Childhood Vaccination Coverage Research Articles

Association between maternal literacy and child vaccination in Ethiopia and southeastern India and the moderating role of health workers: a multilevel regression analysis of the Young Lives study

ABSTRACTBackground: Child vaccination coverage in low- and middle-income countries is still far from complete, mainly among marginalized people such as children with illiterate mothers.Objective: This study aims to examine the association between maternal literacy and immunization status of children in Ethiopia and southeastern India (Andhra Pradesh and Telangana) and test whether state-run health centers and community health workers moderate that association.Methods: This study is based on cross-sectional data from samples of children in Ethiopia and India, collected as part of round 2 within the Young Lives study (2006). Multilevel logistic regression was conducted to estimate the association between maternal literacy and the completion of four kinds of child vaccinations. We further tested for cross-level interactions between state-run health centers or community health workers and maternal literacy. Estimates were adjusted for several individual- and household-level demographic and socioeconomic factors.Results: Literate mothers were more likely to complete all four kinds of vaccinations for their children compared to illiterate mothers in Ethiopia (Odds Ratio (OR)=4.84, Confidence Interval (CI)=1.75-13.36). Presence of a health center was positively associated with completed vaccinations in India only (OR = 6.60, CI = 1.57–27.70). A cross-level interaction between community health workers and maternal literacy on the vaccination completion status of children was significant in Ethiopia only (OR = 0.29, CI = 0.09–0.96).Conclusions: Our findings suggest that increased availability of community health workers may reduce the child vaccination gap for illiterate mothers, depending on the country context.

Genomic epidemiology of Iranian Bordetella pertussis: 50 years after the implementation of whole cell vaccine

ABSTRACT Pertussis caused by Bordetella pertussis, remains a public health problem worldwide, despite high vaccine coverage in infants and children in many countries. Iran has been using whole cell vaccine for the last 50 years with more than 95% vaccination rate since 1988 and has experienced pertussis resurgence in recent years. Here, we sequenced 55 B. pertussis isolates mostly collected from three provinces with the highest number of pertussis cases in Iran, including Tehran, Mazandaran, and Eastern-Azarbayjan from the period of 2008-2016. Most isolates carried ptxP3/prn2 alleles (42/55, 76%), the same genotype as isolates circulating in acellular vaccine-administrating countries. The second most frequent genotype was ptxP3/prn9 (8/55, 14%). Only three isolates (5%) were ptxP1. Phylogenetic analysis showed that Iranian ptxP3 isolates can be divided into eight clades (Clades 1-8) with no temporal association. Most of the isolates from Tehran grouped together as one distinctive clade (Clade 8) with six unique single nucleotide polymorphisms (SNPs). In addition, the prn9 isolates were grouped together as Clade 5 with 12 clade-supporting SNPs. No pertactin deficient isolates were found among the 55 Iranian isolates. Our findings suggest that there is an ongoing adaptation and evolution of B. pertussis regardless of the types of vaccine used.

Pertussis in children in an era of vaccination

Background: Pertussis incidence has been increasing despite high early childhood vaccination coverage. Various strategies have been recommended to combat this problem which includes cocooning, booster doses for adolescents and young adults, and more recently maternal intrapartum vaccination. A previous report had highlighted an increase in pertussis in infants. This review was done to evaluate if there has been any change in the prevalence in the subsequent 10 years. Materials and Methods: Retrospective cohort study of admissions for pertussis in patients aged 0–18 years in a single-center tertiary maternal-pediatric hospital in Singapore from January 1, 2008, to October 31, 2017. Results: There were 221 cases identified. The majority were infants

Improving child immunisation rates in a disadvantaged community in New South Wales, Australia: a process evaluation for research translation.

