Full Vaccination Coverage Research Articles

Vaccination coverage and proportion of incomplete vaccination schedule in children under seven years of age in Mexico

To assess vaccination coverage in children under seven years of age. Study based on the Halfway National Health and Nutrition Survey (Ensanut MC 2016). Full vaccination coverage in children <1 year was 51.7%, (range: 67.6% [pentavalent (PV)] to 93.9% [BCG]), in those aged 12-23 months was 53.9% (range: 68.5% [MMR] to 98.3% [BCG]) and in those 24-35 months was 63.2% (range: 85.3% [pneumococcal]) to 98.6% [BCG]). In children aged six years, the coverage of 1 MMR dose was 97.8% and 50.7% for two doses. Only 2.2% of six year olds were not vaccinated. Variables associated with incomplete schedule were age of 2-5 months, mother being under 20 years of age or maternal language indigenous. The vaccination program needs to improve recruitment of newborns and their follow-up until they complete their immunization schedule, taking advantage of the local contacts with health services to vaccinate them.

Socioeconomic factors associated with full childhood vaccination in Bangladesh, 2014

ObjectivesChildhood vaccination in Bangladesh has improved, but there is room for improvement. This study estimated full immunization coverage in Bangladeshi children and characterized risk factors for incomplete immunization. MethodsUsing the 2014 Bangladesh Demographic and Health Survey (DHS), full vaccination of children aged 12 to 24 months was examined; this was defined as the receipt of one dose of bacillus Calmette–Guérin (BCG), three doses of pentavalent vaccine, three doses of oral polio vaccine (OPV), and one dose of measles-containing vaccine (MCV). Associations between full vaccination and selected risk factors were assessed by logistic regression. ResultsOverall, 83% of children were fully vaccinated. BCG had the highest completion (97%), followed by OPV (92%), pentavalent vaccine (91%), and MCV (85%). Full vaccination coverage ranged from 64.4% in Sylhet to 90.0% in Rangpur and was lowest among non-locals of all regions (78.4%). Children who were in the lowest wealth quintile, who had mothers without antenatal care visits, or who had mothers without autonomy in healthcare decision-making were less likely to be fully vaccinated. ConclusionsOverall, full vaccination of children is high, but varies by vaccine type. Disparities still exist by wealth and by region. Maternal access to care and autonomy in healthcare decision-making are associated with higher vaccination coverage.

The Impact of Migration Background on the Health Outcomes of Preschool Children: Linking a Cross-Sectional Survey to the School Entrance Health Examination Database in Bavaria, Germany.

This study investigated the impact of migration background on the health outcomes of preschool children from families of various social status levels. During the school entrance health examination (Schuleingangsuntersuchung (SEU)) from October 2012 to August 2013, the parents of 5052 preschool children (62% response rate) participated in a cross-sectional health survey within the framework of health-monitoring units (Gesundheits-Monitoring-Einheiten (GME)) in Bavaria, Germany. They were handed a self-administered questionnaire with questions relating to the language spoken at home and other socio-demographic characteristics. By applying the record linkage method, 3747 participants were correctly linked to the corresponding data of the SEU. Based on the merged dataset, 4 definitions of migration background were explored regarding demographic indicators, the parents' mother tongue, and the language spoken at home. The association between migration background and health outcomes of preschool children was analyzed using multivariable logistic regression models separately. The risk estimates were presented for the study population and stratified into high, medium, and low social status. The models were repeated for each of the 4 migration background variables. The results show significant associations between migration background and health outcomes of preschool children (except in pronunciation). A migration background had the strongest impact on the development of word/sentence formation disorder. Compared to non-migrant preschool children, migrant children had twice the chances for full vaccination coverage (OR [95% CI]: 2.4 [1.9-3.1]) but only half the chance to participate in all health examinations from U1 to U9 (0.5 [0.4-0.6]). These children were also at two-fold increased risk to be overweight/obese (2.2 [1.7-2.8]). Moreover, preschool children with double-sided migration from medium social status families faced the highest risk for word/sentence formation disorder (9.5 [5.6-16.1] with SEU definition and 23.3 [10.3-52.6] with GME definition of a migration background). Future prevention programs at the preschool level should focus on children with double-sided migration from medium social status families. With respect to social and cultural integration, the definition of migration background based on the language spoken at home should be appropriate for future SEUs.

