Pediatric Annals

Special Issue Article 

The Effect of the COVID-19 Pandemic on Childhood Immunizations: Ways to Strengthen Routine Vaccination

Veronica Valentine McNally, JD; Henry H. Bernstein, DO, MHCM

Abstract

Primary care providers play key roles in ensuring that children and the community receive vaccines on time. Sometimes, this role includes the task of reassuring parents who are vaccine hesitant that vaccines are safe and effective. Now, because of coronavirus disease 2019 (COVID-19), providers are presented with the additional challenge of maintaining and strengthening routine vaccination during a pandemic. As COVID-19 cases increased and states implemented stay-at-home orders, outpatient visits declined significantly. As a result, childhood immunization rates also declined. Increasing communication efforts regarding the importance of vaccination will be worthwhile, as the effect of the COVID-19 pandemic has highlighted the threat of an infectious disease and has increased awareness of the vaccine development process. Prior to 2020, many parents had not seen the devastating consequences of an infectious disease. The pandemic may change a parent's perspective, particularly as it relates to the influenza vaccine. Providers should continue to promote the importance of well-child and vaccination visits. [Pediatr Ann. 2020;49(12):e516–e522.]

Abstract

Primary care providers play key roles in ensuring that children and the community receive vaccines on time. Sometimes, this role includes the task of reassuring parents who are vaccine hesitant that vaccines are safe and effective. Now, because of coronavirus disease 2019 (COVID-19), providers are presented with the additional challenge of maintaining and strengthening routine vaccination during a pandemic. As COVID-19 cases increased and states implemented stay-at-home orders, outpatient visits declined significantly. As a result, childhood immunization rates also declined. Increasing communication efforts regarding the importance of vaccination will be worthwhile, as the effect of the COVID-19 pandemic has highlighted the threat of an infectious disease and has increased awareness of the vaccine development process. Prior to 2020, many parents had not seen the devastating consequences of an infectious disease. The pandemic may change a parent's perspective, particularly as it relates to the influenza vaccine. Providers should continue to promote the importance of well-child and vaccination visits. [Pediatr Ann. 2020;49(12):e516–e522.]

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 and its global spread continue to present significant challenges in all areas of daily life. As of the end of November 2020, in the United States, more than 12.3 million cases of coronavirus disease 2019 (COVID-19) have been diagnosed and more than 257,016 COVID-19-associated deaths have been reported.1

Scientists are still learning about the virus. A recent summary of US Centers for Disease Control and Prevention (CDC) data shows that about two-thirds of COVID-19 transmissions are from people without symptoms—either because their cases are asymptomatic or presymptomatic.2

The symptoms of COVID-19 are similar in adults and children and can look like other common respiratory illnesses such as colds, strep throat, or allergies. Although the most common symptoms of COVID-19 in children are fever and cough, children may have any of the signs or symptoms listed in Table 1.

Signs and Symptoms of Coronavirus Disease 2019

Table 1.

Signs and Symptoms of Coronavirus Disease 2019

Similar to adults, children with severe COVID-19 may develop respiratory failure, myocarditis, shock, acute renal failure, coagulopathy, and multi-organ system failure.3 Some children with COVID-19 have developed other serious problems like intussusception or diabetic ketoacidosis.4 The CDC and partners are investigating a rare but serious medical condition associated with COVID-19 in children called multisystem inflammatory syndrome in children (MIS-C).5 At this time, the cause of MIS-C and who is at increased risk for developing it are not known.3 As of October 30, 2020, the CDC has received reports of 1,163 confirmed cases of MIS-C and 20 deaths in 44 states, New York City, and Washington, DC.6 Additional cases are under investigation.6 Current data indicate the average age of children with MIS-C is 8 years.6

Racial and ethnic minority groups are being disproportionately affected by COVID-19. Racial and ethnic minority groups represent 40% of the total US population, but nearly 60% of COVID-19 cases.7,8 The CDC has reported that among some racial and ethnic minority groups, including non-Hispanic Black people, Hispanics and Latinx, and American Indians/Alaskan Natives, evidence points to higher rates of cases, hospitalization, or death from COVID-19 than among non-Hispanic White people.9 Non-Hispanic Black people have a rate of infection approximately 5 times that of non-Hispanic White people, Non-Hispanic American Indian, or Alaskan Native people, have a rate approximately 5 times that of non-Hispanic White people, and Hispanic or Latinx people have a rate approximately 4 times that of non-Hispanic White people.9 To date, the majority of patients with MIS-C have been Hispanic/Latinx or Non-Hispanic Black.6

