Colorado’s children had one of the higher flu vaccination rates among all states heading into the pandemic, but COVID-19 could disrupt the historical level this year, a new analysis cautions.

QuoteWizard, an online insurance comparison company, examined 2017 data from the American Academy of Pediatrics for influenza vaccinations among children aged six months to 17 years. The vaccination rate for this population was 62.4% in Colorado, compared with nearly 58% nationally. Wyoming had the lowest rate at 43%, while more than three in four Rhode Island children had been vaccinated.

“As child vaccination rates are on the decline, the chances of a strong flu season are more likely,” QuoteWizard wrote. “A moderate flu season sees over 490,000 hospitalizations. An increase in flu hospitalizations paired with COVID-19 related hospitalizations we could see hospital capacity overwhelmed.”

Data from the Centers for Disease Control and Prevention show wide variation in the number of annual hospitalizations for influenza. For the 2018-2019 flu season, there were an estimated 490,561 hospitalizations. That compared to 810,000 the prior year. Deaths amounted to roughly 7% of the hospitalization total. This year, the CDC has already purchased 14 times its normal quantity of flu vaccine doses. The goal is to prevent hospitals from filling up with influenza cases and make room for potential coronavirus patients.

A report released in May estimated that flu vaccinations declined by 21.5% for children during the COVID-19 pandemic. There was also a decline in other recommended vaccinations. Colorado, with childhood vaccination rates below 90% for such diseases as measles, mumps and rubella, already had the lowest percentage of children inoculated of any state prior to COVID-19.