Potential for a booster dose of rotavirus vaccine to further reduce diarrhea mortality.

Concern has grown that children vaccinated against rotavirus in developing countries may be vulnerable to rotavirus diarrhea in the second year of life due to waning immunity. Adding a booster dose of rotavirus vaccine at 9 or 12 months of age with measles vaccine has been suggested as a strategy to address this. We evaluated the hypothetical potential benefits of a booster dose on reduction of rotavirus mortality. The projected number of deaths averted were calculated using national level full series vaccination coverage, estimated national rotavirus deaths by week of age, and VE at <12 months of age and ≥12 months of age derived from the published literature. We assumed three functional forms of waning based on the VE estimates: stepwise, linear, and logarithmic. We modeled three potential boosting scenarios: (a) reduced VE waning in the second year of life by 50%, (b) reestablished second year of life VE to the levels in the first year of life, and (c) boosted first year VE by 50% of the difference between VE in the first and second years. To express uncertainty resulting from the parameters, each of the nine models were run 1000 times using a random sample of input values. Across all WHO regions, with the stepwise models we estimated a median of 9800 (95%CI: 9400, 10,200), 19,600 (95%CI: 18,800, 20,400), and 29,400 (95%CI: 28,200, 30,700) additional rotavirus deaths averted in the reduced VE waning, reestablished VE, and boosted VE scenarios. These estimates were highly sensitive to the assumed functional form of waning with approximately 65-80% fewer deaths averted if immunity waned in a linear or logarithmic fashion compared to the stepwise model. While these projections will benefit from improved input data points, our resultsinform consideration of booster doses of rotavirus vaccine.

Determinants of defaulting from completion of child immunization in Laelay Adiabo District, Tigray Region, Northern Ethiopia: A case-control study.

BackgroundGlobally 2.5 million children under five years of age die every year due to vaccine preventable diseases. In Tigray Region in Northern Ethiopia, full vaccination coverage in children is low. However, the determinants of defaulting from completion of immunization have not been studied in depth. This study aimed to identify the determinants of defaulting from child immunization completion among children aged 9–23 months in the Laelay Adiabo District, North Ethiopia.MethodsAn unmatched community based case-control study design was conducted among children aged 9–23 months in the Laelay Adiabo District from February—March 2015. A survey was conducted to identify the existence of cases and controls. Two hundred and seventy children aged 9–23 months (90 cases and 180 controls) were recruited from 11 kebeles (the smallest administrative units) by a simple random sampling technique using computer based Open Epi software. Cases were children aged 9–23 months who missed at least one dose of the recommended vaccine. Controls were children aged 9–23 months who had received all recommended vaccines. Data were collected from mothers/care givers using structured pretested questionnaire. The data were entered into Epi Info version 3.5.1 and analyzed using Statistical Package for Social Sciences (SPSS) version 21. Bivariate and Multiple logistic regression analysis were used to identify the predictors of the outcome variable. The degree of association was assessed by using odds ratio with 95% Confidence Interval (CI).ResultThis study shows that mothers who take >30 minutes to reach the vaccination site (Adjusted Odds Ratio (AOR) = 3.56,95%CI:1.58–8.01); households not visited by health extension workers at least monthly (AOR = 2.68,95%CI:1.30–5.51); poor participation in women's developmental groups (AOR = 3.3,95%CI 1.54–7.08); no postnatal care follow-up (AOR = 5.2,95%CI:2.36–11.46); and poor knowledge of child immunization (AOR = 3.3,95%CI:1.87–7.43) were predictors of defaulting from completion of child immunization.ConclusionPostnatal care follow-up, household visits by health extension workers and maternal participation in women’s development groups are important mediums for disseminating information and increasing knowledge to mothers about child immunization. To reduce the rate of defaulters, health providers should motivate and counsel mothers to attend postnatal care. Health extension workers should visit households at least once per month and strengthen mothers’ participation in the women’s development groups.