Effect of Covid-19 on Childhood Immunization Rates

US Data

Community mitigation measures such as shelter-in-place orders resulted in declines in outpatient pediatric visits and fewer vaccine doses administered during the early COVID-19 pandemic, leaving children at risk for vaccine-preventable diseases.10 In New York City, a decrease in the number of vaccine doses administered was detected beginning the week of March 8, 2020, 1 week after the first COVID-19 case was confirmed in New York City (Figure 1).11 Those numbers declined further after the New York State on PAUSE Executive Order went into effect on March 22, which required New Yorkers to stay at home to reduce the spread of SARS-CoV-2. The largest relative decrease was observed during the week of April 5 to 11 in children younger than age 24 months (a 62% decrease, from 33,261 doses in 2019 to 12,746 doses in 2020) and those age 2 to 18 years (a 96% decrease, from 23,631 doses in 2019 to 1,054 doses in 2020).11

Weekly changes in Vaccines for Children Program provider orders (https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html) and Vaccine Safety Datalink doses administered (children age 18 years and younger are eligible if they are Medicaid-eligible, uninsured, American Indian/Alaska Native, or underinsured and vaccinated at federally qualified health centers, rural health clinics, or provider sites with an approved deputization agreement with the state public health department, https://www.cdc.gov/vaccines/programs/vfc/index.html) for routine pediatric vaccines in the United States from January 6 to April 19, 2020. From the Centers for Disease Control and Prevention (Santoli et al.10) (in the public domain; permission is not required).

Figure 1.

Weekly changes in Vaccines for Children Program provider orders (https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html) and Vaccine Safety Datalink doses administered (children age 18 years and younger are eligible if they are Medicaid-eligible, uninsured, American Indian/Alaska Native, or underinsured and vaccinated at federally qualified health centers, rural health clinics, or provider sites with an approved deputization agreement with the state public health department, https://www.cdc.gov/vaccines/programs/vfc/index.html) for routine pediatric vaccines in the United States from January 6 to April 19, 2020. From the Centers for Disease Control and Prevention (Santoli et al.10) (in the public domain; permission is not required).

The COVID-19 pandemic has changed the way outpatient care is being delivered across the US. Early in the pandemic, health care providers began deferring elective visits and converted in-person visits to telemedicine visits. As a result, between mid-March and June 2020, there was a nearly 70% reduction of in-person outpatient visits, and pediatrics was among the hardest hit specialties. There was a 47% cumulative decline in pediatric provider visits during this time period; these disruptions in outpatient medical care were seen among all pediatric age groups (Figure 2).12

Percentage change in visits from baseline across specialties from March 15 to June 20, 2020. From the Centers for Disease Control and Prevention (Wharton13 and Ateev et al.14) (in the public domain; permission is not required).

Figure 2.

Percentage change in visits from baseline across specialties from March 15 to June 20, 2020. From the Centers for Disease Control and Prevention (Wharton13 and Ateev et al.14) (in the public domain; permission is not required).

In this context of reduced health care use among children, on March 24, the CDC posted guidance emphasizing the importance of routine well-childcare and immunization, particularly for children age 24 months or younger, which is the period when many childhood vaccines are recommended.10

The impact of the pandemic on pediatric immunization services in the US was assessed by the CDC in May 2020. Notable decreases in orders for vaccines from the Vaccines for Children (VFC) program began the week after the national emergency declaration for COVID-19. The decrease was less prominent among children age 24 months and younger than among older children.10 Similar declines in childhood vaccination coverage have been reported from state immunization registries as well.15

Other Countries

In July 2020, the World Health Organization (WHO) and UNICEF warned that disruptions in the delivery and uptake of immunization services caused by the COVID-19 pandemic had resulted in an alarming decline in the number of children receiving life-saving vaccines around the world.16 The WHO reports that at least 30 measles vaccination campaigns were or are at risk of being canceled, which could result in additional outbreaks in 2020 and beyond. Preliminary data from the first 4 months of 2020 pointed to a substantial drop in the number of children completing three doses of the diphtheria, tetanus, and pertussis (DTP3) vaccine. The WHO stated, “This is the first time in 28 years that the world could see a reduction in DTP3 coverage—the marker for immunization coverage within and across countries.”16

School and Businesses Reopen: Responses from the CDC and AAP

The CDC and the American Academy of Pediatrics (AAP) recommend every child continue to receive routine vaccinations during the COVID-19 pandemic.17 Well-child visits and vaccinations are essential services and ensure children are protected against vaccine-preventable diseases. As communities reopen, it is vitally important for providers to work with parents to ensure their children stay up to date on routine, universally recommended vaccines.

