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 Expanded Programme on Immunization in 1988

Only 40-50% of the world's children are correctly vaccinated, and each year about 3.5 million children die or become invalids following illnesses preventable by vaccination. It is hoped that new strategies and simplification of vaccination schedules will permit a rapid increase in vaccination coverage so that the UNICEF goal of vaccination of all the world's children by 1990 will be met. As of June 1987, it was estimated that 45% of children in developing countries excluding China had been vaccinated against tuberculosis, 21% against neonatal tetanus, 30% against measles, 45% against whooping cough, and 44% against polio. Most of the illnesses covered by the Expanded Program of Immunization (EPI) can occur very early in life in developing countries. The World Health Organization recommends that children under 1 year old be considered a target group for vaccination. BCG and an extra polio dose should be administered at birth. The DPT injections and oral polio doses should be administered at 6, 10, and 14 weeks. The measles and, where necessary, yellow fever vaccines should be administered at 9 months. The oral polio dose at birth does not always cause antibody synthesis and is intended to provide temporary protection only. The minimum interval between DPT and polio doses is 4 weeks. There is no maximum interval and no need to restart an interrupted series. Vaccination of mothers against tetanus protects the newborn against neonatal tetanus. Pregnant women should be vaccinated twice at intervals of at least 1 month and with the 2nd dose at least 30 days before delivery. The WHO recommends that the target group for tetanus vaccination be enlarged to include all fertile aged women. In the EPI, all vaccines may be administered simultaneously, with DPT, polio, and BCG before 9 months for children seen for the 1st time. Malnourished children should receive priority in vaccination. Premature infants should be given BCG and a preliminary dose of oral polio vaccine before leaving the maternity hospital. Contraindications to vaccination are exceptional and include high fever, acute disorders, and serious reactions to the 1st DPT dose. BCG may be contraindicated for children with clinical signs of AIDS. Vaccination should be integrated into the daily routine of health facilities and the vaccination status of mothers and children should be determined at each contact with the health center. Mass vaccination campaigns can dramatically increase coverage but are costly and require detailed planning and intersectorial coordination.     

The quality of immunization data from routine primary health care reports: a case from Nepal

Reported high immunization coverage achieved in Nepal over the last ten years is expected to reduce child mortality in the country. The present study, carried out in hill district in mid-west Nepal, aimed to assess the quality of immunization data in Nepal. The number of children who received different vaccines during one year was obtained from three sources: 1) the Immunization REgister of three Primary Health Care Service Outlets (PHCSOs) where each immunized child is recorded; 2) monthly PHC Reports, which are based on the Immunization Register; 3) monthly DHO Reports, which are based on the above PHC Reports (the DHO reports are the source of official statistics). The number of children in the PHC Reports was higher than the number in the Immunization REgisters for all vaccines. The number of immunizations in the DHO Reports was higher than the number in the PHC Reports for BCG, DPT, and measles; the number was lower for poliomyelitis. The overall number of immunizations was higher in the DHO Reports than in the Immunization Registers, by 31% for BCG, 44% for DPT, 155% for polio, and 71% for measles. We conclude that the official report overestimates the immunization coverage in the district. The immunization programme, therefore, might not result in the expected reduction of morbidity and mortality despite the investment in the programme and reported high coverage.     

Childhood vaccination timeliness following maternal migration to an informal urban settlement in Kenya

