Age-appropriate Vaccination Coverage Research Articles

Trends and projections of age-appropriate vaccination coverage in 41 low- and middle- income countries in Asia and Sub-Saharan Africa, 2000-2030.

Routine immunization programs have focused on increasing vaccination coverage, which is equally important for decreasing vaccine-preventable diseases (VPDs), particularly in low- and lower-middle-income countries (LMICs). We estimated the trends and projections of age-appropriate vaccination coverage at the regional and national levels, as well as place of residence and wealth index in LMICs. In total, 174 nationally representative household surveys from 2000 to 2020 from 41 LMICs were included in this study. Bayesian hierarchical regression models were used to estimate trends and projections of age-appropriate vaccination. The trend in coverage of age-appropriate Bacillus Calmette-Guérin (BCG), third dose of diphtheria, tetanus, and pertussis (DTP3), third dose of polio (polio3), and measles-containing vaccine (MCV) increased rapidly from 2000 to 2020 in LMICs. Findings indicate substantial increases at the regional and national levels, and by area of residence and socioeconomic status between 2000 and 2030. The largest rise was observed in East Africa, followed by South and Southeast Asia. However, out of the 41 countries, only 10 countries are estimated to achieve 90% coverage of the BCG vaccine by 2030, five of DTP3, three of polio3, and none of MCV. Additionally, by 2030, wider pro-urban and -rich inequalities are expected in several African countries. Significant progress in age-appropriate vaccination coverage has been made in LMICs from 2000 to 2020. Despite this, projections show many countries will not meet the 2030 coverage goals, with persistent urban-rural and socioeconomic disparities. Therefore, LMICs must prioritize underperforming areas and reduce inequalities through stronger health systems and increased community engagement to ensure high coverage and equitable vaccine access.

Frequency of Age-Appropriate Vaccination in Children Till 15 Months of Age Admitted at the Aga Khan Hospital, Karachi, Pakistan

Objective: To determine the frequency of age-appropriate vaccination till 15 months of age at Aga Khan Hospital, Karachi Pakistan. Study design: Cross-sectional study Place and Duration: Inpatient department of the Aga Khan University Hospital from Nov 2019 to Nov 2020 Methodology: All children admitted to the pediatric ward and fulfilling the inclusion criteria were enrolled. A predesigned proforma was used to collect data on the basic demographics of children and parents, their socioeconomic status, parental education, occupation, and vaccination status. The age-appropriate vaccination was defined as children who had received the vaccination, according to their age as per the expanded program of immunization (EPI) schedule of Pakistan. All collected data were analyzed using SPSS version 23. Results: Out of 350 admitted children, 222 (63.4%) were males and 128 (36.6%) were females. Most of the children were vaccinated (95.7%), while 4.3% were not vaccinated. Among vaccinated children, 63.7% had not received age-appropriate vaccination, and only 127 (36.3%) had age-appropriate vaccination. Statistically, the employment status of mothers (p=0.001) and educational level of mothers (p=0.001) and fathers (p=0.001) were significantly associated with age-appropriate vaccination in children of age up to 15 months. Conclusion: Despite having a high vaccination coverage rate, the proportion of age-appropriate vaccination was lower. The factors associated with age-appropriate vaccination were the employment status of the mother and the educational status of the parents. Vaccination programmes should work on identified risk factors in order to improve age-appropriate vaccination coverage. Keywords: Age appropriate vaccination, immunization, vaccination card

Thinking Out-of-Box in Addressing Communication and Service Delivery Challenges: Use of a Traditional Communication Method for Improving Immunization Coverage in Remote Rural Hard-to-Reach Areas of India

