The effect of the COVID-19 pandemic on routine immunization services in Sierra Leone, 2021

Introduction: The COVID-19 pandemic resulted in movement and service restrictions during 2020 and 2021 that may have affected the essential immunization services in Sierra Leone. We analyzed the national routine immunization (RI) data to assess the effect of the COVID-19 pandemic in immunization coverage. Methods: Using national RI data for the period 2018 to 2021, we computed vaccination coverages for pentavalent vaccine (Penta1 and Penta3), first and second doses of measles-rubella (MR1 & MR2). We also computed the dropout rates (DOR) for the same antigens. A coverage of ≥90% and a DOR of <10% were considered good performance. The pre COVID-19 period for this study was 2018 to 2019, while the COVID-19 period was 2020 to 2021. Results: Penta1 and Penta3 coverages increased from 93.9% and 90.6% in 2018 to 96.2%, and 96.2% in 2019, respectively. Although there was a slight decrease from 2019 to 2020, the coverage reduction from 2020 to 2021 was higher with Penta1 and Penta3 coverages decreasing from 93.3% and 91.3% in 2020 to 75.5% and 74. 4% in 2021, respectively. The MR1 coverage target was achieved in 2019 at 93.8% but failed to meet the MR2 target coverage from 2018 to 2021. Ten of the 16 districts achieved the 90% target for Penta3 coverage before the COVID-19 pandemic, but only four districts achieved the target since the COVID-19 pandemic. The dropout rate for Pentavalent was within the target throughout the study period, while measles dropout rate exceeded the target of less than 10% throughout the study period. Conclusion: RI gains in the pre-COVID-19 era were lost during the COVID-19 era, resulting in a negative impact on routine EPI services in Sierra Leone. We recommend that the EPI program strengthen vaccination indicators and increase community awareness on the importance, availability, and timeliness of immunization activities Keywords: COVID-19, routine immunization, immunization coverage, pentavalent, measles-rubella, Sierra Leone