OVERVIEW OF TRENDS IN IMMUNIZATIONS DURING COVID-19 IN MICHIGAN

Vaccine Doses Administered

In Michigan, there has been a 17.4% decrease in non-influenza vaccine doses administered and reported to the MCIR across the lifespan from January 1 to April 23, 2020 compared to the average for the same time period in 2018 and 2019. This represents over 200,000 fewer doses in 2020.

  • 19% decrease in children (0-8 years)

    • 15.7% decrease in children 0-24 months

  • 27.5% decrease in adolescents (9-18 years)

  • 11% decrease in adults (19-105 years)

Public Vaccine Doses Ordered

Compared to March and April 2019 public dose orders in Michigan, there was a 28.2% decrease in public dose orders in March and a 78.1% decrease in April (through April 23).

Childhood Immunization Coverage

According to statewide data on the county report cards, pediatric coverage for children 19-36 months of age for 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 HepB, 1 Varicella, 4 PCV, 2 HepA (43133142) dropped from 59.2% as of December 31, 2019 to 57.3% as of March 31, 2020; late April profile reports are also showing a drop in coverage.

Adolescent Immunization Coverage

Coverage for adolescents 13 through 17 years of age for 1 Tdap, 3 Polio, 2 MMR, 3 HepB, 2 Varicella, 1 MenACWY, 2 or 3 HPV-(1323213) series decreased from February to March for all MCIR regions with a one percentage point decrease at the state level.

CHILDHOOD COVERAGE BY IMMUNIZATION MILESTONE AGES & MEDICAID VS. NON-MEDICAID

Coverage by Milestone Ages

Vaccination status for one-month cohorts of children at ages 1, 3, 5, 7, 16, 19 and 24 months are assessed; ages corresponding to the end of an Advisory Committee on Immunization Practices (ACIP) recommendation period for one or more vaccines.

  • Coverage for the recommended age-based vaccine series has dropped below 50% for children currently 24 months of age (45.8%), 16 months of age (46%), and 7 months of age (47.3%); the 2019 average was 51.6%, 57.5%, and 55.6% respectively. Coverage for children 5 months of age has declined the most with only 52.4% of children 5 months of age receiving their age-based vaccines compared to 67.0% in 2019.

Coverage by Milestone Ages - Medicaid vs. Non-Medicaid Children

Disparities persist at milestone ages by Medicaid status; 38% of children enrolled in Medicaid were up-to-date for age recommended vaccines at 7 months compared to children not enrolled in Medicaid (57.4%).

Here is the Percentage of Children Vaccinated for the ACIP Recommended Vaccines at Milestone Ages by Medicaid status, April 23, 2020.

IMMUNIZATIONS AND COVID-19 – GUIDANCE RESOURCES

We recognize that the pandemic is affecting immunization services differently across providers in the state. CDC indicates that for offices that can only provide limited well-child visits, please prioritize newborn care and vaccination visits through age 24 months when possible. CDC, AAP, and AAFP have issued guidance for routine childhood, adolescent, and adult immunization during the COVID-19 response. There is also guidance regarding maternal immunizations as well as perinatal hepatitis B prevention. Below are these documents: 

CDC has also issued guidance Get Your Clinic Ready for Coronavirus Disease 2019. It provides tips on protecting patients and healthcare workers, including screening patients via telephone before they arrive to the practice and handling patients who present with symptoms and still need to be treated in-person. Another useful CDC resource includes COVID-19 Print Resources with signs that could be utilized at clinic entrances, PPE tip sheets, how to wear cloth face covers, handwashing signs in several languages and more.

Vaccinate Your Family has just released guidance on communication about vaccinations during the pandemic (“Call, don’t cancel”), as well as unique strategies for raising rates. Don’t miss their great tools:

MDHHS RESOURCES & MCIR TOOLS FOR SUPPORT

Attached is our MDHHS Division of Immunization Memo “Important Key Points on Vaccination Services During and After COVID-19”. This document reviews vaccination strategies and tools, including guidance on using the catch-up schedule, vaccinating children when sick, and storage and handling reminders. As mentioned in this memo, it is important to plan for patients who will need to be called back to your office as measures allow. If you are an immunizing provider who utilizes the Michigan Care Improvement Registry (MCIR), we encourage you to utilize tools in MCIR to plan for patients who are overdue and coming due for vaccines. Some providers also have access to clinic-level coverage rates and other helpful reports.

Also attached is MDHHS Guidance on Executive Order 2020-17 – which is regarding “Temporary Restrictions on Non-Essential Medical and Dental Procedures”. This letter provides guidance to consider in determining the timeliness and necessity of care for individual patients. Within the section Systematically prioritize in-person patient interactions, it indicates “Consider allowing medical visits for immunizations. Delayed immunizations can put individuals and communities at risk of vaccine-preventable diseases. Consider reaching out to families to schedule immunization visits in future months, so that patients can remain up to date.”

MCIR Reminder/Recall - Generating letters or mailing labels for patients due or overdue (30 days past overdue date) for vaccines

Immunization Quality Improvement (QI) Reports at the practice/clinic level - There are several QI reports available in MCIR that will identify vaccine coverage percentages, as well as various lists of patients that are due or overdue immunizations.

  • These Quality Improvement reports are available to immunizing provider sites, in MCIR, providing preventive care visits (not urgent care) and vaccinate children at least 6 months of age until the 19th birthday.

  • The information below is a general overview of how to generate QI reports but it does not provide details on each report. These QI reports may be a good tool for find the vaccination rates at a practice and to identify children that are due or overdue for vaccines. The QI reports can be utilized as a strategy to improve timely administration of immunizations and to catch-up children that have fallen behind on immunizations.

  • Questions about QI reports and how to utilize them for your practice? Contact your Local Health Department www.michigan.gov/LHDmap or the MDHHS QI Coordinator at Sanchezs@michigan.gov.

FYI - VACCINE ACCESS WITH THE VFC PROGRAM

There are even more staggering differences in rates when comparing coverage between Medicaid and non-Medicaid children. Ensuring access to vaccine highlights the importance of the Vaccines for Children Program - providing public vaccine at no cost for eligible children. Additionally, with the impact on employment and insurance changes, it is important to be aware of potential changes in patient eligibility. The VFC program provides vaccine at no cost for immunization of eligible children at VFC enrolled provider offices. VFC-eligible children include children 0 through 18 years and meet one of the following:

  • Medicaid-eligible

  • Uninsured

  • Underinsured

  • American Indian or Alaska Native

  • If interested in becoming a VFC provider, please review VFC information online at www.michigan.gov/vfc. There is also CDC VFC information available at https://www.cdc.gov/vaccines/programs/vfc/index.html.

    • The VFC program provides many tools to support your success, as providers are expected to comply with requirements set forth by CDC and MDHHS. If your practice is eligible and would like to enroll in the VFC program, contact your Local Health Department (LHD) at www.michigan.gov/LHDmap.