The World Health Organization's Tailoring Immunization Programmes approach was used to develop a new strategy to increase child vaccination coverage in a disadvantaged community in New South Wales, Australia, including reminders, outreach and home visiting. After 18 months, the strategy hasn't been fully implemented. A process evaluation was conducted to identify barriers and facilitators for research translation. Participants included child health nurses, Population Health staff, managers and general practitioners. The Capability-Opportunity-Motivation model of behaviour change (COM-B) was used to develop questions. Twenty-four participants took part in three focus groups and four interviews. Five themes emerged: (i) designing and adopting new ways of working is time-consuming and requires new skills, new ways of thinking and changes in service delivery; (ii) genuine engagement and interaction across fields and institutions helps build capacity and strengthen motivation; (iii) implementation of a new strategy requires clarity; who's doing what, when and how?; (iv) it is important not to lose sight of research findings related to the needs of disadvantaged families; and (v) trust in the process and perseverance are fundamental. There was strong motivation and opportunity for change, but a need to enhance service capability. Areas requiring support and resources were identified.

Retrospective Analysis of Viral Hepatitis B Incidence in Russia from 2013 to 2017 in the Context of Preventive Vaccination

The article presents the results of a retrospective analysis of viral hepatitis B incidence in the Russian Federation from 2013 to 2017, taking into account the use of vaccines included into the National Immunisation Schedule and the Immunisation Programme in Case of Epidemic Outbreaks. The analysis of the data revealed a trend towards a reduction in the incidence of acute and chronic forms of hepatitis B in the territory of the Russian Federation during the past five years. The reduction of viral hepatitis B incidence was achieved thanks to a higher vaccination coverage of both children and adults. The article presents an overview of monovalent and combination recombinant hepatitis B vaccines licensed in the Russian Federation. It describes the WHO position on preventive vaccination against viral hepatitis B, and pays special attention to vaccination of people at risk. The article considers promising areas for improving immunobiological products for hepatitis B prevention, including new technologies used in vaccine production, development and introduction of new adjuvants or adjuvants systems, and development of therapeutic vaccines.

Understanding Spatial and Contextual Factors Influencing Intraregional Differences in Child Vaccination Coverage in Bangladesh.

In Bangladesh, policy discourse has mostly focused on regional inequities in health, including child immunization coverage. Knowledge of local geographical and contextual factors within regions, however, becomes pertinent in efforts to address these inequities. We used the Bangladesh Demographic and Health Survey 2011 to examine factors that influence intraregional differences in vaccination coverage using a multilevel analysis. We found that in spite of the provision of health facilities at each level of administrative governance, only distance to the Upazilla Health Complex was a consistent predictor for each dose of vaccine, highlighting the remote locations of the communities that remain underserved. Our analysis demonstrates the value of subregional analyses that identify the characteristics of communities that are vulnerable to incomplete immunization coverage. Unless specific policy actions are taken to increase coverage in these remote areas, geographic inequities are likely to persist within regions, and desired targets will not be achieved.

2454. Pertussis Vaccine Effectiveness and Waning Immunity in Alberta, Canada: 2004–2015

BackgroundDespite childhood vaccination coverage rates exceeding 75%, pertussis is still frequently reported in Canada. In Alberta, pertussis incidence ranged from 1.8 to 20.5 cases per 100,000 persons for 2004–2015. Most cases occurred in those aged < 15 years. We investigated pertussis vaccine effectiveness (VE) using a test-negative designed (TND) study.MethodsAll individuals who had undergone a real-time PCR laboratory test for Bordetella pertussis between January 1, 2004 and August 31, 2015, in the province of Alberta, Canada were included. Vaccination history was obtained from Alberta’s immunization repository. Vaccination status was classified as complete, incomplete, or not vaccinated, based on the province’s vaccination schedule. Multivariable logistic regression models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for pertussis infection by time since last vaccination, comparing those with complete or incomplete vaccination to those not vaccinated. We adjusted for age, sex, income, urban/rural status, and the presence of a co-morbid condition. Vaccine effectiveness (VE) was calculated as [(1-aOR)*100].ResultsOf 28,154 individuals tested, 2,297 (12.3%) tested positive for B. pertussis. Among those with complete vs. no vaccination, VE was 88% (95% CI 85–91%) at 1 year, 83% (95% CI 79–86%) at 1 to 3 years, 70% (95% CI 63–76%) at 4 to 6 years, 28% (95% CI 12–42%) at 7 to 9 years, and -4% (95% CI -53 to 29%) at 10 or more years since a last dose of a pertussis vaccine (Figure 1). VE was similar but attenuated in the incompletely vaccinated group, with a comparable waning of immunity.ConclusionPertussis VE was high in the first year after vaccination, then declined noticeably after 5 years. Our results suggest there is a large number of adolescents and adults susceptible to pertussis. Regular boosters throughout childhood, adolescence, and during pregnancy are critical to protect those at greatest risk of infection and complications. Further validation of the strengths and weaknesses of the TND for assessing pertussis VE is needed.Figure 1.Pertussis VE by year since last vaccination in those with complete vaccination status.Disclosures M. L. Russell, Novartis Pharmaceuticals Canada Inc.: Grant Investigator and Unconditional Research Grant, Grant recipient. Merck Frosst Canada Inc.: Grant Investigator and Unconditional Research Grant, Grant recipient.

