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Koc Ö, Van Damme P, Busschots D, Bielen R, Forier A, Nevens F, Robaeys G. Acute hepatitis B notification rates in Flanders, Belgium, 2009 to 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 31362809 PMCID: PMC6668289 DOI: 10.2807/1560-7917.es.2019.24.30.1900064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Belgium is a low-endemic country for hepatitis B. Universal hepatitis B vaccination in infants with catch-up in the age cohort of 10–13 year-olds began in 1999. Aims Our objective was to evaluate the effect of prevention and control strategies on acute hepatitis B notification rates in Flanders (Belgium) from 2009 to 2017. Methods This observational study collected demographic data and risk factors for acute hepatitis B from mandatory notifications to the Agency for Care and Health. Results In Flanders, acute hepatitis B notification rates per 100,000 population decreased from 1.6 in 2009 to 0.7 in 2017. These rates declined in all age groups: 0–4-year-olds: 0.6 to 0.0, 5–14-year-olds: 0.2 to 0.0, 15–24-year-olds: 0.8 to 0.7, 25–34-year-olds: 3.4 to 1.1 and ≥ 35-year-olds: 1.59 to 0.7. There was also a downward trend in acute hepatitis B notification rates in native Belgians and first-generation migrants. Among 15–24-year-olds and 25–34-year-olds, a possible reversal of the decreasing trend was observed in 2016 and 2015, respectively. Among 548 acute hepatitis B cases, the main route of transmission was sexual activity (30.7%), and the pattern of transmission routes over time showed an increasing proportion of sexual transmission in men who have sex with men (MSM) after 2014. During the period from 2009 to 2017, five mother-to-child transmissions were reported. Conclusions Prevention and control strategies were effective in reducing the acute hepatitis B notification rate. However, stronger prevention and control measures are needed in adult risk groups, particularly MSM.
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Affiliation(s)
- Özgür Koc
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Pierre Van Damme
- Vaccine and Infectious Disease Institute, Centre for the Evaluation of Vaccination, Antwerp University, Wilrijk, Belgium
| | - Dana Busschots
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Rob Bielen
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Anmarie Forier
- Department of Infectious Disease Control, Agency for Care and Health, Limburg, Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals KULeuven, Leuven, Belgium
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, University Hospitals KULeuven, Leuven, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
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Masserey Spicher V, Weiss MG. Policy and socio-cultural differences between cantons in Switzerland with high and low adolescent vaccination coverage for hepatitis B and HPV. Vaccine 2019; 37:7539-7546. [PMID: 31630937 DOI: 10.1016/j.vaccine.2019.09.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
Vaccination recommendations in Switzerland are national, but vaccine coverage varies greatly from one canton to another, particularly for vaccinations recommended in adolescence. To explain these differences, we studied vaccination practices and socio-cultural views from the vantage points of policy makers, healthcare providers and community adolescents and parents in 4 cantons with low (LVC) and 4 cantons with high (HVC) vaccination coverage for hepatitis B (HBV) and human papillomavirus (HPV) vaccines. In-depth semi-structured interviews were administered to a policy maker, a private practitioner and 4 to 7 community members (adolescents and parents of adolescents) from each of the 8 cantons. LVCs were notable for less government involvement in vaccination issues, more autonomy of municipalities for school health, lower density of pediatricians, less information about these vaccines, greater emphasis on individual rather than government responsibility for vaccinations and for anticipated community hesitancy. Doctors in HVCs more actively advocated for vaccines. Community views in HVCs were more collectivistic and reliant on schools as a source of information than in LVCs. In both groups, hesitancy and concerns about efficacy were greater for HPV than for HBV vaccine. Findings suggest more systematic involvement of health and school authorities will be appreciated by adolescents and their parents, and will improve vaccination coverage. Interventions focused only on community awareness and hesitancy are likely to be inadequate without efforts to reach policy makers and doctors.
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Affiliation(s)
- Virginie Masserey Spicher
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, P.O. Box, 4002 Basel, Switzerland; University of Basel, P.O. Box, 4001 Basel, Switzerland.
| | - Mitchell G Weiss
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, P.O. Box, 4002 Basel, Switzerland; University of Basel, P.O. Box, 4001 Basel, Switzerland.
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Arat A, Burström B, Östberg V, Hjern A. Social inequities in vaccination coverage among infants and pre-school children in Europe and Australia - a systematic review. BMC Public Health 2019; 19:290. [PMID: 30866881 PMCID: PMC6417277 DOI: 10.1186/s12889-019-6597-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Herd immunity levels of vaccine uptake are still not reached in some high-income countries, usually in countries with persisting social inequities in uptake. Previous studies have focused on factors within one health care system. This study takes a broader health care systems approach by reviewing the socioeconomic distribution of vaccination coverage on the national level in light of structural and organizational differences of primary care for children. METHODS A systematic literature review of socio-economic patterns of uptake of Measles-Mumps-Rubella (MMR) and/or Diphteria-Tetanus-Pertusis (DTP) in population based studies of children 0-5 years of age living in the 30 European Economic Area (EEA) or European Free Trade Association (EFTA) countries and Australia, was carried out using the PRISMA guidelines. The health care system in the countries in the study were categorized by degree of freedom of the primary care provider (hierarchical or non-hierarchical) and whether preventive services were provided in a separate organization (well-baby clinics). RESULTS The review identified 15 studies from 10 European countries and Australia that fulfilled the criteria. Although the heterogeneity of the socio-economic indicators did not allow for a conclusive meta-analysis, the study pointed towards lower levels of inequities in primary care models with well-baby clinics. In non-hierarchical primary care organizations that also lacked well-baby clinics, socioeconomic gaps in uptake were often found to be large. CONCLUSION This review indicates that structural and organizational aspects of health care systems for young children are important for equity in vaccine uptake.
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Affiliation(s)
- Arzu Arat
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Health Equity Studies, Karolinska Institutet/Stockholm University, SE-106 91 Stockholm, Sweden
| | - Bo Burström
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Viveca Östberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Anders Hjern
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Health Equity Studies, Karolinska Institutet/Stockholm University, SE-106 91 Stockholm, Sweden
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Parental Knowledge about Meningococcal Disease and Vaccination Uptake among 0⁻5 years Old Polish Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020265. [PMID: 30669259 PMCID: PMC6352148 DOI: 10.3390/ijerph16020265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/13/2019] [Accepted: 01/15/2019] [Indexed: 12/02/2022]
Abstract
In Poland, in addition to mandatory, free of charge vaccines, listed in the national immunization schedule, numerous self-paid vaccinations are recommended, including meningococcal vaccination (MV). To assess MV uptake among ≤5-year-old children and to evaluate parental knowledge and attitudes regarding invasive meningococcal disease (IMD). A cross-sectional study was conducted in 2018 among 350 parents (mean age: 32.3 years), attending three randomly selected primary care clinics in Szczecin region, Poland. Anonymous questionnaires were administered to the parents by researchers, present at the time the survey was conducted, to self-complete on a voluntary basis. Chi-square or Fisher’s exact for categorical and Mann–Whitney U test for continuous variables. Variables significantly (p < 0.05) associated with ‘good knowledge’ in the bivariate analysis were used to build a logistic regression model. It was found that the response rate was 93.4%, and MV uptake among children was 29.5%. The main knowledge sources were medical staff and media; 72.5% had ever received information about IMD. Only 18.8% of parents self-assessed their knowledge regarding IMD as good; 61.8% scored >50% in the knowledge test 58.9% knew the mode of transmission, 58.7% recognized the severity of meningitis, and 79.7% knew that bacterial meningitis is a vaccine-preventive disease. Knowledge regarding IMD was higher among parents with higher educational level (OR = 3.37; p = 0.01), from urban facilities (OR = 2.20; p = 0.02), who received previous information about IMD (OR = 2.85; p = 0.01) and self-assessed their knowledge as good (OR = 2.59; p = 0.04). Low MV coverage among children up to five years old and knowledge gaps about IMD call for awareness campaigns which may increase the coverage. Although educational interventions should cover all parents, those from provincial facilities, representing lower education level need special attention.
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Cao L, Zheng JS, Cao LS, Cui J, Duan MJ, Xiao QY. Factors influencing the routine immunization status of children aged 2-3 years in China. PLoS One 2018; 13:e0206566. [PMID: 30379911 PMCID: PMC6209328 DOI: 10.1371/journal.pone.0206566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 10/16/2018] [Indexed: 11/28/2022] Open
Abstract
Objectives To examine the factors associated with the routine immunization status of children aged 2–3 years in China for gaining a better understanding of the Expanded Program on Immunization and to provide evidence for formulating specific strategies to guide the allocation of health resources. Methods We analyzed data from 45095 children aged 2–3 years in the 2013 National Immunization Coverage Survey to identify the sociodemographic and provider-associated factors affecting the full immunization status of children. Univariate and multiple logistic regression analyses were performed. Results The immunization rate for children aged 2–3 years ranged from 95.9% (diphtheria and tetanus toxoid with pertussis vaccine, 4th dose) to 99.5% (Japanese encephalitis vaccine, 1st dose) and was 93.1% for full immunization. In terms of sociodemographic factors, male children [adjusted OR (AOR): 1.115; 95% confidence interval(CI):1.016–1.222], minority children (AOR: 1.632; 95% CI: 1.457–1.828), children of fathers with less than high school education (AOR: 1.577; 95% CI: 1.195–2.081), those born at home (AOR: 4.655; 95% CI: 3.771–5.746), those who immigrated from an adjacent county (AOR: 2.006; 95% CI: 1.581–2.546), and those living in urban-rural fringe areas (AOR: 1.807; 95% CI: 1.475–2.214) or mountainous areas (AOR: 1.615; 95% CI: 1.437–1.814) had significantly increased odds of not being fully immunized. In terms of provider-associated factors, administration of vaccines at home (AOR: 2.311; 95% CI: 1.316–4.059), household reminders (AOR: 2.292; 95% CI: 1.884–2.789), and travel time to vaccination providers of >40 minutes (AOR: 1.622; 95% CI: 1.309–2.010) were negatively associated with immunization rates. In addition, compared to 3-year-old years, 2-year-old children (AOR: 1.201; 95% CI: 1.094–1.318) were less likely to be fully immunized. Conclusions All included factors except maternal education level and distance from home to vaccination providers significantly affected immunization rates. Appropriate reminders and accessibility of immunization services played key roles in improving the immunization status. More attention to high-risk groups identified in this study may reduce the disparities in routine childhood immunization in China.
