The COVID-19 pandemic has affected national healthcare systems worldwide, with around 282 million cumulative confirmed cases reported in over 220 countries and territories as of the end of 2021. The Italian National Health System was heavily affected, with detrimental impacts on preventive service delivery. Routine vaccination services were disrupted across the country during the first months of the pandemic, and both access to and demand for vaccines have decreased during the pandemic. In many cases, parents preferred to postpone scheduled appointments for routine paediatric vaccinations because of stay-at-home orders or fear of COVID-19 infection when accessing care. The objective of the current study was to assess the routine childhood vaccine coverage (VC) rates during the COVID-19 epidemic in Italy. We compared 2020 and 2019 VC by age group and vaccine type. The Italian Ministry of Health collected anonymised and aggregated immunisation national data through the local health authorities (LHAs). Results were considered statistically significant at a two-tailed p-value ≤ 0.05. VC rates for mandatory vaccinations decreased in 2020 compared to 2019 (range of VC rate decrease: −1% to −2.7%), while chicken pox increased (+2.2%) in 7-year-old children. Recommended vaccinations were moderately affected (range of VC rate decrease in 2020 vs. 2019: −1.4% to −8.5%), with the exception of anti-HPV in males, Men ACWY, and anti-rotavirus vaccination (VC increase 2020 vs. 2019: +1.8%, +4.7% and +9.4%, respectively). In the COVID-19 era, the implementation of coherent, transparent, and effective communication campaigns and educational programs on safe childhood vaccinations, together with the increase in the number of healthcare staff employed, is essential to support strategies to reinforce vaccination confidence and behaviour, thus avoiding health threats due to VPD during and beyond COVID-19 times.
Michela Sabbatucci, Anna Odone, Carlo Signorelli et al.
Aim To explore immunisation rates and catch‐up delivery to children admitted to hospital before and after an immunisation service was commenced. Methods This pre‐ and post‐intervention study examined 300 admissions prior to (cohort 1) and 300 following (cohort 2) the introduction of an immunisation service. Immunisation rates, documentation, catch‐up delivery and accuracy of the Australian Immunisation Register (AIR) were examined. Results On admission, 75% (cohort 1) and 89% (cohort 2) were up‐to‐date with immunisations. Immunisation history was documented in the medical record in 78% and requirement for catch‐up documented in 10%. AIR was incorrect in one‐third of cases. By 3 months following discharge, 28% (cohort 1) and 64% (cohort 2) of patients were immunised. Conclusions Children admitted to hospital have lower immunisation rates than the national average. Documentation was poor, opportunities for catch‐up were missed and AIR is error‐prone. Catch‐up rates increased following the introduction of an immunisation service.
Adrian J Tarca, Gloria TY Lau, Filomena Mascaro et al.
We analysed Australian Immunisation Register (AIR) data as at 3 April 2022 for children, adolescents and adults for the calendar year 2021, with data on trends from previous years also presented. Children: ‘Fully vaccinated’ coverage in Australian children in 2021 was 0.6–0.8 of a percentage point lower than in 2020 at the 12-month (94.2%) and 60-month (94.0%) age assessment milestones, but stable at the 24-month milestone (92.1%). Due to the lag time involved in assessment at milestone ages, ‘fully vaccinated’ coverage figures for 2020 and 2021 predominantly reflect vaccinations due in 2019 and 2020, respectively, and hence show a small impact on childhood coverage in the first year of the coronavirus disease 2019 (COVID-19) pandemic. ‘Fully vaccinated’ coverage in Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Indigenous) children was 0.7–1.5 percentage points lower in 2021 than 2020 at the 12-month (91.6%), 24-month (90.1%) and 60-month (96.3%) milestones, although 2.3 percentage points higher than children overall at 60 months. Influenza vaccination coverage in children aged 6–59 months was approximately 20 percentage points lower in 2021 than 2020, both for children overall (26.5%) and for Indigenous children (22.5%). ‘On time’ vaccination (within 30 days of the recommended age) was up to two percentage points lower in 2021 than 2020 for vaccines due at 4 and 6 months of age, suggesting possible pandemic impacts, but was similar or higher for vaccines due at 12 months of age. While on-time vaccination in Indigenous children has improved progressively since 2012, it remained 6–13 percentage points lower than in children overall in 2021. ‘Fully vaccinated’ coverage at the earlier milestones (3 months after due date of last scheduled vaccine) of 9, 15, 21 and 51 months was 1.5–2.8 percentage points lower for children living in the least advantaged residential area quintile than the most advantaged, a similar disparity as in 2020. Coverage at the earlier milestones was 2.3–10.0 percentage points lower for Indigenous children living in remote areas than in major cities and regional areas, with disparity at 21 months of age 2.1–2.2 percentage points higher in 2021 than in 2020, and 1.2–2.1 percentage points higher at 51 months. Adolescents: In 2021, a total of 80.3% of girls and 77.2% of boys (and 73.3% and 66.2% of Indigenous girls and boys) had completed the human papillomavirus (HPV) vaccination schedule by 15 years of age, 0.2–0.4 of a percentage point lower than 2020 (1.7–1.8 