IntroductionTimely receipt of recommended vaccines is a proven strategy to reduce preventable under-five deaths. Kenya has experienced impressive declines in child mortality from 111 to 43 deaths per 1000 live births between 1980 and 2019. However, considerable inequities in timely vaccination remain, which unnecessarily increases risk for serious illness and death. Maternal migration is a potentially important driver of timeliness inequities, as the social and financial stressors of moving to a new community may require a woman to delay her child’s immunizations. This analysis examined how maternal migration to informal urban settlements in Nairobi, Kenya influenced childhood vaccination timeliness.MethodsData came from the Nairobi Urban Health and Demographic Surveillance System, 2002–2018. Migration exposures were migrant status (migrant, non-migrant), migrant origin (rural, urban), and migrant type (first-time, circular [previously resided in settlement]). Age at vaccine receipt (vaccination timeliness) was calculated for all basic vaccinations. Accelerated failure time models were used to investigate relationships between migration exposures and vaccination timeliness. Confounding was addressed using propensity score weighting.ResultsOver one-third of the children of both migrants and non-migrants received at least one dose late or not at all. Unweighted models showed the children of migrants had shorter time to OPV1 and DPT1 vaccine receipt compared to the children of non-migrants. After accounting for confounding only differences in timeliness for DPT1 remained, with the children of migrants receiving DPT1 significantly earlier than the children of non-migrants. Timeliness was comparable among migrants with rural and urban origins and among first-time and circular migrants.ConclusionAlthough a substantial proportion of children in Nairobi’s informal urban settlements do not receive timely vaccination, this analysis found limited evidence that maternal migration and migration characteristics were associated with delays for most doses. Future research should seek to elucidate potential drivers of low vaccination timeliness in Kenya.     

Child vaccination in sub-Saharan Africa: Increasing coverage addresses inequalities

BackgroundVaccines have substantially contributed to reducing morbidity and mortality among children, but inequality in coverage continues to persist. In this study, we aimed to examine inequalities in child vaccination coverage in sub-Saharan Africa.MethodsWe analysed Demographic and Health Survey data in 25 sub-Saharan African countries. We defined full vaccination coverage as a child who received one dose of bacille Calmette-Guérin vaccine (BCG), three doses of diphtheria, pertussis, and tetanus vaccine (DTP 3), three oral polio vaccine doses (OPV 3), and one dose of measles vaccine. We used the concentration index (CCI) to measure wealth-related inequality in full vaccination, incomplete vaccination, and zero-dose children within and between countries. We fitted a multilevel regression model to identify predictors of inequality in receipts of full vaccination.ResultsOverall, 56.5% (95% CI: 55.7% to 57.3%) of children received full vaccination, 35.1% (34.4% to 35.7%) had incomplete vaccination, while 8.4% (95% CI: 8.0% to 8.8%) of children remained unvaccinated. Full vaccination coverage across the 25 sub-Saharan African countries ranged from 24% in Guinea to 93% in Rwanda. We found pro-rich inequality in full vaccination coverage in 23 countries, except for Gambia and Namibia, where we found pro-poor vaccination coverage. Countries with lower vaccination coverage had higher inequalities suggesting pro-rich coverage, while inequality in unvaccinated children was disproportionately concentrated among disadvantaged subgroups. Four or more antenatal care contracts, childbirth at health facility, improved maternal education, higher household wealth, and frequently listening to the radio increased vaccine uptake.ConclusionsContinued efforts to improve access to vaccination services are required in sub-Saharan Africa. Improving vaccination coverage and reducing inequalities requires enhancing access to quality services that are accessible, affordable, and acceptable to all. Vaccination programs should target critical social determinants of health and address barriers to better maternal health-seeking behaviour.     

Lost immunization opportunities in Niamey,Niger

During one morning in 1992 in Niamey, Niger, interviews with 380 women aged 15-49 attending five health facilities and with persons bringing 209 infants (0-11 months) to the same centers were conducted to identify weaknesses in the Expanded Program for Immunization in Niger and to define strategies to improve services. Missed opportunities for vaccination were used to evaluate these services. The health facilities were a maternal and child health (MCH) center, a dispensary, a national family health clinic, a social security health center, and a pediatric service at a central hospital. 27% of the infants lacked at least one vaccination. The corresponding figure for the women was 39%. The major types of visits were well-baby visits (45%) and curative visits (32%). The types of child vaccinations missed were all three DPT (diphtheria, pertussis, and tetanus) doses (30% for 1st, 23% for 2nd, and 27% for 3rd), measles (29%), yellow fever (27%), and BCG (15%). Among women, the third and fourth doses of tetanus toxoid were most missed (31% and 23%, respectively). 87% of the persons accompanying the infants and 86% of the women would have accepted the vaccination on the day of the survey had it been made available. Among infants, missed opportunities were more common at the social security health center (56%) and least common at the national family health clinic (5%). Among women, the MCH clinic and the dispensary missed opportunities to vaccinate the most (59%) followed by the national family health clinic (53%), the hospital (47%), and the social security clinic (33%). 88% of persons with the infants had the infant's vaccination card with them. On the other hand, only 9% of women had their vaccination card. Based on these findings, some recommendations were: guarantee a supply of vaccination cards for all women; systematically distribute cards to women aged 15-49 and inform them of the importance of bringing it with them when they visit health services; provide vaccinations every day in all health facilities; and re-evaluate vaccination stocks.     

