Trends In Vaccination Coverage Research Articles

Spatial distribution, determinants and trends of full vaccination coverage in children aged 12–59 months in Peru: A subanalysis of the Peruvian Demographic and Health Survey

ObjectiveTo assess the spatial distribution, trends and determinants of crude full vaccination coverage (FVC) in children aged 12–59 months between 2010 and 2019 in Peru.Design, setting and analysisA cross-sectional study...

Global Health priorities: repositioning routine immunization for infants.

The first year of the Coronavirus disease (COVID-19) pandemic registered the highest number of children under the age of one year who did not receive basic vaccines since 2009. The pronounced rise in vaccine-preventable diseases in 2020 and 2021 was largely attributable to the disruption of the vaccine schedule for children around the world. Routine vaccinations were missed in consideration of movement restrictions to prevent the spread of COVID-19. On the other hand, health resources were re-allocated to COVID-19, resulting in strained health care systems and the marginalization of essential health services like routine vaccination campaigns. The COVID-19 pandemic has clearly illustrated the potential of vaccines in saving lives and preventing disabilities. The unequal roll-out of vaccination programmes has simultaneously deepened the existing gaps between high and low-income countries. Disruption in other key life-saving immunization programmes is driving these inequalities even further. Prompt and sustainable investments in routine immunization programmes, including catch-up vaccination strategies, are essential to avert the impact of years of neglect of this important public health issue. In particular, the recent declining trends in vaccination coverage are putting decades of progress at risk.

Vaccination coverage trends in European Union from 1980 to 2020: A joinpoint Regression Analysis

Abstract Vaccinations are successful, cost-effective public health interventions; nevertheless, vaccine hesitancy represents a concern and several EU countries have implemented mandatory vaccinations to counteract it. The assessment of vaccination coverage data is helpful to clarify the reason behind this choice better and assess its impact. Data were extracted from the WUENIC database as of July 2021. All the 27 EU countries were included, considering the period from 1980 to 2020 (depending on data availability). Coverage indicators on seven vaccinations scheduled during the first year of life to prevent nine vaccine-preventable diseases were considered. Joinpoint regression was run using Joinpoint Trend Analysis Software 4.9.0.0. For each coverage indicator, the last two trends in time identified by the joinpoint regression were considered to identify countries with a positive vaccination coverage trend (having either the last trend significantly positive or the second last significantly negative but followed by a trend reversal) or a negative coverage trend (having either the last trend significantly negative or the second last significantly positive but followed by a trend reversal). To assess each country, we collated together information on each coverage indicator. A total of 180 jointpoint regressions were run. At least one joinpoint was observed in 144 cases: 39 (27.1%) showed a significant positive trend, and 49 (34%) had a significantly negative one. In 36 cases, there was a single trend lacking a joinpoint, either positive (21, 58.3%), negative (8, 22.2%), or not showing a change (7, 19.4%). Overall, 14 countries had mostly negative vaccination coverage trends, whereas 13 had mostly positive vaccination coverage trends. Systematised data collection and analysis of vaccination coverage trends are needed to support public health systems. EU countries differ broadly, but the overall situation shows that coverage trends are a key issue to be addressed. Key messages • Vaccination coverage in the EU shows a general negative trend. The assessment and comparison of coverage trends across EU countries could make policymakers able to respond to critical issues timely. • Mandatory vaccinations have been issued in different countries to prevent vaccination coverages from decreasing. Some countries have not issued any mandate but show high vaccination coverages.

Celebrating 25 Years of Varicella Vaccination Coverage for Children and Adolescents in the United States: A Success Story.

