A general measles vaccination campaign in urban Guinea-Bissau: Comparing child mortality among participants and non-participants

BackgroundMeasles vaccination campaigns targeting children aged 9–59 months are conducted every three years in Guinea-Bissau. Studies have demonstrated beneficial non-specific effects of measles vaccine. We compared mortality one year after the December 2012 measles vaccination campaign in Bissau city for children who received campaign measles vaccine with children who did not receive campaign measles vaccine.MethodsField workers from Bandim Health Project registered all children living in the Bandim Health Project’s study area who received measles vaccination at the campaign posts. Children not seen during the campaign were visited at home and campaign participation status was assessed. We compared mortality rates of participants vs. non-participants in Cox regression models.Results5633 children aged 9–59 months (85%) received campaign measles vaccination and 1006 (15%) did not. During the subsequent year 16 children died. Adjusted for background factors, the hazard ratio (HR) comparing measles vaccinated versus unvaccinated was 0.28 (95% CI: 0.10–0.77). The benefit was larger for girls (HR: 0.17 (0.05–0.59)) and for children who had received routine measles vaccine before the campaign (HR: 0.15 (0.04–0.63)).ConclusionsWe found indications of strong beneficial non-specific effects of receiving measles vaccine during the 2012 campaign, especially for girls and children with previous routine measles vaccination. Measles vaccination campaigns may be an effective way of improving child survival.     

Influenza vaccination coverage among children aged 6-59 months--eight immunization information system sentinel sites, United States, 2007-08 influenza season

Vaccination is the most effective way to prevent influenza-associated morbidity and mortality. However, influenza vaccination coverage among children historically has been low. The Advisory Committee on Immunization Practices (ACIP) recommends annual vaccination with influenza vaccine for all children aged 6-59 months. Previously unvaccinated children and children who received only 1 vaccine dose for the first time in the previous influenza season are recommended to receive 2 influenza vaccine doses. To assess vaccination coverage among children aged 6-59 months during the 2007-08 influenza season, CDC analyzed data from the eight immunization information system (IIS) sentinel sites. For the eight sites, an average (unweighted) of 40.8% of children aged 6-23 months received 1 or more influenza vaccine doses, and an average of 22.1% were fully vaccinated. Among children aged 24-59 months, an average of 22.2% received 1 or more doses, and an average of 16.5% were fully vaccinated. These results indicate that influenza vaccination coverage among children remains low and highlight the need to identify additional barriers to influenza vaccination and to develop more effective interventions to promote vaccination of children aged 6--59 months who are at high risk for influenza-related morbidity and mortality.     

Measles vaccination coverage among Latino children aged 12 to 59 months in Los Angeles County: a household survey.

A high rate of measles transmission has occurred in Los Angeles County since 1987. To determine measles vaccination coverage among Latino preschoolers, the group at highest risk of measles during this period, a cluster survey was conducted among Latino households with children aged 12 to 59 months. Of 279 children enrolled, 240 (86%, 95% confidence interval = 81% to 91%) reportedly had received the measles vaccine. Measles vaccination coverage among Latino preschoolers in Los Angeles County is insufficient to halt measles transmission within this subpopulation.     

Factors affecting non-coverage of measles-rubella vaccination among children aged 9–59 months in Tanzania

