Vaccination coverage and timeliness in three South African areas: a prospective study

Lars T Fadnes, Debra Jackson, Ingunn M S Engebretsen, Wanga Zembe, David Sanders, Halvor Sommerfelt, Thorkild Tylleskär, PROMISE-EBF Study Group, Thorkild Tylleskär, Philippe van de Perre, Eva-Charlotte Ekström, Nicolas Meda, James K Tumwine, Chipepo Kankasa, Debra Jackson, Thorkild Tylleskär, Ingunn M S Engebretsen, Lars T Fadnes, Eli Fjeld Falnes, Knut Fylkesnes, Jørn Klungsøyr, Anne Nordrehaug-Åstrøm, Øystein Evjen Olsen, Bjarne Robberstad, Halvor Sommerfelt, Philippe Van de Perre, Eva-Charlotte Ekström, Barni Nor, Nicolas Meda, Hama Diallo, Thomas Ouedrago, Jeremi Rouamba, Bernadette Traoré, Germain Traoré, Emmanuel Zabsonré, James K Tumwine, Caleb Bwengye, Charles Karamagi, Victoria Nankabirwa, Jolly Nankunda, Grace Ndeezi, Margaret Wandera, Chipepo Kankasa, Mary Katepa-Bwalya, Chafye Siuluta, Seter Siziya, Debra Jackson, Mickey Chopra, Mark Colvin, Tanya Doherty, Carl Lombard, Ameena E Goga, Lungiswa Nkonki, David Sanders, Sonja Swanevelder, Wanga Zembe, Lars T Fadnes, Debra Jackson, Ingunn M S Engebretsen, Wanga Zembe, David Sanders, Halvor Sommerfelt, Thorkild Tylleskär, PROMISE-EBF Study Group, Thorkild Tylleskär, Philippe van de Perre, Eva-Charlotte Ekström, Nicolas Meda, James K Tumwine, Chipepo Kankasa, Debra Jackson, Thorkild Tylleskär, Ingunn M S Engebretsen, Lars T Fadnes, Eli Fjeld Falnes, Knut Fylkesnes, Jørn Klungsøyr, Anne Nordrehaug-Åstrøm, Øystein Evjen Olsen, Bjarne Robberstad, Halvor Sommerfelt, Philippe Van de Perre, Eva-Charlotte Ekström, Barni Nor, Nicolas Meda, Hama Diallo, Thomas Ouedrago, Jeremi Rouamba, Bernadette Traoré, Germain Traoré, Emmanuel Zabsonré, James K Tumwine, Caleb Bwengye, Charles Karamagi, Victoria Nankabirwa, Jolly Nankunda, Grace Ndeezi, Margaret Wandera, Chipepo Kankasa, Mary Katepa-Bwalya, Chafye Siuluta, Seter Siziya, Debra Jackson, Mickey Chopra, Mark Colvin, Tanya Doherty, Carl Lombard, Ameena E Goga, Lungiswa Nkonki, David Sanders, Sonja Swanevelder, Wanga Zembe

Abstract

Background: Timely vaccination is important to induce adequate protective immunity. We measured vaccination timeliness and vaccination coverage in three geographical areas in South Africa.

Methods: This study used vaccination information from a community-based cluster-randomized trial promoting exclusive breastfeeding in three South African sites (Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal) between 2006 and 2008. Five interview visits were carried out between birth and up to 2 years of age (median follow-up time 18 months), and 1137 children were included in the analysis. We used Kaplan-Meier time-to-event analysis to describe vaccination coverage and timeliness in line with the Expanded Program on Immunization for the first eight vaccines. This included Bacillus Calmette-Guérin (BCG), four oral polio vaccines and 3 doses of the pentavalent vaccine which protects against diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B.

Results: The proportion receiving all these eight recommended vaccines were 94% in Paarl (95% confidence interval [CI] 91-96), 62% in Rietvlei (95%CI 54-68) and 88% in Umlazi (95%CI 84-91). Slightly fewer children received all vaccines within the recommended time periods. The situation was worst for the last pentavalent- and oral polio vaccines. The hazard ratio for incomplete vaccination was 7.2 (95%CI 4.7-11) for Rietvlei compared to Paarl.