Sirmaur district in the state of Himachal Pradesh in India is a hard-to-reach area situated in the western Himalayas having an extreme landscape with snow-laden mountains and extensive river systems that makes the delivery of immunization services extremely challenging. Vaccinators needed a long walk through the hilly terrain to reach outreach sites. Community mobilizers were unable to go house to house to inform the caregivers to bring children to the site for vaccination. Caregivers were unaware when the vaccinators arrive at the site. As a result, many children missed vaccination or were not vaccinated timely. Age-appropriate vaccination coverage (according to national immunization schedule) in the Sirmaur district was the lowest in the state. Thinking out-of-box to address the communication barriers with the caregivers, the traditional drum beating was used, for the first time in India, in two blocks of the Sirmaur district (Rajpura and Shillai). The initiative was planned and implemented by the district health system with the support of the local community leaders. An exit interview was conducted to know the reach of the drum beating to caregivers, and a baseline and end line household survey was conducted to know the outcome of the initiative on age-appropriate vaccination coverage. Analysis of exit interviews data indicated a very high reach of a drum beating to the caregivers; more than 97% of caregivers in Rajpura and 100% in Shillai heard drum beating, and almost 95% of caregivers in Rajpura and 98% in Shillai knew the purpose of drum beating. Analysis of immunization data from baseline and end line surveys showed improvement in age-appropriate vaccination coverage for all vaccines in Rajpura (by 2.2% for BCG, 15.3% for Pentavalent 1, 14.9% for Pentavalent 2, 14.1% for Pentavalent 3, and 6.5% for Measles/MR). In Shillai, age-appropriate vaccination coverage improved for Pentavalent 1 (by 3.4%), Pentavalent 2 (by 5%) and Measles/MR (by 1.7%). In addition, dropout rates were reduced in both the blocks, particularly in Rajpura Pentavalent 1 to Measles dropout rate was reduced by 13.5%. Both health workers and community leaders had positive perceptions of the drum beating initiative. However, another important lesson learned from the initiative was that both the access and demand-side barriers need to be addressed for the desired improvement of age-appropriate immunization coverage. In Shillai, there was lower coverage improvement and a reduction in dropout rates attributed to vacant positions of vaccinators that caused an issue with access to immunization services to people.

Measles, mumps, and rubella vaccination coverage in children younger than 5 years attending a paediatric emergency department in Manchester, UK: a cross-sectional observational study

BackgroundIn 2019, the UK lost its WHO measles-free status, due to circulating measles virus and suboptimal coverage with the measles, mumps, and rubella (MMR) vaccine. The National Health Service (NHS) schedule recommends MMR vaccines at age 12 and 40 months. In England in 2020–21, MMR coverage did not meet the 95% target for herd immunity. This work is part of a project to develop a vaccination intervention delivered in the paediatric emergency department (PED). The aim of this study was to quantify unmet MMR-related vaccination need among PED attendees. MethodsThis cross-sectional, single-centre observational study collected data on children (aged 1–5 years) attending a large district general PED in Greater Manchester, UK, from Oct 1 to Oct 31, 2021, with data collected on a single occasion. Ethics approval was for an opt-out approach. Vaccination data were extracted from individual electronic summary care records, as part of the primary care record visible within secondary care. Coverage in the study population was compared with data for the northwest of England from the Cover of Vaccination Evaluated Rapidly surveillance scheme for the period April 1, 2020 to March 31, 2021. χ2 tests were used to examine differences in proportions vaccinated. Findings1059 children aged 1–5 years attended the PED in October, 2021, and data for 977 children were included in this study. Among all children, 638 (65·3%) had at least one dose of MMR recorded in their summary care record. The most similar regional comparator was first-dose MMR by the age of 5 years, which was administered in 86 678 (95·2%) of 91 023 children in 2020–21 (p<0·0001). In our cohort, among eligible children older than 40 months (n=339), only 66 (19·5%) had received both MMR doses, compared with regional coverage (by age 5 years) in 79 535 (87·4%) of 91 023 children (p<0·0001). A power calculation showed 577 participants were needed to detect a 5% difference in second-dose MMR. InterpretationChildren younger than 5 years attending the PED had low rates of age-appropriate MMR vaccination coverage, suggesting considerable unmet need in these PED attendees. Other work within this project looks at tetanus coverage and sources of vaccination data. FundingNone.

