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Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study

Friday, 6th of January 2017

Vaccine. 2017 Jan 11;35(3):443-451. doi: 10.1016/j.vaccine.2016.11.075. Epub 2016 Dec 18.

Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study

Hoest C1, Seidman JC2, Lee G3, Platts-Mills JA4, Ali A5, Olortegui MP6, Bessong P7, Chandyo R8, Babji S9, Mohan VR9, Mondal D10, Mahfuz M10, Mduma ER11, Nyathi E7, Abreu C12, Miller MA2, Pan W13, Mason CJ14, Knobler SL2; MAL-ED Network Investigators.

Author information

1Division of International Epidemiology and Population Studies of Fogarty International Center, National Institutes of Health, 16 Center Drive, Bethesda, MD 20892, USA. Electronic address: christel.host@nih.gov.

2Division of International Epidemiology and Population Studies of Fogarty International Center, National Institutes of Health, 16 Center Drive, Bethesda, MD 20892, USA.

3Department of International Health, Johns Hopkins University, Baltimore, MD, 21205, USA.

4Division of Infectious Diseases and International Health, University of Virginia, P.O. Box 801340, 345 Crispell Drive, Carter Harrison Building, Charlottesville, VA 22908, USA.

5Aga Khan University, Department of Pediatrics and Child Health, Stadium Road, Karachi, Pakistan.

6Asociaciόn Benéfica Proyectos de Informática, Salud, Medicina, y Agricultura (A.B. PRISMA), Ramirez Hurtado 622, Iquitos, Peru.

7HIV/AIDS and Global Health Research Programme, University of Venda, Thohoyandou 0950, South Africa.

8Department of Child Health, Institute of Medicine, Tribhuvan University, Katmandu, Nepal; Centre for International Health, University of Bergen, P.O. Box 7800, 5020 Bergen, Norway.

9Department of Gastrointestinal Sciences/Department of Community Health, Christian Medical College, Vellore, Tamil Nadu 632004, India.

10Nutrition and Clinical Services Division, International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.

11Haydom Lutheran Hospital, POB 9041, Haydom, Manyara Region, Tanzania.

12Instituto de Biomedicina, Departamento de Fisiologia e Farmacologia, Faculdade de Medicina Federal University of Ceara, Rua Coronel Nunes de Melo, 1315, CEP: 60.430-270 - C.P. 3229 - Porangabussu, Fortaleza Ceará, Brazil.

13Department of Environmental Science and Policy and the Duke Global Health Institute, Duke University, Durham, NC, USA.

14Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.

Abstract below; full text is at http://www.sciencedirect.com/science/article/pii/S0264410X1631146X

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.

Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.