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Affiliation(s)
- Lei Cao
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: ,
| | - Jing-Shan Zheng
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ling-Sheng Cao
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jian Cui
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Meng-Juan Duan
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qi-You Xiao
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
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Homel J, Edwards B. Factors associated with delayed infant immunization in a nationally representative cohort study. Child Care Health Dev 2018; 44:583-591. [PMID: 29460321 DOI: 10.1111/cch.12560] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/15/2018] [Accepted: 01/29/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many children in developed countries do not receive recommended vaccines on time. However, knowledge about factors related to timeliness remains limited. Quantifying the relative impact of parental attitudes compared with socio-demographic factors for delayed immunization would inform policy responses. METHODS Participants in the nationally representative Longitudinal Study of Australian Children were matched with their vaccination histories in the Australian Childhood Immunisation Register (N = 4,121). Information about the children and their families were collected in face-to-face interviews in 2003-2004. We considered whether children had completed the primary course for each recommended antigen due by 6 months old. Children were categorized as either fully immunized, delayed, or totally non-immunized. The outcome was examined using logistic regression. Population attributable fractions were estimated for key predictors. RESULTS Delayed immunization was significantly associated with indicators of social disadvantage as well as parental disagreement with immunization. Attributable fractions for delayed immunization included lone motherhood (3.8%; 95% confidence interval CI [0.8, 6.7]), larger family size (39.5%; 95% CI [31.2, 46.8]), residential mobility (3.3%; 95% CI [0.1, 6.5]), lack of private hospital insurance (9.4%; 95% CI [0.7, 17.3]), a medical condition in the child (2.0%; 95% CI [0.2, 3.9]), and parental disagreement with immunization (2.1%; 95% CI [0.3, 3.9]). CONCLUSIONS Parental attitudes accounted for a relatively small percentage of delayed infant immunization. In contrast, many children who did not receive vaccines on time were characterized by social disadvantage, especially larger family size. Researchers and policy-makers should consider how to make timely immunization easier for busy parents.
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Affiliation(s)
- J Homel
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia
| | - B Edwards
- ANU Centre for Social Research and Methods, Australian National University, Canberra, ACT, Australia
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Can Flanders resist the measles outbreak? Assessing vaccination coverage in different age groups among Flemish residents. Epidemiol Infect 2018; 146:1043-1047. [PMID: 29716667 DOI: 10.1017/s0950268818000985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The Belgian strategic plan to eliminate measles contains several vaccination strategies including routine immunisation programmes and catch-up campaigns. A new expanded programme on immunisation-based survey (2016) assessed the uptake of the recommended measles-mumps-rubella (MMR) vaccine in three different cohorts: toddlers, adolescents and parents of toddlers. A two-stage cluster sampling technique was used to select 875 toddlers (age 18-24 months) and 1250 adolescents (born in 2000) from 107 municipalities in Flanders. After consent of the parent(s), 746 (85.2%) families of toddlers and 1012 (81.0%) families of adolescents were interviewed at home. Measles vaccination coverage was high at 18-24 months (96.2%) and 81.5% were vaccinated at recommended age. Toddlers who had two siblings or a non-working mother or changed vaccinator were more at risk for not being vaccinated. Coverage of the teenager dose reached 93.5% and was lower in adolescents with educational underachievement or whose mother was part-time working or with a non-Belgian background. Only 56.0% of mothers and 48.3% of fathers remembered having received at least one measles-containing vaccine. Although measles vaccination coverage in toddlers meets the required standards for elimination, administration of the teenager dose of MMR vaccine and parent compliance to the recent measles catch-up campaign in Flanders leave room for improvement.
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Maertens K, Braeckman T, Blaizot S, Theeten H, Roelants M, Hoppenbrouwers K, Leuridan E, Van Damme P, Vandermeulen C. Coverage of recommended vaccines during pregnancy in Flanders, Belgium. Fairly good but can we do better? Vaccine 2018; 36:2687-2693. [PMID: 29627238 DOI: 10.1016/j.vaccine.2018.03.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/08/2018] [Accepted: 03/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Flanders, Belgium, pertussis vaccination is recommended since 2013 and available free-of-charge in every pregnancy between 24 and 32 weeks of gestation. Influenza vaccination is recommended for more than 10 years with a co-payment system in the second or third trimester of pregnancy, when pregnancy coincides with the influenza season. This study aims to estimate the coverage of pertussis and influenza vaccination during pregnancy in 2016 and to determine predictors for missing vaccination. METHODS Postpartum women were visited at home for a vaccination coverage survey using an Expanded Program on Immunization (EPI)-based two-stage cluster sampling design. Predictors for missed vaccination were identified using a multiple logistic regression model. RESULTS Among 481 participating women, 69.3% were vaccinated against pertussis and 47.2% were vaccinated against influenza. Moreover, 65.3% of pertussis vaccine recipients and 96.9% of influenza vaccine recipients were vaccinated within the recommended gestational window. Surprisingly, among women who were completely informed (i.e. on disease-associated risks, maternal vaccination costs and recommendations), still 12.4% were unvaccinated against pertussis and 23.9% against influenza. In the final models, the only common predictor of missing maternal pertussis and influenza vaccination was multiparity. Significant predictors of maternal pertussis vaccination were family income (less likely if unknown or low (< €3000) than if moderate (€3001-€4000)) and hospital of delivery (less likely if >800 annual deliveries than <800). Significant predictors of maternal influenza vaccination, though with less straight-forward associations, were maternal ethnicity and educational level, involvement of a gynaecologist in pregnancy follow-up, and characteristics of the hospital of delivery. CONCLUSION In Flanders, more than two-third of pregnant women receives pertussis vaccination but less than half of them receives the influenza vaccine. Further improvement for both maternal vaccination programs can be achieved by targeting the underserved populations and diminishing vaccination hurdles.
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Affiliation(s)
- Kirsten Maertens
- Centre for the Evaluation of Vaccination, VAXINFECTIO, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Tessa Braeckman
- Centre for the Evaluation of Vaccination, VAXINFECTIO, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Stéphanie Blaizot
- Centre for Health Economics Research and Modelling Infectious Diseases, VAXINFECTIO, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination, VAXINFECTIO, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Mathieu Roelants
- Environment and Health, KU Leuven, Kapucijnenvoer 35 blok d, 3000 Leuven, Belgium
| | - Karel Hoppenbrouwers
- Environment and Health, KU Leuven, Kapucijnenvoer 35 blok d, 3000 Leuven, Belgium
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination, VAXINFECTIO, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, VAXINFECTIO, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Corinne Vandermeulen
- Leuven University Vaccinology Center, KU Leuven, Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
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Potential Impact of Changes in the Schedule for Primary Diphtheria-Tetanus Toxoids-Pertussis Immunization as Control Strategy for Pertussis. Pediatr Infect Dis J 2018; 37:e36-e42. [PMID: 28859017 DOI: 10.1097/inf.0000000000001752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pertussis is a vaccine-preventable respiratory disease that may cause death mainly in infants. The schedules for primary pertussis vaccination are set in each country by the local health authorities. Several different schedules meet World Health Organization recommendations, 2-4-6 months, 6-10-14 weeks, 2-3-4 months and 3-4-5 months being the most commonly used worldwide. In this work, we analyze the benefits of changing the vaccination schedule to control the disease. METHODS We used an age-structured deterministic mathematical model for pertussis transmission to compute the incidences for the 4 above-mentioned schedules. Different vaccination coverages and vaccine effectiveness levels were considered. Immunization data from Argentina and Belgium were used. RESULTS The highest reduction in incidence was obtained by adopting the 6-10-14 weeks schedule, reaching about a 36% reduction of 0-1-year incidence with respect to the 2-4-6 months schedule. We show the dependence of this reduction on both vaccine effectiveness and coverage. The severe pertussis incidence decreased significantly when the first dose of the 2-4-6 months schedule was accelerated to 6 weeks. Finally, we estimated that the communication campaign adopted in Flanders (Belgium) to improve compliance with the vaccine schedule could lead to a reduction of 16% in severe pertussis incidence and about 7% in total incidence in infants. CONCLUSIONS Our work highlights the use of mathematical modeling to quantify the benefits of the existing vaccination schedules and the strategies that could be implemented to improve their compliance. Our results indicated that the 6-10-14 weeks is the best schedule option and that the Belgium vaccination campaign significantly reduced the incidence of severe cases.
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Bocquier A, Ward J, Raude J, Peretti-Watel P, Verger P. Socioeconomic differences in childhood vaccination in developed countries: a systematic review of quantitative studies. Expert Rev Vaccines 2017; 16:1107-1118. [PMID: 28914112 DOI: 10.1080/14760584.2017.1381020] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The reasons for vaccine hesitancy and its relation to individual socioeconomic status (SES) must be better understood. Areas covered: This review focused on developed countries with programs addressing major financial barriers to vaccination access. We systematically reviewed differences by SES in uptake of publicly funded childhood vaccines and in cognitive determinants (beliefs, attitudes) of parental decisions about vaccinating their children. Using the PRISMA statement to guide this review, we searched three electronic databases from January 2000 through April 2016. We retained 43 articles; 34 analyzed SES differences in childhood vaccine uptake, 7 examined differences in its cognitive determinants, and 2 both outcomes. Expert commentary: Results suggest that barriers to vaccination access persist among low-SES children in several settings. Vaccination programs could be improved to provide all mandatory and recommended vaccines 100% free of charge, in both public organizations and private practices, and to reimburse vaccine administration. Multicomponent interventions adapted to the context could also be effective in reducing these inequalities. For specific vaccines (notably for measles, mumps, and rubella), in UK and Germany, uptake was lowest among the most affluent. Interventions carefully tailored to respond to specific concerns of vaccine-hesitant parents, without reinforcing hesitancy, are needed.