Family structure and full vaccination coverage among children aged 12-23 months in West Africa: Analysis of the interaction effects of maternal education

Childhood vaccination is affected by many maternal socio-economic and family characteristics but these often change over time such that the pattern of relationship needs to be reappraised periodically. In this study, we investigated the influence of family structure and interaction effects of maternal education on full vaccination coverage in the West Africa. Random effects logistic regression was applied to the most recent demographic and health survey data on children aged 12-23 months in six countries. Main explanatory variable was sex of household head and family type. Children living in female-headed households (FHHS) were less likely to be fully vaccinated in five out of six countries [Liberia (OR=0.77), Mali (OR=0.64), Senegal (OR=0.80), Sierra Leone and Togo (OR=0.85)]. Polygyny was negatively associated with full vaccination in three countries [Liberia 9OR=0.79), Mali (OR=0.88), Togo (OR=0.80)]. Interaction effects showed that secondary/higher education enhanced better vaccination coverage among children in FHHs in five countries. Children of single mothers and polygynous women with secondary/higher education recorded higher likelihood of full vaccination. There was a moderate association between family structure and childhood vaccination but the relationship was modified by maternal education which either mitigated the negative influence or amplified the positive effect of family characteristics. Immunization advocacy and awareness programmes may need to target under-five mothers without formal education and those living in female-headed households and polygynous families.

Two-dose seasonal influenza vaccine coverage and timeliness among children aged 6 months through 3 years: An evidence from the 2010–11 to the 2014–15 seasons in Zhejiang province, east China

ABSTRACTObjective: To evaluate the coverage and timeliness of seasonal influenza vaccine vaccination (SIV) among children aged 6 months to 3 years from the 2010–11 through the 2014–15 seasons. Methods: Children registered in Zhejiang Provincial Immunization Information System (ZJIIS) and needed 2 seasonal influenza vaccine doses in a given season from 2010–11 to 2014–15 were enrolled. Socio-economic information and SIV records of target children were extracted from ZJIIS on 1 January 2016. Any (≥1 dose) and full (2 doses) vaccination coverage by December 1 and March 31 as well as interval between 2 doses were calculated. Trends of coverage over time and determinants on fully vaccination coverage and interval between 2 doses were assessed. Results: Full SIV overage by Mar 31 increased from the 2010–11 to the 2014–15 seasons (2.60% vs 2.92%). Less than 1% of children received 2 doses by December 1. The interval between 2 doses among fully vaccinated children decreased over time (2010–11: 68.32 days; 2014–15: 49.51 days; p < 0.05). Age, socio-economic development level of resident areas were inversely associated with full vaccination coverage and resident children had a significantly higher full vaccination coverage. Younger age, resident children, receiving vaccination from higher service frequency clinics and clinics with morning and afternoon sessions were positive determinants of a shorter interval between 2 doses. Conclusion: Majority of children aged 6 months to 3 years remained at risk of incomplete and delayed SIV. The importance of the 2-dose SIV recommendation needs to be emphasized and effective interventions needs to be implemented to improve the completeness and the timeliness of SIV.

Determinants of Vaccination Coverage Against Human Papillomavirus in 10-year-old Girls in 2016 in Rural Senegal

Cervical cancer is the first gynecological cancer in Senegal. As part of the cancer control plan, the Ministry of Health and Social Action conducted a pilot phase of HPV vaccination in the districts of Dakar and Mekhe between 2014 and 2016. The objective of this survey is to study the determinants of HPV vaccination coverage in 10-year-old girls in 2016 in the Mekhe health district. This is a descriptive cross-sectional epidemiological study for analytical purposes. A two-stage survey was conducted. The data were collected during an individual interview at the homes of the mothers. The compendium focused on personal characteristics, knowledge and practices on immunization. Full vaccination coverage was determined. Logistic regression was used to identify factors associated with immunization coverage. Respondents were 300 The mean age was 35 ± 9.64 years. Mothers who knew how to prevent cervical cancer were 171 or 57% [95% CI: 51.2-62.7]. Immunization coverage for girls aged 10 years was 86.3% [95% CI: 81.9-90.0]. The discontinuation between the first and second dose of the vaccine was 6.5% [95% CI: 3.9-10.1]. HPV vaccine coverage was related to the residence environment (OR = 3, 18 [95% CI: 1.34-7.56]); (OR = 22.02, [95% CI: 4.2-113.4]) and information for mothers (OR = 10.92 [95% CI: 2.93-40.64]). Vaccination against HPV is a preventive activity that requires the collaboration with the education sector and a good proximity communication.