Conclusions: There were large differences between the different South African sites in terms of vaccination coverage and timeliness, with the poorer areas of Rietvlei performing worse than the better-off areas in Paarl. The vaccination coverage was lower for the vaccines given at an older age. There is a need for continued efforts to improve vaccination coverage and timeliness, in particular in rural areas.

Trial registration number: ClinicalTrials.gov: NCT00397150.

Figures

Figure 1
Figure 1
Time when receiving vaccines given in the four first vaccination visits for each site presented with inverse and cumulative Kaplan-Meier plots . In the first vaccination visit, an oral polio vaccine (polio0) is given together with the BCG vaccine, in the second, third and fourth vaccination visits, pentavalent vaccines are given together with polio vaccines. (Larger versions of the graph images are available as additional files 3, 4, 5, 6, 7, 8, 9 and10.) 1 The blue vertical lines indicate the recommended age for vaccination (overlapping with red lines at birth for BCG and first polio vaccine), while the red lines indicate the outer ranges for the recommended age. The horizontal dotted lines represent coverage at end of follow-up. 2 The labels on the x-axis indicate the outer ranges for recommended vaccination age. One year of age is indicated as a scaling, but is also the upper recommended age for the measles vaccine. 3 Blue graphs line: Paarl; green graph line: Umlazi; red graph line: Rietvlei.
Figure 2
Figure 2
Cumulative incomplete vaccination and untimely vaccination from birth to 6 months of age (including vaccination with BCG, 4 doses of oral polio vaccines, and 3 doses of pentavalent vaccines) . 1 Coverage: The line drops represent the proportion that has got all the vaccines to that point, but does not get the given vaccine (e.g. if a child get all vaccines except the last pentavalent vaccine, the child will add to the line drop at polio3/DTP3) 2 Timeliness: The line drops represent the proportion that has got all the vaccines to that point within their recommended time ranges, but does not get the given vaccine within the recommended range (e.g. if a child get all vaccines within recommend time except the DPT3 vaccine, the child will add to the line drop at third pentavalent) 3 Measles vaccine and booster vaccination not included due to sub-optimal data quality
Figure 3
Figure 3
Time when receiving the measles vaccine and booster vaccination with measles, DPT and oral polio presented with histogram (must be interpreted with caution) . 1 The blue vertical lines indicate the recommended age for vaccination, while the red lines on the measles vaccine indicate the outer ranges for the recommended age. 2 When the booster vaccine against measles was given at different time from the booster against polio and DPT (3 cases), the time of the measles booster will be presented.