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Affiliation(s)
- Aurélie Bocquier
- a Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information , Marseille , France.,b ORS PACA, Southeastern Health Regional Observatory , Marseille , France
| | - Jeremy Ward
- a Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information , Marseille , France.,c UMR 8236 (LIED) , Université Paris Diderot , Paris , France
| | - Jocelyn Raude
- d UMR "Emergence des Pathologies Virales" (EPV: Aix-Marseille University - IRD 190 - Inserm 1207 - EHESP) , Marseille , France.,e UMR PIMIT, INSERM 1187, CNRS 9192, IRD 249. Plateforme Technologique CYROI , Université de La Réunion , Réunion , France
| | - Patrick Peretti-Watel
- a Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information , Marseille , France.,b ORS PACA, Southeastern Health Regional Observatory , Marseille , France
| | - Pierre Verger
- a Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information , Marseille , France.,b ORS PACA, Southeastern Health Regional Observatory , Marseille , France
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Determinants of under-immunization and cumulative time spent under-immunized in a Quebec cohort. Vaccine 2017; 35:5924-5931. [PMID: 28882440 DOI: 10.1016/j.vaccine.2017.08.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Under-immunization refers to a state of sub-optimal protection against vaccine preventable diseases. Vaccine coverage for age may not capture intentional or non-intentional spacing of vaccines in the recommended provincial immunization guidelines. We aimed to identify factors associated with coverage and under-immunization and to determine the number of days during which children were under-immunized during their first 24months of life. METHODS Secondary analysis of children ≤3years recruited through active surveillance for gastroenteritis from three Quebec pediatric emergency departments from 2012 to 2014. Vaccination status for children at least 24months of age was determined using provincial immunization guidelines. Cumulative days under-immunized were calculated for DTaP-VPI-Hib, PCV, MMR, and Men-C-C. Factors associated with up-to-date (UTD) status at 24months of life and for under-immunization ≥6months were analyzed using logistic regression. RESULTS Of 246 eligible children, 180 (73%) were UTD by 24months of life. The mean cumulative days under-immunized for MMR was 107days, for PCV 209days, for Men-C-C 145days, and for DTaP-VPI-Hib 227days. Overall, 149 children (60%) experienced delay for at least 1 vaccine. Factors associated with both an UTD status at 24months and concurrently associated with being under-immunization ≥6months, included timely initiation of immunization (OR=5.85; 95% CI: 2.80-12.22) and (OR=0.13; 95% CI: 0.07-0.24), failure to co-administer 18-month vaccines (OR=0.15; 95% CI: 0.10-0.21) and (OR=3.29; 95% CI: 2.47-4.39), and having a household with ≥3 children under 18years ((OR=0.50; 0.28-0.86) and (OR=2.99; 1.45-6.22), respectively. CONCLUSION Paired with an unexpected low level of coverage at 24months of life, the majority of our cohort also experienced a state of under-immunization for a least one vaccine. Estimates of coverage do not capture intentional or non-intentional gaps in protection from vaccine preventable illnesses. Timely preventive care should be prioritized.
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Anello P, Cestari L, Baldovin T, Simonato L, Frasca G, Caranci N, Grazia Pascucci M, Valent F, Canova C. Socioeconomic factors influencing childhood vaccination in two northern Italian regions. Vaccine 2017; 35:4673-4680. [DOI: 10.1016/j.vaccine.2017.07.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/16/2017] [Accepted: 07/18/2017] [Indexed: 01/23/2023]
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Ghosh A, Laxminarayan R. Demand- and supply-side determinants of diphtheria-pertussis-tetanus nonvaccination and dropout in rural India. Vaccine 2017; 35:1087-1093. [PMID: 28081971 PMCID: PMC5297340 DOI: 10.1016/j.vaccine.2016.12.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although 93% of 12- to 23-month-old children in India receive at least one vaccine, typically Bacillus Calmette-Guérin, only 75% complete the recommended three doses of diphtheria-pertussis-tetanus (DPT, also referred to as DTP) vaccine. Determinants can be different for nonvaccination and dropout but have not been examined in earlier studies. We use the three-dose DPT series as a proxy for the full sequence of recommended childhood vaccines and examine the determinants of DPT nonvaccination and dropout between doses 1 and 3. METHODS We analyzed data on 75,728 6- to 23-month-old children in villages across India to study demand- and supply-side factors determining nonvaccination with DPT and dropout between DPT doses 1 and 3, using a multilevel approach. Data come from the District Level Household and Facility Survey 3 (2007-08). RESULTS Individual- and household-level factors were associated with both DPT nonvaccination and dropout between doses 1 and 3. Children whose mothers had no schooling were 2.3 times more likely not to receive any DPT vaccination and 1.5 times more likely to drop out between DPT doses 1 and 3, compared with children whose mothers had 10 or more years of schooling. Although supply-side factors related to availability of public health facilities and immunization-related health workers in villages were not correlated with dropout between DPT doses 1 and 3, children in districts where 46% or more villages had a healthcare subcentre were 1.5 times more likely to receive at least one dose of DPT vaccine compared with children in districts where 30% or fewer villages had subcentres. CONCLUSIONS Nonvaccination with DPT in India is influenced by village- and district-level contextual factors over and above individuals' background characteristics. Dropout between DPT doses 1 and 3 is associated more strongly with demand-side factors than with village- and district-level supply-side factors.
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Affiliation(s)
- Arpita Ghosh
- Public Health Foundation of India, Gurgaon, Haryana, India.
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA; Princeton University, Princeton, NJ, USA.
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Yamin D, Atkins KE, Remy V, Galvani AP. Cost-Effectiveness of Rotavirus Vaccination in France-Accounting for Indirect Protection. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:811-819. [PMID: 27712709 DOI: 10.1016/j.jval.2016.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 04/14/2016] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Vaccination against rotavirus has shown great potential for reducing the primary cause of severe childhood gastroenteritis. Previous economic evaluations of rotavirus vaccination in France have not modeled the potential impact of vaccines on disease burden via reduced transmission. OBJECTIVE To determine the cost-effectiveness of the introduction of pentavalent rotavirus vaccination into the French infant vaccination schedule. METHODS We developed an age-structured model of rotavirus transmission calibrated to 6 years of French gastroenteritis incidence and vaccine clinical trial data. We evaluated the cost-effectiveness of pentavalent rotavirus vaccination considering that 75% of infants would receive the three-dose vaccine course. RESULTS Our model predicts that rotavirus vaccination will decrease rotavirus gastroenteritis incidence and associated clinical outcomes in vaccinated and unvaccinated individuals, delay the seasonal peak of infection, and increase the age of infection. From the societal perspective, our base-case scenario predicts that vaccination coverage would be cost-effective at €115 or €135 per vaccine course at €28,500 and €39,500/quality-adjusted life-year (QALY) gained, respectively, and suggests that almost 95% of the financial benefits will be recouped within the first 5 years following vaccination implementation. From the third-party payer perspective, incremental cost-effectiveness ratios ranged from €12,500 to €20,000/QALY, respectively. Our uncertainty analysis suggests that findings were sensitive to various assumptions including the number of hospitalizations, outpatient visits, and the extent of QALY losses per rotavirus episode. CONCLUSIONS Introducing pentavalent rotavirus vaccination into the French infant vaccination schedule would significantly reduce the burden of rotavirus disease in children, and could be cost-effective under plausible conditions.
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Affiliation(s)
- Dan Yamin
- Department of Industrial Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA.
| | - Katherine E Atkins
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
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15
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Tabacchi G, Costantino C, Napoli G, Marchese V, Cracchiolo M, Casuccio A, Vitale F. Determinants of European parents' decision on the vaccination of their children against measles, mumps and rubella: A systematic review and meta-analysis. Hum Vaccin Immunother 2016; 12:1909-23. [PMID: 27163657 PMCID: PMC4964810 DOI: 10.1080/21645515.2016.1151990] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Low measles, mumps and rubella (MMR) immunization levels in European children highlight the importance of identifying determinants of parental vaccine uptake to implement policies for increasing vaccine compliance. The aim of this paper is to identify the main factors associated with partial and full MMR vaccination uptake in European parents, and combine the different studies to obtain overall quantitative measures. This activity is included within the ESCULAPIO project, funded by the Italian Ministry of Health. ORs and CIs were extracted, sources of heterogeneity explored and publication bias assessed. Forty-five papers were retrieved for the qualitative study, 26 of which were included in the meta-analysis. The following factors were associated with lower MMR vaccine uptake: misleading knowledge, beliefs and perceptions on vaccines (OR 0.57, CI 0.37-0.87); negative attitudes and behaviors toward vaccination (OR 0.71, CI 0.52-0.98); demographic characteristics, such as different ethnicity in Southern populations (OR 0.44, CI 0.31-0.61), higher child's age (OR 0.80, CI 0.76-0.85); low socio-economic status (OR 0.64, CI 0.51-0.80), especially low income (OR 0.39, CI 0.25-0.60) and education (OR 0.64, CI 0.48-0.84), high number of children (OR 0.54, CI 0.42-0.69), irregular marital status (OR 0.80, CI 0.66-0.96). The factors explaining heterogeneity were country location, administration modality, collection setting and responses reported on MMR alone or in combination. Findings from this study suggest policy makers to focus communication strategies on providing better knowledge, correct beliefs and perceptions on vaccines, and improving attitudes and behaviors in parents; and to target policies to people of ethnic minority from Southern Europe, low educated and deprived, with higher number of children and non-married marital status.