percentage points for Indigenous), reflecting vaccinations due in school programs prior to the pandemic with possible pandemic impact on catch-up vaccination. However, the proportion of adolescents completing the two-dose HPV vaccination schedule within a calendar year was 15.3 percentage points lower in 2021 than 2020 and 26.9 percentage points lower than in 2019, likely due to pandemic-related disruption to school-based programs. Additionally, 87.3% of adolescents (83.8% for Indigenous) had received the recommended booster dose of diphtheria-tetanus-acellular pertussis (dTpa) vaccine by 15 years, and 76.1% (66.7% for Indigenous) the recommended meningococcal ACWY vaccine dose by 17 years of age. Adults: Zoster vaccine coverage in 2021 remained relatively low, at just over 30%, in adults aged 70 years, but increased to 47% in those aged 71–79 years, reflecting ongoing catch-up vaccination. Coverage of 13vPCV was low in 2021, reaching 17.2% in adults aged 70 years and 20.1% in those aged 71–79 years. Influenza vaccination coverage in adults in 2021 was progressively higher with increasing age, reaching 62.1% in the 65–74 years age group (64.6% in Indigenous) and 68.5% in the 75+ years age group (67.7% in Indigenous). Influenza vaccine coverage for other National Immunisation Program (NIP)-eligible Indigenous adult age groups was only 22.0% for those aged 20–49 years, and 43.5% for those aged 50–64 years. By the end of 2021, a total of 91.6% of people in Australia aged 16+ years had received a second dose of a COVID-19 vaccine (71.8% for Indigenous), with over 99% of those aged 70+ years having received a second dose. Conclusions: Vaccination coverage in children and adolescents remained relatively high in 2021, although with some evidence of COVID-19 pandemic impacts, particularly on receipt of two doses of HPV vaccine within the same calendar year. It will be important to ensure catch-up vaccination in children and adolescents occurs. A strengthened focus on adult vaccination is needed, as coverage remained suboptimal in 2021. The impact of mandatory reporting of all NIP vaccinations from mid-2021, on completeness of AIR data, has not yet been formally evaluated.
Young children face the risk of being infected by a variety of diseases; this makes it necessary to resort to vaccination as a failsafe for ensuring healthy life of the child. However the success of the immunisation drive is conditioned by prevailing conditions. Some of these also determine whether family members opt for full, partial or no immunisation. This paper attempts to identify and estimate the impacts of various socio-economic factors on childhood immunisation coverage in the East district of Sikkim. The study is based on primary data consisting of 204 respondents collected through household survey. The ordered probit and Heckman probit models have been utilised to estimate the significant change in childhood immunisation coverage. The study found that the birth order of child (BOC), mother’s age, the standard of living, caste and religion have a significant impact on childhood immunisation coverage. With regard to the extent of immunisation, the important elements are mother’s education, mother’s age, gender of the household head and distance from hospital.
AIMS We recently conducted a large survey amongst parents of young children exploring attitudes concerning immunisation and the general immunisation status of the children and their parents in Switzerland. Since little is known about the immunisation status of fathers of young children, we present our findings here; data on mothers were previously published elsewhere. METHODS We performed standardised interviews with parents of children born on or after 1 January 2013, and hospitalised at the University of Basel Children’s Hospital, Switzerland, between January and June 2017. If participation was declined, partial consent was sought for four questions regarding age, education level, attitudes towards vaccinations in general and availability of vaccination records of the parents. To compare our study results with other studies focusing on the completeness of the immunisation status of fathers, we conducted a literature search using broad search terms for studies published between 1 April 2009 and 1 December 2019. RESULTS Thirty-nine (20%) fathers of 199 enrolled children participated. The great majority had a positive or mostly positive attitude towards vaccinations, but only 2 (15%) of 13 fathers who participated in immunisation counselling were up-to-date with all generally recommended immunisations. Fifty-two percent of participating fathers reported that the last assessment of their immunisation status by a physician was >5 years ago. After the birth of their child, 56% of fathers had received a recommendation for immunisation against pertussis and 65% of them followed the recommendation. We identified three studies matching our review’s inclusion criteria. None of them reported specific findings for fathers. CONCLUSIONS This is the first study to analyse the complete immunisation status of fathers of young children. It is often incomplete with potentially missed opportunities for updating vaccinations during recent physician consultations. The low participation rate of fathers is a limitation which prohibits generalisation of our findings. However, as healthcare personnel have been shown to have the strongest impact on vaccination uptake, we propose that this group be further sensitised and educated with the goal of improving immunisation rates in fathers of young children.
