Peer-reviewed article
Routine immunization uptake and timeliness in young children exposed to multidrug-resistant tuberculosis: A secondary analysis of the Tuberculosis Child Multidrug-Resistant Preventive Therapy multi-site randomised controlled trial.
Patel F, Purchase S, Dhar M, Horne E, Grab J et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined routine immunization coverage and timeliness in 814 South African children under 5 years old who were exposed to multidrug-resistant tuberculosis, using data from a randomised controlled trial across five sites. Overall vaccination coverage exceeded 80% for most vaccines, but measles vaccination coverage was notably low at 70.6%. The research found that delays and missed vaccinations were more common when the primary caregiver had MDR-TB, in households with lower socioeconomic status, and as children grew older. The study suggests that targeted vaccination interventions for tuberculosis-affected and poorer households, with emphasis on caregiver education, could improve vaccination timeliness.
Key points
- EPI coverage was over 80% for most vaccine types, but only 70.6% for two-dose measles vaccination with 11.3% receiving no measles vaccine
- Delayed and non-vaccination increased with child age
- Delayed/non-vaccination was associated with the primary caregiver being the MDR-TB index patient, lower household socioeconomic status, and study site
- No increase in vaccination delays during the COVID-19 lockdown period was observed
- Population included 35% HIV-exposed children and 1% living with HIV
Limitations
This is a secondary analysis of a preventive therapy trial, so it was not designed primarily to evaluate immunization outcomes. The cross-sectional nature of the analysis does not establish causality, and findings are specific to the five South African sites and may not generalise to other settings.
Abstract
Background The Expanded Programme on Immunization (EPI) reduces vaccine preventable disease-related childhood morbidity and mortality. Vaccine coverage and timeliness are crucial to maximise protection in children < 5 years old. This is especially important for children living in households affected by human immunodeficiency virus (HIV) and tuberculosis. Methods Tuberculosis Child Multidrug-Resistant Preventive Therapy (TB-CHAMP), a randomised controlled trial of multidrug-resistant tuberculosis (MDR-TB) prevention, enrolled participants at five sites across South Africa between 26 Sep 2017 and 21 Jan 2023. In this secondary exploratory analysis, we analysed the coverage and timeliness of EPI vaccinations due by 12 months of age and associations between delayed/non-vaccinations and pre-defined factors relating to child participant, adult MDR-TB index patient, and household. Early, on-time, and delayed vaccinations were defined as > 5 days before, within 28 days of, and > 28 days after the projected dates, respectively. Modified Poisson regression was used to assess factors associated with delayed/non-vaccination and vaccination completeness. The COVID-19 period was defined as the 6 months after the start of South African lockdown. Results Of 922 enrolled children, 814 children < 5 years with complete immunisation records were included. There was equal sex distribution, median age was 2.5 years (IQR 1.2-3.8), 35% were HIV-exposed, and 1% living with HIV. EPI coverage was over 80% across all vaccine types, excluding measles, with a trend towards an increase in delayed doses and non-vaccination as children aged. Two-dose measles vaccination coverage was 70.6% with 11.3% not having any measles vaccination. We found associations between delayed/non-vaccination with the primary caregiver being the MDR-TB index patient, lower household socioeconomic status and the site where children enrolled. We did not observe increased delays and non-vaccination during the COVID-19 period. Conclusions EPI coverage in this vulnerable population was reasonable, except for measles, which was low. There was a trend towards increasing delays and non-vaccination with age. Targeting vaccination interventions at households affected by TB and poorer households emphasising caregiver education on routine vaccination especially as children age is important. Trial registration South African National Clinical Trials Register (SANCTR) (RefDOH270117530) and UK's Clinical Study Registry (Ref ISRCTN92634082, https://doi.org/10.1186/ISRCTN92634082.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Routine Expanded Programme on Immunization (EPI) vaccination delivery through standard health services in households affected by MDR-TB
- Population
- 814 children under 5 years old exposed to MDR-TB from five South African sites; 35% HIV-exposed, 1% living with HIV; median age 2.5 years
Key finding
EPI coverage exceeded 80% for most vaccines excluding measles
F et al. · Europe PMC · 16 Jun 2026