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      Age appropriateness of vaccination with recommended childhood vaccines in Sri Lanka

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          Abstract

          Vaccination status is conventionally measured by up-to-date coverage. This method does not take in to account whether the vaccines were received at the correct age and interval which is essential for optimal disease protection. Sri Lanka – a lower middle-income country in the Indian Ocean, has previously presented with high vaccination coverage for all childhood vaccines. However, few studies investigating timeliness of vaccinations have until now been carried out in Sri Lanka.

          Aim: This study was carried out to investigate the individual coverage and age appropriateness of vaccination, in two different demographic settings in Anuradhapura district, Sri Lanka. The study of cross-sectional descriptive design included 633 children born in 2011. Public Health Midwives kept hand-written documentation of the birth and vaccination dates on each child in her geographic area. Vaccination ages were then compared to the timelines of vaccination provided by the Epidemiology Unit of Sri Lanka.

          The vaccination coverage for all antigens was 97.5% (94.2–99.7%) at age 5–6 years. Timeliness of doses was between 65.0 and 88.6 % (median 80.7%; 65.0–88.6) and significantly lower in the urban population compared to the rural. The present study shows that the vaccine coverage in both urban and rural areas in Sri Lanka was high and that the timeliness predominantly followed national recommendations.

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          Inequalities in full immunization coverage: trends in low- and middle-income countries

          María Restrepo-Méndez, Aluisio Barros, Kerry LM Wong … (2016)
          Abstract Objective To investigate disparities in full immunization coverage across and within 86 low- and middle-income countries. Methods In May 2015, using data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we investigated inequalities in full immunization coverage – i.e. one dose of bacille Calmette-Guérin vaccine, one dose of measles vaccine, three doses of vaccine against diphtheria, pertussis and tetanus and three doses of polio vaccine – in 86 low- or middle-income countries. We then investigated temporal trends in the level and inequality of such coverage in eight of the countries. Findings In each of the World Health Organization’s regions, it appeared that about 56–69% of eligible children in the low- and middle-income countries had received full immunization. However, within each region, the mean recorded level of such coverage varied greatly. In the African Region, for example, it varied from 11.4% in Chad to 90.3% in Rwanda. We detected pro-rich inequality in such coverage in 45 of the 83 countries for which the relevant data were available and pro-urban inequality in 35 of the 86 study countries. Among the countries in which we investigated coverage trends, Madagascar and Mozambique appeared to have made the greatest progress in improving levels of full immunization coverage over the last two decades, particularly among the poorest quintiles of their populations. Conclusion Most low- and middle-income countries are affected by pro-rich and pro-urban inequalities in full immunization coverage that are not apparent when only national mean values of such coverage are reported.
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            Timeliness of childhood vaccinations in the United States: days undervaccinated and number of vaccines delayed.

            K. Shaw, Mary M McCauley, Elizabeth Luman … (2005)
            Only 18% of children in the United States receive all vaccinations at the recommended times or acceptably early. To determine the extent of delay of vaccination during the first 24 months of life. The 2003 National Immunization Survey was conducted by random-digit dialing of households and mailings to vaccination providers to estimate vaccination coverage rates for US children aged 19 to 35 months. Data for this study were limited to 14,810 children aged 24 to 35 months. Cumulative days undervaccinated during the first 24 months of life for each of 6 vaccines (diphtheria and tetanus toxoids and acellular pertussis; poliovirus; measles, mumps, and rubella; Haemophilus influenzae type b; hepatitis B; and varicella) and all vaccines combined, number of late vaccines, and risk factors for severe delay of vaccination. Children were undervaccinated a mean of 172 days (median, 126 days) for all vaccines combined during their first 24 months of life. Approximately 34% were undervaccinated for less than 1 month and 29% for 1 to 6 months, while 37% were undervaccinated for more than 6 months. Vaccine-specific undervaccination of more than 6 months ranged from 9% for poliovirus vaccine to 21% for Haemophilus influenzae type b vaccine. An estimated 25% of children had delays in receipt of 4 or more of the 6 vaccines. Approximately 21% of children were severely delayed (undervaccinated for more than 6 months and for > or vaccines). Factors associated with severe delay included having a mother who was unmarried or who did not have a college degree, living in a household with 2 or more children, being non-Hispanic black, having 2 or more vaccination providers, and using public vaccination provider(s). More than 1 in 3 children were undervaccinated for more than 6 months during their first 24 months of life and 1 in 4 children were delayed for at least 4 vaccines. Standard measures of vaccination coverage mask substantial shortfalls in ensuring that recommendations are followed regarding age at vaccination throughout the first 24 months of life.
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              Is vaccination coverage a good indicator of age-appropriate vaccination? A prospective study from Uganda.

