Gaps in childhood immunizations and preventive care visits during the COVID-19 pandemic: a population-based cohort study of children in Ontario and Manitoba, Canada, 2016-2021

Andrea Evans; Alyson L Mahar; Bhumika Deb; Alexa Boblitz; Marni Brownell; Astrid Guttmann; Therese A Stukel; Eyal Cohen; Joykrishna Sarkar; Nkiruka Eze; Alan Katz; Tharani Raveendran; Natasha Saunders

doi:10.17269/s41997-023-00797-y

Gaps in childhood immunizations and preventive care visits during the COVID-19 pandemic: a population-based cohort study of children in Ontario and Manitoba, Canada, 2016-2021

Can J Public Health. 2023 Oct;114(5):774-786. doi: 10.17269/s41997-023-00797-y. Epub 2023 Jul 13.

Authors

Andrea Evans^{1

2

3}, Alyson L Mahar^{4

5}, Bhumika Deb³, Alexa Boblitz³, Marni Brownell^{4

5

6}, Astrid Guttmann^{3

7

8

9

10

11}, Therese A Stukel^{3

10}, Eyal Cohen^{3

7

8

9

10

11}, Joykrishna Sarkar⁵, Nkiruka Eze⁵, Alan Katz^{4

5

12}, Tharani Raveendran⁸, Natasha Saunders^{13

14

15

16

17

18}

Affiliations

¹ Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
² Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.
³ ICES, Toronto, ON, Canada.
⁴ Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁵ Manitoba Centre for Health Policy, Winnipeg, MB, Canada.
⁶ Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.
⁷ The Hospital for Sick Children, Toronto, ON, Canada.
⁸ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
⁹ Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
¹¹ Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada.
¹² Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada.
¹³ ICES, Toronto, ON, Canada. Natasha.saunders@sickkids.ca.
¹⁴ The Hospital for Sick Children, Toronto, ON, Canada. Natasha.saunders@sickkids.ca.
¹⁵ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada. Natasha.saunders@sickkids.ca.
¹⁶ Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Natasha.saunders@sickkids.ca.
¹⁷ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Natasha.saunders@sickkids.ca.
¹⁸ Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada. Natasha.saunders@sickkids.ca.

Abstract
in English, French

Objective: We aimed to estimate the changes to the delivery of routine immunizations and well-child visits through the pandemic.

Methods: Using linked administrative health data in Ontario and Manitoba, Canada (1 September 2016 to 30 September 2021), infants <12 months old (N=291,917 Ontario, N=33,994 Manitoba) and children between 12 and 24 months old (N=293,523 Ontario, N=33,001 Manitoba) exposed and unexposed to the COVID-19 pandemic were compared on rates of receipt of recommended a) vaccinations and b) well-child visits after adjusting for sociodemographic measures. In Ontario, vaccinations were captured using physician billings database, and in Manitoba they were captured in a centralized vaccination registry.

Results: Exposed Ontario infants were slightly more likely to receive all vaccinations according to billing data (62.5% exposed vs. 61.6% unexposed; adjusted Relative Rate (aRR) 1.01 [95% confidence interval (CI) 1.00-1.02]) whereas exposed Manitoba infants were less likely to receive all vaccines (73.5% exposed vs. 79.2% unexposed; aRR 0.93 [95% CI 0.92-0.94]). Among children exposed to the pandemic, total vaccination receipt was modestly decreased compared to unexposed (Ontario aRR 0.98 [95% CI 0.97-0.99]; Manitoba aRR 0.93 [95% CI 0.91-0.94]). Pandemic-exposed infants were less likely to complete all recommended well-child visits in Ontario (33.0% exposed, 48.8% unexposed; aRR 0.67 [95% CI 0.68-0.69]) and Manitoba (55.0% exposed, 70.7% unexposed; aRR 0.78 [95% CI 0.77-0.79]). A similar relationship was observed for rates of completed well-child visits among children in Ontario (aRR 0.78 [95% CI 0.77-0.79]) and Manitoba (aRR 0.79 [95% CI 0.77-0.80]).

Conclusion: Through the first 18 months of the pandemic, routine vaccines were delivered to children < 2 years old at close to pre-pandemic rates. There was a high proportion of incomplete well-child visits, indicating that developmental surveillance catch-up is crucial.

RéSUMé: OBJECTIF: Nous avons voulu estimer les changements dans l’administration des vaccins de routine et dans les consultations pédiatriques pendant la pandémie. MéTHODE: À l’aide des données administratives sur la santé couplées de l’Ontario et du Manitoba, au Canada (1^er septembre 2016 au 30 septembre 2021), nous avons comparé les taux de réception : a) des vaccins recommandés et b) des consultations pédiatriques recommandées pour les nourrissons de < 12 mois (N = 291 917 en Ontario, N = 33 994 au Manitoba) et pour les enfants de 12 à 24 mois (N = 293 523 en Ontario, N = 33 001 au Manitoba) exposés et non exposés à la pandémie de COVID-19, après ajustement en fonction de mesures sociodémographiques. En Ontario, les vaccins ont été saisis à l’aide de la base de données des factures des médecins; au Manitoba, ils ont été saisis dans un registre de vaccination centralisé. RéSULTATS: Les nourrissons exposés en Ontario étaient légèrement plus susceptibles de recevoir tous les vaccins selon les données de facturation (62,5 % pour les nourrissons exposés c. 61,6 % pour les nourrissons non exposés; risque relatif ajusté [RRa] 1,01 [intervalle de confiance (IC) de 95 % 1,00-1,02]), tandis que les nourrissons exposés au Manitoba étaient moins susceptibles de recevoir tous les vaccins (73,5 % pour les nourrissons exposés c. 79,2 % pour les nourrissons non exposés; RRa 0,93 [IC de 95 % 0,92-0,94]). Chez les enfants exposés à la pandémie, le total des vaccins reçus était un peu plus faible que chez les enfants non exposés (RRa en Ontario 0,98 [IC de 95 % 0,97-0,99]; RRa au Manitoba 0,93 [IC de 95 % 0,91-0,94]). Les nourrissons exposés à la pandémie étaient moins susceptibles d’avoir eu toutes les consultations pédiatriques recommandées en Ontario (33 % pour les nourrissons exposés, 48,8 % pour les nourrissons non exposés; RRa 0,67 [IC de 95 % 0,68-0,69]) comme au Manitoba (55 % pour les nourrissons exposés, 70,7 % pour les nourrissons non exposés; RRa 0,78 [IC de 95 % 0,77-0,79]). Une relation semblable a été observée pour les taux de consultations pédiatriques complètes chez les enfants en Ontario (RRa 0,78 [IC de 95 % 0,77-0,79]) et au Manitoba (RRa 0,79 [(IC de 95 % 0,77-0,80]). CONCLUSION: Au cours des 18 premiers mois de la pandémie, les vaccins de routine ont été administrés aux enfants de < 2 ans à des taux proches de ceux d’avant la pandémie. Il y a eu une forte proportion de consultations pédiatriques incomplètes, ce qui indique qu’il est essentiel de rattraper la surveillance du développement.

Keywords: COVID-19; Cohort study; Family medicine; Health systems; Immunization coverage; Pediatrics; Preventive care; Primary care; Well-child care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
COVID-19* / prevention & control
Child, Preschool
Cohort Studies
Humans
Infant
Manitoba / epidemiology
Ontario / epidemiology
Pandemics*
Vaccination

Grants and funding

VR4-172730/CIHR/Canada

Abstract in English, French

Publication types

MeSH terms

Grants and funding

Abstract
in English, French