Mirjam L. Erb, Tobias E. Erlanger, Ulrich Heininger
Background: Tuberculosis in children is still found in East Java Province at 2017 with 2,749 cases of paediatric tuberculosis. The Bacille Calmette-Guérin (BCG) immunisation coverage and healthy houses in East Java Province increase every year. Purpose: This study aims to analyse the correlation between BCG immunisation and healthy houses with paediatric tuberculosis discovery in East Java Province during 2015–17. Methods: This study is observational with a correlation study design. The population in this study were children aged 0–14 years who suffered from tuberculosis in a district or city in East Java Province in 2015–17. Sampling of this study uses aggregate data on paediatric tuberculosis discovered in children aged 0–14 years, coverage of BCG immunisation and coverage of healthy houses in districts/cities in East Java in 2015–17 found in Health Profile of East Java Province 2015–17. The variables studied were paediatric tuberculosis in children aged 0–14 years, BCG immunisation coverage and healthy house; the analysis techniques were the Kolmogorov-Smirnov normality test and Pearson correlation. Results: This study shows that there is correlation between BCG immunisation and paediatric tuberculosis (p = 0.01, p <0.05) with a correlation value of 0.67, indicating a strong and positive correlation. The results also show that there is a correlation between healthy houses and children with tuberculosis (p = 0.01, p <0.05) with a correlation value of 0.63, indicating a strong and positive correlation. Conclusion: BCG immunisation coverage and healthy houses are positively correlated with paediatric tuberculosis discovered in East Java district/city.
We analysed Australian Immunisation Register (AIR) data, predominantly for National Immunisation Program funded vaccines, as at 2 April 2023 for children, adolescents and adults, focusing on the calendar year 2022 and on trends from previous years. This report aims to provide comprehensive analysis and interpretation of vaccination coverage data to inform immunisation policy and programs. Children: Fully vaccinated coverage in Australian children in 2022 was 0.6–1.1 percentage points lower than in 2021 at the 12-month (93.3%), 24-month (91.0%) and 60-month (93.4%) age assessment milestones. This follows the 0.6–0.8 percentage point decrease at the 12- and 60-month milestones between the 2020 and 2021 reports, which came after eight years of generally increasing coverage. Due to the lag time involved in assessment, fully vaccinated coverage figures for 2021 and 2022 predominantly reflect vaccinations due in 2020 and 2021, respectively, and therefore reflect impacts of the first two years of the coronavirus disease 2019 (COVID-19) pandemic. Fully vaccinated coverage in Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) children was 1.2–2.2 percentage points lower in 2022 than in 2021 at the 12-month (90.0%), 24-month (87.9%) and 60-month (95.1%) milestones, indicating differential impacts of the pandemic. However, at the 60-month milestone, coverage in Indigenous children was 1.7 percentage points higher than in children overall. There were also clear pandemic impacts on on-time (within 30 days of recommended age) vaccination. On-time coverage of both the second dose of diphtheria-tetanus-pertussis and the first dose of measles-mumps-rubella-containing vaccines decreased progressively from mid-2020 onwards (6 and 12 percentage point falls, respectively) before recovering partially in the second half of 2022, with decreases 1.5–2.3 percentage points greater in Indigenous than non-Indigenous children, from an already close to 10 percentage points lower pre-pandemic baseline. Adolescents: Of adolescents turning 15 years in 2022, a total of 85.3% of girls and 83.1% of boys (83.0% and 78.1% of Indigenous girls and boys) had received at least one dose of human papillomavirus (HPV) vaccine by their fifteenth birthday, 0.9–1.3 percentage points lower than in 2021 (2.5–3.1 percentage points for Indigenous adolescents), also reflecting pandemic impacts. It will be important to monitor coverage with the single-dose HPV vaccine schedule – which was implemented from February 2023 – to ensure that it is sustained (ideally, increasing) and equitable, given that coverage in 2022 was 5–6 percentage points lower in adolescents in socioeconomically disadvantaged and remote areas. By 31 December 2022, coverage for an adolescent dose of diphtheria-tetanus-acellular pertussis vaccine in adolescents turning 15 years in 2022 was 86.9% (82.6% for Indigenous adolescents) and coverage for an adolescent dose of meningococcal ACWY vaccine in those turning 17 years was 75.9% (65.6% for Indigenous adolescents). Ongoing