Childhood immunization coverage during the COVID-19 Pandemic in the Province of Siracusa, Italy
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Keywords

COVID-19 pandemic
childhood immunization
vaccine coverage
vaccine-preventable diseases
catch-up programmes

Abstract

Introduction: The COVID-19 pandemic has severely impacted routine immunization activities and a decline in vaccination coverage has been documented around the world. The aim of this study was to assess the impact of the direct and indirect effects of the COVID-19 pandemic on routine childhood vaccination coverage in the Province of Siracusa, Italy.

Methods: We compared 2020 and 2019 vaccination coverage by age group and vaccine type. Results were considered statistically significant at a two-tailed p-value ≤0.05.

Results: Our findings show that vaccination coverage rates for mandatory and recommended vaccinations decreased in 2020 compared with the previous year (range from -1.4 % to -7.8%). Anti-rotavirus vaccination increased (+4.8%, as compared to 2019), while the reductions observed for polio vaccination (hexavalent) and human papillomavirus vaccination in males were not statistically significant. The reduction did not hit the population in the same manner, with the greater decreases observed for children aged >24 months compared to the younger (-5.5% vs. -2.2%) and for booster doses compared to the primary vaccinations (-6.4% vs. -2.6%).

Conclusions: This study found that vaccination coverage of routine childhood immunisations was negatively affected during the COVID-19 pandemic in the Province of Siracusa. It is of huge importance to put in place some catch-up programs to ensure vaccinations at the earliest of individuals who missed immunization during the pandemic.

https://doi.org/10.15167/2421-4248/jpmh2022.63.4.2587
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References

