Entwicklung der Varizellen-Impfraten und mögliche Einflussfaktoren auf die Impfentscheidung der Eltern im Raum München in den Jahren 2009–2011 nach Einführung der allgemeinen Varizellenimpfung

Abstract

Germany introduced routine varicella vaccination for all infants aged 11-14 months in 2004; since 2009, a second dose was recommended for toddlers aged 15-23 months. In Bavaria, vaccination with combined MMRV vaccine has been routinely reimbursed since the introduction of the 2-dose vaccination schedule. We investigated varicella vaccination coverage and factors associated with parental acceptance of varicella vaccination in the area of Munich from 2009 to 2011, within the frame of the 'Bavarian Varicella Surveillance Project' (2006-2011). Annual cross-sectional parent survey of random samples of 600 children aged 18-36 months in Munich on the child's vaccination status for varicella and measles, socio-demographic data and parental attitude towards varicella vaccination. During 2009-2011, the first dose varicella vaccination (VV) coverage increased from 53% (2009) to 68% (2011) while the second dose VV increased from 29% (2009) to 59% (2011). First-dose measles vaccination coverage was 88-91% (2009-2011). In 2009, 51% of all vaccinated children received the combined MMRV vaccine as first dose; in 2011, 94% (p<0.001). In 2009, 27% of all parents considered varicella vaccination as superfluous. This percentage had decreased to 15% by 2011. Recommendation of varicella vaccination by the physician was the most important explanatory factor and was significantly associated with parental acceptance of varicella vaccination in 2009 to 2011 (adjusted OR 11.5; 95%CI 3.6-36.3 (2009), 26.7; 95%CI 5.4-132.2 (2010) and 12.7; 95%CI 3.9-41.4 (2011)). From 2009 to 2011, first dose VV coverage further increased by approximately 15% up to 68%, corresponding with the increased use of MMRV. Although parental acceptance had increased, first dose coverage for varicella was still considerably lower than coverage for measles in 2011. Physician's recommendation of VV was the only independent factor significantly associated with parental acceptance in all study years. A further increase in varicella vaccination coverage is necessary in order to avoid potential negative effects such as an increase in the mean age of children getting infected with varicella. Therefore, information campaigns for both parents and physicians are urgently needed.

Specific Varicella-Related Complications and Their Decrease in Hospitalized Children after the Introduction of General Varicella Vaccination: Results from a Multicenter Pediatric Hospital Surveillance Study in Bavaria (Germany)

“…During the first 3 years of observation, vaccination coverage in the Bavarian population had only increased slowly because of a delay in reimbursement regulations, and VRH remained largely on the pre-vaccination level, with some variation in strength between varicella seasons [12,14,15]. Thus, the main impact on VRCs was seen after 2007, with a large decrease observed in the most frequent VRC categories, but also evident for more rare VRC types.…”

“…In Bavaria, the second largest German Federal State, varicella vaccinations and their impact were studied in the frame of the 'Bavarian Varicella-Surveillance Project' [12][13][14][15][16][17][18]. Similarly to other regions in Germany until 2011, the coverage for first-dose varicella vaccination in children aged 18-36 months increased in the two observed Bavarian regions to 69% and 83%, respectively [12][13][14]. Corresponding to the observed increase in coverage, the estimated incidence of pediatric VRH of 13.3 and 16.8 per 100,000 children \ 17 years of age in Bavarian hospitals in 2005 and 2006 continuously decreased in the following years to 4.8 in 2011 [16].…”

Heterogeneity in coverage for measles and varicella vaccination in toddlers – analysis of factors influencing parental acceptance

“…An extensive description of the data collection methods was provided by Streng (2010) [ 27 ] and Hagemann (2016) [ 29 ]. Random samples of 600 children aged 18–36 months were drawn per study region (Munich, Würzburg) and per survey year (2009, 2010, 2011) from the registration offices in the Munich and Würzburg regions (3600 children in total).…”

“…Varicella vaccination rates (1st dose) for each region and survey year were assessed for children who had been susceptible (i.e., no previous varicella vaccination/history) at the age of 11 months [ 27 , 29 ]. Measles vaccination rates were assessed for all participating children, as the number of children with previous measles was very low and, therefore, had no relevant impact on the results.…”

“…Previous investigations in the region of Munich in the federal state Bavaria had shown that varicella vaccination coverage (first dose) in children 18–36 months of age had increased from 38% in 2006 to 68% in 2011, whereby measles vaccination coverage (first dose) had shown a level of 87% to 91% [ 27 – 29 ]. However, vaccination rates and associated socio-demographic factors in the predominantly urban, economically-favored Munich region may differ from other Bavarian regions, and the socio-demographic factors that impact upon parental decisions concerning vaccination may differ for varicella and measles vaccination.…”