Differences in timeliness, completeness and drop-out rates of MMRV and DTP containing vaccines among Ultra-Orthodox Jews and others in a deprived Northern Israel city: an ecological study

Abstract

Background: The Ultra-Orthodox Jewish (UO) population has been affected by pertussis, polio, and measles outbreaks. Safed, a deprived, undervaccinated city in Israel's North, has a large UO population concentrated in specific neighborhoods. We determined whether in Safed UO population concentration was associated with DTP- containing and MMRV1 vaccines coverage, timeliness and drop-out rates.

Method: For each of Safed's statistical areas, we estimated UO population based on the proportion of votes for UO political parties in Israel's 2020 general elections. We determined whether this proportion was associated with timely and delayed MMRV1 and DTP vaccine coverage for children born 2017-2022 using simple linear regression. We compared DTP and MMRV1 coverage and drop-out rates in UO areas (> 50% vote for UO parties) to others, using chi-square tests.

Results: All eligible 4385 children residing in Safed were included in the MMRV1 and DTP analyses. Vaccine coverage was significantly lower in UO areas compared to non-UO for all doses of DTP and MMRV1 at expected age (-11.8, -15.8, -16.6, -11.8 and - 7.1% points (pp) respectively, P < 0.005) - and at 36 months old (-0.5, -3.9, -6.2, -9.3 and - 2% points respectively, P < 0.005). Gaps narrowed more for MMRV1 (from 7.1 to2 pp), than for DTP4 (from 11.8 to9.3 pp). Increasing UO vote was associated with decreased timely coverage for DTP but not MMRV. DTP1-4 drop-out rates were larger in the UO areas than in non-UO areas (26.2% vs. 18%).

Conclusions: Vaccine coverage was lower in UO neighborhoods, even in a peripheral city where coverage in non-UO areas is already low. Coverage differences between UO and non-UO populations decreased with time for MMRV1 but not DTP. Our findings suggest timeliness should be considered alongside non-vaccination, and vaccination behavior may be vaccine-specific in the UO population.

Keywords: DTP; Equity; Israel; Jewish; MMRV; Religion; Vaccine coverage.

Fig. 1

(A) The location of Safed in Israels map. (B) The map of the city of Safed, divided into statistical areas [28]. The areas colored green marks areas with voting rates for UO parties larger than 50%

Fig. 2

Association between Proportion of UO vote and timely coverage for DTP1 at 3 months (Panel 1), DTP2 at 5 months (Panel 2), DTP3 at 7 months (Panel 3), DTP4 at 13 months (Panel 4) and MMRV1 at 13 months (Panel 5)

Fig. 3

Association between Proportion of UO vote and delayed coverage for DTP1 at 6 months (Panel 1), DTP2 at 8 months (panel 2), DTP3 at 12 months (panel 3), DTP4 at 18 months (panel 4) and MMRV1 at 18 months (panel 5)

Fig. 4

Vaccine coverage among children born 2017–2022 for DTP1 (A) DTP2 (B) DTP3 (C) DTP4 (D) and MMRV1 (E) in Safed UO and non UO neighborhoods

Fig. 5

DTP 1–2, 1–3 and 1–4 dropout rates among 24 month-old children living in UO and non UO areas