Was there a disparity in age appropriate infant immunization uptake in the theatre of war in the North of Sri Lanka at the height of the hostilities?: a cross-sectional study in resettled areas in the Kilinochchi district

Background

It was long speculated that there could be under-immunized pockets in the war affected Northern part of Sri Lanka relative to other areas. With the cessation of hostilities following the military suppression of the rebellion, opportunities have arisen to appraise the immunization status of children in areas of re-settlement in former war ravaged districts.

Methods

We conducted a cross-sectional study to describe the coverage and age appropriateness of infant vaccinations in a former conflict district during the phase of re-settlement. The target population comprised all children of re-settled families in the age group of 12 – 23 months in the district. We selected a study sample of 300 children from among the target population using the WHO’s 30 cluster EPI survey method. Trained surveyors collected data using a structured checklist. The infant vaccination status was ascertained by reviewing vaccination records in the Child Health Development Record or any other alternative documentary evidence.

Results

The survey revealed that the proportion of fully vaccinated children in the district was 91%. For individual vaccines, it ranged from 92% (measles) to 100% (BCG, DPT/OPV1). However, the age appropriateness of vaccination was less than 50% for all antigens except for BCG (94%). The maximum number of days of delay of vaccinations ranged from 21 days for BCG to 253 days for measles. Age appropriate vaccination rates significantly differed for DPT/OPV1-3 and measles during the conflict and post-conflict stages while it did not for the BCG. Age appropriate vaccination rates were significantly higher for DPT/OPV1-3 during the conflict while for the measles it was higher in the post conflict stage.

Conclusions

Though the vaccination coverage for infant vaccines in the war affected Kilinochchi district was similar to other districts in the country, it masked a disparity in terms of low age-appropriateness of infant immunizations given in field settings. This finding underscores the need for investigation of underlying reasons and introduction of remedial measures in the stage of restoring Primary Health Care services in the ex-conflict zone.

     

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.     

Socio-demographic determinants of timely adherence to BCG,Penta3, measles,and complete vaccination schedule in Burkina Faso

Objective

To identify the determinants of timely vaccination among young children in the North-West of Burkina Faso.

Methods

This study included 1665 children between 12 and 23 months of age from the Nouna Health and Demographic Surveillance System, born between September 2006 and December 2008. The effect of socio-demographic variables on timely adherence to the complete vaccination schedule was studied in multivariable ordinal logistic regression with 3 distinct endpoints: (i) complete timely adherence, (ii) failure, and (iii) missing vaccination. Three secondary endpoints were timely vaccination with BCG, Penta3, and measles, which were studied with standard multivariable logistic regression.

Results

Mothers’ education, socio-economic status, season of birth, and area of residence were significantly associated with failure of timely adherence to the complete vaccination schedule. Year of birth, ethnicity, and the number of siblings was significantly related to timely vaccination with Penta3 but not with BCG or measles vaccination. Children living in rural areas were more likely to fail timely vaccination with BCG than urban children (OR = 1.79, 95%CI = 1.24–2.58 (proximity to health facility), OR = 3.02, 95%CI = 2.18–4.19 (long distance to health facility)). In contrast, when looking at Penta3 and measles vaccination, children living in rural areas were far less likely to have failed timely vaccinations than urban children. Mother's education positively influenced timely adherence to the vaccination schedule (OR = 1.42, 95%CI 1.06–1.89). There was no effect of household size or the age of the mother.