The VFC program provides vaccines at no cost to eligible children and has approximately 38,000 enrolled practices, or about 86% of US pediatricians. In May 2020, a survey of practices participating in the VFC program was conducted to assess the capacity of pediatric health care practices to provide immunization services to children during the pandemic. This survey found that approximately 90% are open, and among those open practices, 96% were offering vaccines and 59% were accepting new patients.18

Current Data and Predictions

Although COVID-19 has brought substantial disruptions to routine childhood vaccination services, the CDC reports that there are signs of recovery (Figure 3). Although still below baseline, pediatric outpatient health care use began improving in May 2020.14

Weekly Vaccines for Children program provider orders for pediatric vaccines in the United States, December 23, 2019 to June 21, 2020. From the Centers for Disease Control and Prevention (Wharton13) (in the public domain; permission is not required).

Figure 3.

Weekly Vaccines for Children program provider orders for pediatric vaccines in the United States, December 23, 2019 to June 21, 2020. From the Centers for Disease Control and Prevention (Wharton13) (in the public domain; permission is not required).

Data Supporting the Need to Strengthen Routine Vaccination: Disease Resurgence and Economic Impact

Routine childhood vaccination offers one of the most significant value propositions in the US health care system. With the recommended vaccination of a single US birth cohort, the expected savings in direct health care costs is $20.3 billion.19 This figure considers the costs of vaccine doses, vaccine administration, and treatment for known side effects of vaccines. The value estimate indicates that for every $1 invested in routine childhood vaccination, there is a return of $3.

Vaccination is not just cost-effective; it saves lives. At a time when our health care system is already overwhelmed, we must avoid outbreaks of preventable, potentially deadly diseases. The economic burden of a concurrent outbreak or epidemic would be devastating. A review of measles outbreak cost estimates from the US in the post-elimination era (2004–2017) revealed that median total costs per measles outbreak were $152,308 (range, $9,862–$1,063,936); median cost per case was $32,805 (range, $7,396–$76,154), and median cost per contact was $223 (range, $81–$746).20 The measles outbreak in New York City that began in October of 2018 cost the city $6 million. Most measles cases were among unvaccinated (73%), incompletely vaccinated (7%), or people who did not know their vaccination status (15%).21

Ways to Strengthen Routine Vaccination: Strategies for Providers

Patients who are unvaccinated or incompletely vaccinated are susceptible to preventable illness, creating communities at risk for outbreaks as a result of reduced vaccine administration during the COVID-19 pandemic. Implementation of strategies to promote adherence to the vaccination schedule and ensure catch-up vaccination is exceedingly important, especially for children. Approximately 93% of parents say that their child's provider is their most trusted source of vaccine information (CDC, unpublished data). Therefore, pediatric providers should communicate with families about how they can be safely vaccinated during the pandemic.

The CDC has recommended several communication strategies, including implementing reminder and recall systems to identify patients who are due for or who have missed vaccine doses.22 The vaccination status of all patients should be assessed at each health care visit. This will prevent missed opportunities for vaccination. Health care providers should identify and contact children who have missed well-child visits and/or recommended vaccinations to schedule in-person appointments. Providers should prioritize infants, children younger than age 24 months, and school-aged children. The CDC also recommends the use of standing orders to further improve the efficiency of catch-up vaccination.4

Developmental surveillance and early childhood screenings, including developmental and autism screening, should continue so referrals for early intervention services and further evaluation when concerns are identified can be made.4 All newborns should be seen by a pediatric health care provider shortly after hospital discharge (age 3 to 5 days). The CDC recommends that newborn visits be done in person, even during the COVID-19 pandemic.4 Health care facilities should ensure infection prevention and control policies are in place to minimize chances of exposure to SARS-CoV-2 among providers, patients, and families.