Globally, measles remains a major cause of child mortality, and rubella is the leading cause of birth defects among all infectious diseases. In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan that set a target to eliminate Measles-Rubella (MR) in five of the six World Health Organization (WHO) regions by 2020. This was cross-sectional study employed both quantitative and qualitative research methods. The sample size was calculated to provide overall, age- and sex-specific coverage estimates for MR vaccine among children aged between 9 and 59 months at the national level. Using desired precision of ±5% with an expected coverage of 95%, a total of 15,235 households were required. The age of children, a child who had received the MR vaccine before the campaign, household wealth quintile, the age of caregivers, and their marital status were associated with non-coverage of MR vaccination among children aged 9–59 months in Tanzania. Nationally, an estimated 88.2% (95% CI: 87.3–89%) of children aged 9–59 months received the MR campaign dose, as assessed by caregivers’ recall. These estimates revealed slightly higher coverage in Zanzibar 89.6% (95% CI: 84.7–93%) compared to Mainland Tanzania 88.1% (95% CI 87.2–88.9%). These associated factors revealed causes of unvaccinated children and may be some of the reasons for Tanzania’s failure to meet the MR campaign target of 95 percent vaccination coverage. Thus, vaccine development must increase programmatic oversight in order to improve immunization activities and communication strategies in Tanzanian areas with low MR coverage.     

Distributing insecticide-treated bednets during measles vaccination: a low-cost means of achieving high and equitable coverage

OBJECTIVE: To achieve high and equitable coverage of insecticide-treated bednets by integrating their distribution into a measles vaccination campaign. METHODS: In December 2002 in the Lawra district in Ghana, a measles vaccination campaign lasting 1 week targeted all children aged 9 months-15 years. Families with one or more children less than five years old were targeted to receive a free insecticide-treated bednet. The Ghana Health Service, with support from the Ghana Red Cross and UNICEF, provided logistical support, volunteer workers and social mobilization during the campaign. Volunteers visited homes to inform caregivers about the campaign and encourage them to participate. We assessed pre-campaign coverage of bednets by interviewing caregivers leaving vaccination and distribution sites. Five months after distribution, a two-stage cluster survey using population-proportional sampling assessed bednet coverage, retention and use. Both the pre-campaign and post-campaign survey assessed household wealth using an asset inventory. FINDINGS: At the campaign exit interview 636/776 (82.0%) caregivers reported that they had received a home visit by a Red Cross volunteer before the campaign and that 32/776 (4.1%) of the youngest children in each household who were less than 5 years of age slept under an insecticide-treated bednet. Five months after distribution caregivers reported that 204/219 (93.2%) of children aged 9 months to 5 years had been vaccinated during the campaign; 234/248 (94.4%) of households were observed to have an insecticide-treated bednet; and 170/249 (68.3%) were observed to have a net hung over a bed. Altogether 222/248 (89.5%) caregivers reported receiving at least one insecticide-treated bednet during the campaign, and 153/254 (60.2%) said that on the previous night their youngest child had slept under a bednet received during the campaign. For households in the poorest quintile, post-campaign coverage of insecticide-treated bednets was 10 times higher than pre-campaign coverage of households in the wealthiest quintile (46/51 (90.2%) versus 14/156 (9.0%)). The marginal operational cost was 0.32 US dollars per insecticide-treated bednet delivered. CONCLUSION: These findings suggest that linking bednet distribution to measles vaccination campaigns may provide an important opportunity for achieving high and equitable coverage of bednets.     

Study of incidence of measles and vaccination coverage in Ahmedabad urban slums

Measles incidence and vaccination coverage survey was carried out in Ahmedabad urban slums in February 2000. A total of 3073 children between 9 to 59 months were studied. The incidence rate of measles was 11.2% (95% C.I-10.04-12.36). Measles vaccination coverage was only 59.88%. There was no gender difference in vaccine coverage or measles incidence rate. Diarrhoea was the most common complication observed among both vaccinated and unvaccinated children and it was significantly more among unvaccinated children. Among 1840 vaccinated children only 529 (28.75%) children received vitamin A along with measles vaccination.     

Vaccination coverage in Haiti: results from the 2009 national survey

Introduction

Since 1977, vaccinations to protect against tuberculosis, diphtheria, tetanus, pertussis, polio, and measles (and rubella since 2009) have been offered to children in Haiti through the routine immunization program. From April to July 2009, a national vaccination coverage survey was conducted to assess the success of the routine immunization program at reaching children in Haiti.

