Vaccination Timeliness in Children Under India’s Universal Immunization Program

Shrivastwa, Nijika; Gillespie, Brenda W.; Lepkowski, James M.; Boulton, Matthew L.

doi:10.1097/inf.0000000000001223

Cited by 24 publications

(21 citation statements)

References 26 publications

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“…The low timeliness in the uptake of recommended vaccines within schedule could be an explanation of the reported suspected cases of vaccine preventable diseases recorded in this district and can be investigated to understand the association with low vaccination timeliness. Studies conducted in other settings have reported low timeliness of vaccines with the same trend observed in this study [34][35][36][37][38][39]. Distribution of determinants accounting for such vaccination delays vary according to development settings and contexts across countries [36,[38][39][40].…”

Section: Discussionsupporting

confidence: 79%

EPI immunization coverage, timeliness and dropout rate among children in a West Cameroon health district: a cross sectional study

Ateudjieu

Yakum²,

Goura³

et al. 2020

BMC Public Health

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Background: Monitoring of the expanded program on immunization's performance is not only limited to routine periodic reports but equally includes surveys. Based on unpublished national EPI surveillance data from the past 5 years in Cameroon, the Foumban health district has reported a high number of vaccine preventable disease suspected cases. Contradictory information on the immunization coverage in this district exists from both administrative data and published literature. As a result, the objective of this study was to estimate the immunization coverage and dropout rate in age group 12-23 months and timeliness in age group 0-59 months among children in Foumban Health District (Cameroon), in 2018. Method: This was a descriptive cross-sectional study targeting randomly selected children aged 0-59 months from Foumban health district. Data were collected by trained and supervised surveyors using a pretested questionnaire to describe the immunization coverage, timeliness and dropout rate in eighty clusters of about thirty buildings selected by stratified random sampling in July 2018. Results: In total, 80 clusters covering 2121 buildings were selected and all were reached (100%). A total of 1549 (81.2%) households accepted to participate in the survey and 1430 children aged 0-59 months including 294 (20.6%) aged 12-23 months were enrolled into the study. Of these 1430 children, 427 [29.9 (27.4-32.2)%] aged 0-59 months were vaccinated with evidence. In the age group 12-23 months, the immunization coverage with evidence of BCG, DPT-Hi + Hb 3 and measles/rubella were 28.6(23.4-33.9)%, 22.8 (18.1-27.6)% and 14.3 (10.3-18.1)% respectively. Within age group 0-59 months; the proportion of children who missed their vaccination appointments increased from 23.3 to 31.7% for the vaccine planned at birth (BCG) and last vaccine planned (Measles/Rubella) for the EPI program respectively. In age group 12-23 months; the specific (DPT-Hi + Hb1-3) and general (BCG-Measles/Rubella) dropout rates of vaccination with evidence were 14.1 and 50.0% respectively. Conclusion: Documented immunization coverage, dropout rate and timeliness in Foumban Health district are lower than that targeted by the Cameroon EPI. Competent health authorities have to take necessary actions to ensure the implementation of national guidelines with regards to children access to immunization. Also, studies have to be conducted to identify determinants of low immunization coverage and delays in immunization schedules as well as high dropout rates.

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Section: Discussionsupporting

confidence: 79%

EPI immunization coverage, timeliness and dropout rate among children in a West Cameroon health district: a cross sectional study

Ateudjieu

Yakum²,

Goura³

et al. 2020

BMC Public Health

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“…In this study, the proportion of children receiving DTaP doses on time decreased as the schedule progressed, consistent with previous studies [12,15,26,27]. Because this vaccine requires a minimum interval of four weeks between the first three doses, and six months between the third and fourth dose, children late for those first doses will remain late for subsequent doses, and may be more likely to not receive the fourth dose by the age of 24 months, even with adequate time for catch-up [28].…”

