BISMARCK — Minnesota and the Dakotas saw significant drops in the number of infants and children receiving routine immunizations in 2020 during the COVID-19 pandemic.

Because of low rates of childhood immunization last year, health officials are warning that outbreaks of vaccine-preventable diseases, such as hepatitis B, diphtheria and chickenpox, could occur in schools that hold in-person classes, according to a new Centers for Disease Control and Prevention report dated Friday, June 11.

Minnesota and North Dakota saw large declines in the administration of the measles, mumps and rubella (MMR) vaccine. For children 12 to 23 months, the number of MMR vaccine doses given in March through May of 2020 fell by a median of about 22% in both states compared with the number of doses given during the same months in 2018 and 2019, the CDC report said.

In June through September of 2020, the number of doses administered increased, but not enough to cover the significant gap seen during the beginning of the year.

Minnesota and North Dakota had pandemic lockdown restrictions in place during parts of 2020, and many parents were fearful of COVID-19 exposure at a clinic or hospital — further contributing to the fall in doses of routine vaccinations administered.

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“The concern is as folks are back in school and back socializing, are we going to start to see increases in infectious diseases … that kind of took a back seat during COVID?” said Kris Ehresmann, director of the Minnesota Department of Health’s Infectious Disease Division.

The routine childhood vaccines recommended by the CDC provide immunity for a plethora of severe illnesses that can cause suffering or negative health outcomes. Even a drop in vaccination rates that lasts for a short period of time could compromise herd immunity against a vaccine-preventable disease, the CDC said in its report.

The Minnesota Department of Health is working to boost the number of childhood vaccination doses administered back to pre-pandemic rates by the time school starts in the fall, Ehresmann said. It’s collaborating with medical providers to remind parents and their children to catch up on vaccinations, as well as producing media and education campaigns to get kids vaccinated.

In May, the CDC authorized the COVID-19 vaccine for children 12 and above, and the Minnesota Department of Health is encouraging physicians to administer routine childhood vaccinations concurrently with the COVID-19 shot.

Minnesota experienced a measles outbreak in 2017, which affected the state's Somali population. Back then, MMR vaccination rates were low in the community, and Ehresmann said the state is trying to prevent a repeat measles outbreak.

“We could very much see outbreaks of disease" in Minnesota, she said.

In North Dakota, where pandemic restrictions were rescinded earlier than in Minnesota, officials also attribute the decline in the number of routine childhood vaccine doses administered to fear of COVID-19 exposure.

"I wasn't surprised by this slight decline, and I think it could have been worse," said Molly Howell, North Dakota's immunization manager.

To help get the number of vaccine doses administered back on track, the North Dakota Department of Health is encouraging physicians to give the routine doses during physicals or during other clinic appointments for children, Howell said. North Dakota is also working with medical providers to encourage patients to get vaccinated, including calling the parents of children who are behind in immunizations.

South Dakota was not included in the CDC report. But state figures show the number of doses of measles vaccine administered decreased about 16% from 2019 to 2020 among children through age 10. However, the 2020 statistics are not finalized and could change in the future, said Daniel Bucheli, a spokesperson for the South Dakota Department of Health.

As COVID-19 vaccinations continue and families shift toward going back to their normal lives, Ehresmann said, it’s vital for parents to consider keeping their children up-to-date on vaccinations against preventable diseases as part of the transition back to normalcy.

“It’s really important now as we’re looking to go back (to school) in person for the fall that kids are as protected as they can be so that they can have a safe and healthy learning experience, '' Ehresmann said.

Readers can reach Forum reporter Michelle Griffith, a Report for America corps member, at