New Delhi: Two-thirds of children in India do not receive their vaccinations on time, prolonging their susceptibility to diseases and contributing to untimely deaths, say University of Michigan researchers.
New research by U-M’s School of Public Health found that only 18 percent of children are vaccinated with the recommended three doses of DPT vaccine, while about a third receive the measles vaccination by 10 months under the government-supported immunization program.
Their study is believed to be the first that looks at vaccination timeliness data for children up to 5 years of age, both with and without immunization cards.
India has the highest number of deaths among children younger than 5 years of age globally; the majority are from vaccine preventable diseases. Untimely vaccination unnecessarily prolongs susceptibility to disease and contributes to the burden of childhood morbidity and mortality yet there is scarce literature on vaccination delays. The aim of this study is to characterize the timeliness of childhood vaccinations administered under India’s routine immunization program using a novel application of an existing statistical methodology.
Methods: This study utilized the District Level Household and Facility Survey Data, 2008 from India using vaccination data from children with and without immunization cards. Turnbull estimator of the cumulative distribution function was used to estimate the probability of vaccination at each age. Timeliness of Bacille Calmette-Guerin (BCG), all three doses of diphtheria, pertussis, and tetanus vaccine (DPT), and measles-containing vaccine (MCV) were considered for this analysis.
Findings: Vaccination data on 268,553 children who were 0 to 60 months of age were analyzed; timely administration of BCG, DPT3 and MCV occurred in 31%, 19%, and 34% of children, respectively. The estimated vaccination probability plateaued for DPT and BCG around the age of 24 months, whereas MCV uptake increased another 5% after 24 months of age. The five year coverage of BCG, DPT3, and MCV in Indian children was 87%, 63%, and 76%, respectively.
Interpretation: Lack of timely administration of key childhood vaccines, especially DPT3 and MCV, remains a major challenge in India and likely contributes to the significant burden of VPD-related morbidity and mortality in children.
“Every year, 26 million children are born in India—the greatest number by far of any country in the world,” said Dr. Matthew Boulton, senior associate dean for global public health at the U-M School of Public Health and professor of epidemiology, health management and policy, and preventive medicine.
“Approximately, 95 percent vaccination is required in a population to successfully stop measles outbreaks,” said Boulton, a senior author of the study. “India’s childhood vaccination rate is simply too low to successfully control transmission of disease and prevent measles-related childhood illnesses and deaths.”
“Interventions like awareness building and follow-up with parents will be key to timely vaccinations in India”.
The study, “Vaccination Timeliness in Children under India’s Universal immunization Program,” is published in the Pediatric Infectious Disease Journal. Other U-M authors include Brenda Gillespie of the Center for Statistical Consultation and Research and James Lepkowski of the Institute of Social Research.