Age-appropriate vaccination coverage and its determinants in children aged 12\u201336\u2009months in Nepal: a national and subnational assessment

BackgroundVaccination is one of the effective ways to develop immunity against potential life-threatening diseases in children in early age. This study is focused on analysing the age-appropriate vaccination coverage at national and subnational levels and identify the factors associated with age-appropriate coverage in Nepal.Methods460 children aged 12–36 months were included in the study. The data was obtained from Nepal Demographic and Health Survey (NDHS) 2016–17. Age-appropriate coverage of Bacillus Calmette-Guerin vaccine (BCG), oral polio vaccine (OPV) doses 1–3, pentavalent vaccine (PE) doses 1–3, and first dose of measles, mumps, and rubella vaccine (MMR) were estimated using Kaplan Meier method. Multilevel logistic regression with random intercept was used to identify the factors associated with age-appropriate vaccination.ResultsThe crude coverage of the vaccines included in the study ranged from 91.5% (95% CI, 88.5–93.7) for PE3 to 97.8% (95.8–98.7) for BCG. Although the crude coverage of all the vaccines was above 90%, the age-appropriate coverage was significantly low, ranging from 41.5% (36.5–46.6) for PE3 to 73.9% (69.2–78.1) for PE1. Furthermore, high disparity in timely vaccination coverage was observed at regional level. Compared to the age-appropriate vaccination coverage in other provinces, Province 2 had the lowest coverage of all, followed by that in Province 6. The timeliness of vaccination was significantly associated with subnational regions i.e., provinces and the season of childbirth.ConclusionAlthough the immunization program in Nepal has achieved the target of 90% crude coverage of all the childhood vaccines, the age-appropriate coverage is significantly low which undermines the effectiveness of the vaccines administered. Thus, along with crude coverage, timeliness of the vaccines administered should be taken into consideration and thoroughly monitored at national and subnational levels. Provincial government should formulate tailored strategies to ensure the timely administration of the childhood vaccines.

Timeliness of routine vaccination among children and determinants associated with age-appropriate vaccination in Mongolia

IntroductionRoutine vaccination at the recommended age is crucial to minimize the risk of acquiring vaccine preventable diseases. This study aimed to assess the proportion of children receiving routine immunization at the recommended age and determinants of timely (age-appropriate) vaccination in Mongolia. Material and methodA total of 879 eligible children aged 12–23 months were included in this study. We investigated age-appropriate administration of Bacillus Calmette-Guerin vaccine (BCG); hepatitis B vaccine (Hep B); oral polio vaccine (OPV); pentavalent vaccine; and measles, mumps, and rubella vaccine (MMR) using Kaplan-Meier method. Multilevel logistic regression with random intercept at cluster level was used to assess the determinants of age-appropriate vaccination. ResultsOverall, the crude vaccination coverage for routine vaccinations were above 90% for all vaccines except MMR1 which was 86.0% (95% CI, 83.6–88.2). While the first dose of almost all the vaccines given at birth; BCG, Hep B, and OPV0, were administered in a timely manner, a substantial proportion of second and third doses of these vaccines were not given in a timely manner with age-appropriate vaccination coverage ranging from 35.9% (32.8–39.1%) for MMR1 to 67.7% (64.5–70.7%) for OPV1 respectively. Factors associated with age-appropriate administration of the investigated vaccines included socio-economic status of household, religion of household heads, area of residence, owning mobile phone, and season of childbirth. For instance, children belonging to households from richer wealth quintile had higher possibilities of getting age-appropriate OPV1-OPV3, PE1-PE3 and MMR1 vaccines compared to those from the poorest household wealth quintile. ConclusionOur findings suggest that the commonly used indicator ‘crude vaccination coverage’ could be supplemented by ‘age-appropriate vaccination’ to help to identify gaps in timely vaccinations and stimulate interventions in Mongolia. Factors such as household wealth quintile, place of residence and religion associated with timely vaccination in our study could be considered to promote effective intervention aiming to improve adequate vaccination coverage.