              Lars Fadnes, Victoria Nankabirwa, Halvor Sommerfelt … (2011)
              Timely vaccination is important to protect children from common infectious diseases. We assessed vaccination timeliness and vaccination coverage as well as coverage of vitamin A supplementation in a Ugandan setting. This study used vaccination information gathered during a cluster-randomized trial promoting exclusive breastfeeding in Eastern Uganda between 2006 and 2008 (ClinicalTrials.gov no. NCT00397150). Five visits were carried out from birth up to 2 years of age (median follow-up time 1.5 years), and 765 children were included in the analysis. We used Kaplan-Meier time-to-event analysis to describe vaccination coverage and timeliness. Vaccination coverage at the end of follow-up was above 90% for all vaccines assessed individually that were part of the Expanded Program on Immunization (EPI), except for the measles vaccine which had 80% coverage (95%CI 76-83). In total, 75% (95%CI 71-79) had received all the recommended vaccines at the end of follow-up. Timely vaccination according to the recommendations of the Ugandan EPI was less common, ranging from 56% for the measles vaccine (95%CI 54-57) to 89% for the Bacillus Calmette-Guérin (BCG) vaccine (95%CI 86-91). Only 18% of the children received all vaccines within the recommended time ranges (95%CI 15-22). The children of mothers with higher education had more timely vaccination. The coverage for vitamin A supplementation at end of follow-up was 84% (95%CI 81-87). Vaccination coverage was reasonably high, but often not timely. Many children were unprotected for several months despite being vaccinated at the end of follow-up. There is a need for continued efforts to optimise vaccination timeliness. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Hanna Lindqvist
                Birger Trollfors
                Journal
                Journal ID (nlm-ta): Vaccine X
                Journal ID (iso-abbrev): Vaccine X
                Title: Vaccine: X
                Publisher: Elsevier
                ISSN (Electronic): 2590-1362
                Publication date PMC-release: 01 April 2019
                Publication date Collection: 09 August 2019
                Publication date (Electronic): 01 April 2019
                Volume: 2
                Electronic Location Identifier: 100016
                Affiliations
                [a ]Gothenburg University, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden
                [b ]Faculty of Applied Sciences, Rajarata University of Sri Lanka, Sri Lanka
                [c ]Department of Pediatrics, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden
                Author notes
                [* ]Corresponding author. hanna.lindqvist@ 123456vgregion.se
                Article
                Publisher ID: S2590-1362(19)30017-8 Publisher ID: 100016
                DOI: 10.1016/j.jvacx.2019.100016
                PMC ID: 6668219
                PubMed ID: 31384739
                SO-VID: 7e4e03e6-6879-40a8-a43e-8974f7314bb3
                Copyright © © 2019 The Author(s)
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 25 September 2018
                Date revision received : 9 February 2019
                Date accepted : 20 February 2019
                Categories
                Subject: Regular paper

                Keywords: vaccine coverage,age appropriateness,sri lanka
                Data availability:
                Keywords: vaccine coverage, age appropriateness, sri lanka

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