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Affiliation(s)
- Garden Tabacchi
- a Department of Sciences for Health Promotion and Mother-Child Care "G.D'Alessandro ", University of Palermo , Palermo , Italy
| | - Claudio Costantino
- a Department of Sciences for Health Promotion and Mother-Child Care "G.D'Alessandro ", University of Palermo , Palermo , Italy
| | - Giuseppe Napoli
- a Department of Sciences for Health Promotion and Mother-Child Care "G.D'Alessandro ", University of Palermo , Palermo , Italy
| | - Valentina Marchese
- a Department of Sciences for Health Promotion and Mother-Child Care "G.D'Alessandro ", University of Palermo , Palermo , Italy
| | - Manuela Cracchiolo
- a Department of Sciences for Health Promotion and Mother-Child Care "G.D'Alessandro ", University of Palermo , Palermo , Italy
| | - Alessandra Casuccio
- a Department of Sciences for Health Promotion and Mother-Child Care "G.D'Alessandro ", University of Palermo , Palermo , Italy
| | - Francesco Vitale
- a Department of Sciences for Health Promotion and Mother-Child Care "G.D'Alessandro ", University of Palermo , Palermo , Italy
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16
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Tauil MDC, Sato APS, Waldman EA. Factors associated with incomplete or delayed vaccination across countries: A systematic review. Vaccine 2016; 34:2635-43. [DOI: 10.1016/j.vaccine.2016.04.016] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 11/25/2022]
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Chung HJ, Han SH, Kim H, Finkelstein JL. Childhood immunizations in China: disparities in health care access in children born to North Korean refugees. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2016; 16:13. [PMID: 27074957 PMCID: PMC4830016 DOI: 10.1186/s12914-016-0085-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/02/2016] [Indexed: 11/13/2022]
Abstract
Background Childhood immunization rates are at an all-time high globally, and national data for China suggests close to universal coverage. Refugees from North Korea and their children may have more limited health care access in China due to their legal status. However, there is no data on immunization rates or barriers to coverage in this population. Methods This study was conducted to determine the rates and correlates of immunizations in children (≥1 year) born to North Korean refugees in Yanbien, China. Child immunization data was obtained from vaccination cards and caregiver self-report for 7 vaccines and 1:3:3:3:1 series. Age-appropriate vaccination rates of refugee children were compared to Chinese and migrant children using a goodness-of-fit test. Logistic regression was used to determine correlates of immunization coverage for each vaccine and the 1:3:3:3:1 series. Results Age-appropriate immunization coverage rates were significantly lower in children born to North Korean refugees (12.1-97.8 %), compared to Chinese (99 %) and migrant (95 %) children. Increased father’s age and having a sibling predicted significantly lower vaccination rates. Conclusions Children born to North Korean refugees had significantly lower immunization rates, compared to Chinese or migrant children. Further research is needed to examine barriers of health care access in this high-risk population.
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Affiliation(s)
- Hyun Jung Chung
- Cornell University, Ithaca, NY, USA. .,Yonsei University College of Medicine, 50-1 YonseiRo SeodaemunGu, 120-752, Seoul, South Korea.
| | - Seung Hyun Han
- Department of Environment and Health Science, Soonchunhyang University, Asan-si, South Korea
| | - Hyerang Kim
- Department of Health Systems and Outcomes, Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Moller SP, Hjern A, Andersen AMN, Norredam M. Differences in uptake of immunisations and health examinations among refugee children compared to Danish-born children: a cohort study. Eur J Pediatr 2016; 175:539-49. [PMID: 26567542 DOI: 10.1007/s00431-015-2663-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 10/31/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Refugee children and their families constitute a vulnerable group regarding health and access to care. In a register-based cohort design, we examined differences in uptake of immunisations and child health examinations between refugee children and Danish-born children, including predictors of uptake among refugee children. Refugee children (n = 16,701) who, between January 1993 and December 2010, obtained residency permits in Denmark were included and matched in a 1:6 ratio on age and sex with Danish-born children (n = 100,206). Personal identification numbers were cross-linked to the National Danish Health Service Register, identifying all contacts for immunisation and child health examinations. We estimated hazard ratios (HR) of uptake. Refugee children had a lower uptake of all immunisations compared to Danish-born children. The lowest uptake was found for immunisation against diphtheria, tetanus, pertussis and polio (HR = 0.50; 95 % confidence interval (CI) 0.48-0.51). Participation in child health examinations was also lower among refugee children with the lowest at the last child health examination at age 5 (HR = 0.48; 95 % CI 0.47-0.50). Adjusting the analysis for parental income increased the HRs by 10-20 %. CONCLUSION This Danish register-based study using nationwide data revealed a lower uptake of routine immunisations and child health examinations among refugee children compared to Danish-born children. WHAT IS KNOWN •Uptake of immunisation and child health examination is associated with low household income, unemployment and low educational status among the parents. •Uptake may be even lower among refugee families as they constitute a vulnerable group regarding access to healthcare. What is New: •Refugee children had lower uptake of immunisations and child health examinations compared to Danish-born children. •Several predictors of uptake were identified including region of origin and duration of residence.
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Affiliation(s)
- Sanne Pagh Moller
- Danish Research Centre for Migration, Department of Public Health, Ethnicity and Health (MESU), Section for Health Services Research, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Anders Hjern
- Centre for Health Equity Studies (CHESS), Karolinska Institutet/Stockholm University, SE-106 91, Stockholm, Sweden.,Clinical Epidemiology, Department of Medicine, Karolinska Institutet/Stockholm University, SE-171 76, Stockholm, Sweden
| | - Anne-Marie Nybo Andersen
- Section for Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Department of Public Health, Ethnicity and Health (MESU), Section for Health Services Research, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.,Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Kettegård Allé 30, 2650, Hvidovre, Denmark
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19
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Maertens K, Caboré RN, Huygen K, Hens N, Van Damme P, Leuridan E. Pertussis vaccination during pregnancy in Belgium: Results of a prospective controlled cohort study. Vaccine 2015; 34:142-50. [PMID: 26592142 DOI: 10.1016/j.vaccine.2015.10.100] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/18/2015] [Accepted: 10/23/2015] [Indexed: 11/15/2022]
Abstract
Vaccination during pregnancy has been recommended in some countries as a means to protect young infants from severe infection. Nevertheless, many aspects are still unknown and possible blunting of the infant's immune responses by maternal antibodies, is one of the concerns with maternal vaccination. We report the first prospective controlled cohort study in women and infants on the effects of using Boostrix(®), a combined tetanus, diphtheria and acellular pertussis vaccine, during pregnancy. The primary aim was to measure the influence of this booster dose on the titer and duration of the presence of maternal antibodies in the infants and assess possible interference with infant immune responses. In a controlled cohort study, 57 pregnant women were vaccinated with Tdap vaccine (Tetanus Diphtheria acellular Pertussis, Boostrix, GSK Biologicals), at a mean gestational age of 28.6 weeks. A control group of pregnant women (N=42) received no vaccine. Antibody geometric mean concentrations (GMCs) against tetanus (TT), diphtheria (DT), pertussis toxin (PT), filamentous haemagglutinin (FHA) and pertactin (Prn) were measured with commercial ELISA tests in samples taken preceding maternal vaccination and one month afterwards, at delivery and from the cord blood, and in infants before and 1 month after the primary series of 3 pertussis containing hexavalent vaccines. Infants born to vaccinated women had significantly higher GMC at birth and during the first 2 months of life for all vaccine antigens compared to the offspring of unvaccinated women, thereby closing the susceptibility gap for pertussis in infants. However, blunting was noticed for infant diphtheria and pertussis toxin vaccine responses (p<0.001) in the infants from vaccinated women after the primary vaccination schedule (weeks 8,12 and 16). Since pertussis vaccination has been recommended during pregnancy already, the results of this study support that recommendation and provide additional scientific evidence to document possible interference by maternal antibodies.
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Affiliation(s)
- Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium.
| | - Raïssa Nadège Caboré
- National Reference Centre Bordetella, Service Immunology, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Kris Huygen
- National Reference Centre Bordetella, Service Immunology, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Hasselt University, Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium.
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20
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Hoang HTT, Leuridan E, Maertens K, Nguyen TD, Hens N, Vu NH, Caboré RN, Duong HT, Huygen K, Van Damme P, Dang AD. Pertussis vaccination during pregnancy in Vietnam: Results of a randomized controlled trial Pertussis vaccination during pregnancy. Vaccine 2015; 34:151-9. [PMID: 26529073 DOI: 10.1016/j.vaccine.2015.10.098] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/14/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Abstract
A pertussis vaccination during pregnancy has recently been adopted in several countries to indirectly protect young infants. This study assessed the effect of adding a pertussis component to the tetanus vaccination, in the pregnancy immunization program in Vietnam. A randomized controlled trial was performed. Pregnant women received either a Tdap (tetanus, diphtheria acellular pertussis) vaccine or a tetanus only vaccine between 19 and 35 weeks' gestational age. Immunoglobulin G (IgG) against tetanus (TT), diphtheria (DT), pertussis toxin (PT), filamentous hemaglutinin (FHA) and pertactin (Prn) were measured using commercial ELISA tests, at baseline, 1 month after maternal vaccination, at delivery, and in infants from cord blood and before and after the primary series (EPI: month 2-3-4) of a pertussis containing vaccine. Significantly higher geometric mean concentrations (GMC) were observed for all 3 measured pertussis antigens in the offspring of the Tdap group, up to 2 months of age. One month after completion of the primary infant vaccination schedule, anti-Prn GMC, but not anti-PT and anti-FHA GMCs, was significantly (p=0.006) higher in the control group. Maternal antibodies induced by vaccination during pregnancy close the susceptibility gap for pertussis in young infants. Limited interference with the infant vaccine responses was observed. Whether this interference effect disappears with the administration of a fourth vaccine dose is further studied.
