The Impact of the COVID-19 Pandemic on Immunization Rates for Preventable Diseases in Primary Care and Pediatric Practices in Germany

During the COVID-19 pandemic, various non-pharmacological prevention strategies were implemented in response to this development. This led to changes in the way appointments were made in doctors‘ offices, and non-urgent interventions were postponed. Due to these social distancing rules and lockdowns, but also due to increasing uncertainty among the general population, there was a significant decrease in the frequency of visits to healthcare institutions (1). There are no reliable findings to date regarding the impact of the pandemic on vaccinations in Germany. This study aims to evaluate any changes in the number of vaccinations administered in primary care and pediatric practices in Germany because of the COVID-19 pandemic.

Methods

The IQVIA Vaccine Analyzer is a sub-panel of the German IQVIA Disease Analyzer database, which contains anonymized information about demographic characteristics, prescriptions, and diagnoses of patients in specialist and primary care practices in Germany (2).

The study included patients with at least one visit to one of 143 GP and 75 pediatric practices in Germany in 2019 or 2020. The main outcome of the study was the difference in the number of vaccinations per vaccination type administered between April and December 2019 (non-pandemic period) and between April and December 2020 (pandemic period).

Results

In primary care practices, 78 313 patients received at least one vaccination during the non-pandemic period, 54.6% were female and the mean age was 57.6 (SD=21.8). During the pandemic period, there were 89 384 patients who received at least one vaccination with a share of 54.9% females and a mean age of 59.5 (SD=21.0).

Meanwhile, 80 206 patients received at least one vaccination in a pediatric practice during the non-pandemic period, 49.0% of the patients were female and the mean age was 4.9 (SD=8.5) The corresponding number of patients during the pandemic period was 88 651 with 48.8% female patients and a mean age of 5.4 (SD=9.2).

The number of vaccinations against pneumococci, influenza, herpes zoster, HPV, measles, mumps, and rubella (MMR) administered by primary care physicians increased during the pandemic period compared to the non-pandemic period. In pediatric practices, the number of vaccinations against influenza increased by 108% (Table 1).

Table

Differences in the number of vaccinations per practice in Germany between April and December 2019 and 2020 in primary care and pediatric practices

Fewer combination vaccinations against tetanus were administered in primary care practices during the pandemic period than during the non-pandemic period (–18%). In addition, the number of hepatitis vaccinations declined during the pandemic period (–58%). In pediatric practices, the number of combination vaccines containing tetanus antigen and vaccinations against hepatitis and varicella decreased during the pandemic period compared to the non-pandemic period (–18%, –27% and –27% respectively) (Table 1).

Discussion

In summer 2020, the Standing Vaccination Committee (STIKO) recommended the uptake of vaccinations against influenza, especially for high-risk groups and elderly people (3). This recommendation by STIKO may explain the increase in the number of vaccinations against influenza administered in primary care and pediatric practices in Germany.

The German Federal Minister of Health encouraged elderly people in March 2020 to get vaccinated against pneumococci. Nevertheless, in November 2020, STIKO reaffirmed its recommendation of the vaccine for the high-risk groups only following a public discussion of the extension of this recommendation (4). This may have influenced the increase in numbers receiving the vaccine in primary care practices in our study.

Vaccination against herpes zoster has been recommended by STIKO for all people aged over 60 and patients with chronic diseases aged over 50 in Germany since 2018 (4). The cost of this vaccination has been reimbursed since March 2019 (4). Although the RKI did not detect any increase in uptake until the first quarter of 2020 (4), the reimbursement may have been responsible for a higher uptake during the rest of 2020.

In general, the pandemic period may have led to a greater risk perception in older people and risk groups and more awareness of underlying medical conditions.

The decrease in the numbers of tetanus vaccinations may be due to the decrease in visits to healthcare institutions during the pandemic period in 2020 (1).

STIKO has extended its recommendation for vaccination against measles, mumps, and rubella (MMR) to include people working in medical institutions, in care facilities, higher education institutions etc. (5). This may explain the increase in the number of vaccinations against MMR administered in primary care practices.

Since hepatitis vaccinations are travel vaccinations (5), the decrease of vaccinations may have occurred because of travel restrictions and lockdowns during the pandemic.

As the pandemic is ongoing in Europe, and vaccination against COVID-19 has begun at the end of 2020 and a booster campaign is well underway, further research is needed to examine the future impact of COVID-19 (including immunization against it) on vaccination against other preventable diseases in the German population.

Manuscript submitted on 13 November 2021, revised version accepted on 31 January 2022

Cite this as:
Zingel R, Beinker P, Kostev K: The impact of the COVID-19 pandemic on immunization rates for preventable diseases in primary care and pediatric practices in Germany. Dtsch Arztebl Int 2022; 119: 195–6. DOI: 10.3238/arztebl.m2022.0129

References

1. Damerow S, Rommel A, Prütz F, et al: Developments in the health situation in Germany during the initial stage of the COVID-19 pandemic for selected indicators of GEDA 2019/2020-EHIS. J Health Monit 2020; 5: 3–20.

2. Ohl N, Zingel R, Kostev K: Investigation of the representativeness of the German IQVIA Vaccine Analyzer database. Int J Clin Pharmacol Ther 2022; 60: 79–86

3. Stellungnahme der Ständigen Impfkommission (STIKO) beim Robert Koch-Institut (RKI): Bestätigung der aktuellen Empfehlungen zur saisonalen Influenzaimpfung für die Influenzasaison 2020/21 in Anbetracht der Auswirkungen der COVID-19-Pandemie. Epid Bull 2020; 32/33: 28–30 .

4. Stellungnahme der Ständigen Impfkommission (STIKO) beim Robert Koch-Institut (RKI): Bestätigung der aktuellen STIKO-Empfehlungen zur Pneumokokken-Impfung während der Pandemie. Epid Bull 2020; 47: 27–30 .

5. Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut 2020/2021. Epid Bull 2020; 34: 9 .