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Determinants of low measles vaccination coverage in children living in an endemic area

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Abstract

Measles outbreaks were recently reported in Europe due to low immunization rates. In this scenario, identifying the reasons of no vaccination is crucial to set up strategies to improve immunization rate. A cross-sectional study was conducted to investigate the determinants of missed vaccination in children living in Southern Italy, during the 2016 outbreak. A standardized face-to-face questionnaire was used to record demographic data, immunization status, and reasons for missed vaccination. A total of 1141 children (median age 86 months, male 47.2%) was enrolled, 77.8% of the children were adequately vaccinated for age, 6.3% were incompletely vaccinated for age, and 15.9% did not receive any vaccine dose. Vaccination rate and reasons for not vaccinating significantly varied according to age, with children ≤ 24 months showing the lowest rate (67.8%). Reasons for not vaccinating included fear for side effects (51%), presence of underlying chronic conditions (12.2%), skip scheduled appointment (12.2%), refusal of vaccination (10.3%), acute illnesses (7.2%), and allergy to eggs (4.6%). The presence of underlying condition was a risk factor for inadequate immunization (p < 0.0001). Only 4.7% of conditions were true contraindications to vaccine administration.

Conclusion: We reported inadequate measles immunization rate in Southern Italy, with lowest rates in children ≤ 2 years or with underlying conditions. Only a minority had true contraindications to vaccine uptake. Implementation strategies addressed to health-care professionals and families should focus on the reported determinants to increase measles vaccination coverage.

What is Known:

• Measles is a viral, highly communicable disease, preventable by vaccine.

• Measles elimination in Europe failed as demonstrated by outbreaks in several countries, due to low immunization rates.

What is New:

• Inadequate measles immunization rate due to false contraindications in Southern Italy, with lowest rates in children ≤ 2 years.

• The presence of underlying disease is a risk factor for inadequate immunization.

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Abbreviations

DTaP-HB-IPV-Hib:

Diphtheria/tetanus/pertussis/hepatitis B/polio/haemophilus influenzae type b

MMR:

Measles-mumps-rubella

WHO:

World Health Organization

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Author information

Authors and Affiliations

  1. Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy

    Andrea Lo Vecchio, Maria Donata Cambriglia, Francesca Wanda Basile, Fabrizia Chiatto & Alfredo Guarino

  2. Department of Woman, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy

    Maria Cristina Fedele & Michele Miraglia del Giudice

Authors
  1. Andrea Lo Vecchio
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  2. Maria Donata Cambriglia
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  3. Maria Cristina Fedele
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  4. Francesca Wanda Basile
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  5. Fabrizia Chiatto
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  6. Michele Miraglia del Giudice
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  7. Alfredo Guarino
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Contributions

ALV and AG conceived the study.

ALV and MDC designed the study protocol and prepared the first draft of the survey.

AG revised and approved the survey before dissemination.

MDC, MCF, FC, and FWB administered the survey to families and caregivers.

MDC and MCF developed the database. ALV performed the statistical analysis and wrote the first draft of the manuscript. ALV and MDC produced tables and figures.

AG and MMDG provided substantial contribution to draft the paper and reviewed the final manuscript.

All authors gave their final approval of the version to be published and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Andrea Lo Vecchio.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Nicole Ritz

Electronic supplementary material

Supplemental table S1

STROBE checklist (PDF 96 kb)

Supplemental figure S2

The frequency of real contraindications (black) and false contraindications and other barriers (shaded in black) are reported according to each category. On the right column, different strategies to be addressed to health-care workers and general population are proposed to improve vaccination coverage

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Lo Vecchio, A., Cambriglia, M.D., Fedele, M.C. et al. Determinants of low measles vaccination coverage in children living in an endemic area. Eur J Pediatr 178, 243–251 (2019). https://doi.org/10.1007/s00431-018-3289-5

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  • DOI: https://doi.org/10.1007/s00431-018-3289-5

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