Tracking vaccination coverage is a critical component of monitoring a vaccine program. Three different surveillance systems were used to examine trends in varicella vaccination coverage during the United States vaccination program: National Immunization Survey-Child, National Immunization Survey-Teen, and immunization information systems (IISs). The relationship of these trends to school requirements and disease decline was also examined. Among children aged 19-35 months, ≥1 dose of varicella vaccine increased from 16.0% in 1996 to 89.2% by the end of the 1-dose program in 2006, stabilizing around at least 90.0% thereafter. The uptake of the second dose was rapid after the 2007 recommendation. Two-dose coverage among children aged 7 years at 6 high-performing IIS sites increased from 2.6%-5.5% in 2006 to 86.0%-100.0% in 2020. Among adolescents aged 13-17 years, ≥2-dose coverage increased from 4.1% in 2006 to 91.9% in 2020. The proportion of adolescents with history of varicella disease declined from 69.9% in 2006 to 8.4% in 2020. In 2006, 92% of states and the District of Columbia (DC) had 1-dose daycare or school entry requirements; 88% of states and DC had 2-dose school entry requirements in the 2020-2021 school year. The successes in attaining and maintaining high vaccine coverage were paramount in the dramatic reduction of the varicella burden in the United States over the 25 years of the vaccination program, but opportunities remain to further increase coverage and decrease varicella morbidity and mortality.

How a generally well-accepted measles vaccine mandate may lead to inequities and decreased vaccine uptake: a preregistered survey study in Germany

BackgroundIn Germany, a measles vaccine mandate came into effect in March 2020, requiring proof of measles immunization for children attending kindergarten or school and for staff in a variety of facilities. Mandates can be successful if implemented with care and in a context-sensitive manner. They may, however, also lead to inequities and decreased uptake of other vaccines. The aim of this study was to investigate the acceptance and potential unintended consequences of the measles vaccine mandate in Germany.MethodsAs part of a larger evaluation project on the new mandate, we conducted an online survey among parents in August/September 2020. We assessed differences in knowledge about the mandate and the measles vaccine by socio-economic status. We used linear and logistic regression to estimate how reactance to the mandate was associated with vaccination status and vaccination intention against other diseases. We used mediation analysis to measure how trust in institutions had an impact on the attitude towards the mandate, mediated by level of reactance.ResultsIn total, 4,863 parents participated in the study (64.2% female, mean age = 36.8 years). Of these, 74.1% endorsed a measles vaccine mandate for children. Parents with lower socio-economic status had less knowledge about the mandate and the measles vaccine. The higher parents’ levels of reactance, the lower the vaccination intentions and the likelihood for the child to be vaccinated against other diseases. Furthermore, higher institutional trust decreased the level of reactance and increased positive attitudes towards the mandate (partial mediation).ConclusionsThe new measles vaccine mandate in Germany, though well accepted by many, might have unintended consequences. Parents with lower socio-economic status, who know less about the mandate and vaccine, might be less likely to comply with it. The mandate may also lead to some parents omitting other childhood vaccines, as a way to restore their freedom. This could decrease vaccination coverage of other vaccines. Any potential loss of trust might provoke more reactance and lower acceptance of mandates. Policymakers should now expand communication activities on the mandate, monitor trends in vaccination coverage carefully and take measures to strengthen trust.

Trends in HPV vaccine administration and HPV vaccine coverage in children by race/ethnicity and socioeconomic status during the COVID-19 pandemic in an integrated health care system in California

BackgroundWe sought to evaluate the trends of HPV vaccination between 03/2019–09/2021 and whether the impact of the COVID pandemic on HPV vaccination varied by race/ethnicity and neighborhood deprivation index (NDI). MethodsElectronic medical records at Kaiser Permanente Southern California were used to assess monthly volume of HPV vaccine doses administered among children aged 9–12.9yrs, and up-to-date coverage (% vaccinated) by age 13 between 03/2019–09/2021. Modified Poisson models were used to evaluate the interactions between race/ethnicity, NDI and the pandemic periods on HPV vaccine coverage. ResultsHPV vaccine doses administered in 2020/2021 have returned to the 2019 level after the initial drop. The average up-to-date coverage in 05/2021–09/2021 (54.8%) remained lower than the pre-pandemic level (58.5%). The associations between race/ethnicity, NDI and HPV vaccine coverage did not vary due to the pandemic. ConclusionHPV vaccine promotion efforts are needed to address COVID-19 pandemic’s lasting impact on HPV vaccination coverage.

Trends and characteristics of Tdap vaccination during pregnancy in Ontario, Canada: a retrospective cohort study.

