Peer-reviewed article
Schedule-stage divergence between DTP3 and first-dose measles-containing vaccine coverage in selected Western Balkan countries
Zhinzela Qyli ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study compared childhood vaccination coverage in Albania, Montenegro, North Macedonia and Serbia from 2019 to 2023, using national estimates from WHO and UNICEF. It looked at how coverage of the third DTP dose differed from coverage of the first measles-containing dose. The countries followed different patterns: the gap widened in Albania, narrowed somewhat in North Macedonia and Serbia, and stayed very large in Montenegro. No country reached 95% for both measles doses in 2023. The authors describe the findings as descriptive and hypothesis-generating.
Key points
- Albania kept DTP3 coverage at 97% in 2023, but its DTP3-MCV1 difference widened from 4 to 14 percentage points.
- Montenegro had persistently low coverage across the selected indicators and a 57-point DTP3-MCV1 difference in 2023.
- North Macedonia narrowed the DTP3-MCV1 difference from 17 to 13 points.
- Serbia narrowed the difference from 10 to 9 points and returned MCV2 to its 2019 value.
- No country reached at least 95% for both measles doses in 2023.
Limitations
The study is ecological and uses only five annual data points per indicator, with no inferential modelling. The DTP3-MCV1 difference is not an individual dropout measure and cannot show continuity of vaccination or causes.
Abstract
Objectives. To compare childhood vaccination coverage in Albania, Montenegro, North Macedonia, and Serbia and assess divergence between DTP3 and later measles-containing vaccine coverage during 2019-2023. Material and methods. A retrospective comparative ecological time-trend study used WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) for DTP3, MCV1, and MCV2. Annual trends, change from the 2019 baseline to the lowest value in 2020-2021, subsequent change to 2023, and the DTP3-MCV1 difference were described. The DTP3-MCV1 difference was defined as an ecological indicator of divergence between early infant-series vaccination and later measles-vaccination contact, not as an individual dropout measure. No inferential modeling was performed because only five annual observations per indicator were available. Results. Albania maintained DTP3 coverage at 97% in 2023, while its DTP3-MCV1 difference widened from 4 to 14 percentage points. Montenegro had persistently low coverage across the selected indicators and a 57-point DTP3-MCV1 difference in 2023. North Macedonia narrowed this difference from 17 to 13 points, while Serbia narrowed it from 10 to 9 points and returned MCV2 to its 2019 value. No country reached at least 95% for both measles doses in 2023. Conclusions. DTP3 and MCV1 followed different country-level patterns during 2019-2023. Albania maintained high DTP3 coverage but showed widening DTP3-MCV1 divergence, whereas North Macedonia and Serbia showed partial narrowing, and Montenegro retained a very wide difference. These findings are descriptive and hypothesis-generating; the DTP3-MCV1 comparison is ecological and should not be interpreted as individual dropout, continuity, or causality.