References

    1. Grant CC, Roberts M, Scragg R, Stewart J, Lennon D, Kivell D, Ford R, Menzies R. Delayed immunisation and risk of pertussis in infants: unmatched case-control study. Brit Med J. 2003;326(7394):852–853. doi: 10.1136/bmj.326.7394.852.
    1. Kolos V, Menzies R, McIntyre P. Higher pertussis hospitalization rates in indigenous Australian infants, and delayed vaccination. Vaccine. 2007;25(4):588–590. doi: 10.1016/j.vaccine.2006.08.022.
    1. Heininger U, Zuberbuhler M. Immunization rates and timely administration in pre-school and school-aged children. Eur J Pediatr. 2006;165(2):124–129. doi: 10.1007/s00431-005-0014-y.
    1. von Kries R, Bohm O, Windfuhr A. Haemophilus influenzae b-vaccination: the urgency for timely vaccination. Eur J Pediatr. 1997;156(4):282–287. doi: 10.1007/s004310050601.
    1. The measles epidemic. The problems, barriers, and recommendations. The National Vaccine Advisory Committee. JAMA. 1991;266(11):1547–1552.
    1. Breiman RF, Streatfield PK, Phelan M, Shifa N, Rashid M, Yunus M. Effect of infant immunisation on childhood mortality in rural Bangladesh: analysis of health and demographic surveillance data. Lancet. 2004;364(9452):2204–2211. doi: 10.1016/S0140-6736(04)17593-4.
    1. Akmatov MK, Kretzschmar M, Kramer A, Mikolajczyk RT. Timeliness of vaccination and its effects on fraction of vaccinated population. Vaccine. 2008;26(31):3805–3811. doi: 10.1016/j.vaccine.2008.05.031.
    1. Dayan GH, Shaw KM, Baughman AL, Orellana LC, Forlenza R, Ellis A, Chaui J, Kaplan S, Strebel P. Assessment of delay in age-appropriate vaccination using survival analysis. Am J Epidemiol. 2006;163(6):561–570. doi: 10.1093/aje/kwj074.
    1. Clark A, Sanderson C. Timing of children's vaccinations in 45 low-income and middle-income countries: an analysis of survey data. Lancet. 2009;373(9674):1543–1549. doi: 10.1016/S0140-6736(09)60317-2.
    1. Luman ET, Barker LE, Shaw KM, McCauley MM, Buehler JW, Pickering LK. Timeliness of childhood vaccinations in the United States - Days undervaccinated and number of vaccines delayed. Jama-J Am Med Assoc. 2005;293(10):1204–1211. doi: 10.1001/jama.293.10.1204.
    1. Fadnes LT, Nankabirwa V, Sommerfelt H, Tylleskar T, Tumwine JK, Engebretsen IM. Is vaccination coverage a good indicator of age-appropriate vaccination? A prospective study from Uganda. Vaccine. 2011;29(19):3564–3570. doi: 10.1016/j.vaccine.2011.02.093.
    1. Shann F, Nohynek H, Scott JA, Hesseling A, Flanagan KL. Randomized trials to study the nonspecific effects of vaccines in children in low-income countries. Pediatr Infect Dis J. 2010;29(5):457–461. doi: 10.1097/INF.0b013e3181c91361.
    1. Aaby P, Rodrigues A, Biai S, Martins C, Veirum JE, Benn CS, Jensen H. Oral polio vaccination and low case fatality at the paediatric ward in Bissau, Guinea-Bissau. Vaccine. 2004;22(23-24):3014–3017. doi: 10.1016/j.vaccine.2004.02.009.
    1. Ndiritu M, Cowgill KD, Ismail A, Chiphatsi S, Kamau T, Fegan G, Feikin DR, Newton CR, Scott JA. Immunization coverage and risk factors for failure to immunize within the Expanded Programme on Immunization in Kenya after introduction of new Haemophilus influenzae type b and hepatitis b virus antigens. BMC Public Health. 2006;6(132)
    1. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R. et al.Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375(9730):1969–1987. doi: 10.1016/S0140-6736(10)60549-1.
    1. WHO and UNICEF concerned about measles outbreak in Eastern and Southern Africa.
    1. Nankunda J, Tylleskar T, Ndeezi G, Semiyaga N, Tumwine JK. Establishing individual peer counselling for exclusive breastfeeding in Uganda: implications for scaling-up. Matern Child Nutr. 2010;6(1):53–66. doi: 10.1111/j.1740-8709.2009.00187.x.
    1. National Department of Health South Africa. The national HIV and syphilis prevalence survey South Africa 2007. Pretoria, South Africa: National Department of Health. 2007.
    1. Jackson DJ, Chopra M, Doherty TM, Colvin MS, Levin JB, Willumsen JF, Goga AE, Moodley P. Operational effectiveness and 36 week HIV-free survival in the South African programme to prevent mother-to-child transmission of HIV-1. AIDS. 2007;21(4):509–516. doi: 10.1097/QAD.0b013e32801424d2.
