Covid-19 Related Immunization Disruptions in Rajasthan, India: A Retrospective Observational Study

Abstract

IntroductionGovernments around the world suspended immunization outreach to control COVID-19 spread. Many have since resumed services with an emphasis on catch-up vaccinations to reach children with missed vaccinations. This paper evaluated immunization disruptions during India’s March-May 2020 lockdown and the extent to which subsequent catch-up efforts reversed them in Rajasthan, India.MethodsIn this retrospective observational study, we conducted phone surveys to collect immunization details for 2,144 children that turned one year old between January and October 2020. We used logistic regressions to compare differences in immunization timeliness and completed first-year immunization status among children that were due immunizations just before (unexposed), during (heavily exposed), and after (post-exposure) the lockdown.ResultsRelative to unexposed children, heavily exposed children were significantly less likely to be immunized at or before 9 months (OR 0.550; 95%CI 0.367-0.824; p=0.004), but more likely to be immunized at 10-12 months (OR 1.761; 95%CI 1.196-2.591; p=0.004). They were also less likely to have completed their key first-year immunizations (OR 0.624; 95%CI 0.478-0.816; p=0.001) by the time of survey. In contrast, post-exposure children showed no difference in timeliness or completed first-year immunizations relative to unexposed children, and their immunization coverage was 6.9pp above heavily exposed children despite their younger age. Declines in immunization coverage were larger among children in households that were poorer, less educated, lower caste, and residing in COVID red zones, although subgroup comparisons were not statistically significant.ConclusionDisruptions to immunization services resulted in children missing immunization during the lockdown, but catch-up efforts after it was eased ensured many children were reached at later ages. Nevertheless, catch-up was incomplete and children due their immunizations during the lockdown remained less likely to be fully immunized 4-5 months after it lifted, even as younger cohorts due immunizations in June or later returned to pre-lockdown schedules.

Magnitude and causes of routine immunization disruptions during COVID-19 pandemic in developing countries

“…Another set of data coming from Rajasthan, India reported significant lapses in the timeliness of administration of RI doses. [ 9 ] Subgroup analysis found that children in less educated and poorer households already had lower pre-COVID levels of immunization and were subject to greater declines in RI coverage during and after lockdown. The authors analyzed government’s administrative data obtained from HMIS and commented that increase in post-lockdown numbers may not reflect an increased RI coverage but may be due to seasonal fluctuations or migration of people.…”

The effects of India's COVID-19 lockdown on critical non-COVID health care and outcomes: Evidence from dialysis patients

“… Abdel-Kader and Unruh, 2009 , Dupas and Jain, 2020 , IndiaSpend, 2020a , Jain and Chopra, 2021 , Sever et al, 2015 , Thayer et al, 2021 , The Guardian, 2021 , The Lancet COVID-19 Commission India Task Force, 2021…”

Impact of COVID-19 pandemic on routine immunization

“…This is alarming and may have contributed to the recently reported increase in “Wild virus type 1” confirmed polio cases [ 74 ]. In India, data from Rajasthan province (where lockdown restrictions were greatest between March and May 2020) indicates an 87% relative decline in the number of fully immunized infants aged 9–11 months in April 2020 compared with pre-lockdown levels, although this was then somewhat compensated by the relative 23% increase in May 2020 [ 75 ]. However, while nationwide data shows a similar decline (69% in April 2020), there was no discernible recovery, with rates remaining lower in May and June 2020 (by 23% and 31% respectively) [ 75 ].…”

“…In India, data from Rajasthan province (where lockdown restrictions were greatest between March and May 2020) indicates an 87% relative decline in the number of fully immunized infants aged 9–11 months in April 2020 compared with pre-lockdown levels, although this was then somewhat compensated by the relative 23% increase in May 2020 [ 75 ]. However, while nationwide data shows a similar decline (69% in April 2020), there was no discernible recovery, with rates remaining lower in May and June 2020 (by 23% and 31% respectively) [ 75 ]. It remains to be seen how the more recent devastating upsurge in the COVID-19 pandemic in India has impacted on current immunization patterns.…”