Age-appropriate vaccination coverage and its determinants for the polio containing vaccine 1-3 and measles-containing vaccine doses in Zhejiang province, China: A community-based cross-sectional study

ABSTRACT Background: This study aimed to evaluate the age-appropriate coverage and its associated risk factors for the primary vaccination of Polio containing vaccine (PCV) and measles-containing vaccine (MCV) through the secondary use of the 2018 Zhejiang provincial coverage survey among children aged 12–23 months. Methods: Data were collected through structured pre-tested Chinese version questionnaire by face-to-face interview among 770 mothers whose children aged 12–23 months. Age-appropriate vaccination coverage was measured using Chinese vaccination schedule recommendation. Bivariate and multivariate logistic regression models were adopted to identify determinants of the age-inappropriate vaccination. Results: The age-appropriate vaccination coverage of PCV1, PCV2, PCV3, and MCV was 88.8%, 80.8%, 73.6%, and 75.7%, respectively. The risk factors associated with the age-inappropriate vaccination of PCV 1–3 dose and MCV included child’s gender, birthplace, living area, maternal education level, immigration status, monthly household income, participation of the pregnant women’s seminar, antenatal care follow-up, knowledge on vaccination. Conclusion: The proportions of age-appropriate vaccination coverage were low compared with the up-to-date coverage. Modifiable factors were associated with age-inappropriate vaccinations. Vaccination interventions should consider identified modifiable factors to improve age-appropriate vaccination coverage.

Age-appropriate vaccination coverage and its associated factors for pentavalent 1-3 and measles vaccine doses, in northeast Ethiopia: A community-based cross-sectional study.

BackgroundIn Ethiopia, there are limited studies on age-appropriate vaccinations that children received at the recommended specific ages. Therefore, we assessed age-appropriate vaccinations coverage and its associated factors among children 12 to 23 months of age in Menz Lalo district, northeast Ethiopia.MethodsA community-based cross-sectional study was conducted in Menz Lalo district from March to April/2018 among 417 mothers/caregivers with children 12 to 23 months of age using simple random sampling technique. Data were collected using a pretested structured questionnaire. Information about children’s vaccination status was collected from vaccination cards. Age-appropriate vaccination coverage was measured using World Health Organization vaccination schedule recommendation. Data was entered into Epi-Info7 software and exported to SPSS-20 for analysis. Four consecutive logistic regression models were performed to identify factors associated with age-inappropriate vaccinations. A P-value of ≤ 0.05 was considered to state statistically significant associations.ResultsAge-appropriate vaccination coverage was 39.1% (95% CI: 34.3 to 44) for pentavalent 1, 36.3% (95% CI: 31.6 to 41.5) for pentavalent 2, 30.3% (95% CI: 25.6 to 35) for pentavalent 3 and 26.4% (95% CI: 21.7 to 31) for measles vaccine doses. Age-inappropriate pentavalent 1–3 vaccinations was associated with being male sex (AOR: 0.47, 95% CI: 0.29–0.74), lack of telephone (AOR: 2.2, 95% CI: 1.4–3.6), lack of usual caretaker (AOR: 2.6, 95% CI: 1.3–5.2), unplanned pregnancy (AOR: 1.9, 95% CI: 1.1–3.5), missing pregnant women’s conference (AOR: 2.7, 95% CI: 1.3–5.7), decreasing birth order (AOR: 0.34, 95% CI: 0.17–0.68) and insufficient knowledge (AOR: 2.7, 95% CI: 1.6–4.4).ConclusionThe proportions of age-appropriate vaccination coverage were low in the study area. Modifiable factors were associated with age-inappropriate vaccinations. Vaccination interventions should consider identified modifiable factors to improve age-appropriate vaccinations coverage.

Coverage and timeliness of vaccination and the validity of routine estimates: Insights from a vaccine registry in Kenya