What is the importance of vaccine hesitancy in the drop of vaccination coverage in Brazil?

ABSTRACTThe successful Programa Nacional de Imunizações do Brasil (Brazilian National Immunization Program) has been experiencing a major challenge with regard to vaccination coverage for children, which has been dropping. Several aspects are related, but certainly vaccine hesitancy has been strengthening itself as one of the main concerns of Brazilian public administrators and researchers. Vaccine hesitancy is the delay in acceptance or refusal despite having the recommended vaccines available in health services, being a phenomenon that varies over time, over location and over types of vaccines. Hesitant individuals are between the two poles of total acceptance and refusal of vaccination. Vaccine hesitancy is nothing new in European and North-American countries, and even in Brazil, it has been studied even if under another name. The drop of vaccination coverage observed from 2016 on reiterates the relevance of the theme, which must be better understood through scientific research.

Determinants of low measles vaccination coverage in children living in an endemic area.

Measles outbreaks were recently reported in Europe due to low immunization rates. In this scenario, identifying the reasons of no vaccination is crucial to set up strategies to improve immunization rate. A cross-sectional study was conducted to investigate the determinants of missed vaccination in children living in Southern Italy, during the 2016 outbreak. A standardized face-to-face questionnaire was used to record demographic data, immunization status, and reasons for missed vaccination. A total of 1141 children (median age 86months, male 47.2%) was enrolled, 77.8% of the children were adequately vaccinated for age, 6.3% were incompletely vaccinated for age, and 15.9% did not receive any vaccine dose. Vaccination rate and reasons for not vaccinating significantly varied according to age, with children ≤ 24months showing the lowest rate (67.8%). Reasons for not vaccinating included fear for side effects (51%), presence of underlying chronic conditions (12.2%), skip scheduled appointment (12.2%), refusal of vaccination (10.3%), acute illnesses (7.2%), and allergy to eggs (4.6%). The presence of underlying condition was a risk factor for inadequate immunization (p < 0.0001). Only 4.7% of conditions were true contraindications to vaccine administration.Conclusion: We reported inadequate measles immunization rate in Southern Italy, with lowest rates in children ≤ 2years or with underlying conditions. Only a minority had true contraindications to vaccine uptake. Implementation strategies addressed to health-care professionals and families should focus on the reported determinants to increase measles vaccination coverage. What is Known: • Measles is a viral, highly communicable disease, preventable by vaccine. • Measles elimination in Europe failed as demonstrated by outbreaks in several countries, due to low immunization rates. What is New: • Inadequate measles immunization rate due to false contraindications in Southern Italy, with lowest rates in children ≤ 2years. • The presence of underlying disease is a risk factor for inadequate immunization.