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Affiliation(s)
- Ha Thi Thu Hoang
- National Institute of Hygiene and Epidemiology, Yersin Street 1, Hanoi 10000, Vietnam.
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610 Antwerpen, Belgium
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610 Antwerpen, Belgium
| | - Trung Dac Nguyen
- National Institute of Hygiene and Epidemiology, Yersin Street 1, Hanoi 10000, Vietnam
| | - Niel Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Hasselt, Belguim; Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerpen, Belgium
| | - Ngoc Ha Vu
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Raissa Nadège Caboré
- National Reference Centre Bordetella, Service Immunology, Scientific Institute of Public Health (WIV-ISP), 1180 Brussels, Belgium
| | - Hong Thi Duong
- National Institute of Hygiene and Epidemiology, Yersin Street 1, Hanoi 10000, Vietnam
| | - Kris Huygen
- National Reference Centre Bordetella, Service Immunology, Scientific Institute of Public Health (WIV-ISP), 1180 Brussels, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610 Antwerpen, Belgium
| | - Anh Duc Dang
- National Institute of Hygiene and Epidemiology, Yersin Street 1, Hanoi 10000, Vietnam.
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21
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Ganczak M, Dmytrzyk-Daniłów G, Korzeń M, Szych Z. A cross-sectional serosurvey on hepatitis B vaccination uptake among adult patients from GP practices in a region of South-West Poland. BMC Public Health 2015; 15:1060. [PMID: 26475167 PMCID: PMC4609044 DOI: 10.1186/s12889-015-2388-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatitis B is a significant health burden in Poland with nosocomial transmission being the main source of infection. Therefore, HBV vaccination is widely recommended for those not covered by the national immunisation program. OBJECTIVE To assess the coverage and influencing determinants of HBV vaccination among adult patients attending GP clinics as well as to establish serological status in terms of HBV infection. METHODS Patients who were seen consecutively in March 2013 at four randomly selected GP practices located in Zgorzelec county, in south-western part of Poland, were invited to participate and complete questionnaires on socio-demographic data and other factors related to vaccination. A pilot study was done in one urban GP practice in the city of Gryfino (Gryfino county), the results have been included in the study. Patients' immunisation status was assessed basing on vaccination cards and anti-HBs titer with the use of third-generation testing methods. In addition, serum samples were assayed for anti-HBc total. RESULTS Response rate: 99.3 %. Of 410 participants (66.1 % females, median age 56 years), 55.4 % (95%CI:50.5-60.1 %) were previously vaccinated; in those 11.5 % took 2 doses, 66.1 % - 3 doses,18.1 % - 4 doses. Elective surgery was the main reason (57.7 %) for HBV immunization, 4.8 % - were vaccinated due to recommendations by GPs. The multivariable logistic regression model revealed that living in a city (OR 2.11), and having a surgery in the past (OR 2.73) were each associated with greater odds of being vaccinated. Anti-HBc total prevalence among those unvaccinated was 13.6 % (95%CI:9.3 %-19,5 %), and 7.2 % (95%CI:4.4-11.8 %) among those vaccinated. CONCLUSIONS Low HBV immunization coverage among adult patients from GP clinics and the presence of serological markers of HBV infection among both - those unvaccinated and vaccinated call for comprehensive preventative measures against infection, including greater involvement of family doctors. Although interventions should cover the whole population, inhabitants living in the rural areas should be a group of special interest. Preoperative immunization for HBV seems to be an efficient public health tool to increase the vaccination uptake.
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Affiliation(s)
- Maria Ganczak
- Department of Public Health, Pomeranian Medical University, Zolnierska 48, 71-210, Szczecin, Poland.
| | | | - Marcin Korzeń
- Faculty of Computer Science and Information Technology, West Pomeranian University of Technology, Zolnierska 49, 71-210, Szczecin, Poland.
| | - Zbigniew Szych
- Department of Computer Science and Education Quality Research, Pomeranian Medical University, Zolnierska 53, 71-210, Szczecin, Poland.
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Lin W, Xiong Y, Tang H, Chen B, Ni J. Factors associated with delayed measles vaccination among children in Shenzhen, China: a case-control study. Hum Vaccin Immunother 2015; 10:3601-6. [PMID: 25668667 DOI: 10.4161/21645515.2014.979687] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A delay in the first dose of measles-containing vaccine (MCV1) may contribute to outbreaks of measles, resulting in a high age-specific incidence in infants<1 y of age. To determine the factors associated with delayed MCV1 vaccinations, we used data from the China Information Management System for Immunization Programming. Additionally, the parents/guardians of 430 children whose MCV1 vaccinations were delayed, as well as the parents/guardians of 424 children who received timely vaccinations, were surveyed by telephone. Children were less likely to receive timely MCV1 vaccinations if they belonged to an immigrant group, were male, had poor health status, had a father whose occupation e.g., a manager, had a history of delays in other Expanded Programs on Immunization (EPI) vaccinations, had parents who did not believe vaccinations were important for their children, and experienced shorter travel times to and longer waiting times in EPI clinics. The children of mothers whose occupational status (technician) were more likely to receive timely MCV1 vaccinations. The timeliness of MCV1 vaccinations should be considered as an additional indicator of the quality of vaccination programs.
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Affiliation(s)
- Weiyan Lin
- a Department of Epidemiology and Biostatistics ; Dongguan , China
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Hens N, Abrams S, Santermans E, Theeten H, Goeyvaerts N, Lernout T, Leuridan E, Van Kerckhove K, Goossens H, Van Damme P, Beutels P. Assessing the risk of measles resurgence in a highly vaccinated population: Belgium anno 2013. Euro Surveill 2015; 20. [DOI: 10.2807/1560-7917.es2015.20.1.20998] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- N Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - S Abrams
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - E Santermans
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - H Theeten
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - N Goeyvaerts
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - T Lernout
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - E Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - K Van Kerckhove
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - H Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - P Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
| | - P Beutels
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute (WHO Collaborating Centre), University of Antwerp, Antwerp, Belgium
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Akmatov MK, Kimani-Murage E, Pessler F, Guzman CA, Krause G, Kreienbrock L, Mikolajczyk RT. Evaluation of invalid vaccine doses in 31 countries of the WHO African Region. Vaccine 2014; 33:892-901. [PMID: 25523526 DOI: 10.1016/j.vaccine.2014.10.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 10/06/2014] [Accepted: 10/08/2014] [Indexed: 11/30/2022]
Abstract
We examined (a) the fraction of and extent to which vaccinations were administered earlier than recommended (age-invalid) or with too short intervals between vaccine doses (interval-invalid) in countries of the World Health Organisation (WHO) African Region and (b) individual- and community-level factors associated with invalid vaccinations using multilevel techniques. Data from the Demographic and Health Surveys conducted in the last 10 years in 31 countries were used. Information about childhood vaccinations was based on vaccination records (n=134,442). Invalid vaccinations (diphtheria, tetanus, pertussis [DTP1, DTP3] and measles-containing vaccine (MCV)) were defined using the WHO criteria. The median percentages of invalid DTP1, DTP3 and MCV vaccinations across all countries were 12.1% (interquartile range, 9.4-15.2%), 5.7% (5.0-7.6%), and 15.5% (10.0-18.1%), respectively. Of the invalid DTP1 vaccinations, 7.4% and 5.5% were administered at child's age of less than one and two weeks, respectively. In 12 countries, the proportion of invalid DTP3 vaccinations administered with an interval of less than two weeks before the preceding dose varied between 30% and 50%. In 13 countries, the proportion of MCV doses administered at child's age of less than six months varied between 20% and 45%. Community-level variables explained part of the variation in invalid vaccinations. Invalid vaccinations are common in African countries. Timing of childhood vaccinations should be improved to ensure an optimal protection against vaccine-preventable infections and to avoid unnecessary wastage in these economically deprived countries.
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Affiliation(s)
- Manas K Akmatov
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany.
| | | | - Frank Pessler
- TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Carlos A Guzman
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany
| | - Lothar Kreienbrock
- Department of Biometry, Epidemiology and Information Processing, University for Veterinary Medicine, Hanover, Germany
| | - Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany
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MacDonald SE, Schopflocher DP, Vaudry W. Parental concern about vaccine safety in Canadian children partially immunized at age 2: a multivariable model including system level factors. Hum Vaccin Immunother 2014; 10:2603-11. [PMID: 25483477 PMCID: PMC4977444 DOI: 10.4161/21645515.2014.970075] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Children who begin but do not fully complete the recommended series of childhood vaccines by 2 y of age are a much larger group than those who receive no vaccines. While parents who refuse all vaccines typically express concern about vaccine safety, it is critical to determine what influences parents of ‘partially’ immunized children. This case-control study examined whether parental concern about vaccine safety was responsible for partial immunization, and whether other personal or system-level factors played an important role. A random sample of parents of partially and completely immunized 2 y old children were selected from a Canadian regional immunization registry and completed a postal survey assessing various personal and system-level factors. Unadjusted odds ratios (OR) and adjusted ORs (aOR) were calculated with logistic regression. While vaccine safety concern was associated with partial immunization (OR 7.338, 95% CI 4.138– 13.012), other variables were more strongly associated and reduced the strength of the relationship between concern and partial immunization in multivariable analysis (aOR 2.829, 95% CI 1.151 – 6.957). Other important factors included perceived disease susceptibility and severity (aOR 4.629, 95% CI 2.017 – 10.625), residential mobility (aOR 3.908, 95% CI 2.075 – 7.358), daycare use (aOR 0.310, 95% CI 0.144 - 0.671), number of needles administered at each visit (aOR 7.734, 95% CI 2.598 – 23.025) and access to a regular physician (aOR 0.219, 95% CI 0.057 – 0.846). While concern about vaccine safety may be addressed through educational strategies, this study suggests that additional program and policy-level strategies may positively impact immunization uptake.