Methods

A multi-stage cluster survey was conducted using a modified WHO method for household sampling. A standardized questionnaire was administered to collect vaccination histories, demographic information, and reasons for under-vaccination of children aged 12–23 months. A child who received the eight recommended routine vaccinations was considered fully vaccinated. The routine vaccination schedule was used to define valid doses and estimate the percentage of children vaccinated on time.

Results

Among 1345 children surveyed, 40.4% (95% CI: 36.6–44.2) of the 840 children with vaccination cards had received all eight recommended vaccinations. Coverage was highest for the Bacille Calmette–Guérin vaccine (87.3%), the first doses of the diphtheria–tetanus–pertussis vaccine (92.0%), and oral poliovirus vaccine (93.4%) and lowest for measles vaccine (46.9%). Timely vaccination rates were lower. Assuming similar coverage for the 505 children without cards, coverage with the complete vaccination series among all surveyed children 31.9%. Reasons for under-vaccination included not having enough time to reach the vaccination location (24.8%), having a child who was ill (13.8%), and not knowing when, or forgetting, to go for vaccination (12.8%).

Conclusions and recommendations

Coverage for early-infant vaccines was high; however, most children did not complete the full vaccination series, and many children received vaccinations later than recommended. Efforts to improve the immunization program should include increasing the frequency of outreach services, training for vaccination staff to minimize missed opportunities, and better communicating the timing of vaccinations to encourage caregivers to bring their children for vaccinations at the recommended age. Efforts to promote the benefits of vaccination and card retention are also needed.     

African-American children are at risk of a measles outbreak in an inner-city community of Chicago, 2000

BACKGROUND: Since the measles resurgence of 1989-1991, which affected predominantly inner-city preschoolers, national vaccination rates have risen to record-high levels, but rates among inner-city, preschool-aged, African-American children lag behind national rates. The threat of measles importations from abroad exists and may be particularly important in large U.S. cities. To stop epidemic transmission, measles vaccination coverage should be at least 80%. OBJECTIVE: To determine measles vaccination rates and predictors for having received a dose of measles-containing vaccine by age 19 to 35 months among children in an inner-city community of Chicago.METHODS: We used a cross-sectional survey with probability proportional to size cluster sampling. Immunization histories from parent-held records and providers were combined to establish a complete vaccination history. RESULTS: A total of 2545 households were contacted, and 170 included a resident child aged 12 to 35 months. Of these, 97% (N=165 children) agreed to participate. Immunization history from a parent or provider was not available for 20 children. Among children aged 19 to 35 months with available immunization histories, 74% received measles vaccine (n=100); of these, 84% received the vaccine as recommended at ages 12 to 15 months. However, when including children without immunization histories, measles coverage levels among children aged 19 to 35 months were 64% (n=114). Among children with records, predictors for receipt of measles vaccine by age 19 to 35 months were possessing a hand-held immunization card (odds ratio [OR]=16.8; 95% confidence interval [CI]=4.2-67.1); utilizing a public health department provider for a usual source of care (OR=8.9; 95% CI=1.6-47.2); and being up-to-date for vaccines at 3 months of age (OR=5.0; 95% CI=1.8-14.1). CONCLUSIONS: Optimistically assuming that children without immunization histories are as well immunized as children with immunization histories, the measles vaccination rate among Englewood's children aged 19 to 35 months is too low to maintain immunity (74%). Measles coverage levels lagged behind coverage reported in a national survey in Chicago (86%) and the nation as a whole (92%). Efforts to raise and sustain coverage should be undertaken.     

Evaluation of a measles-smallpox vaccination campaign by a sero-epidemiologic method.