A study to assess the parent’s knowledge and attitudes on childhood immunization

Background: Immunization has greatly reduced the burden of infectious diseases. Immunization prevents illness, disability and death from vaccine-preventable diseases including diphtheria, measles, pertussis, pneumonia, polio, rotavirus diarrhea, rubella and tetanus. Improving childhood vaccination coverage and timelines is a key health policy objective in many developing countries. Parent’s knowledge and their attitudes towards Immunization are likely to influence uptake.Methods: This is a descriptive study using a pre-tested, self-administered questionnaire pertaining to knowledge, attitudes of parents regarding immunization. The questionnaire was given to parents whose children were being immunized at a health center within a one month period.Results: About 90% of parents have the positive attitude towards immunization and 73% of parents have good knowledge about Immunization.Conclusions: Diseases like pneumonia, measles, pertussis that can be prevented by vaccination continue to be major contributors. Knowledge and attitudes of parents and socio cultural factor can influence the immunization status of the children.

MULTI-FACTOR SIMULATION MODELING IN THE SHORT-AND LONG-TERM PROGNOSIS OF MEASLES INCIDENCE

The widespread increase in morbidity and the registration of major measles outbreaks in recent years require the development of new technologies to control the infection. Technologies should be based on the prognosis of morbidity. The aim of the study was to predict the development of the situation in the near and long term in order to determine the adequate technologies of infection control in the metropolis at the stage of its elimination on the basis of a mathematical simulation of the epidemic process of measles. Materials and methods. A simulation model to forecast the incidence of measles was developed using special software AnyLogic Professional 7.0. The model included the main determinants of the epidemic process, established by the results of their own research and literature data. The results of the epidemic process modeling were uploaded to the database. Further work was carried out in the database management system Microsoft SQL Server Management Studio. Analysis and graphical processing of the results are performed using comprehensive software for business intelligence Power BI. Results. It is established that at low (50-60%) coverage of vaccinations of children in the decreed ages and the population as a whole, the probability of measles outbreaks is high both in the short and long term. The increase in vaccination coverage to 90-95% leads to an increase in the period of epidemic well-being, but the likelihood of an outbreak remains. With revaccination every 10 years, at least 60% of the population remains stable for 30 years and the spread of infection does not occur. With the coverage of revaccinating vaccinations 80% of the population-the epidemiological situation remains stable for 50 years. Conclusion. The simulation model of measles morbidity forecast for the near and long term, built with the main determinants of the epidemic process, allows us to predict the development of the epidemic situation in the territory of a large industrial city. Also, the model allows to determine the priority areas for the elimination of measles infection, namely: strict control of the timeliness and completeness of vaccination coverage of children in the decreed age (at least 95%) and maintaining a high immune layer of the population as a whole, which can be provided during the planned revaccination against measles every 10 years.

MULTI-FACTOR SIMULATION MODELING IN THE SHORT-AND LONG-TERM PROGNOSIS OF MEASLES INCIDENCE

The widespread increase in morbidity and the registration of major measles outbreaks in recent years require the development of new technologies to control the infection. Technologies should be based on the prognosis of morbidity. The aim of the study was to predict the development of the situation in the near and long term in order to determine the adequate technologies of infection control in the metropolis at the stage of its elimination on the basis of a mathematical simulation of the epidemic process of measles. Materials and methods. A simulation model to forecast the incidence of measles was developed using special software AnyLogic Professional 7.0. The model included the main determinants of the epidemic process, established by the results of their own research and literature data. The results of the epidemic process modeling were uploaded to the database. Further work was carried out in the database management system Microsoft SQL Server Management Studio. Analysis and graphical processing of the results are performed using comprehensive software for business intelligence Power BI. Results. It is established that at low (50-60%) coverage of vaccinations of children in the decreed ages and the population as a whole, the probability of measles outbreaks is high both in the short and long term. The increase in vaccination coverage to 90-95% leads to an increase in the period of epidemic well-being, but the likelihood of an outbreak remains. With revaccination every 10 years, at least 60% of the population remains stable for 30 years and the spread of infection does not occur. With the coverage of revaccinating vaccinations 80% of the population-the epidemiological situation remains stable for 50 years. Conclusion. The simulation model of measles morbidity forecast for the near and long term, built with the main determinants of the epidemic process, allows us to predict the development of the epidemic situation in the territory of a large industrial city. Also, the model allows to determine the priority areas for the elimination of measles infection, namely: strict control of the timeliness and completeness of vaccination coverage of children in the decreed age (at least 95%) and maintaining a high immune layer of the population as a whole, which can be provided during the planned revaccination against measles every 10 years.