BackgroundThe benefits of childhood vaccines are critically dependent on vaccination coverage. We used a vaccine registry (as gold standard) in Kenya to quantify errors in routine coverage methods (surveys and administrative reports), to estimate the magnitude of survivor bias, contrast coverage with timeliness and use both measures to estimate population immunity. MethodsVaccination records of children in the Kilifi Health and Demographic Surveillance System (KHDSS), Kenya were combined with births, deaths, migration and residence data from 2010 to 17. Using inverse survival curves, we estimated up-to-date and age-appropriate vaccination coverage, calculated mean vaccination coverage in infancy as the area under the inverse survival curves, and estimated the proportion of fully immunised children (FIC). Results were compared with published coverage estimates. Risk factors for vaccination were assessed using Cox regression models. ResultsWe analysed data for 49,090 infants and 48,025 children aged 12–23 months in 6 birth cohorts and 6 cross-sectional surveys respectively, and found 2nd year of life surveys overestimated coverage by 2% compared to birth cohorts. Compared to mean coverage in infants, static coverage at 12 months was exaggerated by 7–8% for third doses of oral polio, pentavalent (Penta3) and pneumococcal conjugate vaccines, and by 24% for the measles vaccine. Surveys and administrative coverage also underestimated the proportion of the fully immunised child by 10–14%. For BCG, Penta3 and measles, timeliness was 23–44% higher in children born in a health facility but 20–37% lower in those who first attended during vaccine stock outs. ConclusionsStandard coverage surveys in 12–23 month old children overestimate protection by ignoring timeliness, and survivor and recall biases. Where delayed vaccination is common, up-to-date coverage will give biased estimates of population immunity. Surveys and administrative methods also underestimate FIC prevalence. Better measurement of coverage and more sophisticated analyses are required to control vaccine preventable diseases.

Pneumococcal vaccination coverage among children with sickle cell anemia, sickle cell trait, and normal hemoglobin.

Children with sickle cell anemia and sickle cell trait are at an increased risk of invasive pneumococcal disease compared to children with normal hemoglobin. We assessed and compared pneumococcal vaccination status among these three groups. Children with sickle cell anemia and sickle cell trait were identified using Michigan newborn screening records (1997-2014); each child was matched to four children with normal hemoglobin based on age, Medicaid enrollment (at least 1 year from 2012-2014), race, and census tract. Vaccination records were obtained from the state's immunization system. Pneumococcal vaccine coverage (PCV7 or PCV13 depending on date of administration) was assessed at milestone ages of 3, 5, 7, and 16 months. The proportion of children with vaccine coverage at each milestone was calculated overall and compared among children with sickle cell anemia, sickle cell trait, and normal hemoglobin using chi-square tests. The study population consisted of 355 children with sickle cell anemia, 17,319 with sickle cell trait, and 70,757 with normal hemoglobin. The proportion of children with age-appropriate pneumococcal vaccination coverage was low at each milestone and generally decreased over time. Children with sickle cell anemia were more likely to be covered compared to children with sickle cell trait or normal hemoglobin. Despite higher pneumococcal vaccination coverage among children with sickle cell anemia, opportunities for improvement exist among all children. Targeted interventions will benefit from mechanisms to identify children with increased risks such as sickle cell anemia or trait to improve pneumococcal vaccination coverage among these groups.

Age-appropriate versus up-to-date coverage of routine childhood vaccinations among young children in Israel

ABSTRACTBackground and aims: Routine childhood vaccinations schedules recommend that children receive the vaccine doses at specific ages. Vaccination coverage data are conventionally reported by the up-to-date method. We aimed to assess vaccination timeliness by the age-appropriate method and compare with the up-to-date vaccination coverage. Methods: Assessment of age-appropriate and up-to-date vaccination coverage among children born in Israel in 2009 and followed to age 48 months (national representative sample, n = 3892). The vaccinations included: Hepatitis B vaccine (HBV), Diphtheria-Tetanus-acellular Pertussis-Polio-Haemophilus-influenzae-b (DTaP-IPV-Hib), Pneumococcal conjugate vaccine (PCV), Measles-mumps-rubella-varicella vaccine (MMR/MMRV) and Hepatitis A vaccine (HAV). The categories defined: age-appropriate (at the recommended age and up to 1 month), delayed less than 6 months, delayed 6 months and above and unvaccinated (48 months). Results: The age-specific vaccinations assessment showed considerable delay in receipt of routine vaccination. While most (96%, 95%, 91%, 96%, 94% and 86%) children were vaccinated up-to-date for HBV3, DTaP-IPV-Hib4, PCV3, MMR/MMRV1, HAV1and HAV2 vaccine doses; only 26%, 29%, 47%, 64%, 55% and 12% were vaccinated age-appropriate. Vaccination delay was more common in vaccines with multiple doses. Vaccination delay was associated with high child's birth order, low socio-economic rank, ethnicity (delay more common in Jews vs. Arabs), season of birth (winter) and delayed receipt of DTaP-IPV-Hib vaccine 1st dose. Conclusions: This study assessed age-appropriate childhood vaccination coverage in a national cohort of children. While the overall vaccination coverage stands in line with the WHO goals, vaccination timeliness and equity are inadequate and targeted public health intervention programs aimed at vaccination timeliness are necessary.