In February 2018, Canada's National Advisory Committee on Immunization (NACI) recommended tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccination during pregnancy to protect newborns against pertussis infection. We sought to describe pre- and postrecommendation trends in Tdap vaccination coverage among pregnant Ontario residents. Using linked health administrative databases, we conducted a population-based retrospective cohort study of all pregnant individuals who gave birth in Ontario hospitals between April 2012 and March 2020. We described Tdap vaccination patterns in pregnancy for the entire study period and before and after the NACI recommendation. We used log-binomial regression to identify characteristics associated with Tdap vaccination during pregnancy. Among the 991 850 deliveries included, 7.0% of pregnant individuals received the Tdap vaccination during pregnancy. Vaccine coverage increased from 0.4% in 2011/12 to 29.2% in 2019/20. Coverage was highest among individuals who were older, had no previous live births, had adequate prenatal care and received maternity care primarily from a family physician. After adjustment, characteristics associated with lower coverage included younger maternal age, having a multiple birth, residing in a rural location and higher area material deprivation. In 2019/20, 71.0% of vaccinated individuals received the Tdap vaccination during the recommended gestational window (27-32 wk). Stratified analyses of the pre- and postrecommendation cohorts yielded similar findings to the main analyses with a few gradient differences after adjustment. During pregnancy, Tdap vaccination coverage increased substantially in Ontario between 2011/12 and 2019/20, most notably after recommendations for universal Tdap vaccination during pregnancy began in Canada. To further improve vaccine coverage in the obstetric setting, public health strategies should consider tailoring their programs to reach subpopulations with lower vaccine coverage.

Child Vaccination Coverage in India and Its Impact: Evidence From NFHS-5 Factsheet

Background: In developing countries various childhood diseases lead the morbidity, mortality and irreversible losses which can be prevented by proper vaccination. This study was conducted to analyse the changing trends of childhood vaccination in India and its impact on childhood diseases and mortality, the trends in coverage of each vaccine along with identification of geographical areas of concern. Materials and methods: NFHS data published by Government of India was analyzed to see the trends in vaccination coverage, female literacy, childhood diseases and under-five mortality, along with online database search for relevant literature. Results: Total vaccination coverage in India has reached to 76.4% as per NFHS- 5 data. Orissa stands at the top with 90.5% coverage while Nagaland at the bottom with 57.9% coverage. Prevalence of childhood diseases and under-five mortality has reduced overtime accountable to increase in vaccination coverage as one of the major factors for same. Conclusion: Despite improvement in total vaccination coverage, the goal of Intensified Mission Indra Dhanush of 90% coverage still remains unachieved. There is reduction in childhood disease and mortality rate, but the pandemic has adversely affected these advances. Therefore, immediate steps should be taken to gain the lost ground.

Pediatric influenza vaccination rates lower than previous estimates in the United States

BackgroundAnnually, pediatric influenza vaccination coverage estimates are ascertained from health surveys, such as the National Immunization Survey (NIS-Flu). From 2010 to 2017, vaccination coverage among children ranged from 51 to 59 %. Recognizing the limitations of national health survey data, we sought to describe temporal trends in pediatric influenza vaccination coverage, and demographic differences among a commercially insured large national cohort from 07/01/2010 to 06/30/2017. MethodsInfluenza vaccination coverage was assessed among children (<18 years) with continuous enrollment in the de-identified Optum Clinformatics® Data Mart database, and from NIS-Flu. Time trends in vaccination coverage were assessed using Joinpoint regression, overall and stratified by age group, sex, and geographic region. ResultsThe average annual pediatric influenza vaccination coverage was 33.4 % in our study population versus 56.5 % reported from NIS-Flu during the same period (p-value < 0.0001). Vaccination coverage was highest in children 6 months-4-years old at 52.6 % (versus 68.8 % NIS-Flu, p-value < 0.0001), and lowest in the 13–17-year-old age group at 20.1 % (versus 42.8 % NIS-Flu, p-value < 0.0001). Vaccination coverage over time remained stable in our study population (average annual percent change 1.8 %, 95 % confidence interval [CI] −2.3 % to 6.0 %) versus significantly increasing by 2.8 % in NIS-Flu (95 % CI 0.3 % to 5.3 %). ConclusionsVaccination coverage in our commercially insured pediatric population was 51.4% lower than estimates from NIS-Flu during the same period, suggesting the need for more accurate vaccination coverage surveillance, which will also be critical in future COVID-19 vaccination efforts. Effective interventions are needed to increase pediatric influenza vaccination rates to the Healthy People 2020 target of 70%.

