Routine pediatric vaccinations in Colorado are lagging more than 7% below pre-pandemic levels, state officials said Wednesday, prompting warnings from providers and a rise in pneumonia and meningitis cases.

In the initial weeks and months of the pandemic, many providers moved to virtual care, community clinics closed or limited services, and concerns about viral spread in health care settings suppressed in-person visits. As a result, pediatric vaccine uptake plummeted nearly 38% between mid-March and mid-April, the state Department of Public Health and Environment said Wednesday.

More than 18 months later, rates have improved but are still in the red, according to state data: Overall doses for children 2 and younger are down 3.2% compared to 2019; 12.3% lower for 3- to 9-year-olds; nearly 12% lower for 10- to 12-year-olds; and 13.5% lower for teens younger than 18.

Even now, as providers and state health officials have more openly urged families to continue to seek regular medical care and keep up with vaccinations, rates remain lower.

Jessica Bralish, spokeswoman for the state health department said doses administered between mid-March and late October 2021 were “7.7% lower than doses administered during that same period in 2019.”

HPV doses are down more than 25% for teenagers. Uptake of the measles, mumps and rubella vaccine has dropped 10.6% for 3- to 9-year-olds. Flu doses for the youngest kids, among whom the virus is most dangerous, dropped 10.4%.

Providers are seeing the impacts. Edwin Asturias, an infectious disease specialist with Children’s Hospital Colorado, said the pediatric system had seen a significant jump in invasive pneumococcal cases – like pneumonia and meningitis. Last year, he said, there were roughly 40 such cases. This year, it’s up to 70.

Fortunately, he said, the measures taken to blunt the spread of COVID-19 – masking, social distancing, hand-washing – have largely helped avoid flu and other respiratory surges (though RSV spread at unprecedented rates earlier this year). That was true for many vaccine-preventable illnesses generally, said Bralish, who also attributed the low numbers to pandemic-related measures.

But starting in October, she said in an email, the state “observed an increase in some vaccine-preventable diseases such as varicella (chickenpox), pertussis (whooping cough) and a bacterial illness caused by Streptococcus pneumoniae, but it is too early to tell if this increase will continue or what is causing the increase.”

Asturias said other, even rarer diseases – like measles – still remain well suppressed. But Colorado and the United States are not alone in seeing their pediatric vaccine uptake drop over the past two years. And as travel reopens again, global movement will pick back up, he said, and those preventable illnesses are more likely to travel across borders.

“We’re expecting, globally, a resurgence of vaccine-preventable illness,” he said.

He praised the state’s efforts to sound the alarm about lagging vaccinations. More outreach to immunization clinics are vital, and schools and day cares need to step up their enforcement to ensure vaccine requirements are being followed, he said.

The emphasis on immunization or community-level clinics, Asturias continued, is particularly vital because many families may not have a go-to pediatrician or primary care provider.

A map of Colorado’s pediatric and adult vaccine providers can be found on the state’s website.