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Abstract

Background

Analyses of temporal trends in immunisation coverage may help to identify problems in immunisation activities at specific points in time. These data are essential for further planning, meeting recommended indicators, monitoring, management and advocacy.

Aim

This study examined the trends of mandatory vaccination coverage in the period 2000–2017 in Serbia.

Methods

Data on completed immunisations were retrieved from annual national reports of the Institute of Public Health of Serbia during the period 2000–2017. To assess the trends of immunisation coverage, both linear and joinpoint regression analyses were performed. A probability p < 0.05 was considered significant.

Results

Over the period 2000–2017 linear regression analysis showed a significant decline in coverage with the primary vaccination against poliomyelitis, diphtheria, tetanus, pertussis and measles, mumps, rubella (MMR) (p ≤ 0.01). In the same period, coverage of all subsequent revaccinations significantly decreased, namely, first revaccination for pertussis (p < 0.01); first, second and third revaccination against diphtheria, tetanus and poliomyelitis (p < 0.01); and second dose against MMR before enrolment in elementary school (p < 0.05). Although linear regression analysis did not show change in vaccination coverage trend against tuberculosis (Bacillus Calmette–Guérin; BCG), hepatitis B (HepB3) in infants and diseases caused by type b (Hib3), the joinpoint regression analysis showed that the coverage declined for BCG after 2006, HepB3 after 2010 and Hib3 after 2008.

Conclusion

To achieve and keep optimum immunisation coverage, it is necessary to address barriers to immunisation, such as the availability of all vaccines and vaccine-hesitancy among parents and healthcare workers in Serbia.

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/content/10.2807/1560-7917.ES.2021.26.26.2000417
2021-07-01
2021-10-27
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2021.26.26.2000417
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References