1. Plotkin SA. Vaccination against the major infectious diseases. Comptes Rendus de l’Académie des Sciences - Series III - Sciences de la Vie. 1999 Nov;322(11):943–51.
2. Andre F. Vaccinology: past achievements, present roadblocks and future promises. Vaccine. 2003 Jan;21(7–8):593–5.
3. Rodrigues CMC, Plotkin SA. Impact of Vaccines; Health, Economic and Social Perspectives. Vol. 11, Frontiers in Microbiology. Frontiers Media S.A.; 2020.
4. Doherty M, Schmidt-Ott R, Santos JI, Stanberry LR, Hofstetter AM, Rosenthal SL, et al. Vaccination of special populations: Protecting the vulnerable. Vaccine. 2016 Dec;34(52):6681–90.
5. Andre F, Booy R, Bock H, Clemens J, Datta S, John T, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ. 2008 Feb 1;86(2):140–6.
6. Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents. JAMA Pediatrics. 2020 Sep 1;174(9):882.
7. WHO. WHO and UNICEF warn of a decline in vaccinations during COVID-19. https://www.who.int/news/item/15-07-2020-who-and-unicef-warn-of-a-decline-in-vaccinations-during-covid-19. Accessed 29 Mar 2022.
8. WHO. At least 80 million children under one at risk of diseases such as diphtheria, measles and polio as COVID-19 disrupts routine vaccination efforts, warn Gavi, WHO and UNICEF.
https://www.who.int/news/item/22-05-2020-at-least-80-million-children-under-one-at-risk-of-diseases-such-as-diphtheria-measles-and-polio-as-covid-19-disrupts-routine-vaccination-efforts-warn-gavi-who-and-unicef. Accessed 29 Mar 2022.
9. Shet A, Carr K, Danovaro-Holliday CM, Sodha S v., Prosperi C, Wunderlich J, et al. Impact of the SARS-CoV-2 Pandemic on Routine Immunization Services: Evidence of Disruption and Recovery From 169 Countries and Territories. SSRN Electronic Journal. 2021;
10. WHO. Immunization coverage. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage. Accessed 29 Mar 2022.
11. Lassi ZS, Naseem R, Salam RA, Siddiqui F, Das JK. The Impact of the COVID-19 Pandemic on Immunization Campaigns and Programs: A Systematic Review. International Journal of Environmental Research and Public Health. 2021 Jan 22;18(3):988.
12. Medscape. Vaccine Rates for All Ages Drop Dramatically During COVID-19. https://www.medscape.com/viewarticle/931913#vp_2. Accessed 29 Mar 2022.
13. Nelson R. COVID-19 disrupts vaccine delivery. The Lancet Infectious Diseases. 2020 May;20(5):546.
14. Roberton T, Carter ED, Chou VB, Stegmuller AR, Jackson BD, Tam Y, et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. The Lancet Global Health. 2020 Jul;8(7):e901–8.
15. UNICEF. The impact of COVID-19 on routine vaccinations. https://www.unicef.org/eap/stories/impact-covid-19-routine-vaccinations. Accessed 29 Mar 2022.
16. Zar HJ, Dawa J, Fischer GB, Castro-Rodriguez JA. Challenges of COVID-19 in children in low- and middle-income countries. Paediatric Respiratory Reviews. 2020 Sep;35:70–4.
17. WHO. Health system considerations: when influenza meets COVID-19 - Preparedness and response measures when COVID-19, influenza and acute respiratory infections coincide in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2020. Licence: CC BY-NC-SA 3.0 IGO.
18. European Centre for Disease Prevention and Control. COVID-19 infection prevention and control measures for primary care, including general practitioner practices, dental clinics and pharmacy settings: first update. 19 October 2020. ECDC: Stockholm; 2020. .
19. WHO. Guiding Principles for Immunization Activities during the COVID-19 Pandemic: Interim Guidance, 26 March 2020; World Health Organization: Geneva, Switzerland, 2020.
20. WHO. Regional Office for Europe. (‎2020)‎. Guidance on routine immunization services during COVID-19 pandemic in the WHO European Region, 20 March 2020. World Health Organization. Regional Office for Europe.
21. Department for Civil Protection. [COVID-19 Italy: regional data digital repository]. 2020. https://github.com/pcm-dpc/COVID-19/tree/master/dati-regioni. Accessed 29 Mar 2022.
22. Government of Italy. Decree of the President of the Council of Ministers 11 March 2020. 2020. https://www.gazzettaufficiale.it/eli/id/2020/03/11/20A01605/sg. Accessed 29 Mar 2022.
23. European Centre for Disease Prevention and Control. https://vaccine-schedule.ecdc.europa.eu/Scheduler/ByCountry?SelectedCountryId=103&IncludeChildAgeGroup=true&IncludeChildAgeGroup=false&IncludeAdultAgeGroup=true&IncludeAdultAgeGroup=false Accessed 29 Mar 2022.
24. Ministero della salute. https://www.salute.gov.it/portale/vaccinazioni/Dettaglio Contenuti
Vaccinazioni.jsp?lingua=english&id=5501&area=vaccinazioni&menu=vuoto.
Accessed 29 Mar 2022.
25. Bozzola E, Spina G, Russo R, Bozzola M, Corsello G, Villani A. Mandatory vaccinations in European countries, undocumented information, false news and the impact on vaccination uptake: the position of the Italian pediatric society. Italian Journal of Pediatrics. 2018 Dec 14;44(1):67.
26. Sabbatucci M, Odone A, Signorelli C, Siddu A, Maraglino F, Rezza G. Improved Temporal Trends of Vaccination Coverage Rates in Childhood after the Mandatory Vaccination Act, Italy 2014–2019. Journal of Clinical Medicine. 2021 Jun 8;10(12):2540.
27. Ministero della salute. https://www.salute.gov.it/portale/documentazione/p6_2_8_3_1.jsp? lingua=italiano&id=20. Accessed 29 Mar 2022.
28. Bechini A, Garamella G, Giammarco B, Zanella B, Flori V, Bonanni P, et al. Paediatric activities and adherence to vaccinations during the COVID-19 epidemic period in Tuscany, Italy: a survey of paediatricians. J Prev Med Hyg. 2020 Jun;61(2):E125–9.
29. Russo R, Bozzola E, Palma P, Corsello G, Villani A. Pediatric routine vaccinations in the COVID 19 lockdown period: the survey of the Italian Pediatric Society. Italian Journal of Pediatrics. 2021 Dec 24;47(1):72.
