early impact of the coronavirus disease covid 19 pandemic and physical distancing CORD-Papers-2022-06-02 (Version 1)

Title: Early impact of the coronavirus disease (COVID-19) pandemic and physical distancing measures on routine childhood vaccinations in England January to April 2020
Abstract: Using electronic health records we assessed the early impact of coronavirus disease (COVID-19) on routine childhood vaccination in England by 26 April 2020. Measles-mumps-rubella vaccination counts fell from February 2020 and in the 3 weeks after introduction of physical distancing measures were 19.8% lower (95% confidence interval: 20.7 to 18.9) than the same period in 2019 before improving in mid-April. A gradual decline in hexavalent vaccination counts throughout 2020 was not accentuated by physical distancing.
Published: 2020-05-14
Journal: Euro Surveill
DOI: 10.2807/1560-7917.es.2020.25.19.2000848
DOI_URL: http://doi.org/10.2807/1560-7917.es.2020.25.19.2000848
Author Name: McDonald Helen I
Author link: https://covid19-data.nist.gov/pid/rest/local/author/mcdonald_helen_i
Author Name: Tessier Elise
Author link: https://covid19-data.nist.gov/pid/rest/local/author/tessier_elise
Author Name: White Joanne M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/white_joanne_m
Author Name: Woodruff Matthew
Author link: https://covid19-data.nist.gov/pid/rest/local/author/woodruff_matthew
Author Name: Knowles Charlotte
Author link: https://covid19-data.nist.gov/pid/rest/local/author/knowles_charlotte
Author Name: Bates Chris
Author link: https://covid19-data.nist.gov/pid/rest/local/author/bates_chris
Author Name: Parry John
Author link: https://covid19-data.nist.gov/pid/rest/local/author/parry_john
Author Name: Walker Jemma L
Author link: https://covid19-data.nist.gov/pid/rest/local/author/walker_jemma_l
Author Name: Scott J Anthony
Author link: https://covid19-data.nist.gov/pid/rest/local/author/scott_j_anthony
Author Name: Smeeth Liam
Author link: https://covid19-data.nist.gov/pid/rest/local/author/smeeth_liam
Author Name: Yarwood Joanne
Author link: https://covid19-data.nist.gov/pid/rest/local/author/yarwood_joanne
Author Name: Ramsay Mary
Author link: https://covid19-data.nist.gov/pid/rest/local/author/ramsay_mary
Author Name: Edelstein Michael
Author link: https://covid19-data.nist.gov/pid/rest/local/author/edelstein_michael
sha: eb3d60ea21245f4c054c6ead3ac4719b29376254
license: cc-by
license_url: https://creativecommons.org/licenses/by/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 32431288
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/32431288
pmcid: PMC7238742
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238742
url: https://www.ncbi.nlm.nih.gov/pubmed/32431288/ https://doi.org/10.2807/1560-7917.es.2020.25.19.2000848
has_full_text: TRUE
Keywords Extracted from Text Content: coronavirus MenACWY −1.1 −6.0 Figure 2 Haemophilus influenzae type b self-isolate UK lockdown measles-mumps-rubella measles hepatitis B infants polio Hexavalent −22.5 −24.2 [2] SystmOne tetanus −5.5 [7] patient −25.9 children hexavalent HPV COVID-19 −4.8 hexavalent vaccine −20.7 −18.9 UK HPRU
Extracted Text Content in Record: First 5000 Characters:Using electronic health records, we assessed the early impact of coronavirus disease (COVID-19) on routine childhood vaccination in England by 26 April 2020. Measles-mumps-rubella vaccination counts fell from February 2020, and in the 3 weeks after introduction of physical distancing measures were 19.8% lower (95% confidence interval: −20.7 to −18.9) than the same period in 2019, before improving in mid-April. A gradual decline in hexavalent vaccination counts throughout 2020 was not accentuated by physical distancing. Childhood vaccination coverage in the United Kingdom (UK) is routinely monitored quarterly, but more timely monitoring is required during the disruption of a pandemic [1, 2] . We analysed electronic patient records from primary care to describe changes in delivery of first doses of hexavalent vaccine (against diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b and hepatitis B) and measles-mumps-rubella (MMR) vaccine as part of the routine childhood vaccination programme in England during the coronavirus disease (COVID-19) outbreak until 26 April 2020 (weeks 1 to 17). Two key milestones in the routine childhood immunisation programme delivered in primary care are first universal vaccinations at the age of 8 weeks, which include the hexavalent vaccine, and vaccinations at the age