The Impact of COVID-19 Restrictions on Childhood Vaccination Uptake: A Rapid Review

Vaccines are highly effective for preventing a range of childhood infections. However, there have been concerns about the decrease in childhood vaccinations in 2020, with the WHO and UNICEF warning of an ‘alarming decline’ due to the COVID-19 pandemic. By analysing 35 published studies and 10 reports by national or international agencies, we found reductions in diphtheria tetanus pertussis, BCG, measles and polio vaccine uptake, as well as a range of other vaccines regularly given to children. Reductions in many settings were reversed once restrictions were lifted. However, not all settings reported a return to complete normality. Smaller declines were seen in younger children than older children. In addition, children born to women who could not read and write were more likely to be incompletely immunised. Barriers to access and maintaining public transport infrastructure impacted uptake of childhood vaccinations as well.The evidence in this review shows that obstacles to the delivery of vaccination services during the COVID-19 pandemic drove down immunisation rates, especially in disadvantaged people and poorer countries.<b>Appendices</b>Appendix 1. The Impact of COVID-19 Restrictions on Childhood Vaccination Uptake<b>Figures</b>Figure 1. PRIMSA 2020 Flow DiagramFigure 2. PRISMA Checklist<b>Tables</b>Table 1. Primary Studies on Childhood Vaccination UptakeTable 2. Reports by National and International Agencies

疫苗在预防多种儿童感染性疾病方面成效显著。然而，2020年儿童疫苗接种率下降引发广泛担忧，世界卫生组织（World Health Organization）与联合国儿童基金会（United Nations Children's Fund, UNICEF）曾发出警示，称受新型冠状病毒肺炎（COVID-19）疫情影响，儿童疫苗接种出现“令人警觉的下滑”。
本研究通过分析35项已发表的研究及10份国家或国际机构发布的官方报告，发现白喉、破伤风、百日咳联合疫苗、卡介苗（BCG）、麻疹疫苗、脊髓灰质炎疫苗，以及其他多种常规儿童接种疫苗的接种率均出现下降。在多数地区，随防疫限制解除，接种率下滑的趋势得到扭转，但并非所有地区都能恢复至疫情前的完全正常水平。与大龄儿童相比，低龄儿童的接种率降幅更小。此外，母亲为文盲的儿童更易出现疫苗接种不完全的情况。疫苗接种可及性障碍与公共交通基础设施维护状况，同样对儿童疫苗接种率造成了影响。
本综述的证据表明，COVID-19疫情期间疫苗接种服务供给面临的各类障碍，导致免疫接种率下降，这一情况在弱势群体与较贫困国家中尤为显著。
<b>附录</b>
附录1. COVID-19防疫限制对儿童疫苗接种率的影响
<b>图表</b>
图1. PRISMA 2020流程图
图2. PRISMA核查清单
<b>表格</b>
表1. 儿童疫苗接种率相关基础研究
表2. 国家及国际机构发布的报告