Vaccination coverage and factors associated with adherence to the vaccination schedule in young children of a rural area in Burkina Faso

ABSTRACT Background: Vaccination is an important tool for reducing infectious disease morbidity and mortality. In the past, less than 80% of children 12–23 months of age were fully immunized in Burkina Faso. Objectives: To describe coverage and assess factors associated with adherence to the vaccination schedule in rural area Burkina Faso. Methods: The study population was extracted from the Nouna Health and Demographic surveillance system cohort. Data from four rounds of interviews conducted between November 2012 and June 2014 were considered. This study included 4016 children aged 12–23 months. We assessed the effects of several background factors, including sex, factors reflecting access to health care (residence, place of birth), and maternal factors (age, education, marital status), on being fully immunized defined as having received Bacillus Calmette–Guérin (BCG), three doses of diphtheria–tetanus–pertussis and oral polio vaccine, and measles vaccine by 12 months of age. The associations were studied using binomial regression to derive prevalence ratios (PRs) in univariate and multivariate regression models. Results: The full vaccination coverage increased significantly over time (72% in 2012, 79% in 2013, and 81% in 2014, p = 0.003), and the coverage was significantly lower in urban than in rural areas (PR 0.84; 0.80–0.89). Vaccination coverage was neither influenced by sex nor influenced by place of birth or by maternal factors. Conclusion: The study documented a further improvement in full vaccination coverage in Burkina Faso in recent years and better vaccination coverage in rural than in urban areas. The organization of healthcare systems with systematic outreach activities in the rural areas may explain the difference between rural and urban areas.

Parental-Reported Full Influenza Vaccination Coverage of Children in the U.S.

Depending upon influenza vaccination history, children aged 6 months-8 years need one or two doses of influenza vaccine to be considered fully vaccinated. The objectives of this study were to quantify the percentage of children aged 6 months-8 years who were fully vaccinated against influenza based on parental report, overall, by state, and by sociodemographic characteristics, and to examine sociodemographic characteristics associated with being fully vaccinated. Data from the National Immunization Survey-Flu for the 2012-2013 and 2013-2014 influenza seasons were analyzed in 2015 using the Kaplan-Meier method to produce vaccination coverage estimates. Wald chi-square tests were used to test for bivariate associations, and Cox proportional hazards models were used to test for demographic characteristics independently associated with the child being fully vaccinated. The percentages of children aged 6 months-8 years who were fully vaccinated during the 2012-2013 and 2013-2014 influenza seasons were 41.0% and 45.2%, respectively. Full vaccination varied widely by state and was more likely for children requiring only one dose. Based on the statistical models, children likely to be fully vaccinated were older, non-black, had a mother with an education >12 years, or lived in a high-income household. Most children in the U.S. are not fully vaccinated against influenza. Reminder systems and interventions that reduce or remove barriers to children receiving their second doses of influenza vaccine may improve full influenza vaccination coverage among all children.

Trends in compliance with two-dose influenza vaccine recommendations in children aged 6 months through 8 years, 2010–2015

BackgroundChildren aged 6 months through 8 years may require two doses of influenza vaccine for adequate immune response against the disease. However, poor two-dose compliance has been reported in the literature. MethodsWe analyzed data for >2.6million children from six immunization information system (IIS) sentinel sites, and assessed full vaccination coverage and two-dose compliance in the 2010–2015 influenza vaccination seasons. Full vaccination was defined as having received at least the recommended number of influenza vaccine doses (one or two), based on recommendations from the Advisory Committee on Immunization Practices. Two-dose compliance was defined as the percentage of children during each season who received at least two doses of influenza vaccine among those who required two doses and initiated the series. ResultsAcross seasons, ⩾1-dose influenza vaccination coverage was mainly unchanged among 6–23montholds (range: 60.9–66.6%), 2–4yearolds (range: 44.8–47.4%), and 5–8yearolds (range: 34.5–38.9%). However, full vaccination coverage showed increasing trends from 2010–11 season to 2014–15 season (6–23months: 43.0–46.5%; 2–4yearolds: 26.3–39.7%; 5–8yearolds, 18.5–33.9%). Across seasons, two-dose compliance remained modest in children 6–23months (range: 63.3–67.6%) and very low in older children (range: 11.6–18.7% in children 2–4yearsand6.8–13.3% in children 5–8years). In the 2014–15 season, among children who required and received 2 doses, only half completed the two-dose series before influenza activity peaked. ConclusionsImproved messaging of the two-dose influenza vaccine recommendations is needed for providers and parents. Providers are encouraged to determine a child’s eligibility for two doses of influenza vaccine using the child’s vaccination history, and to vaccinate children early in the season so that two-dose series are completed before influenza peaks.