Vaccine coverage of children in care of the child welfare system.

To assess vaccine coverage for a cohort of children who have been in the care of the child welfare system compared to children in the general population. This retrospective cohort study used population-based administrative health data for a 2008 birth cohort of children from Alberta, Canada. We assessed coverage at ages 2 (n = 44,206) and 7 (n = 42,241) for three vaccines with different administration schedules for children in care (at any period before the age of assessment) and those who had never been in care, comparing them using risk differences and relative risks (RRs). We similarly assessed coverage for children not in care who shared characteristics of children in care. At age two, vaccination coverage for children in care ranged from 54.3% to 81.4%, depending on vaccine. In comparison, coverage for those not in care ranged from 74.2% to 87.4%. At age seven, coverage for children in care ranged from 53.1% to 65.3%, compared to 76.6% to 83.4% for those not in care. For all vaccines at both ages, the risk for being under-vaccinated was higher for children in care (e.g., diphtheria, pertussis, tetanus, polio, Haemophilus influenzae type b at age 7: RR 2.01, 95% confidence interval [CI] (1.74-2.32). Even for children not in care who had characteristics similar to children in care, we found children in care had lower coverage. Children in care have consistently lower vaccine coverage than children not in care. Policies and practices should promote optimal access to vaccination for these children.

The Influence of Universal Health Coverage on Life Expectancy at Birth (LEAB) and Healthy Life Expectancy (HALE): A Multi-Country Cross-Sectional Study

Background: There are substantial differences in long term health outcomes across countries, particularly in terms of both life expectancy at birth (LEAB) and healthy life expectancy (HALE). Socio-economic status, disease prevention approaches, life style and health financing systems all influence long-term health goals such as life expectancy. Within this context, universal health coverage (UHC) is expected to influence life expectancy as a comprehensive health policy. The aim of the study is to investigate this relationship between Universal Health Coverage (UHC) and life expectancy.Method: A multi-country cross-sectional study was performed drawing on different sources of data (World Health Organization, UNDP-Education and World Bank) from 193 UN member countries, applying administrative record linkage theory. Descriptive statistics, t-tests, Pearson correlations, hierarchical linear regressions were utilized as appropriate.Result: Global average healthy life years was shown to be 61.34 ± 8.40 and life expectancy at birth was 70.00 ± 9.3. Standardized coefficients from regression analysis found UHC (0.34), child vaccination (Diphtheria Pertussis Tetanus−3: 0.17) and sanitation coverage (0.31) were associated with significantly increased life expectancy at birth. In contrast, population growth was associated with a decrease (0.29). Likewise, unit increases in child vaccination (DPT 3), sanitation and UHC would increase healthy life expectancy considerably (0.18, 0.31, and 0.40 respectively), whereas the same for population growth reduces healthy life expectancy by 0.28.Conclusion: Universal Health Coverage (UHC) is a comprehensive health system approach that facilitates a wide range of health services and significantly improves the life expectancy at birth and healthy life expectancy. This study suggests that specific programs to achieve UHC should be considered for countries that have not seen sufficient gains in life expectancy as part of the wider push to achieve the Sustainable Development Goal (SDG).

Inequities in Childhood Vaccination Coverage in Zhejiang, Province: Evidence from a Decomposition Analysis on Two-Round Surveys.