Conclusions

Additional health facilities and encouragement of women to give birth in these facilities could improve timely vaccination with BCG. Rural children had an advantage over the urban children in timely vaccination, which is probably attributable to outreach vaccination teams amongst other factors. As urban children rely on their mothers’ own initiative to get vaccinated, urban mothers should be encouraged more strongly to get their children vaccinated in time.     

Immunization coverage and natural infection rates of vaccine-preventable diseases among children by questionnaire survey in 2005 in Japan

We performed questionnaire survey in 2005, just before the introduction of the MR vaccine, concerning child vaccination and/or infection history for measles, mumps, rubella, varicella, influenza, diphtheria-pertussis-tetanus (DPT), BCG, and Japanese encephalitis. The vaccination rate against measles and rubella did not exceed 95% at any age levels. As a result, children who had contracted measles and/or rubella were observed at all age levels. The vaccination rate was 95% or higher only for BCG and DPT. The vaccination rates for influenza, mumps, and varicella, although vaccination against which diseases was being performed voluntarily, were low, and outbreaks of these diseases were expected to persist. The vaccination rates at a low level for these infectious diseases might be one of the most possible risk factors to the high prevalence of the diseases in nursery schools (daycare centers), kindergartens, and elementary schools all over Japan.     

2009-2011年福田区儿童免疫接种率调查

目的评价2009-2011年福田区儿童国家免疫规划疫苗的接种情况和影响接种率的主要因素。方法采用标准组群抽样法对抽样儿童的建卡、建证情况,卡介苗、糖丸、百白破、乙肝、麻疹、乙脑"六苗"接种的情况及"六苗"覆盖情况,不合格接种原因,未接种的原因进行考核与评价。结果 2009-2011年各抽查福田区12~24月龄儿童210人,建卡率100%,建证率100%,卡证相符率为100%;卡介苗接种率100%,糖丸疫苗接种率100%,百白破疫苗接种率100%,乙肝疫苗接种率99.36%,首剂及时接种率为91.9%,麻疹疫苗接种率100%,乙脑疫苗接种率99.21%,"六苗"全程接种率为99.05%,"六苗"单苗接种率均达到95%以上;2009-2011年"六苗"不合格接种共46人次。提前接种34.78%;超期接种54.35%;间隔不符6.52%;未种4.35%。结论 2009-2011年福田区儿童国家免疫规划疫苗的接种率均维持在较高水平,其中不合格接种的主要原因是提前接种和超期接种。     

243名儿童“四苗”接种免疫效果分析

[目的]了解本市城区儿童接种脊髓灰质炎疫苗、麻疹疫苗、百白破疫苗、乙肝疫苗的免疫效果。[方法]于2007年6月至2009年10月用ELISA法对本市城区243名接种完18月龄百白破疫苗和麻疹疫苗1月后至2岁以内的儿童进行相关6种抗体的检测。[结果]抗体阳性率,脊灰93．83％、麻疹95．06％、百日咳97．94％、白喉96．29％、破伤风98．35％、乙肝68．72％;不同性别间6种抗体阳性率的差异均无统计学意义（P〉0．05）。[结论]脊髓灰质炎疫苗、麻疹疫苗、百白破疫苗接种的免疫效果良好,乙肝疫苗的免疫效果较差。     