Effectiveness of a smartphone app on improving immunization of children in rural Sichuan Province, China: a cluster randomized controlled trial.

BackgroundThe aim of this study was to assess the effectiveness of an EPI smartphone application (EPI app) on improving vaccination coverage in rural Sichuan Province, China.MethodsThis matched-pair cluster randomized controlled study included 32 village doctors, matched in 16 pairs, and took place from 2013 to 2015. Village doctors in the intervention group used the EPI app and reminder text messages while village doctors in the control group used their usual procedures and text messages. The primary outcome was full vaccination coverage with all five vaccines (1 dose of BCG, 3 doses of hepatitis B, 3 doses of OPV, 3 doses of DPT and 1 dose of measles vaccine), and the secondary outcome was coverage with each dose of the five individual vaccines. We also conducted qualitative interviews with village doctors to understand perceptions on using the EPI app and how this changed their vaccination work.ResultsThe full vaccination coverage increased statistically significant from baseline to end-line in both the intervention (67 % [95 % CI:58-75 %] to 84 % [95 % CI:76-90 %], P = 0.028) and control group (71 % [95 % CI:62-79 %] to 82 % [95 % CI:74-88 %], P = 0.014). The intervention group had higher increase in full vaccination coverage from baseline to end-line compared to the control group (17 % vs 10 %), but this was not statistically significant (P = 0.164). Village doctors found it more convenient to use the EPI app to manage child vaccination and also reported saving time by looking up information of caregivers and contacting caregivers for overdue vaccinations quicker. However, village doctors found it hard to manage children who migrated out of the counties.ConclusionsThis study showed that an app and text messages can be used by village doctors to improve full vaccination coverage, though no significant increase in vaccination coverage was found when assessing the effect of the app on its own. Village doctors using EPI app reported having improved their working efficiency of managing childhood vaccination. Future studies should be conducted to evaluate the impact of more integrated approach of mHealth intervention on child immunization.Trial registrationChinese Clinical Trials Registry (ChiCTR): ChiCTR-TRC-13003960, registered on December 6, 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3549-0) contains supplementary material, which is available to authorized users.

Complete Influenza Vaccination Trends for Children Six to Twenty-Three Months.

Prevention of influenza among infants and young children is a public health priority because of their high risk for influenza-related complications. Depending on a child's age and previous influenza vaccination history, they are recommended to receive either 1 dose or 2 doses of influenza vaccine to be considered fully vaccinated against influenza for the season. We compared estimates of full (complete) influenza vaccination coverage of children 6 to 23 months across 10 consecutive influenza seasons (2002-2012), by race/ethnicity, age group, and by number of doses required to be fully vaccinated given child's vaccination history. National Immunization Survey data were used to estimate full influenza vaccination status among children 6 to 23 months on the basis of provider report. Estimates were computed by using Kaplan-Meier survival analysis methods. Full influenza vaccination coverage among children 6 to 23 months increased from 4.8% in the 2002-2003 influenza season to 44.7% in the 2011-2012 season. In all 10 influenza seasons studied, non-Hispanic black children and Hispanic children had lower full influenza vaccination coverage than non-Hispanic white children. For all 10 influenza seasons, full influenza vaccination coverage was higher among children requiring only 1 dose compared with those requiring 2 doses. Less than half of children 6 to 23 months in the United States, and an even a smaller percentage of Hispanic and non-Hispanic black children, are fully vaccinated against influenza. More implementation of evidence-based strategies that increase the percentage of children who are fully vaccinated is needed.

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.

