Vaccination Coverage Among Children Aged 2 Years — U.S. Affiliated Pacific Islands, April–October, 2016

Abstract

Vaccine-preventable diseases (VPDs) cause substantial morbidity and mortality in the United States Affiliated Pacific Islands (USAPI).* CDC collaborates with USAPI immunization programs to monitor vaccination coverage. In 2016, USAPI immunization programs and CDC piloted a method for estimating up-to-date status among children aged 2 years using medical record abstraction to ascertain regional vaccination coverage. This was the first concurrent assessment of childhood vaccination coverage across five USAPI jurisdictions (American Samoa; Chuuk State, Federated States of Micronesia [FSM]; Commonwealth of the Northern Mariana Islands [CNMI]; Republic of the Marshall Islands [RMI]; and Republic of Palau). Differences in vaccination coverage between main and outer islands were assessed for two jurisdictions where data were adequate.** Series coverage in this report includes the following doses of vaccines: ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP); ≥3 doses of inactivated poliovirus vaccine (IPV); ≥1 dose of measles, mumps, and rubella vaccine (MMR); ≥3 doses of Haemophilus influenzae type B (Hib) vaccine; ≥3 doses of hepatitis B (HepB) vaccine; and ≥4 doses of pneumococcal conjugate vaccine (PCV); i.e., 4:3:1:3:3:4. Coverage with ≥3 doses of rotavirus vaccine was also assessed. Completion of the recommended series of each of these vaccines was <90% in all jurisdictions except Palau. Coverage with the full recommended six-vaccine series (4:3:1:3:3:4) ranged from 19.5% (Chuuk) to 69.1% (Palau). In RMI and Chuuk, coverage was lower in the outer islands than in the main islands for most vaccines, with differences ranging from 0.9 to 66.8 percentage points. Medical record abstraction enabled rapid vaccination coverage assessment and timely dissemination of results to guide programmatic decision-making. Effectively monitoring vaccination coverage, coupled with implementation of data-driven interventions, is essential to maintain protection from VPD outbreaks in the region and the mainland United States.

Hepatitis B virus infection on Kwajalein Atoll, Marshall Islands: a seroprevalence, knowledge and attitudes study

“…( 6 - 8 ) However, timely, reliable and disaggregated estimates of disease prevalence are lacking for many Member States in the Region. ( 9 , 10 ) Reported estimates for HBV infection rates tend to be based on infrequent seroprevalence surveys ( 10 , 11 ) and are often expressed in terms of national averages that mask the within-country variations that likely exist across island groups in many PICs.…”

“…Significant challenges exist in the delivery of both vaccines and treatment for HBV in PICs, including lack of resources, geographical dispersion, limited infrastructure and sociocultural barriers to immunization. ( 1 , 9 , 12 , 13 )…”

“…( 18 ) However, immunization rates are known to differ between atolls, with the outer remote islands typically having lower coverage rates. ( 9 , 17 ) This may be due to a higher number of non-hospital births in the more remote islands, which often means the birth dose is delayed. ( 9 , 17 ) While information about HBV disease awareness and attitudes towards vaccination is generally lacking among the adult population in the Marshall Islands, ( 19 ) one study conducted in another PIC suggests a baseline knowledge of HBV in up to 60% of adults.…”