The impact of COVID-19 and catch-up strategies on routine childhood vaccine coverage trends in Latin America: A systematic literature review and database analysis

ABSTRACT Globally, an estimated 23 million children missed vaccination in 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. We analyzed vaccination coverage trends and catch-up strategies/recommendations implemented in Latin America during the pandemic. We performed a national administrative database analysis and a systematic literature review to evaluate vaccination coverage data and identify catch-up strategies for missed vaccinations in selected countries in Latin America (Argentina, Brazil, Chile, Colombia, Mexico and Peru). Data were extracted from national health ministry vaccination coverage and supranational databases to identify coverage of rotavirus (RV), pentavalent/hexavalent, measles, Bacillus Calmette-Guérin (BCG) and pneumococcal conjugate vaccines (PCV) at country level before and during the COVID-19 pandemic. A systematic literature review of published papers was conducted to identify vaccination catch-up strategies published in January 2020–June 2021. National administrative database-reported data showed that vaccination coverage trends were declining prior to 2020. The change in vaccination coverage before and during the COVID-19 pandemic ranged from 2.5% to −11.5% (RV), −3.0% to −11.0% (measles), 1.5% to −7.5% (PCV), 9.0% to −14.0% (pentavalent/hexavalent), and 3.0% to −18.5% (BCG). Among 696 identified studies, 14 studies were included in this review. Catch-up vaccination strategies included prioritizing routine vaccinations as per the national immunization schedule. Overall vaccination coverage declined by varying degrees among the countries investigated. This trend was observed prior to 2020, suggesting multifactorial reasons for declining vaccination rates in Latin America.

Vaccination coverage in children under one year of age in Minas Gerais state, Brazil

The scope of this article is to analyze vaccination coverage rates in children under one year of age during the period from 2015 to 2020 in the state of Minas Gerais (MG). It involved an ecological, time-series study on vaccination coverage in children under 1 year of age, considering the 28 Regional Health Management/Superintendencies (GRS/SRS) of MG as the unit of analysis. The following immunobiological vaccine coverage was analyzed: Bacillus Calmette and Guérin, human rotavirus, pneumococcal 10, pentavalent, meningococcus C, yellow fever, and polio vaccines. The Prais-Winsten autoregressive model was employed for trend analysis. The year 2020 stands out, as it presented the lowest proportion of GRS and SRS that reached the recommended vaccine coverage goals for the immunobiologicals analyzed. Regarding the analysis of the coverage trend, 8 of the 28 GRS/SRS showed a decreasing trend for at least 5 of the 7 immunobiologicals evaluated. We observed a downward trend in the vaccination coverage of at least five immunobiologicals in eight of the GRS/SRS, with emphasis on the Pentavalent vaccine, which showed a downward trend in vaccination coverage in 60.71% of the GRS and SRS.

Geographical and time trends of measles incidence and measles vaccination coverage and their correlation in Nigeria

ABSTRACT Nigeria has one of the highest measles burdens in the world. While measles-containing vaccine is proven to be effective in reducing measles cases, empirical studies on the correlation between measles incidence and measles vaccine coverage in Nigeria has been limited. The aim of this study was to conduct a detailed analysis on measles incidence, measles vaccine coverage, and their correlation between 2012 and 2021. A retrospective observational study was conducted based on the Integrated Disease Surveillance and Response (IDSR) data for the measles incidence in each Nigerian state over time, District Health Information System, V.2 (DHIS2) and Nigeria Demographic and Health Survey (DHS) for the coverage of the first dose of measles containing vaccine (MCV1) over time (2012–2021). We observed the trend of measles incidence and measles vaccine coverage, as well as their correlation. Out of the study period from 2012 to 2021, we found that the majority of measles outbreaks occurred in the northeastern states in recent years after 2019, especially in Borno state, where Boko Haram insurgency has negatively impacted health service delivery, including routine vaccination. We observed a significant negative correlation between measles incidence and measles vaccine coverage across Nigerian states. However, there was no sudden drop in measles vaccine coverage before the recent outbreak in Borno state in 2019, which could be due to various factors other than the overall vaccine coverage.