    1. The South African EPI (EPI-SA) schedule and method of vaccine administration.
    1. Laubereau B, Hermann M, Schmitt HJ, Weil J, von Kries R. Detection of delayed vaccinations: a new approach to visualize vaccine uptake. Epidemiol Infect. 2002;128(2):185–192.
    1. Howe LD, Hargreaves JR, Huttly SR. Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries. Emerg Themes Epidemiol. 2008;5:3. doi: 10.1186/1742-7622-5-3.
    1. Arevshatian L, Clements C, Lwanga S, Misore A, Ndumbe P, Seward J, Taylor P. An evaluation of infant immunization in Africa: is a transformation in progress? Bull World Health Organ. 2007;85(6):449–457. doi: 10.2471/BLT.06.031526.
    1. World Health Organization. State of the world's vaccines and immunization. 3. 2009.
    1. Smith PJ, Nuorti JP, Singleton JA, Zhao Z, Wolter KM. Effect of vaccine shortages on timeliness of pneumococcal conjugate vaccination: results from the 2001-2005 National Immunization Survey. Pediatrics. 2007;120(5):e1165–1173. doi: 10.1542/peds.2007-0037.
    1. Daskalaki I, Spain CV, Long SS, Watson B. Implementation of rotavirus immunization in Philadelphia, Pennsylvania: high levels of vaccine ineligibility and off-label use. Pediatrics. 2008;122(1):e33–38. doi: 10.1542/peds.2007-2464.
    1. Biellik R, Madema S, Taole A, Kutsulukuta A, Allies E, Eggers R, Ngcobo N, Nxumalo M, Shearley A, Mabuzane E. et al.First 5 years of measles elimination in southern Africa: 1996-2000. Lancet. 2002;359(9317):1564–1568. doi: 10.1016/S0140-6736(02)08517-3.
    1. Sudfeld CR, Navar AM, Halsey NA. Effectiveness of measles vaccination and vitamin A treatment. Int J Epidemiol. 2010;39(Suppl 1):i48–55.
    1. Polio vaccines and polio immunization in the pre-eradication era: WHO position paper. Wkly Epidemiol Rec. 2010;85(23):213–228.
    1. Orenstein WA, Strebel PM, Papania M, Sutter RW, Bellini WJ, Cochi SL. Measles eradication: is it in our future? Am J Public Health. 2000;90(10):1521–1525. doi: 10.2105/AJPH.90.10.1521.
    1. Stittelaar KJ, de Swart RL, Osterhaus AD. Vaccination against measles: a neverending story. Expert Rev Vaccines. 2002;1(2):151–159. doi: 10.1586/14760584.1.2.151.
    1. Dai B, Chen ZH, Liu QC, Wu T, Guo CY, Wang XZ, Fang HH, Xiang YZ. Duration of immunity following immunization with live measles vaccine: 15 years of observation in Zhejiang Province, China. Bull World Health Organ. 1991;69(4):415–423.
    1. Strebel P, Cochi S, Grabowsky M, Bilous J, Hersh BS, Okwo-Bele JM, Hoekstra E, Wright P, Katz S. The unfinished measles immunization agenda. J Infect Dis. 2003;187(Suppl 1):S1–7.
    1. World Health Organization. Measles Vaccines: WHO Position Paper. Weekly epidemiological record. 2009;84:349–360.
    1. Rwashana AS, Williams DW, Neema S. System dynamics approach to immunization healthcare issues in developing countries: a case study of Uganda. Health Informatics J. 2009;15(2):95–107. doi: 10.1177/1460458209102971.
    1. Andersen RM. National health surveys and the Behavioral Model of Health Services Use. Med Care. 2008;46(7):647–653. doi: 10.1097/MLR.0b013e31817a835d.
    1. Coovadia H, Jewkes R, Barron P, Sanders D, McIntyre D. The health and health system of South Africa: historical roots of current public health challenges. Lancet. 2009;374(9692):817–834. doi: 10.1016/S0140-6736(09)60951-X.
    1. Ndiritu M, Cowgill KD, Ismail A, Chiphatsi S, Kamau T, Fegan G, Feikin DR, Newton CRJC, Scott JAG. Immunization coverage and risk factors for failure to immunize within the Expanded Programme on Immunization in Kenya after introduction of new Haemophilus influenzae type b and hepatitis b virus antigens. BMC Public Health. 2006;6
    1. Jacobson VJ, Szilagyi P. Patient reminder and patient recall systems to improve immunization rates. Cochrane Database Syst Rev. 2005;CD003941(3)
    1. Jensen H, Benn CS, Lisse IM, Rodrigues A, Andersen PK, Aaby P. Survival bias in observational studies of the impact of routine immunizations on childhood survival. Trop Med Int Health. 2007;12(1):5–14.
    1. Kroger AT, Atkinson WL, Marcuse EK, Pickering LK. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Recomm Rep. 2006;55(RR-15):1–48.

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