Aug 2026· BMC Medicine· Vol 24· 0 citations· 77 references
Medicine
Abstract
Despite well-established childhood immunization programs in many high-income countries, vaccination series are often delayed or not completed. Gaps in vaccination coverage are more common among children from socioeconomically disadvantaged households, among whom they are associated with higher rates of related hospitalizations. We aimed to assess the extent of these gaps in Germany, as well as the presence of socioeconomic inequality and the factors accounting for it. Using health insurance claims data from Techniker Krankenkasse for 2016–2019, we examined vaccination coverage for a comprehensive set of STIKO-recommended childhood vaccinations in six birth-year cohorts (2011–2018; approximately 430,000 children; 2.5 million recommended vaccinations). Coverage was defined as completion of the recommended series with all doses administered within the recommended age window. Socioeconomic inequality was quantified using the Erreygers-corrected concentration index and decomposed into contributions from factors such as parental education and travel time to the treating physician. Approximately 80% of vaccination series in the sample were complete and administered within the recommended age window. Vaccination coverage showed a small but statistically significant socioeconomic gradient (concentration index = 0.024, 95% confidence interval: 0.023 to 0.025) favoring children from higher socioeconomic households. In the decomposition analysis, provider type accounted for the largest share of this gradient, with lower completion rates and timeliness among children whose outpatient care was mainly delivered by general practitioners compared with pediatricians. Parental education contributed to a lesser extent, and travel time contributed little to the observed inequality. Childhood vaccination coverage in Germany remains below national targets and shows a small socioeconomic gradient. The gradient appears to be less strongly related to logistical access barriers than to differences in how vaccinations are delivered in outpatient care outside pediatric settings. These provider-type differences in vaccination delivery may therefore be more relevant for narrowing the observed gradient than further reductions in travel time.
The Sunampe district on the Peruvian coast faces challenges related to adherence to childhood vaccination schedules. This study aimed to assess whether non-compliance with vaccination correlates with an increased risk of vaccine-preventable epidemiological vulnerability and health system fragility among children under five, within the context of low coverage in Sunampe.
An analytical, correlational, cross-sectional study was conducted involving 123 families in Sunampe. Data on vaccination status, reported illnesses, and mortality of children aged 1 to 5 years were collected. Medical records were reviewed for vaccine-preventable diseases, and mortality data were obtained from the SINADEF database. Severe non-compliance was defined as vaccination discontinued by 6 months of age (≥3 missed key doses). Logistic regression with prespecified predictors (knowledge, fear, access) was used to identify determinants of severe non-compliance. Mortality data were obtained from the SINADEF database (2017–2022). Sensitivity analysis using Firth’s penalized logistic regression with dimension reduction (composite knowledge, fear, and access scores) addressed low events-per-variable (EPV = 4.5).
Some Peruvian districts had to improve health facilities, while families in Sunampe perceived the single local health center as insufficient. No active vaccine-preventable illnesses were reported among surveyed children, but SINADEF data showed 10 deaths in children under five between 2017 and 2022, including 6 around respiratory mechanics issues (Pneumococcus) and 1 with malnutrition (no clearly anemia). Also, it was shown the prevalence of illness and incomplete immunization, as well as increased rates of anemia in Peru. Logistic regression models had fair to good predictive power and identified two significant predictors of severe non-compliance: lack of knowledge about vaccination age (Q17: OR = 10.96, 95% CI: 3.40–35.36,
p
= 0.0001) and never attending a vaccine information session (Q18: OR = 3.32, 95% CI: 1.16–9.57,
p
= 0.026). Fear of reactions (reported by 99.2% of mothers) did not reach statistical significance. The model showed good discriminative ability (AUC = 0.852, accuracy = 76.4%). Firth penalized logistic regression on composite scores confirmed knowledge as the only significant predictor (OR = 3.84 per 1-point increase,
p
< 0.001), while fear (OR = 2.82,
p
= 0.082) and access (OR = 0.80,
p
= 0.512) were not significant.