Influenza vaccination coverage in pediatric population in Italy: an analysis of recent trends

BackgroundInfluenza is a major cause of morbidity, mortality and exacerbation of extant chronic disease worldwide. Influenza vaccination is thus fundamental to reduce the burden of disease. In this study, we describe the trend of influenza vaccination coverage in the seasons 2010/11–2020/21 among children aged < 2, 2–4 and 5–8 in Italy.MethodsWe analyzed the trend of influenza vaccination coverage in the pediatric population in Italy from the 2010/11 to the 2020/21 season at national and regional level and observed the incidence of influenza-like illness (ILI) in the pediatric population between 2010/11 and 2020/21.ResultsIn the period 2010/11–2019/20 the highest value of coverage (4.5%) was reached in the age group 2–4 and 5–8 (season 2010/11 and 2011/12, respectively), while the lowest belonged to the < 2 group (1.1% in the season 2015/16). In the season 2020/2021 all the age groups reported a substantial increase of coverage compared with the previous season. The highest value (19.0%) was reported in the age group 2–4, followed by the group 5–8 and < 2 (13.1 and 9.2%, respectively). Considering the rates of annual ILI cases, the highest value for the 0–4 age group was 18.5% in the 2011/12 season; for the 5–14 age group, the highest value was 27.7% in the 2010/11 season.ConclusionsOver the past 11 years pediatric influenza vaccination coverage in Italy has been low, with relevant differences across regions and seasons, albeit a general increase in coverage has been observed in the 2020/21 season. Universal influenza vaccination for children should be considered as a priority for the high incidence in this age group. Further research is needed to improve knowledge and comparability of coverage rates, and to identify the best practices for organizational models of delivery which can support the improvement of trends, the acceptability and accessibility by parents and awareness in stakeholders and decision makers.

Trends of influenza vaccination coverage in pregnant women: a ten-year analysis from a French healthcare database

Pregnant women have a high risk of severe influenza, associated with obstetrical complications. The World Health Organization (WHO) has recommended influenza vaccination for all pregnant women since 2012. The vaccination coverage remains low worldwide, and in Europe, due to a lack of proposition from the health care providers, and a high refusal rate from the women. The primary aim of this study was to estimate the influenza vaccination coverage (IVC) in a population of pregnant women in France, and to analyse its evolution from 2009 to 2018. The secondary objective was to describe the vaccinated population and to find determinants associated with the vaccination. This retrospective cohort study is based on the EGB French health care database, a representative sample of the French population containing data from the health insurance system. All pregnant women who delivered medically or spontaneously over the 2009–2018 period were included. In the 2009–2018 period, only 1.2% pregnant women were vaccinated against influenza (n = 875/72,207; 95% CI 1.14–1.30). The IVC slightly increased after the 2012 WHO recommendation, from 0.33 to 1.79% (p < 0.001) but remained extremely low (4.1% in 2018). Women younger than 25 years old had a low coverage (0.6%) whereas women over 35 years old were more likely to get the influenza vaccine (1.7%; OR: 2.82, 95% CI 2.14–3.71). The vaccination behavior was not influenced by multifetal pregnancy or parity, but socio-economically deprived women were less likely to be vaccinated (OR: 0.81, 95% CI: 0.67–0.98). Women with pre-existing medical conditions had an overall higher vaccination rate (2.5%; OR: 2.32, 95% CI: 1.94–2.77). The vaccine was mainly prescribed by family physicians (58%). Influenza vaccination in pregnant women in France remains very low, particularly in younger, healthy women, and measures such as information campaigns towards pregnant women and studies of the knowledge, attitudes, and practices of the health care professionals need to be undertaken to improve the coverage.