of 1 year, which include the first dose of MMR vaccine [3] . Aggregated weekly counts of the first hexavalent vaccinations delivered to infants younger than 6 months and of the first MMR vaccinations delivered to children aged 12 to 18 months were provided from The Phoenix Partnership (TPP) SystmOne for the first 17 weeks of 2019 and 2020. SystmOne is a software system which provides electronic patient records for more than 2,600 primary care practices in the UK and more than 35 child health providers [4] . Age ranges were selected to describe vaccinations delivered as part of the routine vaccination programme rather than catch-up campaigns, and match age ranges for national routine surveillance of vaccine coverage [1] . Data were anonymous throughout, having been originally extracted as aggregated weekly vaccination counts for the purpose of SystmOne data checks which use population level data. To minimise changes in denominator, only providers active in SystmOne since 2018 contributed to the dataset. The majority of vaccinations entered into SystmOne are entered by general practices in real time. However, vaccinations delivered in general practices which use other patient record software may be recorded at a delay into the SystmOne integrated patient record by local Child Health systems co-ordinating vaccination scheduling. To avoid artefacts from lags in data recording, we included only vaccinations recorded on the same day as they were delivered (which comprised more than 70% of the total hexavalent and MMR vaccination doses recorded as delivered in weeks 1 to 17 of 2019). This analysis was conducted as part of public health usual practice, and was not conducted for research. Ethics approval was therefore not sought. Hexavalent vaccination counts followed a similar pattern in 2020 as in 2019, varying week by week; particularly low counts in week 1 of both years are probably explained by holidays ( Figure 1 ). The MMR vaccination counts also followed a similar pattern in 2020 until week 11, when they fell, and remained low for several weeks before rising again in weeks 16 and 17. The percent change in vaccinations counts in 2020 compared with 2019 varied over the course of the COVID-19 pandemic (Table) . At the start of 2020 (weeks 1 to 9), hexavalent vaccination was 5.8% lower (95% confidence interval (CI): −6.0 to −5.5) and MMR vaccination 1.0% lower (95% CI: −1.1 to −0.9) compared with 2019. Weeks 10 to 12 were a transition period, with public discussion of physical distancing from at least week 10 [5] . On 12 March (week 11), the UK government advised that anyone with a new continuous cough or a fever should self-isolate for 7 days. Physical distancing measures were introduced nationally on 20 March (end of week 12) and subsequently extended on 23 March (start of week 13), closing schools and requiring everyone in the UK to avoid gatherings and non-essential use of public transport, limit contact with others and work from home if possible [6] . In weeks 10 to 12 of 2020, hexavalent vaccination was 4.4% lower (95% CI: −4.8 to −4.0) and MMR vaccination 7.2% lower (95% CI: −7.7 to −6.7) than in 2019. In the 3 weeks after introduction of full physical distancing measures (weeks 13 to 15), hexavalent vaccination was 6.7% lower (95% CI: −7.1 to −6.2) and MMR vaccination 19.8% lower (95% CI: −20.7 to −18.9) than in 2019. Although physical distancing measures remained unchanged nationally throughout the rest of the study period, vaccination counts were higher in weeks 16 and 17 of 2020 than for the same weeks in 2019, for both vaccines. Trends over time in the percent change of vaccination counts in 20
Keywords Extracted from PMC Text: −4.8 patient SystmOne self-isolate −22.5 Td/IPV −6.0 measles lockdown [7] hexavalent vaccine [2] −25.9 children Hexavalent hexavalent MenACWY −24.2 infants −1.1 −5.5 UK HPV −20.7 −18.9 COVID-19
