Examining vaccination coverage in Germany: spatiotemporal clustering of MMR coverage, 2008-14

Safety of Vaccination within First Year of Life-The Experience of One General Medicine Center

Vaccines represent an important preventive strategy in paediatric populations, but the rate of vaccination has been constantly declining in the last decade. Concerns about vaccines' safety represent one of the main causes of vaccine hesitancy among parents. The aim of this study was the analysis of the immediate adverse reactions induced by vaccines included in the national program of immunization for the first year of life. Method: Eighty-one children born between 1st of January 2018 and 31st of March 2019 were included. The vaccination refusal rate, and incidence and severity of adverse effects induced by three mandatory vaccines (Hexavalent, Prevenar 13 and MMR) were analyzed. The level of parents' education and the sources of information that were consulted in order to understand the adverse effects were also analyzed. Results and conclusions: The rate of adverse events was lower than 30% of the total number of doses, and most of them were mild. The incidence and severity of vaccine-induced adverse effects were correlated with prematurity. The vaccine hesitancy rate was lower than the national one, possibly due to a high level of education and good information provided by doctors that might have led to parents' concerns regarding vaccination being answered.

Social clustering of unvaccinated children in schools in the Netherlands

For the measles-mumps-rubella (MMR) vaccine, the World Health Organization-recommended coverage for herd protection is 95% for measles and 80% for rubella and mumps. However, a national vaccine coverage does not reflect social clustering of unvaccinated children, e.g. in schools of Orthodox Protestant or Anthroposophic identity in The Netherlands. To fully characterise this clustering, we estimated one-dose MMR vaccination coverages at all schools in the Netherlands. By combining postcode catchment areas of schools and school feeder data, each child in the Netherlands was characterised by residential postcode, primary and secondary school (referred to as school career). Postcode-level vaccination data were used to estimate vaccination coverages per school career. These were translated to coverages per school, stratified by school identity. Most schools had vaccine coverages over 99%, but major exceptions were Orthodox Protestant schools (63% in primary and 58% in secondary schools) and Anthroposophic schools (67% and 78%). School-level vaccine coverage estimates reveal strong clustering of unvaccinated children. The school feeder data reveal strongly connected Orthodox Protestant and Anthroposophic communities, but separated from one another. This suggests that even at a national one-dose MMR coverage of 97.5%, thousands of children per cohort are not protected by herd immunity.