An assessment technique has been devised whereby children from 30 randomly chosen sampling sites are visited within three days of measles-smallpox vaccination and one month later. Vaccination coverage is measured at house visits and immunologic status is determined by collection of early and late blood samples on filter papers from substratified children in priority age-groups, and by looking at vaccination scars. The methodology was employed in a rural area of the Ivory Coast during the maintenance phase of a measles-smallpox vaccination program; 1762 children from 0--72 months old were inspected. Children in the target age groups, 6--24 months, had a vaccination coverage of 53.6% whereas children outside of the target group had a 10.5% coverage. Of 571 target age children, 94.6% had a measles hemagglutination-inhibition antibody titer of less than 1:10 dilution at the first visit, and were presumed susceptible to measles or vaccine. Of 247 substratified children 6--8 months, 98.3% were susceptible to measles before vaccination; 84.3% of 127 vaccinated children in this age-group sero-converted when re-tested. Of 324 children 9--24 months, 91.7% were susceptible before the campaign; 94.7% of 170 vaccinated children in this age-group converted. A positive history of prior measles or prior measles-vaccination was not a good indicator of measles serologic status. The smallpox vaccination major reaction rate was 93.2%; 91.4% of children with a recent vaccination scar sero-converted to measles vaccine. Thus, the smallpox scar read at the second visit proved the best clinical marker for determining both coverage and immunologic effectiveness of the campaign.     

Measles supplemental immunization activities improve measles vaccine coverage and equity: Evidence from Kenya, 2002

OBJECTIVES: To compare the measles vaccine coverage achieved through the routine vaccination program with that achieved during the 2002 supplemental immunization activity (SIA) at the national and provincial level, the percentage of previously unvaccinated children (zero-dose children) reached during the SIA, and the equity of measles vaccine coverage among children aged 9-23 months in Kenya. METHODS: Using data from a post-SIA coverage survey conducted in Kenya, we compute routine and SIA measles vaccine coverage and the percent of zero-dose children vaccinated during the SIA at the national and provincial level. Nationwide and for each province, we use the concentration index (CI) to measure equity of measles vaccine coverage. RESULTS: The SIA improved both coverage and equity, achieving significantly higher coverage in all provinces with routine measles vaccination coverage less than 80%, reached a large percentage of zero-dose children in these provinces, and reached more children belonging to the poorest households. CONCLUSION: Overall, by improving both measles vaccine coverage and equity in Kenya, the 2002 SIA reduced the gap in immunity between rich and poor households. Measles SIAs provide an ideal platform for delivering other life-saving child health interventions.     

Non-specific effect of measles vaccination on overall child mortality in an area of rural India with high vaccination coverage: a population-based case-control study

OBJECTIVE: To determine whether vaccination against measles in a population with sustained high vaccination coverage and relatively low child mortality reduces overall child mortality. METHODS: In April and May 2000, a population-based, case-control study was conducted at Ballabgarh (an area in rural northern India). Eligible cases were 330 children born between 1 January 1991 and 31 December 1998 who died aged 12-59 months. A programme was used to match 320 controls for age, sex, family size, and area of residence from a birth cohort of 15 578 born during the same time period. FINDINGS: The analysis used 318 matched pairs and suggested that children aged 12-59 months who did not receive measles vaccination in infancy were three times more likely to die than those vaccinated against measles. Children from lower caste households who were not vaccinated in infancy had the highest risk of mortality (odds ratio, 8.9). A 27% increase in child mortality was attributable to failure to vaccinate against measles in the study population. CONCLUSION: Measles vaccine seems to have a non-specific reducing effect on overall child mortality in this population. If true, children in lower castes may reap the greatest gains in survival. The findings should be interpreted with caution because the nutritional status of the children was not recorded and may be a residual confounder. "All-cause mortality" is a potentially useful epidemiological endpoint for future vaccine trials.     