Objective: The objectives of this study were to determine the degree and risk factors of the inequity in the childhood coverage of full primary immunization (FPI) in Zhejiang province. Method: We used data from two rounds of vaccination coverage surveys among children aged 24–35 months conducted in 2014 and 2017, respectively. The household income per month was used as an index of socioeconomic status for the inequality analysis. The concentration index (CI) was used to quantify the degree of inequality, and the decomposition approach was applied to quantify the contributions from demographic factors to inequality in the coverage of FPI. Results: The coverage rates of FPI were 80.6%, with a CI value of 0.12028 for the 2014 survey, while the coverage rates of FPI were 85.2%, with a CI value of 0.10129 for the 2017 survey. The results of decomposition analysis suggested that 68.2% and 67.1% of the socioeconomic inequality in the coverage of FPI could be explained by the mother’s education level for the 2014 and 2017 survey, respectively. Other risk factors including birth order, ethnic group, mother’s age, maternal employment status, residence, immigration status, GDP per-capita, and the percentage of the total health spending allocated to public health could also explain this inequality. Conclusion: The socioeconomic inequity in the coverage of FPI still remained, although this gap was reduced between 2014 and 2017. Policy recommendations for health interventions on reducing the inequality in the coverage of FPI should be focused on eliminating poverty and women’s illiteracy.

Towards a Strategy for Reducing Missed Opportunities for Vaccination in Malawi: Implications of a Qualitative Health Facility Assessment

Missed opportunities for vaccination (MOVs), estimated to be about 32-47% of child healthcare clinic visits in various settings globally, contribute to unfulfilled childhood vaccination coverage targets in the African region. We assessed the extent of MOVs, identify local drivers and test interventions to reduce MOVs in Malawi. We conducted in-depth and key informant interviews with administrators of district hospitals and officers in charge of community health facilities. Focus group discussions were held with health workers and caregivers of children under 24 months of age who received services from study health facilities in Malawi. Coverage rates were collected from the health facility records. Vaccination is appreciated in the communities, but coverage is generally below targets. In some facilities, reported coverage was less than 50%. Opportunities to provide up-to-date vaccination for children were missed due to lack of awareness and knowledge of health workers and caregivers, attitude and priority of health workers, long waiting time, poor coordination and referral of eligible children by clinicians and nurses and overall lack of a team approach to vaccination perceived as a responsibility of health surveillance assistants. Other notable issues included limited time of caregivers labouring on estate farms, unavailability of vaccines resulting from poorly functioning of cold chain equipment and limited transport and failure to appreciate the impact of MOV on poor immunization coverage. Simple, low-cost, pragmatic and community-driven interventions that may reduce MOVs and improve vaccine coverage.

Measles outbreak propagated by children congregating at water collection points in Mayuge District, eastern Uganda, July \u2013 October, 2016

BackgroundOn 12 October, 2016 a measles outbreak was reported in Mayuge District, eastern Uganda. We investigated the outbreak to determine its scope, identify risk factors for transmission, evaluate vaccination coverage and vaccine effectiveness, and recommend evidence-based control measures.MethodsWe defined a probable case as onset of fever (≥3 days) and generalized rash, plus ≥1 of the following: conjunctivitis, cough, and/or runny nose in a Mayuge District resident. A confirmed case was a probable case with measles-specific IgM (+) not explained by vaccination. We reviewed medical records and conducted active community case-finding. In a case-control investigation involving probable case-persons and controls matched by age and village, we evaluated risk factors for transmission for both cases and controls during the case-person’s likely exposure period (i.e., 7–21 days prior to rash onset). We estimated vaccine effectiveness (VE) using the formula: VE ≈ (1-ORprotective) × 100. We calculated vaccination coverage using the percentage of controls vaccinated.ResultsWe identified 62 probable case-persons (attack rate [AR] = 4.0/10,000), including 3 confirmed. Of all age groups, children < 5 years were the most affected (AR = 14/10,000). The epidemic curve showed a propagated outbreak. Thirty-two percent (13/41) of case-persons and 13% (21/161) of control-persons visited water-collection sites (by themselves or with parents) during the case-persons’ likely exposure period (ORM-H = 5.0; 95% CI = 1.5–17). Among children aged 9–59 months, the effectiveness of the single-dose measles vaccine was 75% (95% CI = 25–92); vaccination coverage was 68% (95% CI = 61–76).ConclusionsLow vaccine effectiveness, inadequate vaccination coverage and congregation at water collection points facilitated measles transmission in this outbreak. We recommended increasing measles vaccination coverage and restriction of children with signs and symptoms of measles from accessing public gatherings.

