Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study

Abstract

BackgroundLaunched in 1974, the Expanded Program on Immunization (EPI) is estimated to prevent two-three million deaths annually from polio, diphtheria, tuberculosis, pertussis, measles, and tetanus. Additional lives could be saved through better understanding what influences adherence to the EPI schedule in specific settings.MethodsThe Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study followed cohorts in eight sites in South Asia, Africa, and South America and monitored vaccine receipt over the first two years of life for the children enrolled in the study. Vaccination histories were obtained monthly from vaccination cards, local clinic records and/or caregiver reports. Vaccination histories were compared against the prescribed EPI schedules for each country, and coverage rates were examined in relation to the timing of vaccination. The influence of socioeconomic factors on vaccine timing and coverage was also considered.ResultsCoverage rates for EPI vaccines varied between sites and by type of vaccine; overall, coverage was highest in the Nepal and Bangladesh sites and lowest in the Tanzania and Brazil sites. Bacillus Calmette-Guérin coverage was high across all sites, 87–100%, whereas measles vaccination rates ranged widely, 73–100%. Significant delays between the scheduled administration age and actual vaccination date were present in all sites, especially for measles vaccine where less than 40% were administered on schedule. A range of socioeconomic factors were significantly associated with vaccination status in study children but these results were largely site-specific.ConclusionsOur findings highlight the need to improve measles vaccination rates and reduce delayed vaccination to achieve EPI targets related to the establishment of herd immunity and reduction in disease transmission.

Coverage, Timelines, and Determinants of Incomplete Immunization in Bangladesh

“…Though it is crucial for public health aspects in Bangladesh, limited studies are available to generate evidence about the socio-demographic factors associated with incomplete and untimely vaccination. Furthermore, the available studies focus on specified geographical administrative settings rather than the nation-wide scale [ 13 , 14 ]. However, a few studies have been conducted in neighboring countries [ 15 , 16 , 17 ], and thus our study may generate evidence that could also be useful for comparison with other settings and to address the knowledge gap.…”

Comparison of two schedules of two-dose priming with the ten-valent pneumococcal conjugate vaccine in Nepalese children: an open-label, randomised non-inferiority controlled trial

“…In Nepal the trial findings are likely to correlate well with observations in the community with the WHO estimating coverage of the third pentavalent vaccine (at 14 weeks of age) to be 87% in 2016, whilst one study reports adherence to the EPI for delivery of the first pentavalent vaccine dose (at 6 weeks of age) to be almost 80%. 27,28 How well the community may adhere to the 6+14 or the 6+10 PCV10 schedule is difficult to predict from this trial alone, and further study into community and health care provider preferences are needed to address this question. Limitations of this trial include the open-label design, the timeframe of blood sampling, multiple comparisons, and single-centre design.…”

Analysis of the effects of individual- and community- level predictors on migrant children's primary immunization in Yiwu city, east China

“…Vaccination has been indicated as one of the most cost-effective public health interventions worldwide, through which many serious childhood infectious diseases have been prevented, eliminated or eradicated. 2 However, vaccination may become more effective if children would be given an opportunity to receive the full course of the recommended vaccine doses. For this particular study, 412 children nested 57 clusters were included in the analyses.…”