Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2017 Jan 11;35(3):443-451.
doi: 10.1016/j.vaccine.2016.11.075. Epub 2016 Dec 18.

Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study

Christel Hoest  1 , Jessica C Seidman  2 , Gwenyth Lee  3 , James A Platts-Mills  4 , Asad Ali  5 , Maribel Paredes Olortegui  6 , Pascal Bessong  7 , Ram Chandyo  8 , Sudhir Babji  9 , Venkata Raghava Mohan  9 , Dinesh Mondal  10 , Mustafa Mahfuz  10 , Estomih R Mduma  11 , Emanuel Nyathi  7 , Claudia Abreu  12 , Mark A Miller  2 , William Pan  13 , Carl J Mason  14 , Stacey L Knobler  2 ; MAL-ED Network Investigators
Affiliations
Observational Study

Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study

Christel Hoest et al. Vaccine. .

Abstract

Background: Launched in 1974, the Expanded Program on Immunization (EPI) is estimated to prevent two-three million deaths annually from polio, diphtheria, tuberculosis, pertussis, measles, and tetanus. Additional lives could be saved through better understanding what influences adherence to the EPI schedule in specific settings.

Methods: The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study followed cohorts in eight sites in South Asia, Africa, and South America and monitored vaccine receipt over the first two years of life for the children enrolled in the study. Vaccination histories were obtained monthly from vaccination cards, local clinic records and/or caregiver reports. Vaccination histories were compared against the prescribed EPI schedules for each country, and coverage rates were examined in relation to the timing of vaccination. The influence of socioeconomic factors on vaccine timing and coverage was also considered.

Results: Coverage rates for EPI vaccines varied between sites and by type of vaccine; overall, coverage was highest in the Nepal and Bangladesh sites and lowest in the Tanzania and Brazil sites. Bacillus Calmette-Guérin coverage was high across all sites, 87-100%, whereas measles vaccination rates ranged widely, 73-100%. Significant delays between the scheduled administration age and actual vaccination date were present in all sites, especially for measles vaccine where less than 40% were administered on schedule. A range of socioeconomic factors were significantly associated with vaccination status in study children but these results were largely site-specific.

Conclusions: Our findings highlight the need to improve measles vaccination rates and reduce delayed vaccination to achieve EPI targets related to the establishment of herd immunity and reduction in disease transmission.

Keywords: EPI; Measles; Public health; Socioeconomic factors; Vaccine coverage; Vaccine timing.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Schedule adherence. Number of days between scheduled and actual vaccination day for the first dose of BCG, DPT, OPV, and measles for all children. BCG1: first dose of BCG; DPT1: first dose of DPT; Measles1: first dose of measles.
Fig. 2
Fig. 2
Schedule adherence by vaccine. Percent children vaccinated on schedule (within 7 days of the EPI scheduled date) by vaccine by site. BCG1: first dose of BCG; DPT1: first dose of DPT; Measles1: first dose of measles; BGD: Dhaka, Bangladesh; BRF: Fortaleza, Brazil; INV: Vellore, India; BGD: Bhaktapur, Nepal; PEL: Loreto, Peru; PKN: Naushero Feroze, Pakistan; SAV: Venda, South Africa; TZH: Haydom, Tanzania.
See this image and copyright information in PMC

References

    1. Keja K. Expanded programme on immunization. World Health Stat Q. 1988;41(2):59–63. - PubMed
    1. Dietz V.J. Potential impact on vaccination coverage levels by administering vaccines simultaneously and reducing dropout rates. Arch Pediatr Adolesc Med. 1994;148(9):943–949. - PubMed
    1. WHO. WHO vaccine-preventable diseases: monitoring system. Global summary; 2014 [cited 2014 August 20]. Available from: http://apps.who.int/immunization_monitoring/globalsummary.
    1. WHO. Global vaccine action plan 2011–2020; 2013.
    1. Akmatov M.K., Mikolajczyk R.T. Timeliness of childhood vaccinations in 31 low and middle-income countries. J Epidemiol Community Health. 2012;66(7):e14. - PubMed

Publication types