Incomplete vaccination in Sunampe appears linked to parental knowledge gaps and concerns about vaccine side effects, despite most parents reporting no severe reactions. Fear of reactions did not predict behavior, suggesting that reported safety concerns may reflect social desirability bias rather than true barriers. These findings highlight the need, in clinical decision-making, for targeted education to improve vaccination adherence and reduce epidemiological vulnerability and health system fragility.
Margarita Norma Castro-Fuentes, Carlos Andrés Mugruza-Vassallo· Frontiers in Public Health· 0 citations
Multiple socioeconomic, structural and operational factors were associated with unvaccinated rates, highlighting the relevance of healthcare service organization even in favorable social contexts and classifying municipalities into risk profiles may help guide interventions to improve coverage.
I. N. Schrarstzhaupt, F. A. Diaz-Quijano, F. Fontana Sutile Tardetti Fantinato et al.· medRxiv· 0 citations
Evaluating current influenza vaccination coverage and identifying factors that may influence whether adults choose to be vaccinated suggests that efforts to advance equity may benefit from addressing structural barriers, such as expanding insurance coverage, workplace vaccination programs, and targeted outreach to underserved populations.
Christian Smolen, Joseph P. Fava, Paul E. Kilgore· Infectious Disease and Thera...· 0 citations
Adherence to the vaccination schedule among children younger than one year was insufficient, highlighting the need to strengthen educational interventions for parents, improve access to vaccination services, and implement strategies that promote timely childhood immunization in primary healthcare settings.
Mejia Chiquinquira, Pina Alberto· Journal of Family Medicine a...· 0 citations
BACKGROUND
Delays in receiving vaccinations lead to higher vaccine-preventable disease risk. We quantified the prevalence and drivers of delayed uptake of fee‑based, non-Expanded Program on Immunization (non-EPI) childhood vaccines in urban China.
METHODS
A multicentre clinic-based survey with an embedded discrete-choice experiment (DCE) was conducted from May to July 2024 in 15 immunisation clinics across five provincial capitals in China. Caregivers of children aged 0-6 years provided verified vaccination information, socio demographic data, scores on a 12 item Caregiver Timely Vaccination Scale, and responses to a DCEwith four attributes (price, waiting time, calendar delay, adverse event [AE] risk). Delayed vaccination was defined as receipt of at least one non-EPI dose 30 days or more after the recommended schedule.Weighted logistic regression identified correlates; mixed logit models generated marginal utilities and willingness to pay (WTP).
RESULTS
Among 1 292 valid caregiver-child pairs, the delay prevalence was 23.7% (95%CI: 21.3-26.1). Delay risk increased with monthly household income < ¥10 000 (adjusted OR: 1.24, 95% CI: 1.11-1.38), an unpleasant prior vaccination experience (1.11, 1.01-1.23) and a caregiver's delay history (1.22, 1.10-1.36), and less likely when knowledge was adequate (0.33, 0.25-0.43). The timely scale discriminated delayed from timely caregivers (+ 1.0 mean score). In the DCE, AE risk dominated all other attributes (66.3% relative importance): lowering the stated risk from 5% to 3% increased predicted uptake by 74% points. Reducing queue time from 30 min to 10 min added 24 points. Caregivers were willing to pay ¥106 (≈ US $14) per 1% AE‑risk reduction but only ¥4 for a 10‑day improvement in calendar timeliness.
CONCLUSIONS
Delayed vaccination drives non-EPI under timeliness in urban China. Embedding delay metrics and the brief 3 C screen in routine dashboards, supported by sharper AE‑risk communication and fast‑track queues, could close the gap and advance Immunization Agenda 2030 targets.
Linchen Chu, Kangning Sheng, Jiajun Li et al.· International Journal for Eq...· 0 citations
The analysis reveals the complex interplay of various factors influencing COVID-19 vaccination decisions, emphasizing the importance of residential areas and urbanization.
Neda Firouraghi, Ève Dubé, B. Thierry et al.· Journal of urban health· 0 citations