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Affiliation(s)
- Shannon E MacDonald
- a Faculty of Nursing ; University of Alberta ; Edmonton Clinic Health Academy ; Edmonton , Alberta , Canada
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Vaccination coverage for infants: cross-sectional studies in two regions of Belgium. BIOMED RESEARCH INTERNATIONAL 2014; 2014:838907. [PMID: 24971352 PMCID: PMC4058188 DOI: 10.1155/2014/838907] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 05/05/2014] [Indexed: 11/17/2022]
Abstract
Methods and Objectives. To estimate infant vaccination coverage in the French-speaking region of Belgium (Wallonia) and in the Brussels-Capital Region, two cross-sectional studies were performed in 2012. A face-to-face questionnaire was administered by trained investigators. The objective was to evaluate infant vaccination coverage retrospectively in 18- to 24-month-old children. These studies offered the opportunity to assess some factors influencing vaccine uptake in infants. Results and Discussion. Approximately 99% of the children had received the first dose of IPV-DTaP, 90% the fourth dose, 94% the MMR vaccine, 97% the first dose of pneumococcal vaccine, and 90% the third dose. In both regions, when fitting a logistic model, the most associated factor was attendance at maternal and child clinics (MCH). No association was observed between vaccination coverage and the mother's level of education. For the last immunization session, where the mother was a Belgian native and when she worked more hours, child was better immunized, but only in Brussels. Conclusion. Coverage for the fourth dose of hexavalent vaccine (DTaP-IPV-HBV/Hib) needs to be increased. Indeed, additional effort is needed to increase HIB and pertussis coverage rates because the herd immunity threshold for these two diseases has not been reached.
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Braeckman T, Theeten H, Lernout T, Hens N, Roelants M, Hoppenbrouwers K, Van Damme P. Rotavirus vaccination coverage and adherence to recommended age among infants in Flanders (Belgium) in 2012. ACTA ACUST UNITED AC 2014; 19. [PMID: 24871757 DOI: 10.2807/1560-7917.es2014.19.20.20806] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In Belgium, rotavirus vaccination has been recommended and partially reimbursed since October 2006. Through a retrospective survey in 2012, we estimated the coverage rate of the rotavirus vaccination in Flanders among infants born in 2010. Using a standardised questionnaire, 874 families were interviewed at home, collecting information on demographic characteristics, socio-economic background and documented vaccination history (updated from medical files and vaccination database, if needed). Adherence to the recommended age for vaccination (8, 12 and 16 weeks) was also assessed. The coverage rate for two doses of rotavirus vaccination was 92.2% (95% confidence interval: 90.2-93.8). Respectively 31.7% and 10.1% of the children received their first and second dose at the recommended age. Incomplete vaccination was often a deliberate choice of the parents. Only eight children (1%) were vaccinated after the maximum age of 26 weeks. Factors identified by multiple logistic regression as related to incomplete vaccination were: living in the province of Antwerp, unemployed mother, and three or more older siblings in the household. Four years after introduction, the coverage rates were surprisingly high for a vaccine that is not fully reimbursed and not readily available in the vaccinator's fridge, which is the case for the other recommended infant vaccines.
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Affiliation(s)
- T Braeckman
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Abrams S, Beutels P, Hens N. Assessing mumps outbreak risk in highly vaccinated populations using spatial seroprevalence data. Am J Epidemiol 2014; 179:1006-17. [PMID: 24573540 DOI: 10.1093/aje/kwu014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Mumps is a potentially severe viral infection. The incidence of mumps has declined dramatically in high-income countries since the introduction of mumps antigen-containing vaccines. However, recent large outbreaks of mumps in highly vaccinated populations suggest waning of vaccine-induced immunity and primary vaccine failure. In this paper we present a simple method for identifying geographic regions with high outbreak potential, demonstrated using 2006 mumps seroprevalence data from Belgium and Belgian vaccination coverage data. Predictions of the outbreak potential in terms of the effective reproduction number in future years signal an increased risk of new mumps outbreaks. Literature reviews on serological information for both primary vaccine failure and waning immunity provide essential information for our predictions. Tailor-made additional vaccination campaigns would be valuable for decreasing local pockets of susceptibility, thereby reducing the risk of future large-scale mumps outbreaks.
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Decomposing socioeconomic inequality in child vaccination: results from Ireland. Vaccine 2014; 32:3438-44. [PMID: 24721529 DOI: 10.1016/j.vaccine.2014.03.084] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 01/10/2014] [Accepted: 03/26/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is limited knowledge of the extent of or factors underlying inequalities in uptake of childhood vaccination in Ireland. This paper aims to measure and decompose socioeconomic inequalities in childhood vaccination in the Republic of Ireland. METHODS The analysis was performed using data from the first wave of the Growing Up in Ireland survey, a nationally representative survey of the carers of over 11,000 nine-month old babies collected in 2008 and 2009. Multivariate analysis was conducted to explore the child and parental factors, including socioeconomic factors that were associated with non-vaccination of children. A concentration index was calculated to measure inequality in childhood vaccination. Subsequent decomposition analysis identified key factors underpinning observed inequalities. RESULTS Overall the results confirm a strong socioeconomic gradient in childhood vaccination in the Republic of Ireland. Concentration indices of vaccination (CI=-0.19) show a substantial pro-rich gradient. Results from the decomposition analysis suggest that a substantial proportion of the inequality is explained by household level variables such as socioeconomic status, household structure, income and entitlement to publicly funded care (29.9%, 24% 30.6% and 12.9% respectively). Substantial differences are also observed between children of Irish mothers and immigrant mothers from developing countries. CONCLUSIONS Vaccination was less likely in lower than in higher income households. Access to publicly funded services was an important factor in explaining inequalities.
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Toure A, Saadatian-Elahi M, Floret D, Lina B, Casalegno JS, Vanhems P. Knowledge and risk perception of measles and factors associated with vaccination decisions in subjects consulting university affiliated public hospitals in Lyon, France, after measles infection. Hum Vaccin Immunother 2014; 10:1755-61. [PMID: 24637343 DOI: 10.4161/hv.28486] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2011, a large number of European countries faced measles outbreaks, France accounting for more than half of the reported cases. The Rhône-Alpes region, located in south-east France, was one of the most affected provinces, with an incidence rate of 97.9 cases per 100 000 inhabitants. We conducted a retrospective survey of adults and parents of children consulting university affiliated public hospitals because of measles infections between January 1, 2010 and September 2012 in Lyon, France. Our main objectives were to evaluate (1) the level of study population knowledge of measles, (2) vaccination practices, and (3) changes in opinion with regard to measles vaccination after disease onset. Overall, 73.64% of patients were not vaccinated or partially vaccinated. The main reason for non-vaccination in children was inappropriate age while among non-vaccinated adults, 29.3% could not give any reason. In total, 29.1% of the responding parents and 24.2% of adult cases were opposed to vaccination "in principle." A large number of patients did not recognize measles as a serious illness and were unaware of its complications. Among parents of infected children, knowledge of transmission mode (odds ratio [OR] = 5.9; 95% confidence interval [95% CI]: 1.64-21.26), perceived severity of measles (OR = 1.5; 95% CI: 1.06-2.13), and absence of hepatitis B vaccination (OR = 0.17; 95% CI: 0.04-0.65) were independently associated with a more positive opinion about measles vaccination after disease onset. In adult patients, low education level (OR = 3.39; 95% CI: 1.03-11.11) and lack of knowledge of sequelae (OR = 10.19; 95% CI: 1.14-91.31) were linked with a more positive opinion. Individuals affected by vaccine-preventable diseases are interesting populations to study disease impact on vaccine perception.
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Affiliation(s)
- Abdoulaye Toure
- Hospices Civils de Lyon; Service d'Hygiène; Epidémiologie et Prévention; Unité Epidémiologie et Biomarqueurs de l'Infection; Lyon, France
| | - Mitra Saadatian-Elahi
- Hospices Civils de Lyon; Service d'Hygiène; Epidémiologie et Prévention; Unité Epidémiologie et Biomarqueurs de l'Infection; Lyon, France
| | | | - Bruno Lina
- Hospices Civils de Lyon ; Laboratoire de Virologie Est; Groupement Hospitalier Est; Bron, France
| | | | - Philippe Vanhems
- Hospices Civils de Lyon; Service d'Hygiène; Epidémiologie et Prévention; Unité Epidémiologie et Biomarqueurs de l'Infection; Lyon, France; Université de Lyon; Lyon, France; Université Lyon I; Villeurbanne, France; CNRS, UMR5558; Laboratoire de Biométrie et Biologie Evolutive ; Equipe d'Épidémiologie et Santé Publique; Villeurbanne, France
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THEETEN H, HUTSE V, HOPPENBROUWERS K, BEUTELS P, VAN DAMME P. Universal hepatitis B vaccination in Belgium: impact on serological markers 3 and 7 years after implementation. Epidemiol Infect 2014; 142:251-61. [PMID: 23689103 PMCID: PMC9151132 DOI: 10.1017/s0950268813001064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 03/15/2013] [Accepted: 04/15/2013] [Indexed: 11/06/2022] Open
Abstract
Hepatitis B virus (HBV) can be eliminated by effective universal vaccination. In Belgium, a free-of-charge HBV vaccination programme in infants with catch-up in adolescents was introduced in 1999. To evaluate the effects in <20-year-olds, seroprotection (anti-HBs >11 mIU/ml, according to the assay) and markers of infection (anti-HBc, HBsAg) were assessed in 2443 residual sera collected 7-8 years after implementation of the programme. The maximal prevalence of a solely anti-HBs seroprotective ('vaccinated') serostatus was 82·9% at age 1 year and 60·5% at age 13 years. A clear increase was found in age cohorts targeted by the campaign after a similar serosurvey conducted 4 years earlier. The prevalence of HBV infection remained unchanged at a low level (1·8% in 2006) similar to pre-vaccination data (1993-1994). We conclude that universal HBV vaccination has achieved overall high levels of vaccine-induced immunity, despite regional variations, which may give rise to pockets of susceptible young adults in the future.
