41 - Chicagoland Childhood Vaccination Trends and the COVID-19 Pandemic

Poster Number: 41
Publication Number: 41.1251

Background: Routine childhood vaccination reduces the incidence of disease for up to 14 preventable diseases with high rates of coverage needed to sustain impact. The COVID-19 pandemic may have delayed routine healthcare visits for children. Additionally, there have been reported changes in vaccine hesitancy.

Objective: To examine routine childhood vaccination trends over the last six years, pre- and post- the onset of the COVID-19 pandemic.

Design/Methods: Electronic health record (EHR) data was used to examine vaccination trends across 6 Chicagoland offices from 2017 to 2023. We defined the start of the COVID-19 pandemic as March 17, 2020, the Illinois school closure date. Children were considered up to date on vaccines who had received the combined 7-vaccine series recommended by the CDC for children by 2 years old (4 DTaP, 3 IPV, 1 MMR, ≥3 Hib, 3 Hep-B, 4 PCV, 1 Var). Children ≤25 months old who had a well-child visit at one of the sites were included to allow one month time forgiveness for catch up vaccines. Bivariate analyses were done using chi-square tests on the demographic variables including sex, race/ethnicity, and insurance type. All demographic variables were included in the multivariable logistic regression examining the up to date vaccines outcome.

Results: 21,208 participants ≤25 months were included in the study. Demographics were similar pre- and post- COVID-19 pandemic (data not shown). In the total sample, 51.6% were male and 23.2% had public insurance. Among participants, EHR reported race/ethnicity was 6.6% Asian, 11.8% non-Hispanic (NH) Black, 17.1% Hispanic, 6.9% other, and 56.9% NH White. In bivariate analyses, pre- and post- COVID-19 pandemic, race/ethnicity and insurance type were significantly associated with up to date vaccination (p < 0.0001, data not shown). In the regression model, pre-COVID-19 children were significantly more likely to be up to date on vaccines (Table). Compared to NH White participants, NH Black participants were significantly less likely to be up to date. Compared to those with private insurance, those with public and other insurance types were also significantly less likely to be up to date. The decline in the rate of children up to date on vaccines began before the COVID-19 pandemic, with an 11% decline from 2017-2023 (Figure).

Conclusion(s): Childhood vaccination rates have been steadily declining and were exacerbated post-COVID-19 pandemic. Children with public health insurance and NH Black children were significantly less likely to be up to date on vaccines. Public health efforts should engage communities and ensure access to vaccines to help reduce this gap.