Immunisation status and determinants of left-behind children aged 12-72 months in central China.

Many parents move from rural China to urban areas in search of job opportunities, and leave their children behind to be raised by relatives. We aimed to assess the immunisation coverage, including the 1:3:3:3:1 vaccine series (one dose of Bacilli Chalmette-Guérin vaccine; three doses of live attenuated oral poliomyelitis vaccine; three doses of diphtheria, tetanus and pertussis combined; three doses of hepatitis B vaccine; and one dose of measles-containing vaccine), in children aged 12-72 months and identify the determinants of immunisation uptake among left-behind children in Hubei Province, Central China, in 2014. In this cross-sectional study using the World Health Organization's cluster sampling technique, we surveyed 1368 children from 44 villages in 11 districts of Hubei Province. The socio-demographic and vaccination status data were collected by interviewing primary caregivers using a semi-structured questionnaire and reviewing the immunisation cards of the children. Univariate and multivariate analyses were used to identify the determinants of complete vaccination and age-appropriate vaccination. For each dose of the five vaccines, the vaccination coverage in the left-behind and non-left-behind children was >90%; however, the age-appropriate vaccination coverage for each vaccine was lower in left-behind than in non-left-behind children. For the five vaccines, the fully vaccinated rate of left-behind children were lower than those of non-left-behind children (89·1%, 92·7%; P = 0·013) and age-appropriate immunisation rate of left-behind children were lower than those of non-left-behind children (65·7%, 79·9%; P < 0·001). After controlling for potential confounders, we found that the parenting pattern, annual household income and attitude of the primary caregiver towards vaccination significantly influenced the vaccination status of children. Moreover, we noted a relatively high prevalence of delayed vaccination among left-behind children. Hence, we believe that the age-appropriate immunisation coverage rate among left-behind children in rural areas should be further improved by delivering and sustaining primary care services.

Use of mobile phones for improving vaccination coverage among children living in rural hard-to-reach areas and urban streets of Bangladesh

In Bangladesh, full vaccination rates among children living in rural hard-to-reach areas and urban streets are low. We conducted a quasi-experimental pre-post study of a 12-month mobile phone intervention to improve vaccination among 0–11 months old children in rural hard-to-reach and urban street dweller areas. Software named “mTika” was employed within the existing public health system to electronically register each child's birth and remind mothers about upcoming vaccination dates with text messages. Android smart phones with mTika were provided to all health assistants/vaccinators and supervisors in intervention areas, while mothers used plain cell phones already owned by themselves or their families. Pre and post-intervention vaccination coverage was surveyed in intervention and control areas. Among children over 298 days old, full vaccination coverage actually decreased in control areas – rural baseline 65.9% to endline 55.2% and urban baseline 44.5% to endline 33.9% – while increasing in intervention areas from rural baseline 58.9% to endline 76*8%, difference +18.8% (95% CI 5.7–31.9) and urban baseline 40.7% to endline 57.1%, difference +16.5% (95% CI 3.9–29.0). Difference-in-difference (DID) estimates were +29.5% for rural intervention versus control areas and +27.1% for urban areas for full vaccination in children over 298 days old, and logistic regression adjusting for maternal education, mobile phone ownership, and sex of child showed intervention effect odds ratio (OR) of 3.8 (95% CI 1.5–9.2) in rural areas and 3.0 (95% CI 1.4–6.4) in urban areas. Among all age groups, intervention effects on age-appropriate vaccination coverage were positive: DIDs +13.1–30.5% and ORs 2.5–4.6 (p<0.001 in all comparisons). Qualitative data showed the intervention was well-accepted. Our study demonstrated that a mobile phone intervention can improve vaccination coverage in rural hard-to-reach and urban street dweller communities in Bangladesh. This small-scale successful demonstration should serve as an example to other low-income countries with high mobile phone usage.