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Affiliation(s)
- H. THEETEN
- Center for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Belgium
| | - V. HUTSE
- Scientific Institute of Public Health, Virology Section, Brussels, Belgium
| | | | - P. BEUTELS
- Center for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Belgium
| | - P. VAN DAMME
- Center for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Belgium
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Braeckman T, Lernout T, Top G, Paeps A, Roelants M, Hoppenbrouwers K, Van Damme P, Theeten H. Assessing vaccination coverage in infants, survey studies versus the Flemish immunisation register: achieving the best of both worlds. Vaccine 2013; 32:345-9. [PMID: 24269616 DOI: 10.1016/j.vaccine.2013.11.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/27/2013] [Accepted: 11/11/2013] [Indexed: 11/15/2022]
Abstract
Infant immunisation coverage in Flanders, Belgium, is monitored through repeated coverage surveys. With the increased use of Vaccinnet, the web-based ordering system for vaccines in Flanders set up in 2004 and linked to an immunisation register, this database could become an alternative to quickly estimate vaccination coverage. To evaluate its current accuracy, coverage estimates generated from Vaccinnet alone were compared with estimates from the most recent survey (2012) that combined interview data with data from Vaccinnet and medical files. Coverage rates from registrations in Vaccinnet were systematically lower than the corresponding estimates obtained through the survey (mean difference 7.7%). This difference increased by dose number for vaccines that require multiple doses. Differences in administration date between the two sources were observed for 3.8-8.2% of registered doses. Underparticipation in Vaccinnet thus significantly impacts on the register-based immunisation coverage estimates, amplified by underregistration of administered doses among vaccinators using Vaccinnet. Therefore, survey studies, despite being labour-intensive and expensive, currently provide more complete and reliable results than register-based estimates alone in Flanders. However, further improvement of Vaccinnet's completeness will likely allow more accurate estimates in the nearby future.
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Affiliation(s)
- Tessa Braeckman
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
| | - Tinne Lernout
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium
| | - Geert Top
- Flemish Agency for Care and Health, Infectious Disease Control and Vaccinations, Belgium
| | - Annick Paeps
- Flemish Agency for Care and Health, Infectious Disease Control and Vaccinations, Belgium
| | - Mathieu Roelants
- Department of Public Health and Primary Care, Centre for Youth Health Care, KU Leuven, Belgium
| | - Karel Hoppenbrouwers
- Department of Public Health and Primary Care, Centre for Youth Health Care, KU Leuven, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium; Fund of Scientific Research (FWO), Belgium
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Lernout T, Theeten H, Hens N, Braeckman T, Roelants M, Hoppenbrouwers K, Van Damme P. Timeliness of infant vaccination and factors related with delay in Flanders, Belgium. Vaccine 2013; 32:284-9. [PMID: 24252698 DOI: 10.1016/j.vaccine.2013.10.084] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/23/2013] [Accepted: 10/24/2013] [Indexed: 10/26/2022]
Abstract
Achieving high vaccination coverage is a necessary, but not a sufficient indicator of the quality of a vaccination programme, in terms of control and prevention of childhood infectious diseases. For optimal protection of infants, timeliness of vaccination is increasingly recognized as another important target. The aim of this study was to assess the timeliness of measles-mumps-rubella (MMR) and diphtheria-tetanus-pertussis (DTP) vaccination in infants in Flanders (Belgium), and to identify predictors of vaccination delay. The timeliness was assessed using the Kaplan-Meier estimator in three consecutive vaccination coverage surveys among children aged 18-24 months, conducted in 2005, 2008 and 2012, respectively. Factors associated with delayed administration of the vaccines were identified using Cox regression analysis. Over the time period, vaccination coverage for the first dose of MMR ranged from 94.0 to 96.6% and for the third dose of DTP from 97.9 to 98.7%. However, up to 32% (for MMR1) and 95% (for DTP3) of infants received vaccine doses delayed according to the recommended schedule. Although some improvement was achieved over the last decade, further efforts are needed to reach risk groups with delays, more specifically children vaccinated outside the baby well clinics, born from a mother originating from outside the European Union, children with a higher ranking or in families with a lower income.
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Affiliation(s)
- Tinne Lernout
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Post-doctoral Research Fellow of the Fund of Scientific Research (FWO), Belgium
| | - Niel Hens
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
| | - Tessa Braeckman
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Mathieu Roelants
- Centre for Youth Health Care, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Belgium
| | - Karel Hoppenbrouwers
- Centre for Youth Health Care, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Ganczak M, Dmytrzyk-Daniłów G, Karakiewicz B, Korzeń M, Szych Z. Determinants influencing self-paid vaccination coverage, in 0–5 years old Polish children. Vaccine 2013; 31:5687-92. [DOI: 10.1016/j.vaccine.2013.09.056] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 09/17/2013] [Accepted: 09/24/2013] [Indexed: 11/29/2022]
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Kawakatsu Y, Honda S. Individual-, family- and community-level determinants of full vaccination coverage among children aged 12–23 months in western Kenya. Vaccine 2012; 30:7588-93. [DOI: 10.1016/j.vaccine.2012.10.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 10/03/2012] [Accepted: 10/10/2012] [Indexed: 10/27/2022]
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36
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Cost-effectiveness of hepatitis A vaccination for adults in Belgium. Vaccine 2012; 30:6070-80. [DOI: 10.1016/j.vaccine.2012.07.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 07/11/2012] [Accepted: 07/20/2012] [Indexed: 11/22/2022]
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Goeyvaerts N, Hens N, Theeten H, Aerts M, Damme PV, Beutels P. Estimating vaccination coverage for the trivalent measles-mumps-rubella vaccine from trivariate serological data. Stat Med 2012; 31:1432-49. [DOI: 10.1002/sim.4481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 11/08/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Nele Goeyvaerts
- Interuniversity Institute for Biostatistics and statistical Bioinformatics; Hasselt University; Agoralaan 1 Gebouw D, B3590 Diepenbeek Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics; Hasselt University; Agoralaan 1 Gebouw D, B3590 Diepenbeek Belgium
- Centre for Health Economics Research and Modeling Infectious Diseases and Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute; University of Antwerp; Universiteitsplein 1, B2610 Wilrijk Belgium
| | - Heidi Theeten
- Centre for Health Economics Research and Modeling Infectious Diseases and Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute; University of Antwerp; Universiteitsplein 1, B2610 Wilrijk Belgium
| | - Marc Aerts
- Interuniversity Institute for Biostatistics and statistical Bioinformatics; Hasselt University; Agoralaan 1 Gebouw D, B3590 Diepenbeek Belgium
| | - Pierre Van Damme
- Centre for Health Economics Research and Modeling Infectious Diseases and Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute; University of Antwerp; Universiteitsplein 1, B2610 Wilrijk Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modeling Infectious Diseases and Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute; University of Antwerp; Universiteitsplein 1, B2610 Wilrijk Belgium
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Risk factors for incomplete vaccination in children less than 18 months of age attending the nurseries of day-care centres in Sao Paulo, Brazil. Vaccine 2011; 29:9298-302. [DOI: 10.1016/j.vaccine.2011.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 10/01/2011] [Accepted: 10/06/2011] [Indexed: 11/19/2022]
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39
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Poethko-Müller C, Mankertz A. Sero-epidemiology of measles-specific IgG antibodies and predictive factors for low or missing titres in a German population-based cross-sectional study in children and adolescents (KiGGS). Vaccine 2011; 29:7949-59. [DOI: 10.1016/j.vaccine.2011.08.081] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 08/03/2011] [Accepted: 08/15/2011] [Indexed: 10/17/2022]
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40
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Are we hitting immunity targets? The 2006 age-specific seroprevalence of measles, mumps, rubella, diphtheria and tetanus in Belgium. Epidemiol Infect 2010; 139:494-504. [PMID: 20587123 DOI: 10.1017/s0950268810001536] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Susceptibility to vaccine-preventable diseases in Belgium in 2006 was estimated from a serum survey. Immunoglobulins against measles, mumps, rubella (MMR) and diphtheria at all available ages (1-65 years), and against tetanus in >40-year-olds, were measured by ELISA. Age-standardized overall seronegativity for MMR was low (3·9%, 8·0%, 10·4%, respectively). However, the World Health Organization's targets for measles elimination were not met in 5- to 24-year-olds and about 1 in 7 women at childbearing age (15-39 years) were seronegative for rubella. In adults >40 years, tetanus immunity (87·2%, >0·16 IU/ml) largely exceeded diphtheria immunity (20-45%, >0·1 IU/ml). Despite free universal vaccination against MMR for more than 20 years and against diphtheria and tetanus for almost 60 years, our study revealed specific age groups remaining at risk for infection with these pathogens.
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Stefanoff P, Mamelund SE, Robinson M, Netterlid E, Tuells J, Bergsaker MAR, Heijbel H, Yarwood J. Tracking parental attitudes on vaccination across European countries: The Vaccine Safety, Attitudes, Training and Communication Project (VACSATC). Vaccine 2010; 28:5731-7. [PMID: 20558250 DOI: 10.1016/j.vaccine.2010.06.009] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 05/25/2010] [Accepted: 06/01/2010] [Indexed: 11/29/2022]
Abstract
The paper presents the first results from the European project VACSATC which aimed to track parental attitudes on vaccinations across several European countries. We compared five cross-sectional surveys of parents with children less than 3 years of age in England, Norway, Poland, Spain and Sweden carried out during 2008-2009. Data were collected from 6611 respondents. Two countries used face-to face interviews, one used telephone interviews, and two other countries used mail-in questionnaires. In all countries health professionals were indicated as the most important and trusted source of information on vaccination. The study results also show that parental attitudes on vaccinations in the childhood vaccination programs are generally positive. However, there were differences in attitudes on vaccination between the five countries, possibly reflecting different methods of sampling the respondents, context-specific differences (e.g. level of activity of governmental agencies), but also individual-level parental variation in demographic and socioeconomic status variables.
