Peer-reviewed article
Zero-dose children and the extended immunisation cascade: Understanding the path to full immunisation with six childhood vaccines in 43 countries
Bianca O. Cata-Preta, Larissa Ádna Neves Silva, Francine dos Santos Costa, Thiago Melo Santos, Tewodaj Mengistu et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed immunization data from 43 low- and middle-income countries to understand how children progress through vaccination. It found that 9% of children received no vaccines at all, 59% received at least one dose of each of six key vaccines, and 47% were fully vaccinated. The research shows that once children receive their first vaccine, they are much more likely to continue with subsequent vaccinations.
Key points
- 9.0% of children received zero doses of any routine vaccine across the 43 countries studied
- 58.6% of children received at least one dose of each of the six vaccines studied (BCG, polio, DPT, ROTA, MCV, and PCV)
- 47.2% of children were fully vaccinated with all required doses of all six vaccines
- Among partially vaccinated children, BCG, polio, DPT, and MCV vaccines were most frequently received
- Children who receive an initial vaccine dose are significantly more likely to complete subsequent vaccinations
Limitations
The study uses data from household surveys which may have recall bias or reporting errors. It does not explain the underlying reasons why 9% of children remain zero-dose or identify specific barriers to vaccination in particular countries or populations.
Abstract
Background: As part of the Immunisation Agenda 2030, the World Health Organization set a goal to reduce the number of children who did not receive any routine vaccine by 50% by 2030. We aimed to describe the patterns of vaccines received for children with zero, one, and up to full vaccination, while considering newly deployed vaccines (pneumococcal conjugate vaccine (PCV) and rotavirus (ROTA) vaccine) alongside longstanding ones such as the Bacille Calmete-Guérin (BCG), diphtheria, tetanus, and pertussis (DPT), and poliomyelitis vaccines, and measles-containing vaccines (MCVs). Methods: We used data from national household surveys (Demographic and Health Surveys and Multiple Indicator Cluster Surveys) carried out in 43 low- and middle-income countries since 2014. We calculated the immunisation cascade as a score ranging from zero to six, considering BCG, polio, DPT, and ROTA vaccines, and the MCV and PCV. We also described the most prevalent combination of vaccines. The analyses were pooled across countries and stratified by household wealth quintiles. Results: In the pooled analyses with all countries combined, 9.0% of children failed to receive any vaccines, 58.6% received at least one dose of each of the six vaccines, and 47.2% were fully vaccinated with all doses. Among the few children receiving 1-5 vaccines, the most frequent were BCG vaccines, polio vaccines, DPT vaccines, PCV, ROTA vaccines, and MCV. Conclusions: Targeting children with their initial vaccine is crucial, as those who receive a first vaccine are more likely to undergo subsequent vaccinations. Finding zero-dose children and starting their immunisation is essential to leaving no one behind during the era of Sustainable Development Goals.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Routine childhood immunization programs delivering six vaccines (BCG, polio, DPT, ROTA, MCV, and PCV) in low- and middle-income countries
- Population
- Children in 43 low- and middle-income countries, measured through national household surveys since 2014
Key finding
9.0% of children received zero doses of any vaccine