30. Un Genitore Su Tre Ha Rinviato le Vaccinazioni dei Propri Figli a Causa del COVID-19: Società Italiana di Pediatria. 2021. https://sip.it/2020/07/01/un-genitore-su-tre-ha-rinviato-le-vaccinazioni-dei-propri-figli-a-causa-del-covid-19/. Accessed 29 Mar 2022.
31. Sabbatucci M, Odone A, Signorelli C, Siddu A, Silenzi A, Maraglino FP, et al. Childhood Immunisation Coverage during the COVID-19 Epidemic in Italy. Vaccines (Basel). 2022 Jan 14;10(1):120.
32. Epicentro. La pandemia COVID-19 e la riduzione o sospensione delle attività vaccinali a livello globale. https://www.epicentro.iss.it/vaccini/covid-19-riduzione-attivita-vaccinale. Accessed 29 Mar 2022.
33. Ministero Della Salute. Indagine Sull’impatto Dell’emergenza COVID-19 Sulle Attività di Vaccinazione. https://portale.fnomceo.it/wp-content/uploads/2020/05/Copia_DocPrincipale_Circolare_Servizi_vaccinali__25_05_2020.pdf. Accessed 29 Mar 2022.
34. Ministero Della Salute. Impatto Dell’emergenza COVID-19 Sulle Attività di Vaccinazione—Analisi del Fenomeno e Raccomandazioni Operative. https://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2020&codLeg=75346&parte=1%20&serie=null. Accessed 29 Mar 2022.
35. Ministero Della Salute. https://www.salute.gov.it/portale/documentazione/p6_2_8_3_1.jsp?lingua=italiano&id=20%20(ON-LINE). Accessed 29 Mar 2022.
36. Mao W, Ogbuoji O, Watkins D, Bharali I, Nsiah-Boateng E, Diab MM, et al. Achieving global mortality reduction targets and universal health coverage: The impact of COVID-19. PLOS Medicine. 2021 Jun 24;18(6):e1003675.
37. Filia, A.; Bella, A.; Del Manso, M.; Baggieri, M.; Marchi, A.; Bucci, P.; Magurano, F.; Nicoletti, L.; Rota, M.C. Morbillo & Rosolia News Aggiornamento Mensile Rapporto N 63—Gennaio 2021; Istituto Superiore di Sanità: Roma, Italy, 2021. Accessed 29 Mar 2022.
38. Filia, A.; Bella, A.; Del Manso, M.; Baggieri, M.; Marchi, A.; Bucci, P.; Magurano, F.; Nicoletti, L.; Rota, M.C. Morbillo & Rosolia News Aggiornamento Mensile Rapporto N 64—Settembre 2021; Istituto Superiore di Sanità: Roma, Italy, 2021. Accessed 29 Mar 2022.
39. Yu JH, Jeong H jin, Kim SJ, Lee JY, Choe YJ, Choi EH, et al. Sustained Vaccination Coverage during the Coronavirus Disease 2019 Epidemic in the Republic of Korea. Vaccines (Basel). 2020 Dec 22;9(1):2.
40. Jarchow-MacDonald AA, Burns R, Miller J, Kerr L, Willocks LJ. Keeping childhood immunisation rates stable during the COVID-19 pandemic. The Lancet Infectious Diseases. 2021 Apr;21(4):459–60.
41. Middeldorp M, van Lier A, van der Maas N, Veldhuijzen I, Freudenburg W, van Sorge NM, et al. Short term impact of the COVID-19 pandemic on incidence of vaccine preventable diseases and participation in routine infant vaccinations in the Netherlands in the period March-September 2020. Vaccine. 2021 Feb;39(7):1039–43.
42. Zarocostas J. How to fight an infodemic. The Lancet. 2020 Feb;395(10225):676.
43. Malik AA, McFadden SM, Elharake J, Omer SB. Determinants of COVID-19 vaccine acceptance in the US. EClinicalMedicine. 2020 Sep;26:100495.
44. Bendau A, Plag J, Petzold MB, Ströhle A. COVID-19 vaccine hesitancy and related fears and anxiety. International Immunopharmacology. 2021 Aug;97:107724.
45. Dinleyici EC, Borrow R, Safadi MAP, van Damme P, Munoz FM. Vaccines and routine immunization strategies during the COVID-19 pandemic. Human Vaccines & Immunotherapeutics. 2021 Feb 1;17(2):400–7.
46. WHO. Immunization in the context of COVID-19 pandemic. https://www.who.int/publications/i/item/immunization-in-the-context-of-covid-19-pandemic Accessed 29 Mar 2022.
47. Pan American Health Organization. Vaccinations of newborns in the context of the COVID-19 Pandemic. https://iris.paho.org/bitstream/handle/10665.2/52226/PAHOFPLIMCOVID-19200010_eng.pdf?sequence=1%26isAllowed=y. Accessed 29 Mar 2022.
48. WHO. Pulse survey on continuity of essential health services during the COVID-19 pandemic. Interim report. https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS_continuity-survey-2020.1. Accessed 29 Mar 2022.
49. Glatman-Freedman A, Nichols K. The effect of social determinants on immunization programs. Human Vaccines & Immunotherapeutics. 2012 Mar 13;8(3):293–301.
50. Crocker-Buque T, Edelstein M, Mounier-Jack S. Interventions to reduce inequalities in vaccine uptake in children and adolescents aged <19 years: a systematic review. Journal of Epidemiology and Community Health. 2017 Jan;71(1):87–97.
51. Glatman-Freedman A, Nichols K. The effect of social determinants on immunization programs. Human Vaccines & Immunotherapeutics. 2012 Mar 13;8(3):293–301.
52. MacDonald NE. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015 Aug;33(34):4161–4.
53. Wiysonge CS, Ndwandwe D, Ryan J, Jaca A, Batouré O, Anya B-PM, et al. Vaccine hesitancy in the era of COVID-19: could lessons from the past help in divining the future? Human Vaccines & Immunotherapeutics. 2022 Dec 31;18(1):1–3.
54. Freeman D, Loe BS, Chadwick A, Vaccari C, Waite F, Rosebrock L, et al. COVID-19 vaccine hesitancy in the UK: the Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II. Psychological Medicine. 2020 Dec 11;1–15.
55. Geoghegan S, O’Callaghan KP, Offit PA. Vaccine Safety: Myths and Misinformation. Frontiers in Microbiology. 2020 Mar 17;11.
56. Harrison EA, Wu JW. Vaccine confidence in the time of COVID-19. European Journal of Epidemiology. 2020 Apr 22;35(4):325–30.
57. European Centre for Disease Prevention and Control. Vaccinations of newborns in the context of the COVID-19 Pandemic. https://www.cdc.gov/vaccines/pandemic-guidance/index.html. Accessed 29 Mar 2022.