As parents and pediatricians try to figure out how to keep kids healthy during a pandemic, immunization may be one of the victims of the coronavirus.

More than 117 million children in 37 countries may miss out on receiving the measles vaccine because of the “challenging period” created by the outbreak, the Measles & Rubella Initiative said in a statement this month.

Pediatricians in the U.S. are reporting a drop in immunizations, too.

During the week of April 12, the number of MMR (measles, mumps, and rubella) shots given to kids dropped by 40% compared to the week of Feb. 16 when COVID-19 was not yet widespread, according to PCC, a Vermont company that develops medical record software for pediatricians.

Those figures don’t measure how many kids are overdue for their first dose of MMR, “the real red alert number,” said Chip Hart, director of PCC’s consulting wing. Children should get two shots of the vaccine.

Skipping the measles vaccine is of particular concern because the highly contagious disease has made a comeback in recent years.

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