Further strategies to maintain immunization services include dedicating specific clinics, rooms, or buildings for sick visits and well visits; reducing the number of patients on-site at any one time; closing waiting rooms or registration areas; and having patients check in by phone from their vehicles and receive vaccinations in the parking lot.23

In addition, the CDC recommends the incorporation of everyday infection prevention measures by pediatric health care providers, including the education of patients and families about the infection prevention policies that exist in their offices, emergency departments, hospitals, and clinics.4

During the vaccine-encounter, providers should continue to normalize vaccine administration. For example, if asked by a parent why following the recommended immunization schedule is so important for infants, respond with the points listed in Table 2.

Talking Points to Counter Vaccine Hesitancy in Parents or Caregivers

Table 2.

Talking Points to Counter Vaccine Hesitancy in Parents or Caregivers

In addition to stressing the importance of keeping children up to date with all recommended vaccinations, influenza vaccinations for the 2020 to 2021 influenza season are imperative.27 Despite flu being a vaccine-preventable disease, generally less than 60% of children are immunized against it every season. Whereas vaccine hesitancy for routine vaccines is about 6%, vaccine hesitancy for influenza vaccine is about 26%.28

Table 3 provides a list of parent-friendly influenza talking points that should be discussed with parents.

Parent-Friendly Influenza Talking Points

Table 3.

Parent-Friendly Influenza Talking Points

Conclusion

The COVID-19 pandemic is a reminder of the threat of infectious diseases. Providers are well positioned to counsel parents about the value of vaccination. Uptake is highest when parents are aware that their child is due for specific vaccines and when they feel safe about their children receiving those vaccines. Urgent action is required to maintain and strengthen childhood vaccination during the COVID-19 pandemic. Measures may include the implementation of reminder and recall systems, standing orders, and communication with parents regarding how vaccines are being safely administered in outpatient settings during the pandemic. The well-being of the world depends on high uptake of routine vaccinations. Providers should not miss this opportunity to strengthen trust in public health and vaccines.

