SARS-CoV-2 infection risk during delivery of childhood vaccination campaigns: a modelling study
Authors: Procter Simon R. , Abbas Kaja , Flasche Stefan , Griffiths Ulla , Hagedorn Brittany , O’Reilly Kathleen M. ,   CMMID COVID-19 Working Group, Waterlow Naomi R. , Villabona-Arenas C. Julian , Munday James D. , Medley Graham F. , Lowe Rachel , Mee Paul , Liu Yang , Gimma Amy , van Zandvoort Kevin , Hellewell Joel , Tully Damien C. , Brady Oliver , Auzenbergs Megan , Knight Gwenan M. , Kucharski Adam J. , Barnard Rosanna C. , Waites William , Edmunds W. John , Bosse Nikos I. , Endo Akira , Finch Emilie , Russell Timothy W. , Chan Yung-Wai Desmond , Quaife Matthew , Eggo Rosalind M. , Prem Kiesha , Pung Rachael , Jombart Thibaut , Quilty Billy J. , Clifford Samuel , Koltai Mihaly , Gibbs Hamish P. , Abbott Sam , Jarvis Christopher I. , Jafari Yalda , Klepac Petra , Krauer Fabienne , Sun Fiona Yueqian , Funk Sebastian , Sandmann Frank G. , Nightingale Emily S. , Lei Jiayao , Meakin Sophie R. , Rosello Alicia , Pearson Carl A. B. , Hodgson David , McCarthy Ciara V. , Foss Anna M. , Atkins Katherine E. , Jit Mark 
Published: August 2021

Background

The COVID-19 pandemic has disrupted the delivery of immunisation services globally. Many countries have postponed vaccination campaigns out of concern about infection risks to the staff delivering vaccination, the children being vaccinated, and their families. The World Health Organization recommends considering both the benefit of preventive campaigns and the risk of SARS-CoV-2 transmission when making decisions about campaigns during COVID-19 outbreaks, but there has been little quantification of the risks.

Methods

We modelled excess SARS-CoV-2 infection risk to vaccinators, vaccinees, and their caregivers resulting from vaccination campaigns delivered during a COVID-19 epidemic. Our model used population age structure and contact patterns from three exemplar countries (Burkina Faso, Ethiopia, and Brazil). It combined an existing compartmental transmission model of an underlying COVID-19 epidemic with a Reed-Frost model of SARS-CoV-2 infection risk to vaccinators and vaccinees. We explored how excess risk depends on key parameters governing SARS-CoV-2 transmissibility, and aspects of campaign delivery such as campaign duration, number of vaccinations, and effectiveness of personal protective equipment (PPE) and symptomatic screening.

Results

Infection risks differ considerably depending on the circumstances in which vaccination campaigns are conducted. A campaign conducted at the peak of a SARS-CoV-2 epidemic with high prevalence and without special infection mitigation measures could increase absolute infection risk by 32 to 45% for vaccinators and 0.3 to 0.5% for vaccinees and caregivers. However, these risks could be reduced to 3.6 to 5.3% and 0.1 to 0.2% respectively by use of PPE that reduces transmission by 90% (as might be achieved with N95 respirators or high-quality surgical masks) and symptomatic screening.

Conclusions

SARS-CoV-2 infection risks to vaccinators, vaccinees, and caregivers during vaccination campaigns can be greatly reduced by adequate PPE, symptomatic screening, and appropriate campaign timing. Our results support the use of adequate risk mitigation measures for vaccination campaigns held during SARS-CoV-2 epidemics, rather than cancelling them entirely.