Measles epidemic in Romania, 1996-1998: assessment of vaccine effectiveness by case-control and cohort studies

A measles epidemic occurred in Romania with 32,915 cases and 21 deaths reported between November 1996 and June 1998, despite high vaccination coverage since the early 1980s. Most cases were unvaccinated children aged <2 years and vaccinated school-aged children. A case-control study among preschool children and a cohort study among primary-school children were conducted to estimate effectiveness of Romanian-produced measles vaccine, and to evaluate age at vaccination and waning immunity as risk factors for vaccine failure. Both studies indicated that measles vaccine was highly effective. One dose reduced the risk for measles by 89% (95% confidence interval (CI) 85, 91); two doses reduced the risk by 96% (95% CI 92, 98). Children vaccinated at <1 year of age were not at increased risk for measles compared with children vaccinated at > or =1 year. Waning immunity was not identified as a risk factor since vaccine effectiveness was similar for children vaccinated 6-8, 9-11, and 12-14 years in the past. Because specific groups were not at risk for vaccine failure, an immunization campaign that targets all school-aged children who lack two doses may be an effective strategy for preventing outbreaks. A mass campaign followed by increased first-dose coverage should provide the population immunity required to interrupt indigenous measles virus transmission in Romania.     

Measles outbreak in the Republic of the Marshall Islands, 2003

BACKGROUND: Measles is a highly contagious viral infection. Measles transmission can be prevented through high population immunity (>or=95%) achieved by measles vaccination. In the Republic of the Marshall Islands (RMI), no measles cases were reported during 1989-2002; however, a large measles outbreak occurred in 2003. Reported 1-dose measles vaccine coverage among children aged 12-23 months varied widely (52-94%) between 1990 and 2000. METHODS: RMI is a Pacific island nation (1999 population: 50,840). A measles case was defined as fever, rash, and cough, or coryza, or conjunctivitis, in an RMI resident between July 13 and November 7, 2003. A vaccination campaign was used for outbreak control. RESULTS: Of the 826 reported measles cases, 766 (92%) occurred in the capital (Majuro). There were 186 (23%) cases in infants aged <1 year and 309 (37%) of cases in persons aged >or=15 years. The attack rate was highest among infants (Majuro atoll: 213 cases/1,000 infants). Among cases aged 1-14 years, 281 (59%) reported no measles vaccination before July 2003. There were 100 hospitalizations and 3 deaths. The measles H1 genotype was identified. The vaccination campaign resulted in 93% coverage among persons aged 6 months to 40 years. Interpretation Populations without endemic measles transmission can accumulate substantial susceptibility and be at risk for large outbreaks when measles virus is imported. 'Islands' of measles susceptibility may develop in infants, adults, and any groups with low vaccine coverage. To prevent outbreaks, high population immunity must be sustained by maintaining and documenting high vaccine coverage.     

Influenza vaccination coverage among children aged 6-59 months--six immunization information system sentinel sites, United States, 2006-07 influenza season

In June 2006, the Advisory Committee on Immunization Practices (ACIP) expanded its 2004 recommendation for routine influenza vaccination of children aged 6-23 months to include children aged 24-59 months. The 2006 ACIP recommendations also reemphasized that previously unvaccinated children aged <9 years should receive 2 doses of influenza vaccine administered at least 1 month apart to be fully vaccinated. In 2007, using data from six immunization information system (IIS) sentinel sites, CDC conducted the first assessment of influenza vaccination coverage among children aged 6-59 months during the 2006-07 influenza season. The findings demonstrated that, at all six sites, <30% of children aged 6-23 months and <20% of children aged 24-59 months were fully vaccinated. Vaccination coverage data from national and state surveys for an influenza season generally are not available until the next influenza season. Rapid assessment of influenza vaccination coverage can help direct activities of state and local public health agencies aimed at increasing the number of children fully vaccinated against influenza.     

