SARS-CoV-2 infection risk during delivery of childhood vaccination campaigns: a modelling study

CMMID COVID-19 working group, Simon R. Procter*, Kaja Abbas, Stefan Flasche, Ulla Griffiths, Brittany Hagedorn, Kathleen M. O’Reilly, W. John Edmunds, Frank G. Sandmann, Mark Jit

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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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.

Original languageEnglish
Article number198
JournalBMC Medicine
Issue number1
Publication statusPublished - 12 Aug 2021

Bibliographical note

Funding Information: The following funding sources are acknowledged as providing funding for the working group authors. This research was partly funded by the Bill & Melinda Gates Foundation (INV-001754: MQ; INV-003174: JYL, KP, and YL; NTD Modelling Consortium OPP1184344: GFM; OPP1139859: BJQ; OPP1183986: ESN). EDCTP2 (RIA2020EF-2983-CSIGN: HPG). Elrha R2HC/UK FCDO/Wellcome Trust/. This research was partly funded by the National Institute for Health Research (NIHR) using UK Aid from the UK government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the UK Department of Health and Social Care (KvZ). ERC Starting Grant (#757699: MQ). ERC (SG 757688: CJVA and KEA). This project has received funding from the European Union’s Horizon 2020 research and innovation programme—project EpiPose (101003688: AG, KP, RCB, WJE, and YL). FCDO/Wellcome Trust (Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z: KvZ). This research was partly funded by the Global Challenges Research Fund (GCRF) project ‘RECAP’ managed through RCUK and ESRC (ES/P010873/1: CIJ and TJ). HPRU (NIHR200908: NIB). Innovation Fund (01VSF18015: FK). MRC (MR/N013638/1: EF and NRW; MR/V027956/1: WW). Nakajima Foundation (AE). NIHR (16/136/46: BJQ; 16/137/109: BJQ, FYS, and YL; 1R01AI141534-01A1: DH; Health Protection Research Unit for Modelling Methodology HPRU-2012-10096: TJ; NIHR200908: AJK; NIHR200929: FGS; PR-OD-1017-20002: ARand WJE). Royal Society (Dorothy Hodgkin Fellowship: RL). UK DHSC/UK Aid/NIHR (PR-OD-1017-20001: HPG). UK MRC (MC_PC_19065 - Covid 19: Understanding the dynamics and drivers of the COVID-19 epidemic using real-time outbreak analytics: SC, TJ, WJE, and YL; MR/P014658/1: GMK). The authors of this research receive funding from the UK Public Health Rapid Support Team funded by the UK Department of Health and Social Care (TJ). UKRI (MR/V028456/1: YJ). Wellcome Trust (206250/Z/17/Z: AJK and TWR; 206471/Z/17/Z: OJB; 208812/Z/17/Z: SC; 210758/Z/18/Z: JDM, JH, SA, SFunk, and SRM; 221303/Z/20/Z: MK; UNS110424: FK). No funding (AMF, DCT, YWDC).

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Publisher Copyright: © 2021, The Author(s).

Citation: Procter, S.R., Abbas, K., Flasche, S. et al. SARS-CoV-2 infection risk during delivery of childhood vaccination campaigns: a modelling study. BMC Med 19, 198 (2021).



  • COVID-19
  • Healthcare workers
  • Infection risk
  • Outbreaks
  • SARS-CoV-2
  • Supplementary immunisation activity
  • Vaccination campaign


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