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. 2014 Nov 1;210 Suppl 1(0 1):S514-22.
doi: 10.1093/infdis/jiu108.

Overview of global, regional, and national routine vaccination coverage trends and growth patterns from 1980 to 2009: implications for vaccine-preventable disease eradication and elimination initiatives

Aaron S Wallace  1 , Tove K Ryman  1 , Vance Dietz  1
Affiliations

Overview of global, regional, and national routine vaccination coverage trends and growth patterns from 1980 to 2009: implications for vaccine-preventable disease eradication and elimination initiatives

Aaron S Wallace et al. J Infect Dis. .

Abstract

Background: Review of the historical growth in annual vaccination coverage across countries and regions can better inform decision makers' development of future goals and strategies to improve routine vaccination services.

Methods: Using the World Health Organization (WHO) and the United Nations Children's Fund estimates of annual national third dose of diphtheria-tetanus-pertussis-containing vaccine (DTP3) and third dose of polio vaccine (POL3) coverage for 1980-2009, we calculated the mean absolute annual rate of change in national DTP3 coverage among all countries (globally) and among countries within each WHO region, as well as the number of years taken by each region to reach specific regional coverage levels. Last, we assessed differences in mean absolute annual rate of change in DTP3 coverage, stratified by baseline level of DTP3 coverage.

Results: During the 1980s, global DTP3 coverage increased a mean of 5.3 percentage points/year. Annual rate of change decreased to 0.5 percentage points/year in the 1990s and then increased to 0.9 percentage points/year during the 2000s. Mean annual rate of change in coverage across all countries was highest (9.2 percentage points) when national coverage levels were 26%-30% and lowest (-0.9 percentage points) when national coverage levels were 96%-100%. Regional differences existed as both WHO South-East Asia Region and WHO African Region countries experienced mean negative DTP3 coverage growth at lower coverage levels (81%-85%) than other regions. The regions that have achieved 95% DTP3 coverage (Americas, Western Pacific, and European) took 25-29 years to reach that level from a level of 50% DTP3 coverage. POL3 coverage change trends were similar to described DTP3 coverage change trends.

Conclusions: Mean national coverage growth patterns across all regions are nonlinear as coverage levels increase. Saturation points of mean 0 percentage-point growth in annual coverage varies by region and require further investigation. The achievement of >90% routine coverage is observed to take decades, which has implications for disease eradication and elimination initiatives.

Keywords: DTP3; Polio; coverage; routine; vaccination.

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Figures

Figure 1
Figure 1
Global and regional vaccination coverage from 1980 to 2009, based on World Health Organization (WHO)/United Nations Children's Fund coverage estimates [12]. Region definitions are based on WHO categorization [14]. Abbreviations: DTP3, third dose of diphtheria-tetanus-pertussis–containing vaccine; MCV1, first dose of measles-containing vaccine; POL3, third dose of polio vaccine.
Figure 2
Figure 2
National coverage with a third dose of diphtheria-tetanus-pertussis–containing vaccine (DTP3) during 2009 and absolute annual rate of change in national DTP3 coverage during 1999–2009. Each dot represents 1 country; the size of the dot is defined by the number of unvaccinated children in the country as of 2009, based on World Health Organization (WHO)/United Nations Children's Fund DTP3 coverage estimates and United Nations population estimates [12, 13]. GIVS, Global Immunization Vision and Strategy Framework for 2006 to 2015 (used as a global framework of goals and objectives for vaccination programs worldwide, including the GIVS 2015 national coverage goals of 90%).
Figure 3
Figure 3
Mean and cumulative absolute annual rates of change in global vaccination coverage, by coverage category, 1980–2009. Data are based on World Health Organization/United Nations Children's Fund coverage estimates [12]. DTP3, third dose of diphtheria-tetanus-pertussis–containing vaccine; MCV, measles-containing vaccine; POL3, third dose of polio vaccine.
Figure 4
Figure 4
Mean and cumulative absolute annual rates of change in regional coverage by the third dose of diphtheria-tetanus-pertussis–containing vaccine (DTP3) per coverage category, 1980–2009. Data are based on World Health Organization (WHO)/United Nations Children's Fund coverage estimates [12]. Regions and countries are defined according to WHO standards [14].
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References

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