Immunization coverage and predictive factors for complete and age-appropriate vaccination among preschoolers in Athens, Greece: a cross- sectional study

Abstract

BackgroundIn Greece, several new childhood vaccines were introduced recently but were reimbursed gradually and at different time points. The aim of this study was to assess immunization coverage and identify factors influencing complete and age-appropriate vaccination among children attending public nurseries in the municipal district of Athens.MethodsA cross-sectional study, using stratified sampling was performed. Immunization history was obtained from vaccination booklets. Demographic and socioeconomic data were obtained from school registries and telephone interviews. Vaccination rates were estimated by sample weighted proportions while associations between complete and age-appropriate immunization and potential determinants by logistic regression analysis.ResultsA total of 731 children (mean age: 46, median: 48, range: 10–65 months) were included. Overall immunization coverage with traditional vaccines (DTP, polio, Hib, HBV, 1st dose MMR) was satisfactory, exceeding 90%, but the administration of booster doses was delayed (range: 33.7- 97.4%, at 60 months of age). Complete vaccination rates were lower for new vaccines (Men C, PCV7, varicella, hepatitis A), ranging between 61-92%. In addition, a significant delay in timely administration of Men C, PCV7, as well as HBV was noted (22.9%, 16.0% and 27.7% at 12 months of age, respectively). Child’s age was strongly associated with incomplete vaccination with all vaccines (p< 0.001), while as immigrant status was a predictor of incomplete (p=0.034) and delayed vaccination (p<0.001) with traditional vaccines. Increasing household size and higher maternal education were negatively associated with the receipt of all and newly licensed vaccines, respectively (p=0.035).ConclusionsOur findings highlight the need to monitor uptake of new vaccines and improve age- appropriate administration of booster doses as well as early vaccination against hepatitis B. Immigrant status, increased household size and high maternal education may warrant targeted intervention.

A cross-sectional vaccination coverage study in preschool children attending nurseries-kindergartens: Implications on economic crisis effect

“…Rates remained very high for all 4 doses, both for the general population and immigrant children. 13,14,20,21 Coverage with 3 DTP doses by 12 months (95.7%), a key WHO indicator, was similar to the estimated coverage for the European region of WHO in 2013. 22 Delay in completing 4 doses by 24 months, although lower than in 2012, is possibly due to the increased number of vaccines in the second year of life.…”

“…1A), in concordance with local data and suboptimal coverage rates in other countries. 13,14,20,21,28,29 The delay is attributable to the overcrowded vaccination schedule in the first 6 months as well as the nonuniversal use of hexavalent vaccines. The use of combined vaccines has potential benefits, including reduced number of patient visits, fewer complications associated with multiple injections, decreased stocking and visit costs, and lowering the risk of delayed or missed vaccinations.…”

“…However, vaccination rates are much higher than those in 2 recent local studies in the Athens area and a prospective one in Athens and Viotia. 20,21,32 Apart from the overcrowding of the NIP, reduced coverage with the fourth dose and delayed vaccination completion in the general population and especially immigrant children may be linked to an increasing number of uninsured children during the socioeconomic crisis and the relatively high vaccine cost. Similar observations of non adherence to recommended PCV schedules have been made in other European countries and may impact protection against pneumococcal disease.…”

“…[15][16][17][18] In addition, socioeconomic factors, parental perceptions and concerns regarding vaccine safety along with the growing complexity of immunization schedules undermine adherence to the NIP. [19][20][21] The study aimed to assess full and timely vaccination coverage among preschool children attending nurseries-kindergartens (N-K) nationwide and the socioeconomic crisis impact on it.…”

Polio Vaccine; Inactivated Polio Vaccine Intervention and Polio Eradication Campaign; Knowledge and Attitude of Young Doctors

“…Research conducted in Greece revealed that IPV was best accepted by caregivers in countries by repeated strong, clear and simple messages regarding the effectiveness of the new vaccines for caregivers. 14 In our study one interesting finding was that a quarter among the participants had attended polio surveillance training workshop in last 2 years and participated in polio National Immunization days. Increasing experience and attending training were insignificantly associated with knowledge of doctors about Polio Vaccine.…”