Local measles vaccination gaps in Germany and the role of vaccination providers

Abstract

BackgroundMeasles elimination in Europe is an urgent public health goal, yet despite the efforts of its member states, vaccination gaps and outbreaks occur. This study explores local vaccination heterogeneity in kindergartens and municipalities of a German county.MethodsData on children from mandatory school enrolment examinations in 2014/15 in Reutlingen county were used. Children with unknown vaccination status were either removed from the analysis (best case) or assumed to be unvaccinated (worst case). Vaccination data were translated into expected outbreak probabilities. Physicians and kindergartens with statistically outstanding numbers of under-vaccinated children were identified.ResultsA total of 170 (7.1%) of 2388 children did not provide a vaccination certificate; 88.3% (worst case) or 95.1% (best case) were vaccinated at least once against measles. Based on the worst case vaccination coverage, <10% of municipalities and <20% of kindergartens were sufficiently vaccinated to be protected against outbreaks. Excluding children without a vaccination certificate (best case) leads to over-optimistic views: the overall outbreak probability in case of a measles introduction lies between 39.5% (best case) and 73.0% (worst case). Four paediatricians were identified who accounted for 41 of 109 unvaccinated children and for 47 of 138 incomplete vaccinations; GPs showed significantly higher rates of missing vaccination certificates and unvaccinated or under-vaccinated children than paediatricians.ConclusionsMissing vaccination certificates pose a severe problem regarding the interpretability of vaccination data. Although the coverage for at least one measles vaccination is higher in the studied county than in most South German counties and higher than the European average, many severe and potentially dangerous vaccination gaps occur locally. If other federal German states and EU countries show similar vaccination variability, measles elimination may not succeed in Europe.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4663-3) contains supplementary material, which is available to authorized users.

Challenges facing vaccinators in the 21stcentury: results from a focus group qualitative study

“…In Germany, vaccines are given by private physicians or general practitioners in their offices. 25,26 Vaccines recommended by the German Standing Vaccination Committee (STIKO) are available free of charge through the statutory insurance policy. 24 In India, most vaccines recommended by the Indian Academy of Pediatrics (IAP) are provided free of charge.…”

The impact of parents' health behaviours on their preferences regarding vaccinations

“…At present, many parents forego vaccinations. Negative opinions that undermine the effectiveness and safety of preventive vaccinations as a form of infection prevention are widely disseminated [26].…”

“…On online portals and forums, there is information regarding the harmfulness of preventive vaccinations, complications arising from vaccinations, and the impact of mercury on the emergence of autism, autoimmune diseases, or weakening of the body's resistance. Anti-vaccine content is also spread among those who use homeopathic and natural medicine [26]. A negative example of the dissemination of false information regarding vaccinations was the investigation by Wakefield, who put forward the concept of a relationship between the MMR vaccination and autism [27].…”

Contemporary vaccination policy in the European Union: tensions and dilemmas

“…A comparison between the federal states reveals a mixed picture. For historical reasons, we find a higher degree of institutionalization under the public health service in East German federal states, and that results in higher rates of vaccination [22,23].…”

“…This lack of formalization had a negative effect on vaccination uptake. Although reimbursement is now guaranteed, "severe and potentially dangerous vaccination gaps occur locally" [22] as studies have shown with regard to measles. A comparison between the federal states reveals a mixed picture.…”