The impact of COVID-19 and catch-up strategies on routine childhood vaccine coverage trends in Latin America: A systematic literature review and database analysis

Globally, an estimated 23 million children missed vaccination in 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. We analyzed vaccination coverage trends and catch-up strategies/recommendations implemented in Latin America during the pandemic. We performed a national administrative database analysis and a systematic literature review to evaluate vaccination coverage data and identify catch-up strategies for missed vaccinations in selected countries in Latin America (Argentina, Brazil, Chile, Colombia, Mexico and Peru). Data were extracted from national health ministry vaccination coverage and supranational databases to identify coverage of rotavirus (RV), pentavalent/hexavalent, measles, Bacillus Calmette-Guerin (BCG) and pneumococcal conjugate vaccines (PCV) at country level before and during the COVID-19 pandemic. A systematic literature review of published papers was conducted to identify vaccination catch-up strategies published in January 2020-June 2021. National administrative database-reported data showed that vaccination coverage trends were declining prior to 2020. The change in vaccination coverage before and during the COVID-19 pandemic ranged from 2.5% to -11.5% (RV), -3.0% to -11.0% (measles), 1.5% to -7.5% (PCV), 9.0% to -14.0% (pentavalent/hexavalent), and 3.0% to -18.5% (BCG). Among 696 identified studies, 14 studies were included in this review. Catch-up vaccination strategies included prioritizing routine vaccinations as per the national immunization schedule. Overall vaccination coverage declined by varying degrees among the countries investigated. This trend was observed prior to 2020, suggesting multifactorial reasons for declining vaccination rates in Latin America. Plain Language Summary What is the context? The coronavirus disease 2019 (COVID-19) led to health immunization disruptions in at least 68 countries, affecting around 80 million children. Routine childhood vaccination coverage was already suffering a decline in Latin America in the past decade, this situation could deteriorate further due to COVID-19. Consensus is lacking on the use of current guidelines and recommendations for catch-up vaccinations, as these are difficult to implement. What is new? We analyzed national health ministry databases to evaluate vaccination coverage trends in Latin America before and during the COVID-19 pandemic. We also conducted a systematic literature review to describe catch-up strategies for missed vaccinations during the pandemic. Vaccination coverage declined for the rotavirus, measles and pneumococcal conjugate vaccines at country level from 2017-2020. Pentavalent/hexavalent and Bacillus Calmette-Guerin vaccine coverage varied among countries for the same period. Catch-up vaccination strategies included prioritizing routine vaccinations as per the national immunization schedule. What is the impact? Continued efforts from healthcare officials and providers could prevent unvaccinated children from severe disease through catch-up vaccinations.