Vaccination coverage and factors associated with routine childhood vaccination uptake in rural Vellore,southern India, 2017

BackgroundVellore district in southern India was selected for intensified immunization efforts through India’s Mission Indradhanush campaign based on 74% coverage in the National Family Health Survey in 2015. As rural households rely almost entirely on the Universal Immunization Program (UIP), we assessed routine immunization coverage and factors associated with vaccination status of children in rural Vellore.MethodsWe conducted a cross-sectional household survey among parents or primary caretakers of children aged 12–23 months during August–September 2017 using two-stage, EPI cluster sampling. We verified vaccination histories from vaccination cards and collected data on sociodemographic and non-socio-demographic characteristics by using mobile data capture. Associations with vaccination status were examined with univariate and multivariate logistic regression models.ResultsA total of 643 children were included. Coverage of BCG, third dose pentavalent/DPT, measles/MR vaccines and full vaccination (BCG, three doses of polio and pentavalent/DPT and measles/MR vaccines) among children with vaccination cards (n = 606) was 94%, 96%, 93% and 84%, respectively. Of children with vaccination cards, 70.8% had received all recommended doses according to the UIP schedule. No socio-demographic differences were identified, but parents’ familiarity with the schedule (Adjusted Prevalence Odds Ratio (aPOR): 2.06, 95%CI = 1.26–3.38) and receiving information on recommended vaccinations during antenatal visits (aPOR: 2.16, 95% CI = 1.13–4.12) were significantly associated with full vaccination status of the children.ConclusionsWe found higher UIP antigen coverage and proportion of fully vaccinated children than previously reported from rural Vellore. However, adherence to the recommended schedule was still not optimal. Our study highlights the potential of improving parental awareness of vaccination schedule and targeting health education interventions at pregnant women during antenatal visits to sustain and improve routine immunization coverage.     

The Australian Measles Control Campaign, 1998

The 1998 Australian Measles Control Campaign had as its aim improved immunization coverage among children aged 1-12 years and, in the longer term, prevention of measles epidemics. The campaign included mass school-based measles-mumps-rubella vaccination of children aged 5-12 years and a catch-up programme for preschool children. More than 1.33 million children aged 5-12 years were vaccinated at school: serological monitoring showed that 94% of such children were protected after the campaign, whereas only 84% had been protected previously. Among preschool children aged 1-3.5 years the corresponding levels of protection were 89% and 82%. During the six months following the campaign there was a marked reduction in the number of measles cases among children in targeted age groups.     

1989年广西12~24月龄儿童麻疹接种率监测与麻疹抗体水平的研究

对12~24月龄1 842名儿童在作疫苗接种率监测时,同时检测麻疹HI抗体。结果,接种率为99.57%,HI抗体阳性率为83.50%,有298名接种后仍为HI阴性儿童,有6名未种,阴性率为16.50%。在交通方便、全年气温较低的地区和接种对象月龄>8月的,阳性率较高,反之较低。因此提出今后大面积麻苗预防接种时,须考虑接种季节、月龄和增加注射剂量等方面的意见。     

The use of a computerized database to monitor vaccine safety in Viet Nam

Health information systems to monitor vaccine safety are used in industrialized countries to detect adverse medical events related to vaccinations or to prove the safety of vaccines. There are no such information systems in the developing world, but they are urgently needed. A large linked database for the monitoring of vaccine-related adverse events has been established in Khanh Hoa province, Viet Nam. Data collected during the first 2 years of surveillance, a period which included a mass measles vaccination campaign, were used to evaluate the system. For this purpose the discharge diagnoses of individuals admitted to polyclinics and hospitals were coded according to the International Classification of Diseases (ICD)-10 guidelines and linked in a dynamic population database with vaccination histories. A case-series analysis was applied to the cohort of children vaccinated during the mass measles vaccination campaign. The study recorded 107,022 immunizations in a catchment area with a population of 357,458 and confirmed vaccine coverage of 87% or higher for completed routine childhood vaccinations. The measles vaccination campaign immunized at least 86% of the targeted children aged 9 months to 10 years. No medical event was detected significantly more frequently during the 14 days after measles vaccination than before it. The experience in Viet Nam confirmed the safety of a measles vaccination campaign and shows that it is feasible to establish health information systems such as a large linked database which can provide reliable data in a developing country for a modest increase in use of resources.     