Effects of three interventions and determinants of full vaccination among children aged 12–59 months in Nyanza province, Kenya

ObjectivesThe purpose of this study is to describe the effects of the three main interventions and identify the individual and community determinants of full vaccination coverage among children aged 12–59 months in Nyanza province, Kenya. Study designCross-sectional study. MethodsWe utilized three datasets. One is the Nyanza Province County-based Multiple Indicator Cluster Survey 2011. The other two datasets are the lists of community units and health facilities in Nyanza Province, Kenya. A three-level multilevel logistic regression analysis was performed. ResultsIn the final model, the highest wealth quintile (AOR: 2.49; 95% CI: 1.333–4.642; P = 0.004), the community with high coverage of media devices (AOR: 1.50; 95% CI: 1.029–2.198; P = 0.035), the participation of mass immunization campaigns (AOR: 1.63; 95% CI: 1.153–2.303; P = 0.006) were the significant determinants of complete child vaccination. ConclusionsIn conclusion, further implementation of mass immunization campaigns is the recommended intervention to increase the uptake of required vaccinations among children. In addition, further attention to the poor and the low coverage of media devices is necessary, since they are the most vulnerable population in terms of accessibility of vaccination services. Implementation community based activity, such as community health workers, would have a positive impact on vaccination coverage, if their performance is continuously high.

Determinants of childhood vaccination completion at a peri-urban hospital in Kenya, December 2013 -January 2014: a case control study.

IntroductionVaccine preventable diseases account for about 17% of deaths among children below five years in Kenya. Immunization is one the most cost-effective ways of reducing child mortality and morbidity worldwide. In Kenya, national full vaccination coverage today stands at above 80%. However there continue to be pockets of low full vaccination coverage like the catchment area of Alupe Sub-District Hospital which pose a threat to the rest of the country.MethodsThis was a case-control study at Alupe Sub-District Hospital, Western Kenya. Sixty one (61) cases and 122 controls were sampled from the facility maternal and child health register by systematic random sampling and traced to their households. Cases were defined as children 12-23 months resident in Kenya who received at least one infant vaccine at the facility but were not fully vaccinated at the time of the study, while controls were children 12-23 months who were fully vaccinated by the time of the study. Pretested structured questionnaires were used for data collection. Data entry and analysis was done using Epi-Info 3.5.4 statistical software.ResultsIndependent determinants of infant vaccination completion were the child's age < 18 months (AOR 4.2(1.8-9.6), p < 0.01), maternal age < 25 years (AOR 2.5(1.1-5.0), p = 0.03), maternal tetanus toxoid vaccination status < 2 TT doses (AOR 2.5(1.2-5.4), p < 0.02) and late receipt of BCG [AOR 3.2(1.4-7.3), p = 0.005).ConclusionStrategies to increase full vaccination should target young mothers especially during antenatal period.

Socioeconomic inequalities are still a barrier to full child vaccine coverage in the Brazilian Amazon: a cross-sectional study in Assis Brasil, Acre, Brazil.

IntroductionVaccines are very important to reduce morbidity and mortality by preventable infectious diseases, especially during childhood. Optimal coverage is not always achieved, for several reasons. Here we assessed vaccine coverage for the first 12 months of age in children between 12 and 59 months old, residing in the urban area of a small Amazonian city, and factors associated with incomplete vaccination.MethodsA census was performed in the urban area of Assis Brasil, in the Brazilian Amazon, in January 2010, with mothers of 282 children aged 12 to 59 months old, using structured interviews and data from vaccination cards. Mixed logistic regression was used to determine factors associated with incomplete vaccination schemes.ResultsOnly 82.6% of all children had a completed the basic vaccine scheme for the first year of life. Vaccine coverage ranged from 52.7% coverage (oral rotavirus vaccine) to 99.7% coverage (for Bacille Calmette-Guérin). The major deficiencies occurred in doses administered after the first six months of life. Incomplete vaccination was associated with not having enough income to buy a house (aOR = 2.12, 95% CI 1.06-4.21), low maternal schooling (aOR = 2.60, 95% CI 1.28 – 5.29) , and time of residence of the child in the urban area of the city (aOR = 0.73, 95% CI 0.55 – 0.95).ConclusionsThis study showed that vaccine coverage in the first twelve months of life in Assis Brasil is similar to other areas in the Amazon and it is below the coverage postulated by the Brazilian Ministry of Health. Low vaccine coverage was associated with socioeconomic inequities that still prevail in the Brazilian Amazon. Short and long-term strategies must be taken to update child vaccines and increase vaccine coverage in the Amazon.

