September 2020: COVID-19 Effects on Immunizations

Written by: Courtney Sorenson, PharmD Candidate and Paige Thomey, PharmD Candidate

Key Points

  • Compared to former years, Michigan children have received significantly fewer immunizations
  • Decreased immunization rates and the similarities between influenza and COVID-19 pose serious threats to our healthcare communities as influenza season approaches

Michigan has seen a significant decrease in routine immunizations as a result of the stay-at-home and shelter-in-place orders. Compared to 2018 and 2019, children in Michigan have received 21.5% fewer vaccines in January-April 2020.1 It is essential to maintain or reinitiate routine immunizations in order to protect our communities from preventable diseases and outbreaks. Routine vaccination for children, adolescents, and adults (including pregnant women) should not be delayed because of the COVID-19 pandemic. Influenza vaccines will be particularly important this year in order to avoid additional burden on healthcare systems as they adjust for increased levels of respiratory illnesses.2

Immunization Trends in the United States During January – April 20203

Alarming Statistics

  • Southeast Michigan had a measles outbreak last year of 42 cases4
    • Measles is a vaccine preventable disease
  • Preliminary data for the first 4 months of 2020 suggest a substantial drop in the number of children completing 3 doses of DTP3
    • This is the first time in 28 years that the world may see a reduction in DTP3 coverage
  • According to the WHO, globally, 62 of the 82 countries that responded reported that due to COVID-19 their immunization programs were disrupted in some way as of May 20205

Potential Challenges this Flu Season6

The 2020-21 Influenza season will present new challenges with the addition of the COVID-19 pandemic. Preventing influenza with immunization will be essential. Some potential challenges that may arise are as follows:

  • Influenza and COVID-19 share many of the same symptoms, so correctly diagnosing patients can be difficult. Rapid tests for influenza can produce false negatives depending on the type of test kit used and the type of influenza virus. Testing every patient with symptoms for COVID-19 may become excessive and expensive.
  • With concurrent respiratory conditions being treated, there will be more demand for ICU utilization, respiratory therapists, PPE utilization.

Strategies for Initiating Immunizations2,7

*Available online from the Michigan Department of Health and Human Services
**Instructions on implementing standing orders can be found the Immunization Action Coalition website

Safe Practices for Providing Immunizations2,8

  • Screen for COVID-19 symptoms
  • Limit and monitor points of entry into facility
  • Use of cloth face coverings in all over age of 2 years if tolerated
  • Ensure respiratory hygiene, cough etiquette, and hand hygiene
  • Providers should
    • Always wear medical facemask
    • Use eye protection
    • Wear gloves—changing between patients in addition to performing hand hygiene
  • Ensure physical distancing
    • Reduce crowding in waiting areas by asking patients to wait outside (in vehicles if applicable)
    • Separation of at least 6 feet maintained during check-in, checkout, screening procedures, and postvaccination monitoring
    • Utilize electronic communication instead of clipboard and pens
  • Other precautions
    • Scheduling well and sick visits at different times of the day
    • Physically separating patients in different locations
    • Rigorous sanitizing of offices

Additional Repercussions of Missed or Skipped Immunizations8

  • Missed physical exams and developmental screenings
  • Delayed laboratory testing
  • Missed hearing, vision, and oral health screenings
  • Delaying any of these visits can lead to worsening diseases that could have been caught and treated earlier

Immunizations in Patients with Suspected or Confirmed COVID-192

The CDC currently recommends deferring patients with suspected or confirmed COVID-19 until isolation criteria have been met in order to reduce the risk of exposing others to the virus.

CDC Immunization Schedules



  1. Individuals & Families | Alliance for Immunization in Michigan. Accessed July 24, 2020.
  2. Vaccination Guidance During a Pandemic. Published July 6, 2020. Accessed July 24, 2020.
  3. Santoli JM, Lindley MC, DeSilva MB, et al. Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020. MMWR Morb Mortal Wkly Rep 2020;69:591–593. DOI:
  4. MDHHS – 2019 Michigan Measles Outbreak Information. Accessed July 24, 2020.,5885,7-339-73971_4911_4914-492981–,00.html
  5. WHO and UNICEF warn of a decline in vaccinations during COVID-19. Accessed July 24, 2020.
  6. CDC. Flu Symptoms & Complications. Centers for Disease Control and Prevention. Published July 10, 2020. Accessed July 24, 2020.
  7. Schools Vaccines Required For School Entry In Michigan. Published online December 11, 2019. Accessed July 24, 2020.
  8. Jenco M. AAP urges vaccination as rates drop due to COVID-19. AAP News. Published online July 22, 2020. Accessed July 24, 2020.

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