2009年河南油田入托入学儿童接种证查验及补种情况分析

目的了解入托、入学查验接种证工作开展现况及影响因素,为儿童预防接种工作扎实开展提供科学依据。方法按照《南阳市卫生局关于开展2009年秋期入学入托儿童预防接种证查验及适龄儿童摸底登记活动的通知》要求,对河南油田所属9所托幼机构和8所小学的2009年秋期入托、入学新生的接种证持证情况,以及国家免疫规划疫苗接种情况进行查验。结果接种证查验单位覆盖率为100%(17/17);预防接种证持有率为89.5%,其中托幼机构为93.1%,小学为87.8%;有包括卡介苗、脊髓灰质炎疫苗(基础)、百白破三联、麻疹疫苗、乙肝疫苗、A群流脑疫苗、麻风二联疫苗、麻腮二联疫苗等8种疫苗接种率超过90%;接种率不足90%的疫苗包括A+C群流脑疫苗、乙脑疫苗、甲肝疫苗、脊髓灰质炎疫苗(第4剂)和白破二联。脊髓灰质炎疫苗第4剂、A群流脑疫苗、A+C群流脑疫苗和乙脑疫苗接种率,小学均低于托幼机构,差异有统计意义(χ12=98.1,χ22=22.3,χ32=246.7,χ24=443.5,P1-40.01),而麻风二联疫苗接种率小学高于托幼机构(χ2=11.22,P0.01)。对所有缺证、漏种儿童进行了逐个通知和补证(种)。结论河南油田托幼机构及小学新生预防接种证查验工作开展情况良好。但仍应切实落实相关规定,托幼机构及小学应进一步主动做好新生入托、入学预防接种证查验工作。     

Spatial and socio-demographic predictors of time-to-immunization in a rural area in Kenya: Is equity attainable?

We conducted a vaccine coverage survey in Kilifi District, Kenya in order to identify predictors of childhood immunization. We calculated travel time to vaccine clinics and examined its relationship to immunization coverage and timeliness among the 2169 enrolled children (median age: 12.5 months). 86% had vaccine cards available, >95% had received three doses of DTP-HepB-Hib and polio vaccines and 88% of measles. Travel time did not affect vaccination coverage or timeliness. The Kenyan EPI reaches nearly all children in Kilifi and delays in vaccination are few, suggesting that vaccines will have maximal impact on child morbidity and mortality.     

Immunization coverage in tribal and rural areas of Visakhapatnam district of Andhra Pradesh,India

Objective  This paper aims to report and compare the immunization coverage of various vaccines among tribal and rural children in a distinct socio-economic environment in India. Methods  The study was conducted in two tribal and two rural developmental blocks of Visakhapatnam district of Andhra Pradesh, India, by employing both qualitative and quantitative data collection techniques. Data collected included the immunisation coverage and the associated socio-demographic factors. Results  The majority of mothers was aware of vaccination of children, and usually the primary heath centres and their health workers were the source of vaccination. Vaccination cards were received by 79.2% of tribal and 71.3% of rural children. Some of the socio-demographic characters of mothers, such as habitat, caste and occupation, were associated with the reception of a vaccination card. The coverage of various vaccines was higher among the tribal than among the rural population. Of the eligible children aged above 9 months, 63.3% of tribal children and only 14.5% of rural children were fully vaccinated [three doses of diphtheria, pertussis and tetanus (DPT), four doses of oral polio vaccine, Bacille Calmette Guerin (BCG) and measles vaccine]. The coverage of vaccination against measles and vitamin-A supplementation were very low among rural children (19.6% and 15.2%, respectively) when compared to tribal children (69.2% and 64.2%, respectively). The qualitative data indicated that the community was not satisfied with regard to vaccination services, particularly in the rural area. Conclusion  The coverage of various vaccines was moderate in tribal areas and poor in rural areas. The sole dependence on and demand for public health services was responsible for relatively better coverage of immunisation in tribal areas compared to rural areas where the private sector plays a major role. The existing strategies of health-care delivery including delivery of vaccination services need to be examined and improved. Improvements in physical access, infrastructure, quality of care and increased use of mass media and interpersonal communication are indispensable for improvement in the provision of services.     

Assessing the timeliness of vaccine administration in children under five years in India, 2013

Morbidity from vaccine-preventable diseases is high in India, but precise estimates of vaccination timeliness are difficult to compute because many children lack records of vaccination dates. This study assessed vaccination timeliness after accounting for right and left censoring of data. This cross-sectional study used the 2012–2013 District Level Household and Facility Survey in India. The outcome was vaccination timeliness for 9 vaccine doses: 1 dose Bacillus Calmette-Guérin (BCG), 4 doses oral polio vaccine, 3 doses diphtheria-pertussis-tetanus vaccine (DPT), and 1 dose measles-containing vaccine. Age-specific probabilities of vaccination were calculated using Turnbull estimators: children not yet vaccinated were right censored, and children vaccinated but without a recorded date were left censored. Data from 108,783 children under 5?years were available. For children 25–60?months, maternal recall was a more common source of information than a vaccination record with dates. At one month past the recommended vaccination age, estimated coverage ranged from 35% for DPT-3 to 55% for BCG. Accounting for censored data improved vaccination timeliness measures, and demonstrated little increase in vaccination coverage after age one. Efforts to reduce morbidity from vaccine-preventable diseases in India should focus on eliminating missed opportunities for vaccination and instituting special vaccination programs for older children.     

