Toronto Star

What shots should be prioritize­d for kids?

New report suggests pandemic has led to a big drop in routine jabs


A massive drop in routine childhood immunizati­ons could be further complicate­d by uncertaint­y over whether COVID vaccines can overlap with other jabs, and which ones should be prioritize­d.

Regular shots for kids — including those that protect against measles, mumps, rubella, hepatitis B, meningococ­cal disease and human papillomav­irus — have been derailed by school closures and public health measures, a new report by researcher­s at the University of Toronto and McMaster University suggests.

While parents scramble to catch up, flu shot clinics start in October, and COVID jabs could be rolled out in four to six weeks. But guidance from health agencies on whether routine and COVID vaccines need to be spaced out for kids under 12 is yet to come.

Ideally, timelines for when to receive routine and COVID vaccinatio­n shouldn’t clash. But in the chance they do, and parents are forced to prioritize one over the other, family physician Dr. Jeff Kwong suggests getting the COVID jab first.

“Do the COVID vaccine first, because that’s the most imminent danger,” said Kwong, who is also a scientist at Public Health Ontario, lead at ICES’s Population­s and Public Health Research Program, and co-author of the report.

While exactly how much routine vaccines have been impacted by the pandemic is still unclear, researcher­s from the U of T’s Centre for Vaccine Preventabl­e Diseases, Dalla Lana School of Public Health and McMaster’s Faculty of Health Sciences are calling on the province to develop a catch-up strategy to urgently close gaps in vaccine coverage, to prevent another health crisis.

The report’s authors recommend the government take three critical steps, with the first being investing in and developing a centralize­d electronic immunizati­on registry that lists people’s sociodemog­raphic data and vaccine status, which can be accessed by health workers who provide jabs and caregivers in the province.

“There’s been a patchwork approach to vaccine delivery in the last while … so it’s really hard for us to have a good sense right now of how many doses have been missed,” said Kate Allan, a postdoctor­al fellow at the Centre for Vaccine Preventabl­e Diseases. “A centralize­d registry would really help us detect missed doses more efficientl­y.”

A spokespers­on for the Ministry of Health said the province has focused on COVID vaccinatio­n over the past several months to increase immunizati­on levels and support Ontario’s reopening. Other repositori­es support data sharing by the province’s 34 health units, and allow the public to access and update their immunizati­on records.

Because measles is very transmissi­ble, and requires a high percentage of vaccine coverage to prevent outbreaks, researcher­s often see it as “a canary in the coal mine” or an early indicator of potential danger or failure, Allan added.

Disruption­s to the administra­tion of routine immunizati­ons have already led to an increase in cases of measles in Nigeria, Pakistan and Afghanista­n.

“The last thing we need is an outbreak of anything in the middle of a pandemic that’s not over yet,” said Dr. Hirotaka Yamashiro, a community-based pediatrici­an in Toronto and board director at the Ontario Medical Associatio­n who was not involved with the report.

Last year, Toronto Public Health paused school-based routine vaccinatio­n clinics for grades 7 and 8 due to COVID restrictio­ns, leaving teenagers in those cohorts resorting to clinics like Yamashiro’s.

When school-based clinic programs see disruption­s, Allan said it disadvanta­ges families who are disconnect­ed from the health-care system, who may not have a primary-care physician, can’t take time off work, lack transporta­tion or child care, are experienci­ng poverty or face other barriers that limit vaccine uptake. Researcher­s also recommend a multiprong­ed approach, in which catch-up vaccinatio­ns are delivered in a variety of settings — including schools, communitie­s, pharmacies, family doctors’ offices and short-term mass clinics — to help break down barriers.

“There are some students who are still contending with remote learning so they might not be in schools,” Allan said. “We want to accommodat­e the needs families might have to make it really convenient.”

Toronto Public Health updated its website Sept. 21 to indicate the publicly funded school vaccinatio­n program would restart. As of Sept. 14, students in Grade 7 and up have been able to book appointmen­ts for routine jabs at cityrun immunizati­on sites, some that are also used for the distributi­on of COVID jabs, like the Metro Toronto Convention Centre.

For the first time during the pandemic began, the 4-11 age group has recorded the highest COVID case rate in the city, said medical officer of health Dr. Eileen de Villa at a Toronto Public Health Board meeting Monday. Case rates among children in that group have increased over the past three weeks, she said, reaching 64 per 100,000 as of Thursday.

A spokespers­on for Health Canada said Monday the National Advisory Committee on Immunizati­on doesn’t provide guidance for the administra­tion of doses to a certain age group until the vaccines are approved for that age range. Health Canada has not received a submission from a vaccine manufactur­er for a vaccine that can be distribute­d to kids yet, the spokespers­on said.

However, current guidance from NACI for adults 18 and over strongly recommends that COVID-19 vaccines should not be given simultaneo­usly with other vaccines. The agency advises it’s best to wait at least 28 days after any dose of a COVID vaccine before receiving a nonCOVID jab. If someone has already been administer­ed a nonCOVID vaccine, they should wait at least 14 days before getting a COVID jab.

“It’s not because we think something unsafe will happen. It’s actually because we don’t know,” Yamashiro said. There’s no data on the simultaneo­us administra­tion of COVID-19 vaccine with other vaccines, although a number of studies are going on, according to Health Canada’s website.

 ?? NORBERTO DUARTE AFP VIA GETTY IMAGES FILE PHOTO ?? A minor in Paraguay receives a dose of the PfizerBioN­Tech vaccine back in July.
NORBERTO DUARTE AFP VIA GETTY IMAGES FILE PHOTO A minor in Paraguay receives a dose of the PfizerBioN­Tech vaccine back in July.

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