本文摘译自MASSDEVICE 2020年5月12日新闻

以下为详文

根据美国疾病控制和预防中心（CDC）研究人员的数据，由于COVID-19大流行，社区采取强制执行的隔离保护措施，使父母和孩子远离医生办公室，这种情况促使了美国儿童常规疫苗接种量急剧下降。

3月13日宣布全国紧急状态后，小儿疫苗接种量急剧下降，这表明某些儿童患上其他严重传染性疾病（例如麻疹）的风险可能会增加。

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研究人员把2020年1月6日至4月19日联邦资助疫苗的每周订单与2019年的同期订单进行了比较。

他们特别提到，到研究期结束时，CDC免疫实践咨询委员会推荐的儿童常规小儿非流感疫苗订单，COVID-19相关的累积剂量下降了250万剂，此外，麻疹疫苗订单的累积剂量下降了25万剂。

CDC发言人Richard Quartarone表示，研究期间的疫苗接种，总体下降幅度较大。上述数字的下降，显然与COVID-19大流行有关。

在2020年3月16日开始的一周内，为≥24个月的孩子订购的麻疹疫苗周数量急剧下降到500份左右；在3月23日开始的一周内，进一步下降到约250份；直到4月13日开始的那一周，一直保持这个水平。相比之下，宣布紧急状况之前，即在3月2日开始的一周内，订购了2500多份。

对于2岁以下的儿童，下降幅度明显较小。从3月23日开始的一周内，这些孩子的订单下降到约750份左右，不过，3周内略有上升。相比之下，在3月2日的那一周，这些孩子的疫苗订单大约是2000份。

5月8日在线发表在《CDC发病率和死亡率周报》上的这项调查结果，来自对联邦儿童疫苗计划（VFC）订购数据的分析，以及来自CDC疫苗追踪系统和疫苗安全协作数据链（VSD）的疫苗管理数据。

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对于18岁或18岁以下的，VFC为他们大约有一半的人数免费提供联邦购买的疫苗。VSD与CDC免疫安全办公室和全国八家大型医疗机构在疫苗覆盖率方面进行合作。疫苗接种覆盖率是评估疫苗使用情况的常用指标，提供方的指令和给药剂量是两个替代措施。

来自CDC免疫服务部门、国家免疫和呼吸系统疾病中心的研究人员强调，在大流行期间保持定期接种疫苗非常重要，并指出：“常规的儿童疫苗订购和使用剂量的确定下降数据可能说明，美国儿童及其社区面临着疫苗可预防疾病爆发的风险增加。”因此，应该提醒父母，必须保护自己的孩子免受疫苗可预防疾病的侵害。

研究人员预测，随着社区隔离的缓和，未接种疫苗的儿童将更容易感染其他严重疾病。他们总结道：“地方、州、联邦各级的医疗保健提供者和公共卫生官员之间，需要继续协调努力，有必要实现快速补种疫苗。”

原文：

COVID-19 Fears Tied to Dangerous Drop in Child Vaccinations

Medscape Medical News     Diana Swift     May 12, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The social distancing and sheltering in place mandated because of the COVID-19 pandemic are keeping parents and kids out of their doctors' offices, and that has prompted a steep decline in recommended routine vaccinations for US children, according to Centers for Disease Control and Prevention (CDC) researchers.

Pediatric vaccinations dropped sharply after the national emergency was declared on March 13, suggesting that some children may be at increased risk for other serious infectious diseases, such as measles.

The researchers compared weekly orders for federally funded vaccines from January 6 to April 19, 2020, with those during the same period in 2019.

They noted that by the end of the study period, there was a cumulative COVID-19–related decline of 2.5 million doses in orders for routine noninfluenza pediatric childhood vaccines recommended by the CDC's Advisory Committee on Immunization Practices, as well as a cumulative decline in orders of 250,000 doses of measles vaccines.

Although the overall decrease in vaccinations during the study period was larger, according to CDC spokesperson Richard Quartarone, the above figures represent declines clearly associated with the pandemic.

The weekly number of measles vaccines ordered for children aged 24 months or older fell dramatically to about 500 during the week beginning March 16, 2020, and fell further to approximately 250 during the week beginning March 23. It stayed at that level until the week beginning April 13. By comparison, more than 2500 were ordered during the week starting March 2, before the emergency was declared.

The decline was notably less for children younger than 2 years. For those children, orders dropped to about 750 during the week starting March 23 and climbed slightly for 3 weeks. By comparison, during the week of March 2, about 2000 vaccines were ordered.

The findings, which were published online May 8 in the CDC's Morbidity and Mortality Weekly Report, stem from an analysis of ordering data from the federal Vaccines for Children (VFC) Program, as well as from vaccine administration data from the CDC's Vaccine Tracking System and the collaborative Vaccine Safety Datalink (VSD).

The VFC provides federally purchased vaccines at no cost to about half of persons aged 18 years or younger. The VSD collaborates on vaccine coverage with the CDC's Immunization Safety Office and eight large healthcare organizations across the country. Vaccination coverage is the usual metric for assessing vaccine usage; providers' orders and the number of doses administered are two proxy measures, the authors explain.

"The substantial reduction in VFC-funded pediatric vaccine ordering after the COVID-19 emergency declaration is consistent with changes in vaccine administration among children in the VSD population receiving care through eight large US health care organizations," write Jeanne M. Santoli, MD, and colleagues, of the CDC's Immunization Services Division, National Center for Immunization and Respiratory Diseases. "The smaller decline in measles-containing vaccine administration among children aged ≤24 months suggests that system-level strategies to prioritize well child care and immunization for this age group are being implemented," they state.

Santoli, who is an Atlanta-based pediatrician, and associates stress the importance of maintaining regular vaccinations during the pandemic. "The identified declines in routine pediatric vaccine ordering and doses administered might indicate that US children and their communities face increased risks for outbreaks of vaccine-preventable diseases," they write. "Parental concerns about potentially exposing their children to COVID-19 during well child visits might contribute to the declines observed." Parents should therefore be reminded of the necessity of protecting their children against vaccine-preventable diseases.

In 2019, a Gallup survey reported that overall support for vaccination continued to decline in the United States.

The researchers predict that as social distancing relaxes, unvaccinated children will be more susceptible to other serious diseases. "In response, continued coordinated efforts between health care providers and public health officials at the local, state, and federal levels will be necessary to achieve rapid catch-up vaccination," they conclude.