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Fully immunized child: coverage, timing and sequencing of routine immunization in an urban poor settlement in Nairobi, Kenya.

Mutua MK, Kimani-Murage E, Ngomi N, Ravn H, Mwaniki P, Echoka E - Trop Med Health (2016)

Bottom Line: Vaccine effectiveness depends on the timing of its administration, and it is not optimal if given early, delayed or not given as recommended.Results show higher levels of missed opportunities and low coverage of routine childhood vaccinations given at later ages.New strategies are needed to enable health care providers and parents/guardians to work together to increase the levels of completion of all required vaccinations.

View Article: PubMed Central - PubMed

Affiliation: African Population and Health Research Center, Manga Close, Nairobi, Kenya ; Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.

ABSTRACT

Background: More efforts have been put in place to increase full immunization coverage rates in the last decade. Little is known about the levels and consequences of delaying or vaccinating children in different schedules. Vaccine effectiveness depends on the timing of its administration, and it is not optimal if given early, delayed or not given as recommended. Evidence of non-specific effects of vaccines is well documented and could be linked to timing and sequencing of immunization. This paper documents the levels of coverage, timing and sequencing of routine childhood vaccines.

Methods: The study was conducted between 2007 and 2014 in two informal urban settlements in Nairobi. A total of 3856 children, aged 12-23 months and having a vaccination card seen were included in analysis. Vaccination dates recorded from the cards seen were used to define full immunization coverage, timeliness and sequencing. Proportions, medians and Kaplan-Meier curves were used to assess and describe the levels of full immunization coverage, vaccination delays and sequencing.

Results: The findings indicate that 67 % of the children were fully immunized by 12 months of age. Missing measles and third doses of polio and pentavalent vaccine were the main reason for not being fully immunized. Delays were highest for third doses of polio and pentavalent and measles. About 22 % of fully immunized children had vaccines in an out-of-sequence manner with 18 % not receiving pentavalent together with polio vaccine as recommended.

Conclusions: Results show higher levels of missed opportunities and low coverage of routine childhood vaccinations given at later ages. New strategies are needed to enable health care providers and parents/guardians to work together to increase the levels of completion of all required vaccinations. In particular, more focus is needed on vaccines given in multiple doses (polio, pentavalent and pneumococcal conjugate vaccines).

No MeSH data available.


Related in: MedlinePlus

Vaccine coverage curves by 12 months among children aged 12–23 months
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Fig2: Vaccine coverage curves by 12 months among children aged 12–23 months

Mentions: The coverage curves are shown in Fig. 2 for the whole period and for each year’s visit in the additional file (Additional file 3: Figure S1a and S1b). The curves for each vaccine by definition end at 100 % for FIC children. Vaccination timing among FIC are remarkable especially for the polio and pentavalent doses which are almost upright apart from a few children who received them a bit later. The MV and BCG coverage curves appear less upright. The FIC coverage curves for the OPV doses improved over the years. The coverage curves among the non-FIC children do not reach 100 % and are less upright compared to FIC children which shows that more non-FIC children have their vaccines delayed compared to FIC. Results from log rank tests showed significant differences in Kaplan-Meier curves between third doses of polio and pentavalent (P value 0.004) and non-significant differences between the first doses (P values = 0.242) and second doses (P value = 0.054) of polio and pentavalent vaccines in all children, respectively. Significant differences (P value <0.001) in Kaplan-Meier curves of each antigen by FIC status were observed from log rank tests. Additional file 4: Table S3 shows children are receiving their vaccines earlier than recommended ages: more than 4 days for OPV 1 (3.3 %) and pentavalent 1 (2.7 %) and MV (8.4 %). Five percent of the children received MV more than 14 days before the appropriate age. The proportion of early immunization is high among the non-FIC compared to FIC children for pentavalent doses (P values, 0.005, 0.029 and 0.001 for first, second and third doses, respectively) and the first polio dose (P value = 0.010).Fig. 2


Fully immunized child: coverage, timing and sequencing of routine immunization in an urban poor settlement in Nairobi, Kenya.