Determinants and Coverage of Vaccination in Children in Western Kenya from a 2003 Cross-Sectional Survey

This study assesses full and timely vaccination coverage and factors associated with full vaccination in children ages 12-23 months in Gem, Nyanza Province, Kenya in 2003. A simple random sample of 1,769 households was selected, and guardians were invited to bring children under 5 years of age to participate in a survey. Full vaccination coverage was 31.1% among 244 children. Only 2.2% received all vaccinations in the target month for each vaccination. In multivariate logistic regression, children of mothers of higher parity (odds ratio [OR] = 0.27, 95% confidence interval [95% CI] = 0.13-0.65, P ≤ 0.01), children of mothers with lower maternal education (OR = 0.35, 95% CI = 0.13-0.97, P ≤ 0.05), or children in households with the spouse absent versus present (OR = 0.40, 95% CI = 0.17-0.91, P ≤ 0.05) were less likely to be fully vaccinated. These data serve as a baseline from which changes in vaccination coverage will be measured as interventions to improve vaccination timeliness are introduced.

Influenza vaccination coverage and timeliness among children requiring two doses, 2004–2009

ObjectiveTo assess influenza vaccination coverage and timeliness among children requiring two doses in a season. MethodsThis study examined seasonal influenza vaccination of 17,800 children from five academically-affiliated clinics in New York City using hospital and city immunization registries. Eligible children were 6months–8years and needed two influenza vaccine doses in a given season between 2004–05 and 2009–10. Any (≥1 dose) and full (2 doses) vaccination coverage by December 15 and March 31 as well as interval between doses were calculated. Vaccination trends over time, determinants, and missed opportunities were assessed. ResultsChildren were primarily Latino and publicly insured. Full coverage by March 31 increased between the 2004–05 and 2009–10 seasons (9% vs. 29%, p<0.001). Few children received both doses by December 15 (2–13%). The interval between doses was almost twice as long as recommended and increased over time (2004–05: 52days; 2009–10: 64days; p<0.001). Older age and Latino ethnicity were negative predictors of full vaccination by March 31. Missed opportunities for the second dose were common. ConclusionDespite improvements, low-income, minority children requiring two influenza vaccine doses remain at risk of incomplete and delayed vaccination. Barriers to and strategies for timely full vaccination should be explored.

Regional inequality and vaccine uptake: a multilevel analysis of the 2007 Welfare Monitoring Survey in Malawi

BackgroundA significant part of childhood mortality can be prevented given the existence of a well functioning health care system that can deliver vaccines to children during their first year of life. This study assesses immunization differentials between regions in Malawi, and attempts to relate regional disparities in immunization to factors on individual, household and village level.MethodWe used data from the 2007 Welfare Monitoring Survey which includes 18 251 children ages 10–60 months. Multilevel logistic regression models were applied for data analysis.ResultsMajor differences in full vaccine coverage (children receiving all of the 9 recommended vaccines) were documented between the 27 official regions, called districts, of Malawi. The vaccine coverage among regions varied from 2% to 74% when all children 10 – 60 months old were included. Vaccine coverage was significantly higher for women that had their delivery attended by a midwife/nurse, or gave birth at a hospital or maternity clinic. Regions with a high percentage of deliveries attended by health personnel were also characterized by a higher coverage. Characteristics of health care utilization on the individual level could in part account for the observed regional variations in coverage.Several factors related to socio-demographic characteristics of individuals and households were significantly correlated with coverage (child’s age, illiteracy, income, water and sanitary conditions), implying a lower coverage among the most vulnerable parts of the population. However, these factors could only to a minor extent account for the regional variation in coverage.ConclusionsThe persistent regional inequalities suggest that the low immunization coverage in Malawi is less likely to be a result of geographical clustering of social groups with difficult level-of living conditions. Although the mean vaccine coverage in Malawi is low, some regions have succeeded in reaching a relatively high proportion of their children. The relative success of some regions implies that there is a substantial potential for political intervention to improve vaccine coverage. One important negative implication of regional inequality is the presence of clusters with under-vaccinated children, leading to an increased vulnerability during outbreaks of vaccine-preventable diseases.