References

  1. Centers for Disease Control and Prevention. United States COVID-19 cases and deaths by state. Accessed November 25, 2020. https://covid.cdc.gov/covid-data-tracker/#cases_casesinlast7days
  2. Centers for Disease Control and Prevention. COVID-19 pandemic planning scenarios. Accessed November 23, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html
  3. Centers for Disease Control and Prevention. COVID-19 in children and teens. Accessed November 15, 2020. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/symptoms.html
  4. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19). Information for pediatric healthcare providers. Accessed November 15, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html
  5. Centers for Disease Control and Prevention. For parents: multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. Accessed November 15, 2020. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/mis-c.html
  6. Centers for Disease Control and Prevention. Health department-reported cases of multisystem inflammatory syndrome in children (MIS-C) in the United States. Accessed November 23, 2020. https://www.cdc.gov/mis-c/cases/?deliveryName=USCDC_2067-DM37553
  7. United States Census Bureau. Quick Facts. Accessed November 15, 2020. https://www.census.gov/quickfacts/fact/table/US/PST045219
  8. Centers for Disease Control and Prevention. Demographic trends of COVID-19 cases and deaths in the US reported to CDC. Accessed November 15, 2020. https://www.cdc.gov/covid-data-tracker/index.html#demographics
  9. Centers for Disease Control and Prevention. Health equity considerations and racial and ethnic minority groups. Accessed November 23, 2020.
  10. 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(19):591–593. doi:10.15585/mmwr.mm6919e2 [CrossRef] PMID:32407298
  11. Langdon-Embry M, Papadouka V, Cheng I, Almashhadani M, Ternier A, Zucker JR. Notes from the field: rebound in routine childhood vaccine administration following decline during the COVID-19 pandemic - New York City, March 1–June 27, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(30):999–1001. doi:10.15585/mmwr.mm6930a3 [CrossRef] PMID:32734936
  12. Mehrotra A, Chernew M, Linetsky D, Hatch H, Cutler D. The impact of the COVID-19 pandemic on outpatient visits: practices are adapting to the new normal (Commonwealth Fund, June 2020). doi:10.26099/2v5t-9y63 [CrossRef]
  13. Wharton M. Maintaining and strengthening childhood vaccination during the COVID-19 pandemic. Oral presentation at: Advisory Committee on Immunization Practices Meeting. ; June 22, 2020. ; Virtual Meeting.
  14. Ateev M, Chernew M, Linetsky D, Hatch H, Cutler D. To the Point (blog) (Commonwealth Fund, May 19, 2020.
  15. Bramer CA, Kimmins LM, Swanson R, et al. Decline in child vaccination coverage during the COVID-19 pandemic - Michigan Care Improvement Registry, May 2016–May 2020. MMWR Morb Mortal Wkly Rep. 2020;69(20):630–631. doi:10.15585/mmwr.mm6920e1 [CrossRef] PMID:32437340
  16. World Health Organization. WHO and UNICEF warn of a decline in vaccinations during Covid-19. Accessed November 15, 2020. https://www.who.int/news-room/detail/15-07-2020-who-and-unicef-warn-of-a-decline-in-vaccinations-during-covid-19
  17. Centers for Disease Control and Prevention. Routine vaccination during the COVID-19 outbreak. Accessed November 23, 2020. https://www.cdc.gov/vaccines/parents/visit/vaccination-during-COVID-19.html
  18. Vogt TM, Zhang F, Banks M, et al. Provision of pediatric immunization services during the COVID-19 pandemic: an assessment of capacity among pediatric immunization providers participating in the Vaccines for Children Program - United States, May 2020. MMWR Morb Mortal Wkly Rep. 2020;69(27):859–863. doi:10.15585/mmwr.mm6927a2 [CrossRef] PMID:32644980
  19. Zhou F, Shefer A, Wenger J, et al. Economic evaluation of the routine childhood immunization program in the United States, 2009. Pediatrics. 2014;133(4):577–585. doi:10.1542/peds.2013-0698 [CrossRef] PMID:24590750
  20. Pike J, Leidner AJ, Gastañaduy PA. A review of measles outbreak cost estimates from the US in the post-elimination era (2004–2017): estimates by perspective and cost type [published online ahead of print January 22, 2020]. Clin Infect Dis. doi:10.1093/cid/ciaa070 [CrossRef]
  21. Office of the Mayor News. The Official Website of New York City. Mayor de Blasio, health officials declare end of measles outbreak in New York City Accessed November 15, 2020. https://www1.nyc.gov/office-of-the-mayor/news/409-19/mayor-de-blasio-health-officials-declare-end-measles-outbreak-new-york-city
  22. Centers for Disease Control and Prevention. Vaccination guidance during a pandemic. Accessed November 15, 2020. https://www.cdc.gov/vaccines/pandemic-guidance/index.html
  23. Washington State Department of Health. Please continue vaccinating patients during COVID-19. Accessed November 15, 2020. https://files.constantcontact.com/9817310a001/66cddbb8-c4f9-44b4-a762-20e04beaaed3.pdf
  24. Centers for Disease Control and Prevention. Reasons to follow CDC's recommended immunization schedule. Accessed November 23, 2020. https://www.cdc.gov/vaccines/parents/schedules/reasons-follow-schedule.html
  25. Centers for Disease Control and Prevention. Risks of delaying or skipping vaccines. Accessed November 23, 2020. https://www.cdc.gov/vaccines/parents/why-vaccinate/risks-delaying-vaccines.html
  26. Centers for Disease Control and Prevention. The journey of your child's vaccine. Accessed November 19, 2020. https://www.cdc.gov/vaccines/parents/infographics/journey-of-child-vaccine.html
  27. Grohskopf LA, Alyanak E, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices - United States, 2020–21 influenza season. MMWR Recomm Rep. 2020;69(8):1–24. doi:10.15585/mmwr.rr6908a1 [CrossRef] PMID:32820746
  28. Kempe A, Saville AW, Albertin C, et al. Parental hesitancy about routine childhood and influenza vaccinations: a national survey. Pediatrics. 2020;146(1):e20193852. doi:10.1542/peds.2019-3852 [CrossRef]. PMID:32540985
  29. Solomon DA. Seasonal influenza vaccination. JAMA. 2020;324(13):1362. doi:10.1001/jama.2020.14772 [CrossRef] PMID:32797144
  30. Mistry RD, Fischer JB, Prasad PA, Coffin SE, Alpern ER. Severe complications in influenza-like illnesses. Pediatrics. 2014;134(3):e684–e690. doi:10.1542/peds.2014-0505 [CrossRef] PMID:25092942
  31. Centers for Disease Control and Prevention. Estimated influenza illnesses, medical visits, hospitalizations, and deaths in the United States—2019–2020 influenza season. Accessed November 15, 2020. https://www.cdc.gov/flu/about/burden/2019-2020.html
  32. Centers for Disease Control and Prevention. Key facts about seasonal flu vaccine. Accessed November 23, 2020. https://www.cdc.gov/flu/prevent/keyfacts.htm
  33. Centers for Disease Control and Prevention. Influenza (flu). Flu vaccine and people with egg allergies. Accessed November 15, 2020. https://www.cdc.gov/flu/prevent/egg-allergies.htm
  34. Centers for Disease Control and Prevention. Vaccine effectiveness: how well do the flu vaccines work? Accessed November 23, 2020. https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm
  35. Tamma PD, Ault KA, del Rio C, Steinhoff MC, Halsey NA, Omer SB. Safety of influenza vaccination during pregnancy. Am J Obstet Gynecol. 2009;201(6):547–552. doi:10.1016/j.ajog.2009.09.034 [CrossRef] PMID:19850275