Influenza Vaccination Coverage in Children With Neurologic Disorders and Their Siblings, July 2006 to June 2014.

Children with neurologic disorders are at high risk for influenza-associated complications. We identified 184,460 children 1-17 years of age with neurologic disorders and 204,966 siblings in a commercial insurance claims database from July 2006 to June 2014. Among children with neurologic disorders, coverage increased from 22.4% in 2006-2007 to 42.3% in 2013-2014, but remained suboptimal. A lower proportion of siblings were vaccinated.

Assessment of hepatitis B immunization programme among school students in Qatar.

In 2010, Qatar adopted the target of reducing hepatitis B prevalence to < 1% in children by 2015. The World Health Organization Region for the Eastern Mediterranean is identified with intermediate hepatitis B virus (HBV) endemicity, ranging from 2% to 7%. It is estimated that 4.3 million individuals are living with HBV infection in the Region. This study was conducted to assess hepatitis B seroprevalence in children, hepatitis B vaccination coverage, potential exposure to risk factors, and knowledge among parents/guardians about hepatitis B infection. We carried out this cross-sectional study in Qatar during the academic year 2015/16. Multistage cluster sampling was used to select a nationally representative sample of 2735 grade 1 school students aged ≥ 5 years. Blood was collected by finger prick and tested using the point-of-care test/rapid test. A self-administered, precoded questionnaire was used to assess parent/guardian knowledge about HBV and collect information on the child's HBV vaccination coverage. All blood samples were HBsAg negative. Qataris had a vaccination card and were totally vaccinated but 17.7% of non-Qataris did not hold a vaccination card and most parents/guardians were not aware of the vaccination status of their children. Children were exposed to various hepatitis B risk practices. Knowledge about hepatitis B among parents/ guardians was low. Qatar has averted the hepatitis B threat and maintained high vaccination coverage for children.

Vaccination status of children aged 1–4 years in Afghanistan and associated factors, 2015

BackgroundChildhood mortality in Afghanistan fell by half between 1990 and 2015, due in part to the government’s commitment to improving pediatric immunization services. Although progress has been made, immunization coverage has nonetheless remained low with only 65% of children receiving the third dose of Diphtheria-Pertussis-Tetanus (DPT3) based on WHO estimates. This study aims to calculate the proportion of Afghan children aged 1–4 years who were fully vaccinated, under-vaccinated, or non-vaccinated with government-recommended Expanded Program on Immunization vaccines and identify predictors related to the family’s sociodemographic status and maternal autonomy. MethodsData from the 2015 Afghanistan Demographic and Health Survey was used to calculate the proportion of children who were fully vaccinated (i.e. received all recommended vaccines), under-vaccinated (i.e. received some, but not all), and non-vaccinated (i.e. did not receive any vaccines) according to WHO guidelines. A multivariable multinomial logistic regression model generated odds ratios for under-vaccination and non-vaccination versus full vaccination, and examined associations between independent factors and full vaccination status. ResultsWe found 40.6% of Afghan children age 1–4 were fully vaccinated, 42.4% under-vaccinated, and 17% non-vaccinated. Large disparities characterized immunization coverage among provinces and between urban and rural regions. Birthing in a government institution (vs. non-institutional setting), a higher number of antenatal care visits, and a visit to a health facility in the past 12 months were all associated with increased odds of full immunization. Factors related to maternal autonomy including maternal decision-making and maternal attitudes towards beating were also significantly associated with vaccination status. ConclusionApproximately 60% of children in Afghanistan are under-vaccinated or non-vaccinated, leaving millions of children unnecessarily at risk for vaccine-preventable diseases. Engagement with community and religious leaders to create programs that increase women’s autonomy and expand access to institutional delivery could lead to downstream increases in childhood vaccination coverage.