Trends in adolescent COVID-19 vaccination receipt and parental intent to vaccinate their adolescent children, United States, July to October, 2021

Introduction There was a five-fold increase in COVID-19 hospitalization case counts among children and adolescents between June and October 2021. However, polls suggest that adolescent COVID-19 vaccination coverage has plateaued in the United States. Methods Using the Census Bureau’s Household Pulse Survey, we assessed trends in COVID-19 vaccination among adolescents ages 12–17 years, parents’ intention to vaccinate their adolescent children, and their reasons for not intending to vaccinate their children from July to October 2021 using a large, nationally representative survey of U.S. households (n = 59,424). Trends in COVID-19 adolescent vaccination coverage, nationally and by sociodemographic characteristics, factors associated with adolescent vaccination status and parental intent to vaccinate their adolescent children, as well as changes in reasons for non-vaccination were examined using regression models. Results Receipt of ≥1 dose of a COVID-19 vaccine among adolescents ages 12–17 years increased five percentage points, from 56% (July) to 61% (October), with significant increases across most sociodemographic variables. However, there were no significant changes in parental intention to vaccinate their adolescent children during the same time period. Approximately one-quarter of parents were unsure about or reluctant to vaccinate their children, which remained consistent from July to October. Among those who had not vaccinated their children, lack of trust in the government and vaccines, and the belief that the COVID-19 vaccine is not needed or effective, was higher in October compared to July. Conclusions Parental intention to vaccinate their children has remained relatively stable throughout the late summer and early fall of 2021. Encouraging paediatricians to discuss the importance and safety of COVID-19 vaccines, addressing concerns and misinformation, as well as recommending and offering vaccines are important for increasing parental confidence in vaccines as well as vaccination uptake among adolescents. KEY MESSAGE Receipt of ≥1 dose of a COVID-19 vaccine among adolescents ages 12–17 years increased five percentage points, from 56% (July) to 61% (October), with significant increases across most sociodemographic variables. Approximately one quarter of parents were unsure about or reluctant to vaccinate their children, which remained consistent from July to October. Encouraging paediatricians to discuss the importance and safety of COVID-19 vaccines, addressing concerns and misinformation, as well as recommending and offering vaccines is important for increasing parental confidence in vaccines as well as vaccination uptake among adolescents.

PCV-15 and PPSV-23 coverage of invasive and respiratory tract Streptococcus pneumoniae, including MDR and XDR isolates: CANWARD 2007-20.

To compare the proportion of invasive and respiratory tract isolates of Streptococcus pneumoniae, including MDR and XDR strains, that demonstrated PCV-15 and PPSV-23 serotypes in Canada from 2007 to 2020. The CANWARD study collected 2984 S. pneumoniae isolates from 2007 to 2020 (1054 invasive, 1930 respiratory). Serotyping was performed using the Quellung reaction. Antimicrobial susceptibility testing was performed using CLSI methods. MDR/XDR was defined as resistance to ≥3/≥5 antimicrobial classes, respectively. Overall, the proportion of vaccine serotypes demonstrating a PCV-15/PPSV-23 serotype was significantly higher in blood isolates (54.6%/76.2%, respectively) than respiratory isolates (38.9%/55.3%; P < 0.0001). Similarly, PCV-15 and PPSV-23 vaccine coverage was higher for blood isolates for all demographic categories, including both genders, all regions and all age groups (P ≤ 0.0213). PCV-15/PPSV-23 coverage was also significantly higher for blood isolates demonstrating clarithromycin resistance (60.4/75.1% blood, 47.8/57.4% respiratory; P ≤ 0.009) and penicillin resistance (68.9/63.0% blood, 45.2/43.0% respiratory; P < 0.0001) and trimethoprim/sulfamethoxazole-resistant isolates for PPSV-23 only (82.6% blood, 64.3% respiratory; P = 0.0057). Vaccine coverage was numerically higher but not significantly different between specimen source for children <2 years of age, as well as ceftriaxone-, doxycycline- and levofloxacin-resistant isolates. PCV-15/PPSV-23 vaccine coverage for MDR isolates (61.8%/67.3% blood, 52.2%/56.2% respiratory) and XDR isolates (93.3% blood, 89.6% respiratory for both vaccines) was not significantly different between specimen sources. PCV-15 and PPSV-23 serotype coverage is generally greater for blood versus respiratory isolates but not for MDR and XDR isolates. Continued pneumococcal surveillance is warranted to determine future trends in vaccine coverage, serotype distribution and antimicrobial susceptibilities under the pressure of vaccine use.

