Abstract
Ensuring the sustained immunization of displaced persons is a key objective in humanitarian emergencies. Typically, humanitarian actors measure coverage of single vaccines following an immunization campaign; few measure routine coverage of all vaccines. We undertook household surveys of Syrian refugees in Jordan and Lebanon, outside of camps, using a mix of random and respondent-driven sampling, to measure coverage of all vaccinations included in the host country’s vaccine schedule. We analyzed the results with a critical eye to data limitations and implications for similar studies. Among households with a child aged 12–23 months, 55.1% of respondents in Jordan and 46.6% in Lebanon were able to produce the child’s EPI card. Only 24.5% of Syrian refugee children in Jordan and 12.5% in Lebanon were fully immunized through routine vaccination services (having received from non-campaign sources: measles, polio 1–3, and DPT 1–3 in Jordan and Lebanon, and BCG in Jordan). Respondents in Jordan (33.5%) and Lebanon (40.1%) reported difficulties obtaining child vaccinations. Our estimated immunization rates were lower than expected and raise serious concerns about gaps in vaccine coverage among Syrian refugees. Although our estimates likely under-represent true coverage, given the additional benefit of campaigns (not captured in our surveys), there is a clear need to increase awareness, accessibility, and uptake of immunization services. Current methods to measure vaccine coverage in refugee and displaced populations have limitations. To better understand health needs in such groups, we need research on: validity of recall methods, links between campaigns and routine immunization programs, and improved sampling of hard-to-reach populations.
Highlights
The severity and frequency of humanitarian emergencies are increasing, as are populations affected by these events: there are currently more persons displaced by conflict than at any other time in history [1]
A total of 1634 households in Jordan and 2165 in Lebanon were approached to participate in the survey
The average age of refugee responses was similar in both countries (Jordan mean = 38 years, median = 36, range: 15–95; Lebanon mean = 36, median = 34; range: 16–95)
Summary
The severity and frequency of humanitarian emergencies are increasing, as are populations affected by these events: there are currently more persons displaced by conflict than at any other time in history [1]. Important is the management of vaccine-preventable disease through rapid immunization campaigns. The re-emergence of polio was seen in Syria, along with measles outbreaks in neighboring areas [6]. To prevent such outbreaks, rapid immunization campaigns are recommended in the immediate aftermath of an acute humanitarian emergency [7]. Measles and polio vaccinations are the most consistently recommended campaigns [4,7,8]. Despite these recommendations, some suggest that immunization campaigns are underutilized in humanitarian settings, warning that this costs lives but sets back global disease eradication and elimination efforts [6,9]
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