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.