Added Value of Electronic Immunization Registries in Low- and Middle-Income Countries: Observational Case Study in Tanzania

BackgroundThere is growing interest and investment in electronic immunization registries (EIRs) in low- and middle-income countries. EIRs provide ready access to patient- and aggregate-level service delivery data that can be used to improve patient care, identify spatiotemporal trends in vaccination coverage and dropout, inform resource allocation and program operations, and target quality improvement measures. The Government of Tanzania introduced the Tanzania Immunization Registry (TImR) in 2017, and the system has since been rolled out in 3736 facilities in 15 regions.ObjectiveThe aims of this study are to conceptualize the additional ways in which EIRs can add value to immunization programs (beyond measuring vaccine coverage) and assess the potential value-add using EIR data from Tanzania as a case study.MethodsThis study comprised 2 sequential phases. First, a comprehensive list of ways EIRs can potentially add value to immunization programs was developed through stakeholder interviews. Second, the added value was evaluated using descriptive and regression analyses of TImR data for a prioritized subset of program needs.ResultsThe analysis areas prioritized through stakeholder interviews were population movement, missed opportunities for vaccination (MOVs), continuum of care, and continuous quality improvement. The included TImR data comprised 958,870 visits for 559,542 patients from 2359 health facilities. Our analyses revealed that few patients sought care outside their assigned facility (44,733/810,568, 5.52% of applicable visits); however, this varied by region; facility urbanicity, type, ownership, patient volume, and duration of TImR system use; density of facilities in the immediate area; and patient age. Analyses further showed that MOVs were highest among children aged <12 months (215,576/831,018, 25.94% of visits included an MOV and were applicable visits); however, there were few significant differences based on other individual or facility characteristics. Nearly half (133,337/294,464, 45.28%) of the children aged 12 to 35 months were fully vaccinated or had received all doses except measles-containing vaccine–1 of the 14-dose under-12-month schedule (ie, through measles-containing vaccine–1), and facility and patient characteristics associated with dropout varied by vaccine. The continuous quality improvement analysis showed that most quality issues (eg, MOVs) were concentrated in <10% of facilities, indicating the potential for EIRs to target quality improvement efforts.ConclusionsEIRs have the potential to add value to immunization stakeholders at all levels of the health system. Individual-level electronic data can enable new analyses to understand service delivery or care-seeking patterns, potential risk factors for underimmunization, and where challenges occur. However, to achieve this potential, country programs need to leverage and strengthen the capacity to collect, analyze, interpret, and act on the data. As EIRs are introduced and scaled in low- and middle-income countries, implementers and researchers should continue to share real-world examples and build an evidence base for how EIRs can add value to immunization programs, particularly for innovative uses.

Two decades of regional trends in vaccination completion and coverage among children aged 12-23\u2009months: an analysis of the Uganda Demographic Health Survey data from 1995 to 2016

