BQ Journal Vol 43 - Q2 2021 - 24

Morbidity and Mortality Weekly Report
Summary
What is already known about this topic?
Routine health care services have been disrupted during the
COVID-19 pandemic.
What is added by this report?
During the first week after the national COVID-19 emergency
declaration in March 2020, weekly vaccination rates among
Medicare beneficiaries aged ≥65 years declined by 25%-62%,
compared with the corresponding period in 2019. By mid-April,
vaccination rates in this group reached nadirs of 70%-89%
below 2019 rates. Rates partially recovered gradually during
May-July 2020.
What are the implications for public health practice?
Vaccination providers should emphasize the importance of
routine adult vaccination to their patients and ensure the safe
provision of vaccines to protect older adults from vaccinepreventable
diseases during the ongoing COVID-19 pandemic.
vaccine administration (6) and childhood vaccination coverage
(7) during the pandemic. Declines were similar across all racial/
ethnic groups; however, the magnitude of recovery varied by
race and ethnicity and vaccine. Vaccination rates among racial
and ethnic minority adults were lower than were those among
White adults.§§ The COVID-19 pandemic has disproportionally
affected certain racial and ethnic minority groups directly
(8); therefore, monitoring and early intervention to mitigate
similar disparities in indirect effects of the pandemic, such
as use of other preventive services, might be needed to avoid
compounding this disparity.
The findings in this report are subject to at least three limitations.
First, the analysis included only Medicare beneficiaries
in a fee-for-service plan, which represents approximately 66%
of total Medicare beneficiaries; therefore, the findings might
not be applicable to all older U.S. adults, who might also have
a different racial or ethnic distribution. Second, vaccination
was identified on claims data submitted for reimbursement.
Vaccination claims not accounted for were those that were not
submitted yet or were not billed to Medicare. Finally, race/
ethnicity groups other than White and Black could be potentially
misidentified in the Medicare administrative enrollment
records (9); therefore, actual declines in vaccination among
those groups might be different from those reported.
Because all 50 states had begun lifting business restrictions
or stay-at-home orders in some way by August 2020
(10), the likelihood of exposure to infectious diseases,
§§ https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubsresources/NHIS-2017.html
including
vaccine-preventable diseases, is increasing.¶¶ Levels
of SARS-CoV-2 virus circulation and associated illnesses
increased during September 2020-January 2021.*** In
response, some jurisdictions reissued lockdown policies,†††
which might have affected observed recovery in vaccination
rates. As the pandemic continues, vaccination providers should
continue efforts to resolve disruptions in routine adult vaccination
(3). When resuming in-person visits, vaccination providers
should take actions to prevent the spread of SARS-CoV-2
and address patient concerns about exposure to SARS-CoV-2
during visits. Vaccination providers should also provide reassurance
that vaccination services (including influenza vaccination
to mitigate non-COVID respiratory illness and preserve
health care capacity to treat COVID-19 during the influenza
season) can be delivered safely and emphasize the importance
of routine vaccination to protect patient health. It is important
that vaccination providers counsel patients about expected
reactogenicity of some vaccines, such as RZV, to help them
understand the potential overlap between vaccination reactions
and symptoms of COVID-19. Ultimately, continued efforts
by vaccination providers and public health officials at all levels,
including specific vaccination guidance for providers by state
health departments,§§§ will be needed to ensure that routine
adult vaccination returns to prepandemic levels to optimize
protection of all older persons against vaccine-preventable
diseases. Now that safe and effective COVID-19 vaccines are
available, those efforts could also help older U.S adults obtain
COVID-19 vaccination.
¶¶ Persons can contract varicella zoster virus, the virus that causes zoster, from
someone who has zoster. If the infected persons never had chickenpox or never
received the chickenpox vaccine, they will develop chickenpox, and perhaps then
develop zoster later in life. However, zoster cannot be contracted from someone
who has zoster. https://www.cdc.gov/shingles/about/transmission.html
*** https://www.cdc.gov/coronavirus/2019-ncov/covid-data/pdf/
covidview-02-05-2021.pdf
††† https://www.chicago.gov/content/dam/city/sites/covid/healthorders/2021/2021.1.20-Stay-at-Home-Advisory.pdf
§§§
Washington: https://www.doh.wa.gov/Portals/1/Documents/1600/
coronavirus/PleaseContinueVaccinatingPatients.pdf; Massachusetts: https://
www.mass.gov/doc/encouraging-vaccination-during-the-covid-19pandemic/download
Corresponding
author: Kai Hong, opu1@cdc.gov.
1Immunization Services Division, National Center for Immunization and
Respiratory Diseases, CDC; 2Division of Bacterial Diseases, National Center
for Immunization and Respiratory Diseases, CDC; 3Division of Viral Diseases,
National Center for Immunization and Respiratory Diseases, CDC.
All authors have completed and submitted the International
Committee of Medical Journal Editors form for disclosure of potential
conflicts of interest. No potential conflicts of interest were disclosed.
248
MMWR / February 19, 2021 / Vol. 70 / No. 7
US Department of Health and Human Services/Centers for Disease Control and Prevention
Diagnostics I Pharmaceuticals I DxRx Solutions I Continuing Education I News
24
A Henry Schein Publication

https://www.cdc.gov/shingles/about/transmission.html https://www.cdc.gov/coronavirus/2019-ncov/covid-data/pdf/covidview-02-05-2021.pdf https://www.cdc.gov/coronavirus/2019-ncov/covid-data/pdf/covidview-02-05-2021.pdf https://www.chicago.gov/content/dam/city/sites/covid/health-orders/2021/2021.1.20-Stay-at-Home-Advisory.pdf https://www.chicago.gov/content/dam/city/sites/covid/health-orders/2021/2021.1.20-Stay-at-Home-Advisory.pdf https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/PleaseContinueVaccinatingPatients.pdf https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/PleaseContinueVaccinatingPatients.pdf https://www.mass.gov/doc/encouraging-vaccination-during-the-covid-19-pandemic/download https://www.mass.gov/doc/encouraging-vaccination-during-the-covid-19-pandemic/download https://www.mass.gov/doc/encouraging-vaccination-during-the-covid-19-pandemic/download https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubs-resources/NHIS-2017.html https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubs-resources/NHIS-2017.html

BQ Journal Vol 43 - Q2 2021

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