic" of Covid and flu taking hold later this winter.

If the recent spike in cases of RSV this summer is any indication, co-occurring surges of infection can have scary consequences, including a shortage of hospital beds and ICU capacity. And given the fact that the highly contagious Delta variant is still on the rise—especially among kids—taking any possible extra precaution is recommended.

Vaccines can boost kids' immune systems

Another potential benefit from vaccinations for childhood diseases is that they may confer some protection against other infections, like Covid-19.

A review study in 2020 posited that the routine pediatric immunizations that children receive may boost their innate immune response and be one factor protecting them from severe forms of Covid, known as cross-immunity.

"Cross-immunity refers to the phenomenon whereby a vaccine triggers a protective immune response against other pathogens or infections not targeted by the vaccine," says Dr. Chulie Ulloa. "The concept of vaccines inducing cross-immunity to other infections has been investigated for quite some time."

Some suggest that the routine immunizations children receive from a young age may be one of the reasons why children seem to only get mild forms of Covid in the majority of cases. Experts also impart that the MMR, varicella and Hepatitis B vaccines may provide some immunity against the novel coronavirus in kids. One small study even found that the MMR vaccine provided some protection against Covid in adults. While we don't have enough direct data to fully support this link yet, the relationship is interesting—and one that will hopefully be studied more in the near future.

Dr. Chulie Ulloa adds: "It is plausible that routine pediatric vaccines may provide some SARS-CoV-2 [the virus responsible for Covid-19] cross-protection that may reduce disease severity. However, this does not replace the need for individuals to be vaccinated against COVID-19." The AAP recommends Covid-19 vaccination for kids 12 years of age and older who do not have contraindications to the COVID-19 vaccine. Vaccines for kids under 12 should be released in fall 2021.

Here's how to get back on track

While the timing of recommended childhood vaccinations is important in order to promote the strongest immunity, it's never too late to get back on schedule if you've missed or delayed a shot previously.

Additionally, doctors' offices have adapted to the new pandemic protocols through practices such as masking requirements, increased cleaning between patients and asking patients to wait in their cars instead of waiting rooms. Some offices are even doing drive-up vaccinations.

Here are the CDC's tips for getting back on track with childhood vaccinations:

  1. Contact your doctor to find out how they are safely seeing patients during the pandemic. Ask about what precautions their office has in place and any requirements you should know before visiting.
  2. Talk to your doctor to find out if your child is on track with well-child checkups and routine childhood vaccinations. Set up a plan to get any missed shots scheduled. The CDC's catch-up schedule is a good starting point to help guide parents and pediatricians to get kids back on track.
  3. Ask your doctor or pharmacist about free options if you're not covered by insurance. Programs such as CDC's Vaccines for Children program help ensure eligible children receive free vaccines.
  4. Prepare for your vaccination visit. Take steps to make shots less stressful for both you and your child. Bringing your child's favorite lovey can help calm nerves, or breastfeeding your baby while they receive a shot can help reduce pain.

Should you space out routine vaccinations with the flu shot or Covid-19 vaccine?

No, this isn't something to worry about, says Dr. Chulie Ulloa. "Given the importance of routine vaccination and the need for rapid uptake of COVID-19 vaccines, the AAP and the CDC both support co-administration of routine childhood and COVID-19 vaccinations. I anticipate that this recommendation will extend to the 5 to 11 age group once the COVID-19 vaccine is approved for them," Dr. Chulie Ulloa adds. Same goes for flu shots—experts say you can get them in quick succession or even simultaneously with other routine shots if necessary.

Childhood vaccines can provide lifelong immunity to dangerous diseases, and these vaccines can be given at the same time as COVID-19 vaccines," says Dr. Wharton. Your best next step? Be sure to talk to your doctor to work out a plan that best supports your child.

Featured Experts:

Melinda Wharton, MD, Associate Director for Vaccine Policy at the CDC

E.R. Chulie Ulloa, MD, MSc, Assistant Professor, UC Irvine School of Medicine, Department of Pediatrics

Sources:

Beric-Stojsic B, Kalabalik-Hoganson J, Rizzolo D, Roy S. Childhood immunization and COVID-19: an early narrative reviewFrontiers in Public Health. 2020;8. doi:10.3389/fpubh.2020.587007

Lyu J, Miao T, Dong J, Cao R, Li Y, Chen Q. Reflection on lower rates of COVID-19 in children: Does childhood immunizations offer unexpected protection?Med Hypotheses. 2020;143:109842. doi:10.1016/j.mehy.2020.109842

Salman S, Salem ML. Routine childhood immunization may protect against COVID-19Med Hypotheses. 2020;140:109689. doi:10.1016/j.mehy.2020.109689

Yengil E, Onlen Y, Ozer C, Hambolat M, Ozdogan M. Effectiveness of Booster Measles-Mumps-Rubella Vaccination in Lower COVID-19 Infection Rates: A Retrospective Cohort Study in Turkish AdultsInt J Gen Med. 2021;14:1757-1762. doi:10.2147/IJGM.S309022