adolescent coverage gaps warrant tailored strategies to achieve higher vaccine uptake. Adults: Zoster vaccination coverage in 2022 was 41.3% in adults turning 71 years (37.7% in Indigenous adults), 2.6 (3.6) percentage points higher than in 2021, and was highest in adults turning 75 years (54.6% and 54.0%), reflecting a combination of vaccination at 70 years and catch-up at older ages. Coverage of 13-valent pneumococcal conjugate vaccine (13vPCV) was 33.8% in adults turning 70 years in 2022 (37.7% in Indigenous adults), 9.9 (12.6) percentage points higher than in 2021. These increases may be partly due to more complete reporting following the introduction of mandatory reporting to the AIR in mid-2021. Influenza vaccination coverage in adults in 2022 increased with increasing age, reaching 73.0% in the ≥ 75 years age group. Coverage was higher in 2022 than in 2021 across all adult age groups, with the proportionate increase since 2019 four- to five-fold higher in those aged < 65 years than in those aged ≥ 65 years. This likely reflects increased completeness due to mandatory reporting, with coverage previously substantially underestimated in younger adults. Conclusions: Vaccination coverage in children and adolescents decreased modestly in 2022, reflecting impacts of the COVID-19 pandemic, but remained relatively high in global terms. The decrease in coverage was greater in Indigenous children and adolescents, with timeliness of vaccination an ongoing issue exacerbated by the pandemic. While adult coverage increased in 2022 – likely, in part, due to the introduction of mandatory reporting to AIR resulting in more accurate estimates – it remains suboptimal. Limited evidence suggests the lower coverage in children and adolescents is due to a combination of acceptance and access factors. Particularly given the evidence that these modest declines in coverage have continued into the first half of 2023, further exploration is needed to better understand these factors and to inform approaches to effectively address barriers and increase vaccine uptake.
Immunisation remains one of the most effective public health interventions, yet in Nigeria, significant gaps in coverage persist, leaving millions vulnerable to preventable diseases. This chapter examines the current state of immunisation in Nigeria, highlighting the challenges that hinder widespread coverage, including cultural, economic, and geographical barriers. It explores strategies for reaching zerodose children, emphasising the importance of integrating immunisation efforts with other health services. Additionally, the chapter discusses the role of disease surveillance and early detection systems in preventing outbreaks. By analysing success stories and best practices, this chapter offers insights into overcoming the barriers to achieving high immunisation coverage in Nigeria and other developing nations.
We analysed Australian Immunisation Register (AIR) data as at 31 March 2021 for children, adolescents and adults. This is the first time that adolescent and adult coverage data from the AIR have been included in our annual coverage report.
This 9th annual immunisation coverage report shows data for 2015 derived from the Australian Childhood Immunisation Register and the National Human Papillomavirus (HPV) Vaccination Program Register. This report includes coverage data for ‘fully immunised’ and by individual vaccines at standard age milestones and timeliness of receipt at earlier ages according to Indigenous status. Overall, ‘fully immunised’ coverage has been mostly stable at the 12- and 24-month age milestones since late 2003, but at 60 months of age, coverage reached its highest ever level of 93% during 2015. As in previous years, coverage for ‘fully immunised’ at 12 and 24 months of age among Indigenous children was 3.4% and 3.3% lower than for non-Indigenous children overall, respectively. In 2015, 77.8% of Australian females aged 15 years had 3 documented doses of HPV vaccine (jurisdictional range 68.0–85.6%), and 86.2% had at least one dose, compared to 73.4% and 82.7%, respectively, in 2014. The differential of on-time vaccination between Indigenous and non-Indigenous children in 2015 diminished progressively from 18.4% for vaccines due at 12 months to 15.7% for those due at 24 months of age. In 2015, the proportion of children whose parents had registered an objection to vaccination was 1.2% at the national level, with large regional variations. This was a marked decrease from 1.8% in 2014 and the lowest rate of registered vaccination objection nationally since 2007 when it was 1.1%. Medical contraindication exemptions for Australia were more than double in 2015 compared with the previous year (635 to 1,401).
