COVID-19 related immunization disruptions in Rajasthan, India: A retrospective observational study

Abstract

Introduction Governments around the world suspended immunization outreach to control COVID-19 spread. Many have since resumed services with an emphasis on catch-up 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. Methods In 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. Results Relative 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, despite their younger age. First-year immunization coverage among heavily exposed children decreased by 6.9pp to 10.4pp (9.7% to 14.0%). 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. Conclusion Disruptions 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.

The Impact of COVID-19 Pandemic on Inequity in Routine Childhood Vaccination Coverage: A Systematic Review

“…In summary, although two moderate risk-of-bias studies [20,22] failed to show evidence of increasing inequity during the pandemic, three low-risk-of-bias studies [14,21,23] report moderately strong evidence of increasing inequity, with additional, but weak, supporting evidence from Bramer et al [24].…”

“…All the included studies reported on the COVID lockdown in their respective countries during the first wave between March and September 2020. Six studies reported data for a pre-lockdown period in addition to a lockdown period [ 14 , 20 , 21 , 22 , 23 , 24 ].…”

Impact of COVID-19 on child health and healthcare services

“…This decline was higher in children from a poorer, less educated background and residing in COVID-19 red zones. 6 …”

Impact Assessment of COVID-19 on Immunization Service for Children

“…Based on results of risk mapping analysis, it was obtained that recommendations of immunization services could be a selection of service sites that corresponded with regional conditions (Jain et al, 2021). Healthcare facilities like Community Health Center and Integrated Health Post for Child Health in areas that remained as susceptible could conduct the services with a proactive system.…”

“…WHO underlined that immunizations were the basic healthcare services and hence should be the priority and be maintained even during COVID-19 pandemics (Jain et al, 2021)…”