Peer-reviewed article
Vaccination Coverage Among Preschool Children in Germany: Trends, Regional Disparities, and Determinants from School Enrolment Examinations in Two Metropolitan Regions
Christopher Dyer, Judith Welker, Kholoud Assaad, Nina Knab, Sanjida Rahman Mim et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined vaccination coverage among preschool children in two German metropolitan regions (Frankfurt and Rhein Neckar) using school entry examination data from 2017 to 2024. Vaccination rates remained stable over the period including before and after the COVID-19 pandemic, with no post-pandemic decline observed. However, significant disparities existed across sociodemographic groups, particularly affecting children from non-German backgrounds and lower socioeconomic status families. Children who completed regular preventive medical check-ups had substantially higher vaccination completion rates, suggesting that healthcare access is a critical factor in vaccination uptake.
Key points
- Overall vaccination coverage remained stable across both regions during 2017-2024, with no evidence of decline following the COVID-19 pandemic
- Children who completed preventive medical check-ups had significantly higher odds of completing recommended vaccination schedules
- In Frankfurt, children from non-German birthplaces had dramatically reduced odds of complete vaccination when preventive care was incomplete, indicating synergistic risk factors
- Children from Eastern European language families and lower socioeconomic backgrounds in Rhein Neckar showed different vaccination patterns, being more likely to complete standard vaccines but skip newer additions like rotavirus
- Risk factors for incomplete vaccination are not additive but synergistic, requiring nuanced public health approaches rather than one-size-fits-all messaging
Limitations
This study is limited to two metropolitan regions in Germany and uses data from school entry examinations, which may not capture vaccinations of children who do not enrol in school. The analysis is retrospective and cannot establish causation, only associations between sociodemographic factors and vaccination completion.
Abstract
Background: Vaccinations are highly effective in preventing infectious diseases, which otherwise present a serious challenge to the health of individuals and public health. To identify potential gaps in vaccination coverage, we examined childhood vaccination levels in Frankfurt am Main (FFM) and the Rhein Neckar district (including Heidelberg city, RNHD) prior to, during and following the COVID-19 pandemic. Moreover, we explored various factors that appear to contribute to lower vaccination levels in specific communities in either or both locations. The results are intended to guide strategies for designing and improving vaccination services for specific groups in local health settings. Methods: A retrospective analysis was conducted to examine the vaccination rates of children in Frankfurt am Main and the Rhein Neckar district (including Heidelberg city) by using anonymized data from school entry examinations spanning the years 2017 to 2024. Data pre-processing, analysis, and visualization were performed using R (5.4.2). Frequencies and percentages were calculated for sociodemographic and vaccination rates (the completeness of the vaccination schedule recommended by STIKO for children). Multivariate logistic regression was performed to determine factors with a significant impact on vaccination uptake. Results: Multinomial logistic regression with ‘measles-only’ (Measles) as the reference category revealed distinct predictor patterns across vaccination levels. In both regions, children who completed preventive medical check-ups had higher odds of completing the schedule of vaccination plus at least one additional vaccine (ScheduledPlus) versus, measles-only vaccination. In RNHD, children from Eastern European language families and low- and medium-social-status backgrounds showed higher odds of completing the scheduled vaccinations without the recently introduced rotavirus vaccination (ScheduledNotRota), versus measles-only vaccination. In FFM, strong interaction effects were observed between medical examination completion and migration background, with children from non-German birthplaces showing dramatically reduced odds of complete vaccination when preventive care was incomplete. Discussion: The proportion of children with a complete vaccination status remained stable over the study period in both locations, with no evidence of post-pandemic decline. Nevertheless, this stability masks important heterogeneity in vaccine coverage patterns across sociodemographic groups. Systematic identification and modeling of interactions between nationality, parental employment, and healthcare utilization tell a compelling “double jeopardy” story that the effects of these risk factors are not additive but synergistic. Regular medical check-ups remain an important factor in ensuring high vaccination coverage among children until they start school and underscore the justification for such established preventive care programs. A nuanced understanding, however, is crucial for moving beyond simplistic, one-size-fits-all public health messaging.