BackgroundChildhood vaccination is an important public health intervention but there is limited information on coverage, trends, and determinants of vaccination completion in Uganda at the regional level. We examined trends in regional vaccination coverage and established the determinants of vaccination completion among children aged 12-23 months in Uganda.MethodsWe analyzed data from the women’s questionnaire for the 1995-2016 Uganda Demographic Health Survey (UDHS). Vaccine completion was defined as having received a dose of Bacillus-Calmette Guerin (BCG) vaccine; three doses of diphtheria, pertussis, and tetanus (DPT) vaccine; three doses of oral polio vaccine (OPV) (excluding OPV given at birth); and one dose of measles vaccine. We performed Chi-square tests to compare vaccination completion by socio-demographic factors stratified by 10 sub-regions: Eastern, East Central, Central 1, Central 2, Kampala, Karamoja, North, Western, West Nile, and Southwest. We performed logistic regression analysis for each of the regions to identify factors associated with vaccination completion at 5% level of statistical significance.ResultsOverall vaccination completion was 48.6% (95%CI, 47.2, 50.1) and ranged from 17.3% in Central 1 to 65.9% in Southwest. Vaccination completion rates declined significantly by 10.4% (95% confidence interval (CI), − 16.1, − 4.6) between 1995 and 2000, and increased significantly by 10.0% (95% CI, 4.6, 15.4) between 2000 and 2006, and by 5.4% (95% CI, 0.2, 10.6) between 2006 and 2011. Maternal education (secondary or higher level), receipt of tetanus toxoid (TT) during pregnancy, and possession of a child health card were associated with vaccination completion across all the sub-regions. Other factors like place of residence, religious affiliation, household wealth, maternal age, childbirth order, size of child at birth, and place of delivery were associated with vaccination completion but differed between the 10 sub-regions.ConclusionBesides considerable regional variations, the vaccination completion rate among children aged 12-23 months in Uganda remains suboptimal despite the availability of vaccines. Maternal education, receipt of TT, and possession of a child health card are associated with a higher likelihood of vaccination completion among children aged 12-23 months in all the regions of Uganda. Interventions to improve the utilization of vaccination services in Uganda should consider these factors.

HPV vaccination coverage in women between 15 and 55years old in Spain: Temporal trend during the period 2007-2020.

The objective of this study was to analyse the temporal trend of HPV vaccination coverage (VC) in Spain in women aged 15-55 years not included in systematic vaccination programmes during the period 2007-2020. We assessed the vaccine coverage rate in this population based on three estimations: 1) annual vaccination coverage with at least one dose (VCR≥1d), 2) annual VC for the full schedule (VCR3d), and 3) cumulative VC for the full schedule (aVCR). Annual VCR≥1d and VCR3d were highest in 2008 (2.40% and 0.66% respectively) and subsequently decreased drastically in 2011 (0.55% and 0.15%). From 2017 to 2019 there was an increase from 1.4-fold to 1.6-fold, respectively, which decreased in 2020. In relation to aVCR, there was an increasing trend throughout the study period with approximately 4.03% of the study population having been vaccinated against HPV in 2020. In Spain, the cumulative vaccination coverage against HPV in women between 15-55 years old not included in current vaccination programmes remains very low. Nonetheless, the temporal trend has shown a slight increase in recent years. Despite the COVID-19 pandemic in 2020, no significant negative impact on vaccination coverage has been observed in this population.

Cobertura vacinal infantil de hepatite A, tríplice viral e varicela: análise de tendência temporal em Minas Gerais, Brasil

ABSTRACT: Objective: To analyze the temporal trend of vaccination coverage for hepatitis A, measles, mumps and rubella, and varicella in a Brazilian state from 2014 to 2020. Methods: An ecological, time-series study that considered data from 853 municipalities in the state of Minas Gerais that compose the 14 regions of the state, these being the territorial units of analysis. Records of applied doses of hepatitis A, measles, mumps and rubella, and varicella vaccines registered in the Brazilian Immunization Information System were analyzed. Trends were estimated by Prais-Winsten regression and 95% confidence intervals of measures of variation were calculated. Results: Low vaccine coverage of hepatitis A, measles, mumps and rubella, and varicella was identified. Coverages above 95% were observed only in 2015 for the vaccine against hepatitis A (98.8%) and, in 2016, for varicella (98.4%). The measles, mumps and rubella vaccine showed coverage of less than 95% in all analyzed years. Decreases of 13.6 and 4.3% between the years 2019 and 2020 were identified for the measles, mumps and rubella, and hepatitis A vaccines, respectively. There was a decreasing trend in hepatitis A vaccination coverage in the South (p=0.041), East (p=0.030), and North (p=0.045) regions; and for the measles, mumps and rubella in Jequitinhonha Valley (p=0.002), East (p=0.004), and North (p=0.024) regions. Increasing coverage was observed only for varicella in eight regions of the state. Conclusions: The data point to heterogeneity in the temporal behavior of vaccination coverage in Minas Gerais. The downward trend in some regions causes concern about the possibility of resurgence of diseases, such as measles, which until then had been controlled.