Abstract
Immunisation registers are regarded as an appropriate solution to measure vaccination coverage on a population level. In Germany, a decentralised healthcare system and data protection regulations constrain such an approach. Moreover, shared responsibilities in the process of immunisation and multiple providers form the framework for public health interventions on vaccination issues. On the national level, those interventions consist mainly of conceptualising immunisation strategies, establishing vaccination programmes, and issuing recommendations. This paper provides an overview on sources and methods for collecting appropriate coverage data at national level and their public health relevance in Germany. Methods of data collection and available information on immunisations are described for three approaches: school entrance health examination, population surveys and insurance refund claim data. School entrance health examinations allow regional comparisons and estimation of trends for a specific cohort of children and for all recommended childhood vaccinations. Surveys deliver population based data on completeness and timeliness of selected vaccinations in populations defined by age or socio-demographic parameters and on knowledge and attitudes towards vaccination. Insurance refund claim data inform continuously on immunisation status (e.g. of children aged two years) or on vaccination incidence promptly after new or modified recommendations. In a complex healthcare system, the German National Public Health Institute (Robert Koch Institute, RKI) successfully compiles coverage data from different sources, which complement and validate one another. With the German approach of combining different data sources in the absence of immunisation registers, it is possible to gain solid and reliable data on the acceptance of vaccination programmes and target groups for immunisation. This approach might be of value for other countries with decentralised healthcare systems.
Highlights
Germany has a population of 82 million people living in 16 federal states
This paper provides an overview on sources and methods for collecting appropriate coverage data at national level and their public health relevance in Germany
This paper provides an overview on sources and methods used by the Robert Koch Institute (RKI) for collecting appropriate coverage data at national level in the context of the German healthcare system and with regard to their public health relevance
Summary
Germany has a population of 82 million people living in 16 federal states. Health legislation with regard to communicable diseases is national and recommendations on vaccination are released annually by the German Standing Committee on Vaccination (STIKO) [1,2]. STIKO recommendations are not legally binding but are usually closely complied with or complemented by the official recommendations of the federal states. STIKO recommendations are the basis for the decision by the Joint Federal Committee (selfgoverning body of physicians and health insurance funds), whether the costs of vaccinations are covered by the statutory health insurances. The majority (85%) of people living in Germany are members of a variety of statutory health insurances, all of which provide a basic healthcare plan by statute and are funded by fixed fees paid by the members and their employers. The remaining 15% are mainly insured with private health insurance companies
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