Indirect Effects of the COVID-19 Pandemic on Routine Childhood Vaccination in Low-Income Countries: A Systematic Review to Set the Scope for Future Pandemics.

Publication date: Mar 13, 2024

The COVID-19 pandemic halted progress in global vaccine coverage and disrupted routine childhood vaccination practices worldwide. While there is ample evidence of the vaccination decline experienced during the pandemic, it is less clear how low-income countries were affected. We executed a systematic review to synthesize the current literature on the impacts of routine childhood vaccinations in low-income countries from 1 January 2020 to 8 February 2023. We collected data using an extraction form on Covidence and assessed the quality of studies included in the review using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Effect estimates for changes in vaccination during the pandemic were reported and summarized. Factors that influenced changes were grouped into descriptive themes. Thirteen studies, encompassing 18 low-income countries and evaluating 15 vaccines at varying doses, were included in the final review. We found that routine childhood vaccinations during the COVID-19 pandemic varied considerably by vaccine type, location, and phase of the pandemic. Nine different themes were identified as factors that influenced changes in vaccination. Documenting past experiences and lessons learned is crucial for informing preparedness efforts in anticipation of future public health emergencies. Failure to effectively address these things in the next public health emergency could result in a recurrence of declining routine childhood vaccinations.

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Concepts Keywords
Covid children
February COVID-19
Pandemic low-income
Robins pandemic
Vaccinations public health


Type Source Name
disease MESH COVID-19 Pandemic
disease VO vaccination
disease VO vaccine
disease IDO quality
disease MESH emergencies
disease VO USA
disease MESH polio
disease MESH measles
pathway KEGG Measles
disease MESH influenza
disease MESH smallpox
disease IDO history
disease VO vaccinated
disease MESH vaccine preventable diseases
drug DRUGBANK Coenzyme M
disease VO dose
disease MESH diphtheria
disease MESH tetanus
disease MESH pertussis
pathway KEGG Pertussis
disease VO diphtheria tetanus and whole cell pertussis vaccine
disease VO Diphtheria-Tetanus-Pertussis vaccine
disease VO immunization
disease VO vaccination coverage
drug DRUGBANK Aspartame
disease VO time
disease VO population
disease MESH birth defects
disease MESH infectious diseases
disease VO protocol
disease MESH Etiology
disease IDO process
disease IDO object
disease IDO country
disease MESH tuberculosis
pathway KEGG Tuberculosis
drug DRUGBANK BCG vaccine
disease MESH hepatitis
disease VO conjugate vaccine
drug DRUGBANK Penciclovir
disease VO Rotavirus
disease MESH rubella
drug DRUGBANK Pentaerythritol tetranitrate
disease MESH malaria
pathway KEGG Malaria
disease MESH yellow fever
disease VO ReCOV
drug DRUGBANK Cysteamine
disease VO monthly
disease VO vaccination dose
disease VO vaccine dose
disease IDO production
disease MESH infection
drug DRUGBANK Trestolone
drug DRUGBANK Etoperidone
disease VO effective
disease VO organization
disease MESH Allergy
disease VO Equity
disease VO organ

Original Article

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