TY - JOUR
T1 - Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study
AU - The MAL-ED Network Investigators
AU - Hoest, Christel
AU - Seidman, Jessica C.
AU - Lee, Gwenyth
AU - Platts-Mills, James A.
AU - Ali, Asad
AU - Olortegui, Maribel Paredes
AU - Bessong, Pascal
AU - Chandyo, Ram
AU - Babji, Sudhir
AU - Mohan, Venkata Raghava
AU - Mondal, Dinesh
AU - Mahfuz, Mustafa
AU - Mduma, Estomih R.
AU - Nyathi, Emanuel
AU - Abreu, Claudia
AU - Miller, Mark A.
AU - Pan, William
AU - Mason, Carl J.
AU - Knobler, Stacey L.
N1 - Funding Information:
The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation, the Foundation for the NIH, and the National Institutes of Health, Fogarty International Center.
Publisher Copyright:
© 2016 The Authors
PY - 2017/1/11
Y1 - 2017/1/11
N2 - Background Launched in 1974, the Expanded Program on Immunization (EPI) is estimated to prevent two-three million deaths annually from polio, diphtheria, tuberculosis, pertussis, measles, and tetanus. Additional lives could be saved through better understanding what influences adherence to the EPI schedule in specific settings. Methods The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study followed cohorts in eight sites in South Asia, Africa, and South America and monitored vaccine receipt over the first two years of life for the children enrolled in the study. Vaccination histories were obtained monthly from vaccination cards, local clinic records and/or caregiver reports. Vaccination histories were compared against the prescribed EPI schedules for each country, and coverage rates were examined in relation to the timing of vaccination. The influence of socioeconomic factors on vaccine timing and coverage was also considered. Results Coverage rates for EPI vaccines varied between sites and by type of vaccine; overall, coverage was highest in the Nepal and Bangladesh sites and lowest in the Tanzania and Brazil sites. Bacillus Calmette-Guérin coverage was high across all sites, 87–100%, whereas measles vaccination rates ranged widely, 73–100%. Significant delays between the scheduled administration age and actual vaccination date were present in all sites, especially for measles vaccine where less than 40% were administered on schedule. A range of socioeconomic factors were significantly associated with vaccination status in study children but these results were largely site-specific. Conclusions Our findings highlight the need to improve measles vaccination rates and reduce delayed vaccination to achieve EPI targets related to the establishment of herd immunity and reduction in disease transmission.
AB - Background Launched in 1974, the Expanded Program on Immunization (EPI) is estimated to prevent two-three million deaths annually from polio, diphtheria, tuberculosis, pertussis, measles, and tetanus. Additional lives could be saved through better understanding what influences adherence to the EPI schedule in specific settings. Methods The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study followed cohorts in eight sites in South Asia, Africa, and South America and monitored vaccine receipt over the first two years of life for the children enrolled in the study. Vaccination histories were obtained monthly from vaccination cards, local clinic records and/or caregiver reports. Vaccination histories were compared against the prescribed EPI schedules for each country, and coverage rates were examined in relation to the timing of vaccination. The influence of socioeconomic factors on vaccine timing and coverage was also considered. Results Coverage rates for EPI vaccines varied between sites and by type of vaccine; overall, coverage was highest in the Nepal and Bangladesh sites and lowest in the Tanzania and Brazil sites. Bacillus Calmette-Guérin coverage was high across all sites, 87–100%, whereas measles vaccination rates ranged widely, 73–100%. Significant delays between the scheduled administration age and actual vaccination date were present in all sites, especially for measles vaccine where less than 40% were administered on schedule. A range of socioeconomic factors were significantly associated with vaccination status in study children but these results were largely site-specific. Conclusions Our findings highlight the need to improve measles vaccination rates and reduce delayed vaccination to achieve EPI targets related to the establishment of herd immunity and reduction in disease transmission.
KW - EPI
KW - Measles
KW - Public health
KW - Socioeconomic factors
KW - Vaccine coverage
KW - Vaccine timing
UR - http://www.scopus.com/inward/record.url?scp=85006378299&partnerID=8YFLogxK
U2 - 10.1016/j.vaccine.2016.11.075
DO - 10.1016/j.vaccine.2016.11.075
M3 - Article
C2 - 27998640
AN - SCOPUS:85006378299
SN - 0264-410X
VL - 35
SP - 443
EP - 451
JO - Vaccine
JF - Vaccine
IS - 3
ER -