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      Improved coverage and timing of childhood vaccinations in two post-Soviet countries, Armenia and Kyrgyzstan

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          Abstract

          Background

          Timing of childhood vaccinations has received close attention in many countries. Little is known about the trends in correctly timed vaccination in former Soviet countries. We examined trends in vaccination coverage and correct timing of vaccination in two post-Soviet countries, Armenia and Kyrgyzstan, and analyzed factors associated with delayed vaccinations.

          Methods

          We used data from the Demographic and Health Surveys; the surveys were conducted in 2000 ( n = 1726), 2005 ( n = 1430) and 2010 ( n = 1473) in Armenia and in 1997 ( n = 1127) and 2012 ( n = 4363) in Kyrgyzstan. We applied the Kaplan-Meier method to estimate age-specific vaccination coverage with diphtheria, tetanus and pertussis (DTP) vaccine and a measles-containing vaccine (MCV). A Cox proportional hazard regression with shared frailty was used to examine factors associated with delayed vaccinations.

          Results

          Vaccination coverage for all three doses of the DTP vaccine increased in Armenia from 92 % in 2000 to 96 % in 2010. In Kyrgyzstan, DTP coverage was 96 % and 97 % in 1997 and 2012, respectively. Vaccination coverage for MCV increased from 89 % (Armenia, 2000) and 93 % (Kyrgyzstan, 1997) to 97 % (Armenia, 2010) and 98 % (Kyrgyzstan, 2012). The proportion of children with correctly timed vaccinations increased over time for all examined vaccinations in both countries. For example, the proportion of children in Armenia with correctly timed first DTP dose (DTP1) increased from 46 % (2000) to 66 % (2010). In Kyrgyzstan, the proportion of correctly timed DTP1 increased from 75 % (1997) to 87 % (2012). In Armenia, delays in the third DTP dose (DTP3) and MCV vaccinations were less likely to occur in the capital, whereas in Kyrgyzstan DTP3 and MCV start was delayed in the capital compared to other regions of the country. Also, in Armenia living in urban areas was associated with delayed vaccinations.

          Conclusions

          Vaccination coverage and timing of vaccination improved over the last years in both countries. Further efforts are needed to reduce regional differences in timely vaccinations.

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          Most cited references 31

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          Timeliness of childhood vaccinations in the United States: days undervaccinated and number of vaccines delayed.

          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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            The 21st century health challenge of slums and cities.

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              Timeliness of childhood vaccinations in 31 low and middle-income countries.

              This study assessed the extent of delays in childhood vaccinations and examined sociodemographic correlates of delayed and missing vaccinations. Datasets from the 2005-7 Multiple Indicator Cluster Surveys from 31 countries were used. Information on vaccinations was based on vaccination cards. Survival analysis was applied to assess age-specific vaccination rates, and multilevel logistic regression analysis was used to assess factors associated with delayed and missing vaccinations. The median vaccination coverage across all countries varied from 91% measles-containing vaccine (MCV) to 98% bacille Calmette-Guérin vaccine (BCG). The median fraction of timely administered vaccinations was 65% (range 14.5-97.2%) for BCG, 67% (11.6-89.3%) for the first dose of vaccine against diphtheria, tetanus and pertussis (DTP1), 41% (10.8-82.1%) for DTP3, 68% (29.7-90.3%) for the first dose of polio vaccine (polio1), 38% (10.5-81.0%) for polio3 and 51% (22.3-91.1%) for MCV. The median of the median delays across all countries was 2.1 weeks (IQR 0.9-3.0) for BCG, 2.4 weeks (1.5-3.1) for DTP1; 6.3 weeks (3.3-9.0) for DTP3; 2.0 weeks (1.3-3.1) for polio1, 6.6 weeks (4.3-9.3) for polio3 and 4.1 weeks (2.5-5.8) for MCV. A higher number of children in households and lower socioeconomic status were associated with delayed and missing vaccinations; however, the effects of socioeconomic gradient varied by country. Most countries achieved high up-to-date vaccination coverage. However, there were substantial vaccination delays. Collecting information on the timeliness of vaccination in national surveillance systems will provide a more complete view of vaccination coverage. Missing and delayed vaccinations can be addressed jointly in prevention programmes.
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                Author and article information

                Contributors
                +49 (0) 228 433302 944 , aparna.schweitzer@dzne.de
                gerard.krause@helmholtz-hzi.de
                frank.pessler@twincore.de
                manas.akmatov@twincore.de
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                19 August 2015
                19 August 2015
                2015
                : 15
                Affiliations
                [ ]Helmholtz Centre for Infection Research, Braunschweig, Germany
                [ ]Hannover Medical School, Hannover, Germany
                [ ]TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany
                Article
                2091
                10.1186/s12889-015-2091-9
                4545703
                26285702
                © Schweitzer et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

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