MMR Immunization Ratesin the COVID-19 Pandemic

ABSTRACT

Purpose/Objectives: The COVID-19 pandemic caused a nationwide immunization delay leading to a decline in routine childhood immunization rates. In response, a team from Walter Reed General Pediatrics Primary Care Medical Home (WR-PCMH) devised a quality improvement project aimed to increase immunization rates by identifying and addressing barriers for children to receive vaccinations. Specifically, we focused on MMR immunization rates at 12 through 48 months due to the high morbidity and mortality rates from measles, mumps, and rubella. Design/Methods: MMR immunization rates were quarried monthly from September 2020 to June 2021 via Carepoint, a military patient metrics database. Search criteria included children mapped to WR-PCMH aged 12 to 48 months and their first MMR (MMR1) vaccination status. Per Carepoint review in January 2021, 92 children enrolled in WR-PCMH were delayed in MMR1. These families were contacted with a phone survey to evaluate barriers and reasons for their underimmunization status and encourage vaccination. Results: Per Figure 1, the MMR1 vaccination rate declined to a low of 75% in November 2020, but increased to >90% by December where it stayed for the rest of the data collection period. Of the 92 patients identified as delayed in MMR1, 84 had phone numbers on record. From February to June 2021, 59 contacted families completed the phone survey. Of the respondents, 25 (42%, N=52) were aware that their child did not receive his/her MMR1 vaccine (Figure 2). COVID-related concerns were cited as the reason for delayed MMR immunization in 48% of respondents (N=31), and 77% of these families were specifically concerned about COVID exposures during clinic visits (N=17). Other COVIDrelated reasons cited include perceptions that clinics were closed, time constraints, distance to WR-PCMH and completing virtual well child checks. Conclusion/Discussion: Similar to national trends, WR-PCMH recorded a decrease in MMR immunization during the COVID-19 pandemic. Initial strategies to encourage vaccination included a drive-up immunization tent and extended clinic hours. In winter 2020, new measures were initiated including providing parents with lists of additional military immunization clinic locations and hours, vaccine reminder calls to families, and announcements during clinic huddle to screen for delayed immunizations. The etiology of the increase in MMR1 rate between November and December is not fully understood, but may be related to these initiatives. In conducting our survey of the remaining unvaccinated patients, approximately half of families stated COVID-19 was the reason for delayed immunization. In addition to fear of exposure, convenience and accessibility were reported as barriers. This quality improvement project suggests that the aforementioned clinic practices were effective in preventing a long-term decline in MMR1 vaccination in our military population and that future initiatives should continue to focus on vaccine schedule awareness, accessibility, and reducing actual and perceived risk of COVID exposures at clinic. (Figure Presented).