Missed Opportunities for Measles, Mumps, and Rubella (MMR) Immunization in Mesoamerica: Potential Impact on Coverage and Days at Risk

Abstract

BackgroundRecent outbreaks of measles in the Americas have received news and popular attention, noting the importance of vaccination to population health. To estimate the potential increase in immunization coverage and reduction in days at risk if every opportunity to vaccinate a child was used, we analyzed vaccination histories of children 11–59 months of age from large household surveys in Mesoamerica.MethodsOur study included 22,234 children aged less than 59 months in El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama. Child vaccination cards were used to calculate coverage of measles, mumps, and rubella (MMR) and to compute the number of days lived at risk. A child had a missed opportunity for vaccination if their card indicated a visit for vaccinations at which the child was not caught up to schedule for MMR. A Cox proportional hazards model was used to compute the hazard ratio associated with the reduction in days at risk, accounting for missed opportunities.ResultsEl Salvador had the highest proportion of children with a vaccine card (91.2%) while Nicaragua had the lowest (76.5%). Card MMR coverage ranged from 44.6% in Mexico to 79.6% in Honduras while potential coverage accounting for missed opportunities ranged from 70.8% in Nicaragua to 96.4% in El Salvador. Younger children were less likely to have a missed opportunity. In Panama, children from households with higher expenditure were more likely to have a missed opportunity for MMR vaccination compared to the poorest (OR 1.62, 95% CI: 1.06–2.47). In Nicaragua, compared to children of mothers with no education, children of mothers with primary education and secondary education were less likely to have a missed opportunity (OR 0.46, 95% CI: 0.24–0.88 and OR 0.25, 95% CI: 0.096–0.65, respectively). Mean days at risk for MMR ranged from 158 in Panama to 483 in Mexico while potential days at risk ranged from 92 in Panama to 239 in El Salvador.ConclusionsOur study found high levels of missed opportunities for immunizing children in Mesoamerica. Our findings cause great concern, as they indicate that families are bringing their children to health facilities, but these children are not receiving all appropriate vaccinations during visits. This points to serious problems in current immunization practices and protocols in poor areas in Mesoamerica. Our study calls for programs to ensure that vaccines are available and that health professionals use every opportunity to vaccinate a child.

Reliability and validity of a survey to identify vaccine hesitancy among parents in Changxing county, Zhejiang province

“…It was consistent with the previous reports from home and abroad and it suggested that the higher education level dose not necessarily correlate with the positive health behaviour related to immunization. [17][18][19][20][21] The possible explanations included: first, parents with higher education background were more likely to have a career and they might have less time to spare for their child's immunization. Second, parent with a higher education level might had an increased concern on the quality and safety as important measures for vaccines, leading to a lower rate or an untimely of vaccination uptake.…”

“…For example, 22.1% of the participants stated that they had delayed their children's immunization for reasons other than illness or allergy, which was higher than previous studies. Gust 22 found 13% of the surveyed parents had delayed a vaccination for their child in a 2003-2004 national survey and Mokdad 20 found 14% of the surveyed parents had delayed childhood immunizations for reasons other than their child being ill. Additionally, 24.9% of the surveyed parents would refuse to have their children vaccinated with all the recommended vaccinations. It was higher than the results Freed 1 and Gust 22 found, which were only 12% and 6%, respectively.…”

“…We found the concern of the vaccine efficacy was associated with the under-immunization, which was similar to the previous studies in other settings. These studies found parents who were not convinced of the efficacy of vaccines were more likely to consider claiming an exemption from vaccination for their children 19,20,28,29 .…”

Spatial, temporal, and spatiotemporal analysis of mumps in Guangxi Province, China, 2005–2016

“…Given the limitations of medical resources and economic conditions in different regions, the coverage of vaccination is low, especially in the underdeveloped province of Guangxi. An effective antibody barrier did not form in the crowd and susceptible populations continued to accumulate, thereby leading to a cyclical outbreak of mumps [ 29 ]. MMR was included in the EPI by the Chinese government in 2008.…”

Burden of disease in francophone Africa, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

“…It has been shown that effective coverage of vaccines is often lower than the reported crude coverage due to problems with health information systems and cold chains in Africa and other parts of the world. 36 Additionally, the Central African Republic and Congo are among the top ten high-burden countries for tuberculosis based on severity of disease burden (incidence per capita). 37 Conventionally, and like everywhere in Africa, planning for health in francophone Africa has been focused on communicable diseases.…”