Extracted PMC Text Content in Record: First 5000 Characters:Two key milestones in the routine childhood immunisation programme delivered in primary care are first universal vaccinations at the age of 8 weeks, which include the hexavalent vaccine, and vaccinations at the age of 1 year, which include the first dose of MMR vaccine [3]. Aggregated weekly counts of the first hexavalent vaccinations delivered to infants younger than 6 months and of the first MMR vaccinations delivered to children aged 12 to 18 months were provided from The Phoenix Partnership (TPP) SystmOne for the first 17 weeks of 2019 and 2020. SystmOne is a software system which provides electronic patient records for more than 2,600 primary care practices in the UK and more than 35 child health providers [4]. Age ranges were selected to describe vaccinations delivered as part of the routine vaccination programme rather than catch-up campaigns, and match age ranges for national routine surveillance of vaccine coverage [1]. Data were anonymous throughout, having been originally extracted as aggregated weekly vaccination counts for the purpose of SystmOne data checks which use population level data. To minimise changes in denominator, only providers active in SystmOne since 2018 contributed to the dataset. The majority of vaccinations entered into SystmOne are entered by general practices in real time. However, vaccinations delivered in general practices which use other patient record software may be recorded at a delay into the SystmOne integrated patient record by local Child Health systems co-ordinating vaccination scheduling. To avoid artefacts from lags in data recording, we included only vaccinations recorded on the same day as they were delivered (which comprised more than 70% of the total hexavalent and MMR vaccination doses recorded as delivered in weeks 1 to 17 of 2019). For weeks 1 to 17, the dataset included 69,568 hexavalent doses delivered in 2019 and 67,116 in 2020 as well as 68,849 MMR doses delivered in 2019 and 66,301 in 2020. This analysis was conducted as part of public health usual practice, and was not conducted for research. Ethics approval was therefore not sought. Hexavalent vaccination counts followed a similar pattern in 2020 as in 2019, varying week by week; particularly low counts in week 1 of both years are probably explained by holidays (Figure 1). The MMR vaccination counts also followed a similar pattern in 2020 until week 11, when they fell, and remained low for several weeks before rising again in weeks 16 and 17. The percent change in vaccinations counts in 2020 compared with 2019 varied over the course of the COVID-19 pandemic (Table). At the start of 2020 (weeks 1 to 9), hexavalent vaccination was 5.8% lower (95% confidence interval (CI): −6.0 to −5.5) and MMR vaccination 1.0% lower (95% CI: −1.1 to −0.9) compared with 2019. Weeks 10 to 12 were a transition period, with public discussion of physical distancing from at least week 10 [5]. On 12 March (week 11), the UK government advised that anyone with a new continuous cough or a fever should self-isolate for 7 days. Physical distancing measures were introduced nationally on 20 March (end of week 12) and subsequently extended on 23 March (start of week 13), closing schools and requiring everyone in the UK to avoid gatherings and non-essential use of public transport, limit contact with others and work from home if possible [6]. In weeks 10 to 12 of 2020, hexavalent vaccination was 4.4% lower (95% CI: −4.8 to −4.0) and MMR vaccination 7.2% lower (95% CI: −7.7 to −6.7) than in 2019. In the 3 weeks after introduction of full physical distancing measures (weeks 13 to 15), hexavalent vaccination was 6.7% lower (95% CI: −7.1 to −6.2) and MMR vaccination 19.8% lower (95% CI: −20.7 to −18.9) than in 2019. Although physical distancing measures remained unchanged nationally throughout the rest of the study period, vaccination counts were higher in weeks 16 and 17 of 2020 than for the same weeks in 2019, for both vaccines. Trends over time in the percent change of vaccination counts in 2020 compared with 2019 were modelled using Joinpoint regression (version 4.8.0.0), which finds the best fit for points of change in trend [7]. For the hexavalent vaccination, this suggested a general decrease in vaccination throughout weeks 1 to 15 in 2020 compared with the same weeks in 2019, which did not accentuate on introduction of physical distancing, but reversed in week 15, with a percent increase in weeks 16 and 17 of 2020 compared with 2019 (Figure 2). The percent change of first MMR doses delivered in 2020 compared with 2019 was steady until week 9, but then decreased to a low point of −24.2% (95% CI −25.9 to −22.5%) in week 13 before also reversing, with a percent increase in weeks 16 and 17 of 2020 compared with 2019 (Figure 2). In the 3 weeks following introduction of physical distancing measures (weeks 13–15), the percent change in hexavalent vaccination in 2020 compared with 2019 varied by region, ranging from increases of +17.4%
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