India witnesses more than one million deaths of under-five children annually and two-third of all these deaths occur due to vaccine preventable diseases High share of incomplete immunization in India (WHO, 2022) leaves socioeconomically disadvantage group exposed to high morbidity and mortality risk factors. It demands comprehensive assessment of nature and extent of socioeconomic related inequity in child immunisation. Using the indirect standardisation method and Erreygers (2009); corrected concentration index we first measured the degree of horizontal and vertical inequities, and then linearly decompose them to identify the major factors contributing towards the respective indices. We also adopt several strategies for robustness and sensitivity check on our findings. Our findings show that the incomplete immunisation is significantly concentrated among children belonging to poorer households. After controlling for the confounding effects of need factors, the inequity is still significantly pro-poor (indicating horizontal inequity). Its decomposition reveals that lower education, lower consumption and rural dwelling are the major factors driving the corresponding inequity. Further, the differential effect of needs between all and the target groups (at least based on education), is observed however is not significant enough to realise into inequity (indicating vertical equity). Hence, the direction and magnitude of vertical inequity is ambiguous but not significant. Overall, the inequity is being induced via non-need factors, but public health services (like Anganwadi) found to be the major reducing factor.
Azharuddin Akhtar, Indrani Roy Chowdhury, Pallabi Gogoi et al.
Background: In 2017, Pakistan outsourced to a non-government organisation the management of its vaccination programme in 2 Sindh Province districts. Aim: To determine the impact on coverage of outsourcing vaccination programme in 2 districts of Sindh Province, Pakistan. Methods: Between August and October 2024, we interviewed parents or caregivers of 1600 children aged 12–24 months from 4 (2 outsourced and 2 non-outsourced) districts in Sindh Province, to collect sociodemographic and immunisation data. We analysed the data with STATA version 17, using chi-square test and Man-Whitney U test to compare the participants’ characteristics and immunisation status, and regression model to estimate the difference in immunisation rates between the 2 groups at 9 months. Results: Full immunisation coverage was slightly higher in the outsourced (78.8%) than the non-outsourced (75.8%) districts, but there was no statistically significant difference (P = 0.067). At 9 months, a significant difference (P = 0.036) was observed in immunisation rates: 15.0% decrease in compliance in the outsourced, compared to 19.7% in the nonoutsourced, districts. Conclusion: There was a partial improvement in vaccination coverage due to outsourcing: coverage was better only in one of the outsourced districts. There is a need for further research to understand the reasons for the slight differences in immunisation coverage between the outsourced and non-outsourced districts, and the cost-effectiveness of outsourcing.
Background/Objectives: Routine immunisation (RI) coverage declines during the COVID-19 pandemic, from 2020 to 2022, are well-reported. With the declared end to the Public Health Emergency of International Concern in May 2023, and the end of most non-pharmaceutical interventions that were introduced to prevent or minimise COVID-19 spread, we (I) assess whether routine immunisation coverage has rebounded to pre-pandemic trends, and (II) seek to identify factors that help predict whether country performance has exceeded, maintained, or declined compared to expectations (based on time-series forecasting). Methods: We quantify global and country-level routine immunisation diphtheria-tetanus-pertussis (DTP) coverage trends post-pandemic (2023) compared to pre-pandemic trends using time-series forecasting across 190 countries. We used Discriminant Analysis of Principal Components and Random Forests to identify relevant predictors of country-level coverage performance, including 28 indicators of health system strength, health workforce, country income, pandemic containment, economic, and health policies, and demographic aspects. Results: We show that mean global DTP third-dose coverage levels remained on average 2.7% [95% confidence intervals: 1.1% - 4.3%] lower than expected in 2023. However, once accounting for temporal demographic changes, we find that this translates to the total number of immunised children almost reverting to expected levels, owing to decreasing fertility reducing global-level immunisation target populations. At a country-level, notable disruption remaining in over 30 countries (17.6% of countries below expectations, 81.6 within expected ranges, and 1.7% above expectations). Neither predictive method performed well at identifying factors associated with coverage disruptions. Conclusions: Despite the end of COVID-19 pandemic measures, RI remains below expectations in 20% of countries. No clear drivers of this continued disruption were identified. Further research is required to inform recovery efforts and prevent future epidemic and pandemic disruptions to routine health services.
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems worldwide, leading to concerns about reduced access to routine childhood immunisations. However, comprehensive data on how the pandemic specifically impacted paediatric vaccination coverage in Switzerland remain limited across the country. The present study provides an analysis of the timeliness and coverage of routine childhood immunisations in Switzerland before and during the COVID-19 pandemic, offering insights into potential fluctuations in coverage. AIMS: To assess the impact of the COVID-19 pandemic on routine childhood immunisation in Switzerland by comparing vaccination coverage and timeliness for children under 35 months of age before and during the pandemic. Additionally, the study seeks to identify factors associated with the likelihood of children receiving vaccinations, considering demographic and geographic variables. METHODS: We used 2019–2023 data from the Swiss National Vaccination Coverage Survey (SNVCS), a cross-sectional survey that collected immunisation information of children under 35 months of age from a nationally representative sample of households. Children who were eligible for a vaccine from March 2020 to March 2021 were considered as the COVID-affected group and those eligible for a vaccine before this date were included in the pre-COVID-19 cohort. Coverage of the following vaccine doses was considered: diphtheria at one, two and three doses (Di1, Di2, Di3); pneumococcus at one, two and three doses (PCV1, PCV2, PCV3); and measles first and second dose (MCV1, MCV2). Vaccine timeliness was defined as receiving a dose on time with a tolerance period of 30 days. We used logistic regression models to identify and understand the factors that might influence vaccination rates. RESULTS: For the diphtheria vaccines (Di1, Di2, Di3), while coverage remained high, there was a slight decrease observed in timely vaccination rates for some doses, with reductions of around 1% to 3% compared to pre-COVID-19 levels. The impact on PCV1, PCV2 and PCV3 showed similar trends, with slight reductions in coverage during the pandemic, but these differences were not statistically significant. For measles-containing vaccines (MCV1 and MCV2), coverage during the pandemic was higher compared to pre-COVID-19 rates. Geographic and demographic factors, such as an urban setting, nationality and linguistic region, significantly influence childhood vaccination rates in Switzerland. CONCLUSION: While minor declines in vaccine timeliness were observed (diphtheria vaccine, pneumococcal conjugate vaccine), the overall likelihood of vaccination was not significantly affected by the COVID-19 pandemic. However, changes in vaccination recommendations introduced in 2019 may have influenced these trends.
Vasiliki Baroutsou, Monica N. Wymann, Jan S. Fehr et al.
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.