Childhood vaccination coverage and equity impact in Ethiopia by socioeconomic,geographic, maternal,and child characteristics

BackgroundEthiopia is a priority country of Gavi, the Vaccine Alliance to improve vaccination coverage and equitable uptake. The Ethiopian National Expanded Programme on Immunisation (EPI) and the Global Vaccine Action Plan set coverage goals of 90% at national level and 80% at district level by 2020. This study analyses full vaccination coverage among children in Ethiopia and estimates the equity impact by socioeconomic, geographic, maternal and child characteristics based on the 2016 Ethiopia Demographic and Health Survey dataset.MethodsFull vaccination coverage (1-dose BCG, 3-dose DTP3-HepB-Hib, 3-dose polio, 1-dose measles (MCV1), 3-dose pneumococcal (PCV3), and 2-dose rotavirus vaccines) of 2,004 children aged 12–23 months was analysed. Mean coverage was disaggregated by socioeconomic (household wealth, religion, ethnicity), geographic (area of residence, region), maternal (maternal age at birth, maternal education, maternal marital status, sex of household head), and child (sex of child, birth order) characteristics. Concentration indices estimated wealth and education-related inequities, and multiple logistic regression assessed associations between full vaccination coverage and socioeconomic, geographic, maternal, and child characteristics.ResultsFull vaccination coverage was 33.3% [29.4–37.2] in 2016. Single vaccination coverage ranged from 49.1% [45.1–53.1] for PCV3 to 69.2% [65.5–72.8] for BCG. Wealth and maternal education related inequities were pronounced with concentration indices of 0.30 and 0.23 respectively. Children in Addis Ababa and Dire Dawa were seven times more likely to have full vaccination compared to children living in the Afar region. Children in female-headed households were 49% less likely to have full vaccination.ConclusionVaccination coverage in Ethiopia has a pro-advantaged regressive distribution with respect to both household wealth and maternal education. Children from poorer households, rural regions of Afar and Somali, no maternal education, and female-headed households had lower full vaccination coverage. Targeted programmes to reach under-immunised children in these subpopulations will improve vaccination coverage and equity outcomes in Ethiopia.     

Community cohort study of Cryptosporidium parvum infections: sex-differential incidences associated with BCG and diphtheria-tetanus-pertussis vaccinations

OBJECTIVE: Community studies in West Africa have suggested that routine vaccinations may have sex-differential non-targeted effects, the female-male mortality ratios being increased after receiving diphtheria-tetanus-pertussis (DTP) vaccination and reduced after administration of BCG or measles vaccine (MV). Using an existing data set, we examined whether vaccinations were associated with gender-differential incidences of Cryptosporidium parvum infection. METHODS: Two hundred children had been recruited shortly after birth and followed until 2 years of age or until follow-up was interrupted by a war. We performed weekly morbidity interviews and collected stool specimens, irrespective of whether the children had diarrhoea. Vaccination status for each child was classified according to the most recent vaccination with BCG, DTP, or MV. FINDINGS: The female-male incidence rate ratio (IRR) for Cryptosporidium infection among children who had received BCG as their last vaccine was 0.0 (95% CI: 0-3.49). However, among those who had received DTP as their last vaccine, the female-male IRR was 6.25 (2.06-18.9) for Cryptosporidium infection and 3.60 (0.91-14.2) for Cryptosporidium-associated diarrhoea. The female-male IRRs for Cryptosporidium infection differed significantly among BCG and DTP recipients (p=0.01). Among children who had received measles as their last routine vaccine, the female-male IRR was 1.57 (0.60-4.11) for Cryptosporidium infection and 0.98 (0.28-3.52) for Cryptosporidium-associated diarrhoea. The female-male IRRs for Cryptosporidium infection differed among DTP and MV recipients (p=0.02). For girls, early DTP vaccination compared with late or no DTP vaccination was associated with increased incidence rate of Cryptosporidium infection (IRR=4.23 (1.04-17.2)). For girls, the incidence rate decreased when they received MV. INTERPRETATION: Routine immunisations may affect morbidity for non-targeted infections. As in studies of infant mortality, BCG is associated with a low risk for girls relative to boys, whereas DTP is associated with a high female-male IRR of C. parvum infection.     