Potential for Improving Age-Appropriate Vaccination Coverage by Maximizing the 18-Month Well-Child Visit

To evaluate potential age-appropriate up-to-date (UTD) vaccination coverage achievable in preschool children if missing vaccinations were administered during a well-child visit at 18 months of age. Data from the 2004 National Immunization Survey were used in a series of simulations analyzing UTD coverage of the 4:3:1:3:3:1 (diphtheria, tetanus, pertussis/poliovirus/measles-containing vaccine/Haemophilus influenzae type b/hepatitis B/varicella) and 4:3:1:3:3:1 (+) pneumococcal conjugate vaccine (PCV) series. In the models, children not already up-to-date received up to four missing vaccinations during a simulated routine 18-month-old well-child visit. For the 4:3:1:3:3:1 series, UTD coverage increased from baseline 61 percent (95% confidence interval [CI] = 60-62) to simulated 87 percent (95% CI = 86-88). Among the baseline non-UTD children, 69 percent became up-to-date by simulation with the single visit, of which 44 percent required only one vaccination. For the 4:3:1:3:3:1 (+) PCV series, UTD coverage increased from baseline 38 percent (95% CI = 37-40) to simulated 74 percent (95% CI = 73-75). Among the baseline non-UTD children, 59 percent became up-to-date by simulation with the single visit, of which 47 percent required only one vaccination. UTD coverage increased substantially for all racial/ethnic groups and in all states. Taking full advantage of the recommended 18-month-old well-child visit to administer missing vaccines would be a strategically timed opportunity to achieve high age-appropriate UTD coverage in preschool children.

Erfahrungen und Schwierigkeiten bei der Implementierung von Impfregistern in Sachsen-Anhalt

In the German Federal State of Saxony-Anhalt, the Health Department must be notified of vaccines administered to children <7 years of age including their names. The goal of this mandatory notification is to improve and stabilize the age-appropriate vaccination coverage. However, difficulties have been encountered in implementing mandatory notification. Therefore, the Health Departments of Magdeburg and Halle have launched a model project focusing on analysing and eliminating these problems. Mandatory notification requires parents' approval, endorsement of vaccantors, and availability of human and technicely resources in the Health Department. An enquiry among paediatricians and family doctors in private practice revealed widespread reservations about mandatory notification because of privacy issues related to data and legal protection. Furthermore, family doctors believed that parents disapproved of notification by name. However, a survey among young mothers revealed this not to be the case. Winning young mothers' approval depends largely on the positive attitude of the vaccinators. To implement the mandatory notification of vaccinations to the Health Department, it is necessary to dispel physicians' concerns and to inform young parents about the practical benefits. However, this places high demands on the Health Departments for maintaining immunization registries, communicating with physicians and notifying parents when immunisations are due or late.

Contraindications to vaccination in the Russian Federation.

Failure to achieve high levels of immunity among children contributed to the epidemic of diphtheria that occurred in the Russian Federation during the 1990s. A major factor in this failure was the extensive list of contraindications to vaccination that was in use throughout the countries of the former Soviet Union. In 1980, the Ministry of Health (MOH) of the Soviet Union adopted an extensive list of contraindications for use of the diphtheria-tetanus toxoids-pertussis (DTP) vaccine. In 1994, the MOH of the Russian Federation revised the list of contraindications to vaccination to be largely in accord with World Health Organization recommendations. Since then, age-appropriate vaccination coverage has increased markedly: In 1996, DTP3 coverage among children 12 months of age had increased to 87% from 60% in 1990.

A Community Outreach Program To Improve Vaccination Coverage in Family Home Day Care

Although preliminary data suggest that some unvaccinated children can be reached through licensed family day-care home providers, attaining age-appropriate vaccination coverage of these children will depend on the ability of providers to interpret records correctly. The baseline knowledge of providers may be insufficient to accomplish this without educational programs.