Mutua MK, Kimani-Murage E, Ngomi N, Ravn H, Mwaniki P, Echoka E - Trop Med Health (2016)

Vaccine coverage curves by 12 months among children aged 12–23 months
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940963&req=5

Fig2: Vaccine coverage curves by 12 months among children aged 12–23 months
Mentions: The coverage curves are shown in Fig. 2 for the whole period and for each year’s visit in the additional file (Additional file 3: Figure S1a and S1b). The curves for each vaccine by definition end at 100 % for FIC children. Vaccination timing among FIC are remarkable especially for the polio and pentavalent doses which are almost upright apart from a few children who received them a bit later. The MV and BCG coverage curves appear less upright. The FIC coverage curves for the OPV doses improved over the years. The coverage curves among the non-FIC children do not reach 100 % and are less upright compared to FIC children which shows that more non-FIC children have their vaccines delayed compared to FIC. Results from log rank tests showed significant differences in Kaplan-Meier curves between third doses of polio and pentavalent (P value 0.004) and non-significant differences between the first doses (P values = 0.242) and second doses (P value = 0.054) of polio and pentavalent vaccines in all children, respectively. Significant differences (P value <0.001) in Kaplan-Meier curves of each antigen by FIC status were observed from log rank tests. Additional file 4: Table S3 shows children are receiving their vaccines earlier than recommended ages: more than 4 days for OPV 1 (3.3 %) and pentavalent 1 (2.7 %) and MV (8.4 %). Five percent of the children received MV more than 14 days before the appropriate age. The proportion of early immunization is high among the non-FIC compared to FIC children for pentavalent doses (P values, 0.005, 0.029 and 0.001 for first, second and third doses, respectively) and the first polio dose (P value = 0.010).Fig. 2

Bottom Line: Vaccine effectiveness depends on the timing of its administration, and it is not optimal if given early, delayed or not given as recommended.Results show higher levels of missed opportunities and low coverage of routine childhood vaccinations given at later ages.New strategies are needed to enable health care providers and parents/guardians to work together to increase the levels of completion of all required vaccinations.

View Article: PubMed Central - PubMed

Affiliation: African Population and Health Research Center, Manga Close, Nairobi, Kenya ; Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.

ABSTRACT

Background: More efforts have been put in place to increase full immunization coverage rates in the last decade. Little is known about the levels and consequences of delaying or vaccinating children in different schedules. Vaccine effectiveness depends on the timing of its administration, and it is not optimal if given early, delayed or not given as recommended. Evidence of non-specific effects of vaccines is well documented and could be linked to timing and sequencing of immunization. This paper documents the levels of coverage, timing and sequencing of routine childhood vaccines.

Methods: The study was conducted between 2007 and 2014 in two informal urban settlements in Nairobi. A total of 3856 children, aged 12-23 months and having a vaccination card seen were included in analysis. Vaccination dates recorded from the cards seen were used to define full immunization coverage, timeliness and sequencing. Proportions, medians and Kaplan-Meier curves were used to assess and describe the levels of full immunization coverage, vaccination delays and sequencing.

Results: The findings indicate that 67 % of the children were fully immunized by 12 months of age. Missing measles and third doses of polio and pentavalent vaccine were the main reason for not being fully immunized. Delays were highest for third doses of polio and pentavalent and measles. About 22 % of fully immunized children had vaccines in an out-of-sequence manner with 18 % not receiving pentavalent together with polio vaccine as recommended.

Conclusions: Results show higher levels of missed opportunities and low coverage of routine childhood vaccinations given at later ages. New strategies are needed to enable health care providers and parents/guardians to work together to increase the levels of completion of all required vaccinations. In particular, more focus is needed on vaccines given in multiple doses (polio, pentavalent and pneumococcal conjugate vaccines).

No MeSH data available.


Related in: MedlinePlus