Vaccine Coverage Across the Life Course in Michigan During the COVID-19 Pandemic: January‒September 2020.

Objectives. To assess the impact of the COVID-19 pandemic on immunization services across the life course. Methods. In this retrospective study, we used Michigan immunization registry data from 2018 through September 2020 to assess the number of vaccine doses administered, number of sites providing immunization services to the Vaccines for Children population, provider location types that administer adult vaccines, and vaccination coverage for children. Results. Of 12 004 384 individual vaccine doses assessed, 48.6%, 15.6%, and 35.8% were administered to children (aged 0-8 years), adolescents (aged 9-18 years), and adults (aged 19‒105 years), respectively. Doses administered overall decreased beginning in February 2020, with peak declines observed in April 2020 (63.3%). Overall decreases in adult doses were observed in all settings except obstetrics and gynecology provider offices and pharmacies. Local health departments reported a 66.4% decrease in doses reported. For children, the total number of sites administering pediatric vaccines decreased while childhood vaccination coverage decreased 4.4% overall and 5.8% in Medicaid-enrolled children. Conclusions. The critical challenge is to return to prepandemic levels of vaccine doses administered as well as to catch up individuals for vaccinations missed. (Am J Public Health. 2021;111(11):2027-2035. https://doi.org/10.2105/AJPH.2021.306474).

Decline in Child Vaccination Coverage During the COVID-19 Pandemic - Michigan Care Improvement Registry, May 2016-May 2020.

On March 13, 2020, the United States declared a national state of emergency to control the pandemic spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1). Public health response measures to mitigate the pandemic have centered on social distancing and quarantine policies, including shelter-in-place and stay-at-home orders. Michigan implemented a stay-at-home order on March 23, 2020, to facilitate social distancing (2). Such strategies might result in decreased accessibility to routine immunization services, leaving children at risk for vaccine-preventable diseases and their complications (3). To evaluate whether vaccination coverage has changed during the pandemic, data from the Michigan Care Improvement Registry (the state's immunization information system) (MCIR) were analyzed. Changes in vaccine doses administered to children and the effects of those changes on up-to-date status were examined for vaccinations recommended at milestone ages corresponding to the end of an Advisory Committee on Immunization Practices (ACIP) recommendation period for one or more vaccines (4).

Assessing the ability of an immunization information system to prevent overimmunization of pediatric influenza vaccines.

CONTEXT: The Advisory Committee on Immunization Practices (ACIP) publishes annual recommendations for the prevention and control of seasonal influenza. Between 2011 and 2013, the ACIP recommended 2 approaches that providers could use to determine how many influenza vaccine doses children aged 6 months through 8 years should receive. One did not consider doses received prior to the 2010-2011 season; the other considered complete influenza immunization history, such as that available in immunization information system (IIS). OBJECTIVES: To use Michigan's IIS, the Michigan Care Improvement Registry (MCIR), to compare the number of children recommended to receive 2 doses of influenza vaccine under each ACIP approach, and to determine the potential for overimmunization of Michigan children with influenza vaccine if providers do not use the data in MCIR. DESIGN: Cross-sectional analysis in the 2011-2012 to 2013-2014 influenza seasons. SETTING: We used the seasonal influenza and 2009 H1N1 monovalent vaccine doses in MCIR to determine the number of influenza vaccine doses children should receive using both ACIP approaches each season. PARTICIPANTS: We analyzed data for more than 900 000 children aged 6 months through 8 years in each influenza season. MAIN OUTCOME MEASURE: Number of children recommended 2 doses of influenza vaccine using each ACIP approach in each influenza season. RESULTS: Our evaluation showed that using MCIR could prevent the overimmunization with a second influenza vaccine dose for 70 323 children during the 2011-2012 influenza season, 126 076 children during the 2012-2013 season, and 81 635 children during the 2013-2014 season. CONCLUSIONS: This is the first study to use an IIS to quantify the difference between ACIP's approaches for 2-dose influenza vaccine recommendations. The immunization history and 2-dose forecasting algorithm available through MCIR minimizes overimmunization and has potential cost-saving implications. Our study illustrates the value of a centralized repository provided by IISs to immunization providers, public health, and caregivers.

Adolescent immunization coverage and implementation of new school requirements in Michigan, 2010.

OBJECTIVES: We examined the effect of Michigan's new school rules and vaccine coadministration on time to completion of all the school-required vaccine series, the individual adolescent vaccines newly required for sixth grade in 2010, and initiation of the human papillomavirus (HPV) vaccine series, which was recommended but not required for girls. METHODS: Data were derived from the Michigan Care Improvement Registry, a statewide Immunization Information System. We assessed the immunization status of Michigan children enrolled in sixth grade in 2009 or 2010. We used univariable and multivariable Cox regression models to identify significant associations between each factor and school completeness. RESULTS: Enrollment in sixth grade in 2010 and coadministration of adolescent vaccines at the first adolescent visit were significantly associated with completion of the vaccines required for Michigan's sixth graders. Children enrolled in sixth grade in 2010 had higher coverage with the newly required adolescent vaccines by age 13 years than did sixth graders in 2009, but there was little difference in the rate of HPV vaccine initiation among girls. CONCLUSIONS: Education and outreach efforts, particularly regarding the importance and benefits of coadministration of all recommended vaccines in adolescents, should be directed toward health care providers, parents, and adolescents.

Seasonal influenza and Tdap vaccination policies in Michigan hospitals: progress yet substantial capacity to improve.

We determined the prevalence of mandatory influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination policies for staff in Michigan hospitals and factors affecting policy implementation. Forty-one percent of responders reported a mandatory influenza vaccination policy, and 11% reported a mandatory Tdap vaccination policy. The support of hospital leadership is critical to policy implementation and overcoming barriers.

Assessing the relationship between seasonal and H1N1 influenza vaccination status in Michigan children, 2009-2010.

UNLABELLED: OBJECTIVES To examine the relationship between the outcome of vaccination for H1N1 influenza and receipt of seasonal influenza vaccine in Michigan children during the 2009-2010 season, we examined the influenza vaccination status of all Michigan residents aged six months to 18 years who were enrolled in the Michigan Care Improvement Registry. METHODS: We calculated descriptive statistics for dichotomous and categorical variables, including numbers of children vaccinated with either influenza (H1N1) monovalent vaccine and/or seasonal influenza vaccine, gender, race! / ethnicity, provider type, moved-or-gone-elsewhere (MOGE) status, and vaccin type. We used logistic regression, adjusting for potential confounders and effect modifiers (age and MOGE status), to calculate odds ratios associate with H1N1 vaccine status (vaccinated vs. unvaccinated). RESULTS. Michigan children who were vaccinated for seasonal influenza from August 1, 2009, to February 27, 2010, were 6.26 (95% confidence interval 6.18, 6.34) times as likely as children who were unvaccinated for seasonal influenza to be vaccinated with H1N1 2009 monovalent vaccine. Private health-care providers administered 91% of the seasonal influenza vaccine and 59% of the H1N1 vaccine. CONCLUSIONS. Increasing seasonal influenza vaccination campaign efforts could also benefit pandemic influenza vaccination efforts. Special educational outreach to parents regarding the importance of influenza vaccination for all children, regardless of age, may be needed. Stocking and offering traditional seasonal vaccine with pandemic-specific vaccine may aid in increasing immunization uptake. Efforts should be made to ensure that private providers are supplied with adequate pandemic vaccine as part of preparedness planning.