Local measles vaccination gaps in Germany and the role of vaccination providers

BMC Public Health

Research Article

Stephanie Wjst¹  Martin Eichner¹  Linda Eichner²  Kerstin Wolfers³  Stefan O. Brockmann³ 

[1] Institute for Clinical Epidemiology and Applied Biometrics, University Tübingen, Silcherstraße 5, 72076, Tübingen, Germany;Institute for Clinical Epidemiology and Applied Biometrics, University Tübingen, Silcherstraße 5, 72076, Tübingen, Germany;Public Health Office Reutlingen (Landratsamt Reutlingen), Gesundheitsamt, St.-Wolfgang-Straße 13, 72764, Reutlingen, Germany;Public Health Office Reutlingen (Landratsamt Reutlingen), Gesundheitsamt, St.-Wolfgang-Straße 13, 72764, Reutlingen, Germany;

关键词: Measles;    Vaccination;    Vaccination gaps;    Immunization rate;    Kindergarten;   

DOI  :  10.1186/s12889-017-4663-3

 received in 2016-11-03, accepted in 2017-08-01,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundMeasles elimination in Europe is an urgent public health goal, yet despite the efforts of its member states, vaccination gaps and outbreaks occur. This study explores local vaccination heterogeneity in kindergartens and municipalities of a German county.MethodsData on children from mandatory school enrolment examinations in 2014/15 in Reutlingen county were used. Children with unknown vaccination status were either removed from the analysis (best case) or assumed to be unvaccinated (worst case). Vaccination data were translated into expected outbreak probabilities. Physicians and kindergartens with statistically outstanding numbers of under-vaccinated children were identified.ResultsA total of 170 (7.1%) of 2388 children did not provide a vaccination certificate; 88.3% (worst case) or 95.1% (best case) were vaccinated at least once against measles. Based on the worst case vaccination coverage, <10% of municipalities and <20% of kindergartens were sufficiently vaccinated to be protected against outbreaks. Excluding children without a vaccination certificate (best case) leads to over-optimistic views: the overall outbreak probability in case of a measles introduction lies between 39.5% (best case) and 73.0% (worst case). Four paediatricians were identified who accounted for 41 of 109 unvaccinated children and for 47 of 138 incomplete vaccinations; GPs showed significantly higher rates of missing vaccination certificates and unvaccinated or under-vaccinated children than paediatricians.ConclusionsMissing vaccination certificates pose a severe problem regarding the interpretability of vaccination data. Although the coverage for at least one measles vaccination is higher in the studied county than in most South German counties and higher than the European average, many severe and potentially dangerous vaccination gaps occur locally. If other federal German states and EU countries show similar vaccination variability, measles elimination may not succeed in Europe.

【 授权许可】

CC BY   
© The Author(s). 2017