Measuring the timeliness of childhood vaccinations: Using cohort data and routine health records to evaluate quality of immunisation services

BackgroundTo achieve full benefits of vaccination programmes, high uptake and timely receipt of vaccinations are required.ObjectivesTo examine uptake and timeliness of infant and pre-school booster vaccines using cohort study data linked to health records.MethodsWe included 1782 children, born between 2000 and 2001, participating in the Millennium Cohort Study and resident in Wales, whose parents gave consent for linkage to National Community Child Health Database records at the age seven year contact. We examined age at receipt, timeliness of vaccination (early, on-time, delayed, or never), and intervals between vaccine doses, based on the recommended schedule for children at that time, of the following vaccines: primary (diphtheria, tetanus, pertussis (DTP), polio, Meningococcal C (Men C), Haemophilus influenzae type b (Hib)); first dose of measles, mumps and rubella (MMR); and pre-school childhood vaccinations (DTP, polio, MMR). We compared parental report with child health recorded MMR vaccination status at age three years.ResultsWhile 94% of children received the first dose of primary vaccines early or on time, this was lower for subsequent doses (82%, 65% and 88% for second and third doses and pre-school booster respectively). Median intervals between doses exceeded the recommended schedule for all but the first dose with marked variation between children. There was high concordance (97%) between parental reported and child health recorded MMR status.ConclusionsRoutine immunisation records provide useful information on timely receipt of vaccines and can be used to assess the quality of childhood vaccination programmes. Parental report of MMR vaccine status is reliable.     

2012年中山市儿童免疫接种率及其影响因素

目的评价中山市儿童实施国家扩大免疫规划后的疫苗接种情况及其影响因素。方法 2012年采用容量比例概率抽样（PPS）,对9-48月龄常住儿童的建证、入册情况,卡介苗、脊髓灰质炎、百白破、乙型肝炎（乙肝）、麻疹、乙型脑炎（乙脑）、＂六苗＂全程及甲肝、流行性脑脊髓膜炎（流脑）的接种情况进行评价。调查儿童家长对接种疫苗认知情况及其未接种原因。结果共抽查中山市常住儿童417人,其中流动儿童155人（37.2%）。建证率为98.3%（410/417）,入册率为97.1%（405/417）。＂六苗＂基础免疫接种率分别为卡介苗98.1%（409/417）,脊髓灰质炎96.6%（403/417）,百白破94.2%（393/417）,乙肝95.2%（397/417）,麻疹92.6%（386/417）,乙脑90.4%（377/417）。加强免疫疫苗接种率分别为百白破74.4%（116/156）,麻疹77.6%（121/156）,乙脑55.7%（87/156）。扩大免疫疫苗接种率为甲肝49.7%（140/282）,流脑77.2%（203/263）。麻疹和乙肝疫苗首针及时接种率分别为45.6%（190/417）、86.3%（360/417）。流动儿童＂六苗＂接种率为77.4%（120/155）,低于该地户籍儿童85.5%（224/262）（χ2=4.399,P〈0.05）。55名儿童未种或未全程接种,其主要原因为没有时间（47.27%）、忘记（20.00%）和因病（12.73%）。结论中山市儿童基础免疫接种率较高,加强免疫接种率、乙肝和麻疹首针及时接种率均偏低。该地户籍儿童接种率高于流动儿童,应加强流动儿童预防接种的管理和加大对国家免疫规划政策的宣传。