IMMUNIZATION RATES AT THE SCHOOL ENTRY IN 2012: NATIONWIDE GERMAN DATA WITH REGIONAL AND LOCAL BREAKDOWN

Wednesday, 14th of January 2015

“Stronger informational efforts must be undertaken to improve the public acceptance of immunization against hepatitis B and measles, so that these immunization rates can rise. For measles in particular, uniform nationwide recommendations might help increase the immunization rate.”

IMMUNIZATION RATES AT THE SCHOOL ENTRY IN 2012: NATIONWIDE GERMAN DATA WITH REGIONAL AND LOCAL BREAKDOWN

Dtsch Arztebl Int 2014; 111(46): 788-94; DOI: 10.3238/arztebl.2014.0788

Weigel, M; Bruns, R; Weitmann, K; Hoffmann, W 

University Medicine Greifswald, Institute for Community Medicine, Section Epidemiology of Health Care and Community Health: Dr. med. Weigel, Weitmann, Prof. Dr. med. Hoffmann, MPH
University Medicine Greifswald, Center for Child and Adolescent Medicine: PD Dr. med. habil Bruns

 

Full text, with figures, is at http://www.aerzteblatt.de/int/archive/article?id=163524

 

Background: The immunization rates for some diseases, including measles, were so low in Germany in recent years that endemic outbreaks occurred. A finely detailed geographic analysis of immunization rates is necessary for the identification of under-immunized areas.

Methods: We addressed this question with the aid of regional and local data from school entrance examinations, which were made available to us by the health departments of the German federal states. These data are represented both in tabular form and with the aid of a geographical information system (GIS).

Results: The immunization rates for tetanus, pertussis, and poliomyelitis were high throughout Germany (96.5%, 95.6%, and 95.2%, respectively). In contrast, major variation across regions was seen in immunization rates for hepatitis B (range: 53.5% to 99.1%) and measles (52.1% to 98.3%), with higher immunization rates in areas of the former East Germany. Low immunization rates were particularly evident in some areas in the states of Bavaria and Baden–Württemberg. In some parts of Saxony (a state in the former East Germany), the official immunization recommendations differ from those of the nationwide Standing Committee on Vaccination (STIKO); as a result, these areas had a mean measles immunization rate of only 66.7% among children entering school.

Conclusion: High immunization rates were found across Germany for tetanus, pertussis, and poliomyelitis, although the rates in some regions were lower than they should be. Stronger informational efforts must be undertaken to improve the public acceptance of immunization against hepatitis B and measles, so that these immunization rates can rise. For measles in particular, uniform nationwide recommendations might help increase the immunization rate.

 

Immunizations are an effective measure for preventing infectious diseases, which cause substantial morbidity and whose sequelae, especially in children, can lead to retardation, disability, and even death (1, 2, e1). High rates of immunization in the population are desirable, because in this way, collective protection (“herd immunity”) can be achieved for some vaccine-preventable diseases (3, e2). Herd immunity is reached once a pathogen does not encounter a sufficiently large number of susceptible persons and its spread is therefore interrupted.

For some vaccine-preventable diseases, immunization rates in Germany are too low, so that endemic transmission and outbreaks are possible (4, 5). The applicable and most up to date recommendations on vaccination are published by Germanys Standing Committee on Vaccination (STIKO), but these are not accepted by all doctors and patients. Common reasons for vaccine-skeptical behavior are the fear of unknown side effects and a lack of trust in the safety of vaccines (6, 7, e3). New vaccines are clinically tested before they receive license approval, and they are subject to continuing postmarketing surveillance afterwards. Because relevant results are published, doubts and fears are usually unsubstantiated in the context of the vaccines in use today (8).

Data on immunization rates in Germany are collected in the context of annual school entrance examinations by the public health offices in the regional and local administrative districts. The data are aggregated at the level of the federal state (Land; pl., Länder) and passed on to the Robert Koch Institute (RKI), which publishes immunization rates for the whole of Germany on this basis. For 2012, the RKI reported nationwide immunization rates of 96.1% for tetanus, 95.4 for pertussis, 94.9% for polio, 86.9% for hepatitis B, and 92.4% for measles (9). Regional immunization rates are also collected and evaluated at the international level—for example, in Australia in the Australian Childhood Immunisation Register (ACIR) and in New Zealand in the National Immunisation Register (NIR) (10, 11). An up to date detailed description of nationwide immunization rates in Germany at the level of regional administrative districts does currently not exist. The present study aims to describe immunization rates for selected vaccinations in small areas, in order to identify regions with an increased need for information and education about the importance of immunizations and the increased risk of endemic outbreaks.