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Affiliation(s)
- Pawel Stefanoff
- Department of Epidemiology, National Institute of Public Health-National Institute of Hygiene, 24, Chocimska Str., 00-791 Warsaw, Poland.
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Danis K, Georgakopoulou T, Stavrou T, Laggas D, Panagiotopoulos T. Socioeconomic factors play a more important role in childhood vaccination coverage than parental perceptions: a cross-sectional study in Greece. Vaccine 2010; 28:1861-9. [DOI: 10.1016/j.vaccine.2009.11.078] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Revised: 11/29/2009] [Accepted: 11/30/2009] [Indexed: 10/20/2022]
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Vorsters A, Tack S, Hendrickx G, Vladimirova N, Bonanni P, Pistol A, Metlicar T, Pasquin MJA, Mayer MA, Aronsson B, Heijbel H, Van Damme P. A summer school on vaccinology: Responding to identified gaps in pre-service immunisation training of future health care workers. Vaccine 2009; 28:2053-9. [PMID: 20038430 DOI: 10.1016/j.vaccine.2009.12.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 12/14/2009] [Indexed: 11/25/2022]
Abstract
Immunisation is one of the corner stones of public health. Most health care consumers see the health care worker as their major source of information on immunisation and vaccine safety. Doctors, nurses and midwives should be appropriately and timely trained for that role. Within the Vaccine Safety, Attitudes, Training and Communication (VACSATC) EU-project a specific work package focused on the possible improvements of pre-service training of future health care workers. Surveys to assess current pre-service training about knowledge, skills and competences towards immunisation were distributed to students and curriculum managers of medical schools, universities and nursing training institutions in seven EU countries. In all responding institutions training on vaccines and immunisation is disseminated over a wide range of courses over several academic years. Topics as immunology and vaccine-preventable diseases are well covered during the pre-service training but major gaps in knowledge and competences were identified towards vaccine safety, communication with parents, addressing anti-vaccine arguments and practical skills. This assessment underlined the rationale for adequate pre-service training and identified opportunities for improvement of pre-service training. A prototype of an accurate pre-service immunisation curriculum was developed, implemented and evaluated in the summer of 2009 with a group of 36 students from 19 countries during a summer school on vaccinology at the Antwerp University, Belgium.
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Affiliation(s)
- A Vorsters
- Vaccine and Infectious Disease Institute, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium.
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Bicaba A, Haddad S, Kabore M, Taminy E, Feletto M, Fournier P. Monitoring the performance of the Expanded Program on Immunization: the case of Burkina Faso. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2009; 9 Suppl 1:S12. [PMID: 19828056 PMCID: PMC3226231 DOI: 10.1186/1472-698x-9-s1-s12] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background The greatest challenge facing expanded programs on immunization in general, and in Burkina Faso in particular, lies in their capacity to achieve and sustain levels of immunization coverage that will ensure effective protection of children. This article aims to demonstrate that full immunization coverage of children, which is the primary indicator for monitoring national immunization programs, is sufficient neither to evaluate their performance adequately, nor to help identify the broad strategies that must be implemented to improve their performance. Other dimensions of performance, notably adherence to the vaccination schedule and the efficacy of the approaches used to reach all the children (targeting) must also be considered. Methods The study was carried out using data from surveys carried out in Burkina Faso: the 1993, 1998 and 2003 Demographic and Health Surveys and the 2003 national Survey of Immunization Coverage. Essentially, we described levels of immunization coverage and their trends according to the indicators considered. Performance differences are illustrated by amplitudes and maximum/minimum ratios. Results The health regions' performances vary according to whether they are evaluated on the basis of full immunization coverage or vaccination status of children who have not completed their vaccinations. The health regions encompass a variety of realities, and efforts of substantially different intensity would be required to reach all the target populations. Conclusion Decision-making can be improved by integrating a tripartite view of performance that includes full immunization coverage, adherence to the vaccination schedule (timely coverage), and the status of children who are not fully vaccinated. With such an approach, interventions can be better targeted. It provides information on the quality and timeliness of vaccination and identifies the efforts required to meet the objectives of full immunization coverage. Abstract in French See the full article online for a translation of this abstract in French.
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Affiliation(s)
- Abel Bicaba
- Société d'Etudes et de Recherche en Santé Publique (SERSAP), Ouagadougou, Burkina Faso.
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Gilca V, Boulianne N, Dubé E, Sauvageau C, Ouakki M. Attitudes of nurses toward current and proposed vaccines for public programs: A questionnaire survey. Int J Nurs Stud 2009; 46:1219-35. [DOI: 10.1016/j.ijnurstu.2009.02.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 01/09/2009] [Accepted: 02/28/2009] [Indexed: 11/27/2022]
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Theeten H, Vandermeulen C, Roelants M, Hoppenbrouwers K, Depoorter AM, Van Damme P. Coverage of recommended vaccines in children at 7-8 years of age in Flanders, Belgium. Acta Paediatr 2009; 98:1307-12. [PMID: 19432835 DOI: 10.1111/j.1651-2227.2009.01331.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Evaluation of the coverage of primary diphtheria-tetanus-pertussis (DTP), poliomyelitis, hepatitis B (HBV) and measles-mumps-rubella (MMR) vaccine doses recommended before the age of 18 months in 7-year-old school children in Flanders, Belgium. Meningococcal serogroup C and DT-polio vaccines offered respectively as catch-up and booster vaccinations were also evaluated. METHODS Parents of 792 children born in Flanders in 1997 and selected by cluster sampling were interviewed at home in 2005. Vaccination data since infancy were collected retrospectively from vaccination documents and school health records. RESULTS Coverage rates were 88.0% for the first dose of MMR, and 72.0%, 84.2% and 91.4% for the recommended HBV, DTP and poliomyelitis primary vaccine doses, respectively. These rates included catch-up of missed infant MMR (4.9%) and HBV (6.4%) vaccinations. In addition, 88.3% of the target group received the DT-polio booster dose recommended at 6 years of age and 83.1% a meningococcal C vaccine dose. Preventive public health services as well as private physicians were involved to a varying extent. A lower socioeconomic status of the family was associated with a higher risk of nonvaccination. CONCLUSION Vaccinators in Flanders reach children relatively well during infancy and at school age, but catch-up of missed infant vaccine doses, especially MMR, should be optimized.
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Affiliation(s)
- Heidi Theeten
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, B-2610 Antwerp, Belgium.
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Theeten H, Hens N, Aerts M, Vandermeulen C, Roelants M, Hoppenbrouwers K, Van Damme P, Beutels P. Common attitudes about concomitant vaccine injections for infants and adolescents in Flanders, Belgium. Vaccine 2009; 27:1964-9. [DOI: 10.1016/j.vaccine.2009.01.096] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 01/13/2009] [Accepted: 01/22/2009] [Indexed: 11/26/2022]
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Poethko-Müller C, Ellert U, Kuhnert R, Neuhauser H, Schlaud M, Schenk L. Vaccination coverage against measles in German-born and foreign-born children and identification of unvaccinated subgroups in Germany. Vaccine 2009; 27:2563-9. [PMID: 19428862 DOI: 10.1016/j.vaccine.2009.02.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 01/19/2009] [Accepted: 02/02/2009] [Indexed: 10/21/2022]
Abstract
Data from the representative German Health Interview and Examination Survey for Children and Adolescents were used to identify unvaccinated subgroups that should be targeted by vaccination programmes in order to interrupt measles transmission. Measles vaccination coverage was low among children below the age of 3, having > or =3 siblings and in foreign-born migrants. Multivariate analyses show that vaccination coverage was strongly related to the place of birth in migrants: foreign-born children have a three-fold odds of being unvaccinated. Odds were also higher in children living in former West Germany, having > or =3 siblings, and it was especially high in children with parents reporting reservations against vaccinations.
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Bilcke J, Van Damme P, Beutels P. Cost-Effectiveness of Rotavirus Vaccination: Exploring Caregiver(s) and ``No Medical Care'' Disease Impact in Belgium. Med Decis Making 2009; 29:33-50. [PMID: 18948433 DOI: 10.1177/0272989x08324955] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim . To estimate the cost-effectiveness of universal childhood rotavirus vaccination in Belgium, taking into account the impact of caregiver burden and the burden of sick children for whom no medical care is sought (``no medical care''). Methods . A cohort of newborns is modeled in relation to costs and health outcomes for rotavirus disease, distinguishing episodes leading to consultations, hospitalizations, and deaths from no medical care episodes. Fully funded universal vaccination is compared with no vaccination as well as with the current situation in Belgium, whereby the 2-dose Rotarix or the 3-dose RotaTeq vaccine can be bought at market prices, which are partially reimbursed. Results . Compared with no vaccination, fully funded universal rotavirus vaccination would cost 51,030 per quality-adjusted life year (QALY) gained with Rotarix and 65,767 with RotaTeq (for society, 7572 and 30,227 per QALY, respectively). However, there is considerable uncertainty due to some analytical choices: the proportion of simulations with an acceptable incremental cost-effectiveness ratio (given a willingness to pay 50,000 for an additional QALY), increases from 2%/0.6% (Rotarix/RotaTeq) to 86%/59% when considering no medical care, and including 2 caregivers to estimate QALY loss instead of zero. Uncertainty is greater still under the societal than under the health care payer perspective. Conclusion . For the Belgian health care payer, at current vaccine prices, universal childhood rotavirus vaccination is unlikely to be judged cost-effective versus no vaccination but would be a more efficient and equitable choice than continuing with current practice.
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Affiliation(s)
- Joke Bilcke
- Centre for Health Economics & Modelling Infectious Diseases, Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Pierre Van Damme
- Centre for Health Economics & Modelling Infectious Diseases, Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economics & Modelling Infectious Diseases, Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Belgium, School of Public Health, University of Sydney, Australia
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