Signs and Symptoms of Coronavirus Disease 2019

<list-item>

Fever or chills

</list-item><list-item>

Cough

</list-item><list-item>

Nasal congestion or runny nose

</list-item><list-item>

New loss of taste or smell

</list-item><list-item>

Sore throat

</list-item><list-item>

Shortness of breath or difficulty breathing

</list-item><list-item>

Diarrhea

</list-item><list-item>

Nausea or vomiting

</list-item><list-item>

Stomachache

</list-item><list-item>

Tiredness

</list-item><list-item>

Headache

</list-item><list-item>

Muscle or body aches

</list-item><list-item>

Poor appetite or poor feeding, especially in babies younger than age 1 year

</list-item>

Talking Points to Counter Vaccine Hesitancy in Parents or Caregivers

<list-item>

Vaccines provide immunity early in life, when children are most at risk for contracting serious illness24

</list-item><list-item>

Vaccines are scheduled at ages when your child will have the best response to develop immunity24

</list-item><list-item>

Infants and young children who do not follow the recommended immunization schedules and are at risk of developing diseases during the time that the shots are delayed25

</list-item><list-item>

The Centers for Disease Control and Prevention schedule has been carefully tested, studied, and reviewed by medical experts26

</list-item>

Parent-Friendly Influenza Talking Points

<list-item>

Influenza and COVID-19 epidemics will occur together this year, and the common signs and symptoms of COVID-19 (eg, fever, cough, and difficulty breathing) also occur with influenza13

</list-item><list-item>

Influenza is a respiratory illness that is estimated to cause between 9.3 million and 45 million illnesses, leading to 12,000 to 61,000 deaths in the US every year.29 Approximately 80% of those who who die from the flu did not receive a flu shot30

</list-item><list-item>

During the flu season, the CDC estimates that the flu vaccine prevented 4.4 million flu illnesses, 58,000 hospitalizations, and 3,500 deaths.29 During the 2019–2020 season, 188 flu-related pediatric deaths were reported31

</list-item><list-item>

It is important to get the vaccine early in the fall before flu season begins. It takes 2 weeks before the vaccine becomes effective32

</list-item><list-item>

The flu shot is an attenuated vaccine, meaning it does not cause the flu32

</list-item><list-item>

Egg allergy is no longer a reason to avoid the flu vaccine33

</list-item><list-item>

Influenza vaccination is a community effort—the more people who are vaccinated in a population, the larger protective effect of the vaccine34

</list-item><list-item>

Influenza vaccination has been shown to be safe and effective in pregnant women. Pregnant women and their fetuses are at high risk of severe complications of flu, so vaccination is strongly recommended35

</list-item>
Authors

Veronica Valentine McNally, JD, is the President & Co-Founder, Franny Strong Foundation. Henry H.Bernstein, DO, MHCM, is a Professor of Pediatrics, Zucker School of Medicine at Hofstra/Northwell and Cohen Children's Medical Center.

Address correspondence to Veronica Valentine McNally, JD, Franny Strong Foundation, 5767 West Maple, Suite 200, West Bloomfield, MI 48322; email: info@frannystrong.org.

Disclosure: The authors have no relevant financial relationships to disclose.

10.3928/19382359-20201115-01

Sign up to receive

Journal E-contents