EFFECT OF THE COVID-19 PANDEMIC ON ROUTINE CHILDHOOD IMMUNIZATION IN RURAL COMMUNITIES IN SOUTHERN INDIA

Abstract

Intro: Due to the ongoing COVID-19 pandemic, routine childhood immunization coverage globally decreased from 86% in 2019 to 81% in 2021. In India, the impact of the pandemic and associated lockdowns on routine childhood immunization has not been adequately reported. Here, we survey the effect of the pandemic on routine childhood immunization coverage and examine delays in previously censused rural communities in Tamil Nadu, southern India. Methods: In this community-based cross-sectional study conducted in September 2021, we approached all households with children born between March 2019 and February 2021 located in two rural blocks - Jawadhu hills, a primarily tribal population, and Timiri. A structured questionnaire was administered to the parents or primary caregivers using a mobile phone-based data collection application. From the available immunization card, dates for each vaccine administered to the child were recorded and cross-verified, and caregivers were asked for reasons for delayed or missed doses of specific vaccines. Findings: Overall, 1254 and 1962 households with children in Jawadhu hills and Timiri blocks consented to participate. Coverage for all vaccines was significantly lower in the Jawadhu hills block compared to Timiri before and during the pandemic (except for OPV-0 during the pandemic). During the pandemic, vaccine coverage remained unchanged or improved for all vaccines except for measles in the Timiri site (p<0.001). During the pandemic, an increased number of delays for all vaccines was seen in Jawadhu hills, but in Timiri, only the OPV-3, pentavalent-3, and Rotavirus-3 vaccines were delayed. Perceived reasons for delays in vaccination provided by caregivers did not change during the pandemic. Conclusion: Routine childhood immunization coverage during the pandemic for most vaccines was comparable to the pre-pandemic period in both rural sites, but significant delays in vaccination were noted. The effect of the pandemic was primarily seen in vaccines given after three months of age.