Linked vaccination coverage surveys plus serosurveys among Ethiopian toddlers undertaken three years apart to compare coverage and serologic evidence of protection in districts implementing the RED-QI approach

In low and middle-income countries, estimating the proportion of vaccinated toddlers in a population is important for controlling vaccine-preventable diseases by identifying districts where immunization services need strengthening. Estimates measured before and several years after specific interventions can assess program performance. However, employing different methods to derive vaccination coverage estimates often yield differing results.MethodsLinked vaccination coverage surveys and seroprotection surveys performed among ~300 toddlers 12–23 months of age in districts (woredas), one per region, of Ethiopia (total, ~900 toddlers) in 2013 to estimate the proportion vaccinated with tetanus toxoid (a proxy for pentavalent vaccine) and measles vaccine. The surveys were followed by implementation of the Reaching Every District using Quality Improvement (RED-QI) approach to strengthen the immunization system.Linked coverage/serosurveys were repeated in 2016 to assess effects of the interventions on vaccination coverage. Indicators included “documented coverage” (vaccination card and/or health facility register records) and “crude coverage” (documented plus parent/caretaker recall for children without cards). Seroprotection thresholds were IgG-ELISA tetanus antitoxin ≥0.05 IU/ml and plaque reduction neutralization (PRN) measles titers ≥120 mIU/ml.FindingsImproved markers in 2016 over 2013 include coverage of pentavalent vaccination, vaccination timeliness, and fewer missed opportunities to vaccinate. In parallel, tetanus seroprotection increased in the 3 woredas from 59.6% to 79.1%, 72.9% to 83.7%, and 94.3 to 99.3%. In 2015, the Ethiopian government conducted supplemental measles mass vaccination campaigns in several regions including one that involved a project woreda and the campaign overlapped with the RED-QI intervention timeframe; protective measles PRN titers there rose from 31.0% to 50.0%.InterpretationThe prevalence of seroprotective titers of tetanus antitoxin (stimulated by tetanus toxoid components within pentavalent vaccine) provides a reliable biomarker to identify children who received pentavalent vaccine. In the three study woredas, the RED-QI intervention appeared to improve immunization service delivery, as documented by enhanced pentavalent vaccine coverage, vaccination timeliness, and fewer missed vaccination opportunities. A measles mass vaccination campaign was followed by a markedly increased prevalence of measles PRN antibodies. Collectively, these observations suggest that wider implementation of RED-QI can strengthen immunization, and periodic linked vaccination surveys/serosurveys can monitor changes.     

Reasons for non-vaccination during national immunization days: a case study in Istanbul,Turkey

OBJECTIVE: The member states of the 41st World Health Assembly agreed to aim for the global eradication of polio by the year 2000. Turkey adopted this goal and made substantial progress. In this report, we present the results of a coverage and risk factor survey conducted to evaluate vaccine delivery during the 1999 national immunization days (NIDs) in a large district of Istanbul, Turkey. This study provides important information regarding risk factors and reasons for non-vaccination during the NIDs, defines rumours about the NIDs, and provides estimates of vaccination coverage. SETTING AND PARTICIPANTS: A survey was conducted 3-10 days after the second round of 1999 NIDs using the standard expanded programme on immunization cluster survey method, for each of 10 health centre areas in Umraniye. In total, 2102 children were included in the analysis. RESULTS: The vaccination coverage rate was 82.2%. Logistic regression analysis showed increased risk of non-vaccination in people who did not know the purpose of the NIDs, who had not had contact with a mobile vaccination team, who were unvaccinated in the first round of 1999 NIDs and who lived in the area of the Central Health Centre. Use of primary-level state healthcare facilities for routine childhood immunizations, and living in the area of the Adem Yavuz Health Centre had significant positive effects on vaccination. CONCLUSIONS: To achieve better results, better publicity of national campaigns using mass media, and improved use of mobile teams, are necessary.