Section: Discussionsupporting

confidence: 92%

Timeliness of childhood vaccination in the Federated States of Micronesia

Tippins

Leidner

Meghani

et al. 2017

Vaccine

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Background: Vaccination coverage is typically measured as the proportion of individuals who have received recommended vaccine doses by the date of assessment. This approach does not provide information about receipt of vaccines by the recommended age, which is critical for ensuring optimal protection from vaccine-preventable diseases (VPDs). Objective: To assess vaccination timeliness in the Federated States of Micronesia (FSM), and the projected impact of suboptimal vaccination in the event of an outbreak. Methods: Timeliness of the 4th dose of diphtheria, tetanus, and acellular pertussis vaccine (DTaP) and 1st dose of measles, mumps, and rubella vaccine (MMR) among children 24–35 months was assessed in FSM. Both doses are defined as on time if administered from 361 through 395 days in age. Timeliness was calculated by one-way frequency analysis, and dose delays, measured in months after recommended age, were described using inverse Kaplan-Meier analysis. A time-series susceptible-exposed-infected-recov ery (TSEIR) model simulated measles outbreaks in populations with on time and late vaccination. Results: Total coverage for the 4th dose of DTaP ranged from 36.6% to 98.8%, and for the 1st dose of MMR ranged from 80.9% to 100.0% across FSM states. On time coverage for the 4th dose of DTaP ranged from 3.2% to 52.3%, and for the 1st dose of MMR ranged from 21.1% to 66.9%. Maximum and median dose delays beyond the recommended age varied by state. TSEIR models predicted 10.8–13.7% increases in measles cases during an outbreak based on these delays. Conclusions: In each of the FSM states, a substantial proportion of children received DTaP and MMR doses outside the recommended timeframe. Children who receive vaccinations later than recommended remain susceptible to VPDs during the period they remain unvaccinated, which may have a substantial impact on health systems during an outbreak. Immunization programs should consider vaccination timeliness in addition to coverage as a measure of susceptibility to VPDs in young children.

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“…A coverage rate of 90% at a later age may not be sufficient to assure the adequate protection of children, especially for the VPDs with high basic reproduction numbers (such as measles and pertussis), although it has been indicated that rising immunization coverage would increase the timeliness of vaccination simultaneously [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Timeliness of Childhood Primary Immunization and Risk Factors Related with Delays: Evidence from the 2014 Zhejiang Provincial Vaccination Coverage Survey

Chen

2017

IJERPH

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Background: this study aimed to assess both immunization coverage and timeliness, as well as reasons for non-vaccination, and identity the risk factors of delayed immunization, for the vaccines scheduled during the first year of life, in Zhejiang province, east China. Methods: A cluster survey among children aged 24-35 months was conducted. Demographic information and socio-economic characteristics of the selected child, the mother, and the household were collected. Immunization data were transcribed from immunization cards. Timeliness was assessed with Kaplan-Meier analysis for each vaccine given before 12 months of age, based on the time frame stipulated by the expanded program on immunization of China. Cox proportional hazard regression was applied to identify risk factors of delayed immunization. Results: A total of 2772 eligible children were surveyed. The age-appropriate coverage ranged from 25.4% (95% CI: 23.7-27.0%) for Bacillus Calmette-Guerin (BCG) to 91.3% (95% CI: 90.2-92.3%) for the first dose of oral poliomyelitis vaccine (OPV1). The most frequent reason for non-vaccination was parent's fear of adverse events of immunization. Delayed immunizations were associated with mother having a lower education level, mother having a job, delivery at home, increasing number of children per household, and having a lower household income. Conclusions: Although the timeliness of immunization has improved since 2011, necessary steps are still needed to achieve further improvement. Timeliness of immunization should be considered as another important indicator of expanded program on immunization (EPI) performance. Future interventions on vaccination coverage should take into consideration demographic and socio-economic risk factors identified in this study. The importance of adhering to the recommended schedule should be explained to parents.

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Vaccination Timeliness in Children Under India’s Universal Immunization Program

Abstract: Lack of timely administration of key childhood vaccines, especially DPT3 and MCV, remains a major challenge in India and likely contributes to the significant burden of vaccine preventable disease-related morbidity and mortality in children.

Cited by 24 publications

References 26 publications

EPI immunization coverage, timeliness and dropout rate among children in a West Cameroon health district: a cross sectional study

EPI immunization coverage, timeliness and dropout rate among children in a West Cameroon health district: a cross sectional study

Timeliness of childhood vaccination in the Federated States of Micronesia

Timeliness of Childhood Primary Immunization and Risk Factors Related with Delays: Evidence from the 2014 Zhejiang Provincial Vaccination Coverage Survey

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