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

Abstract

Background: In 2004, routine varicella vaccination was introduced in Germany for children aged 11-14 months. Routine measles vaccination had already been introduced in 1973 for the same age group, but coverage is still too low (<95%) in some areas to eliminate measles. The present study assessed varicella and measles vaccination coverage and determinants of parental acceptance in two study regions, situated in Northern and Southern Bavaria (Germany). Methods: From 2009 to 2011, annual cross-sectional parent surveys were performed on random samples of 600 children aged 18-36 months in the Bavarian regions of both Munich and Würzburg. Logistic regression models were used to identify factors associated with varicella and measles vaccination. Results: In 2009, 2010 and 2011, vaccination coverage was lower in Munich than in Würzburg, for both varicella (Munich 53%, 67%, 69% vs. Würzburg 72%, 81%, 83%) and for measles (Munich 88%, 89%, 91% vs. Würzburg 92%, 93%, 95%). Recommendation by the physician was the main independent factor associated with varicella vaccination in both regions (adjusted odd ratios (OR) with 95% confidence interval (CI): Munich OR 19.7, CI 13.6-28.6; Würzburg OR 34.7, CI 22.6-53.2). Attendance at a childcare unit was positively associated with a higher acceptance of varicella vaccination in Munich (OR 1.5, CI 1.1-2.2). Regarding measles vaccination, attendance at a childcare unit was positively associated in both regions (Munich OR 2.0; CI 1.3-3.0; Würzburg OR 1.8; CI 1.1-3.1), and a higher level of parental school education was negatively associated in Würzburg (OR 0.5, CI 0.3-0.9). Conclusions: Vaccination rates differed between regions, with rates constantly higher in Würzburg. Within each region, vaccination rates were lower for varicella than for measles. Measles vaccination status was mainly dependent upon socio-demographic factors (attendance at a childcare unit, parental school education), whereas for the more recently introduced varicella vaccination recommendation by the physician had the strongest impact. Hence, different strategies are needed to further improve vaccination rates for both diseases.

Determinants of Vaccination Coverage for the Second Dose of Measles-Rubella Vaccine in Tokyo, Japan

“…We also found consistent results for notification by two or more letters, the proportion of non-Japanese elementary school students, and the moving-in rate. A study in Germany found from annual cross-sectional parent surveys that nursery school attendance was positively associated with vaccination coverage and that caregivers' school education was negatively associated (Hagemann et al 2017). From the perspective of our hypothesis, their findings can be interpreted as follows: attendance at nursery schools might represent information sharing among caregivers and nurse teachers.…”

“…To date, many factors associated with vaccination coverage have been discussed in the literature: income (Klevens and Luman 2001;Smith et al 2004;Wu et al 2008;Sakai et al 2015;Hagemann et al 2017), physician density (Smith et al 2011), caregiver education (Wei et al 2009), and a recommendation or reminder from a physician or public health authorities (Anderberg et al 2011;Vannice et al 2011;Stockwell et al 2012;Gargano et al 2013;Busso et al 2015;Sakai. 2018).…”

Probabilistic reconstruction of measles transmission clusters from routinely collected surveillance data

“…As measles is highly infectious, under-immunized communities (also called pockets of susceptibles) resulting from local heterogeneity in vaccine coverage can lead to large, long-lasting outbreaks [30][31][32][33][34]. Detecting these pockets of susceptibles can be challenging, as historical local values of coverage throughout a given country are rarely available.…”

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)

“…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].…”