  1. Plotkin SL, Plotkin SA. A short history of vaccination. In: Plotkin SA, Orenstein WA, eds. Plotkin’sVaccines, 7thed. Philadelphia: Elsevier; 2018. pp.1-15.
  2. World Health Organization (WHO). 10 facts on immunization. Geneva: WHO; 2018. [Accessed 15 Jan 2020]. Available from: https://www.who.int/news-room/facts-in-pictures/detail/immunization
  3. Official Gazette of the Republic of Serbia No. 15/2016. [Law on the protection of population from infectious diseases]. Serbian. [Accessed 5 Feb 2020]. Available from: https://www.paragraf.rs/propisi/zakon_o_zastiti_stanovnistva_od_zaraznih_bolesti.html
  4. Official Gazette of the Republic of Serbia No. 11/2006, 25/2013, 63/2013, 99/2013, 118/2013, 65/2014 i 32/2015. [Rulebook on immunization and chemoprophylaxis]. Serbian. [Accessed 5 Jan 2020]. Available from: http://www.pravno-informacioni-sistem.rs/SlGlasnikPortal/reg/viewAct/7648144d-9226-46bc-90f5-16fe5dc2201d
  5. Trifunović V. Framing Vaccination in Post-Socialist Serbia: An Anthropological Perspective. Issues Ethnol Anthropol.2019;14(2):507-29.  https://doi.org/10.21301/eap.v14i2.5 
  6. The Institute of Public Health of Serbia. [The report of conducted immunization in the Republic of Serbia in 2017]. 2018. Serbian. [Accessed 18 Oct 2019]. Available from http://www.batut.org.rs/download/izvestaji/Godisnji%20izvestaj%20imunizacija%202017.pdf
  7. United Nations Children's Fund (UNICEF). Knowledge, attitudes and practices in relation to immunization of children in Serbia 2017. Belgrade: UNICEF; 2018. [Accessed 1 Nov 2019]. Available from: https://www.unicef.org/serbia/sites/unicef.org.serbia/files/2018-12/Knowledge_Attitudes_Practices_Immunisation.pdf
  8. World Health Organization (WHO). Training for mid-level managers. Monitoring of the immunisation system. Geneva: WHO; 2008. [Accessed 20 Sep 2020]. Available from https://www.who.int/immunization/documents/MLM_module5.pdf
  9. Nedeljković J, Rakić Adrović S, Tasić G, Kovačević-Jovanović V, Lončarević G, Hübschen JM, et al. Resurgence of measles in Serbia 2010-2011 highlights the need for supplementary immunization activities. Epidemiol Infect. 2016;144(5):1121-8.  https://doi.org/10.1017/S0950268815002277  PMID: 26449667 
  10. Medić S, Petrović V, Lončarević G, Kanazir M, Begović Lazarević I, Rakić Adrović S, et al. Epidemiological, clinical and laboratory characteristics of the measles resurgence in the Republic of Serbia in 2014-2015. PLoS One. 2019;14(10):e0224009.  https://doi.org/10.1371/journal.pone.0224009  PMID: 31622429 
  11. World Health Organization (WHO). Immunization Coverage. Geneva: WHO. [Accessed 5 Jan 2020]. Available from: https://www.who.int/immunization/monitoring_surveillance/routine/coverage/en/index1.html
  12. National Cancer Institute. Joinpoint trend analysis software. [Accessed 20 Jan 2020]. Available from https://surveillance.cancer.gov/joinpoint/
  13. Bechini A, Boccalini S, Ninci A, Zanobini P, Sartor G, Bonaccorsi G, et al. Childhood vaccination coverage in Europe: impact of different public health policies. Expert Rev Vaccines. 2019;18(7):693-701.  https://doi.org/10.1080/14760584.2019.1639502  PMID: 31268739 
  14. Signorelli C, Odone A, Cella P, Iannazzo S. Childhood vaccine coverage in Italy after the new law on mandatory immunization. Ann Ig. 2018;30(4) Supple 1;1-10. PMID: 30062373 
  15. Burioni R, Odone A, Signorelli C. Lessons from Italy’s policy shift on immunization. Nature. 2018;555(7694):30.  https://doi.org/10.1038/d41586-018-02267-9  PMID: 29493608 
  16. Lévy-Bruhl D, Fonteneau L, Vaux S, Barret AS, Antona D, Bonmarin I, et al. Assessment of the impact of the extension of vaccination mandates on vaccine coverage after 1 year, France, 2019. Euro Surveill. 2019;24(26):1900301.  https://doi.org/10.2807/1560-7917.ES.2019.24.26.1900301  PMID: 31266592 
  17. Wagner KS, White JM, Lucenko I, Mercer D, Crowcroft NS, Neal S, et al. , Diphtheria Surveillance Network. Diphtheria in the postepidemic period, Europe, 2000-2009. Emerg Infect Dis. 2012;18(2):217-25.  https://doi.org/10.3201/eid1802.110987  PMID: 22304732 
  18. World Health Organization Regional Office for Europe (WHO/Euro). 33rd meeting of the European Regional Commission for Certification of Poliomycelitis Eradication (RCC) Report (2019). Copenhagen: WHO/Euro; 2019. [Accessed 21 Feb 2020]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0016/414025/33rd-RCC-eng.pdf?ua=1
  19. World Health Organization (WHO). Global MR strategic plan 2012-2020. Achieve and maintain a world without measles, rubella and congenital rubella syndrome (CRS). Geneva: WHO; 2012. [Accessed 21 Feb 2020]. Available from: https://apps.who.int/iris/bitstream/handle/10665/44855/9789241503396_eng.pdf;sequence=1
  20. Patel MK, Dumolard L, Nedelec Y, Sodha SV, Steulet C, Gacic-Dobo M, et al. Progress Toward Regional Measles Elimination - Worldwide, 2000-2018. MMWR Morb Mortal Wkly Rep. 2019;68(48):1105-11.  https://doi.org/10.15585/mmwr.mm6848a1  PMID: 31805033 
  21. Institute of Public Health of Serbia. Current epidemiology report on measles in the Republic of Serbia. Serbian. [Accessed 18 Oct 2019]. Available from http://www.batut.org.rs/index.php?content=1629
  22. Phillips DE, Dieleman JL, Lim SS, Shearer J. Determinants of effective vaccine coverage in low and middle-income countries: a systematic review and interpretive synthesis. BMC Health Serv Res. 2017;17(1):681.  https://doi.org/10.1186/s12913-017-2626-0  PMID: 28950899 
  23. World Health Organization Regional Office for Europe (WHO/Europe). European Vaccine Action Plan 2015-2020. Copenhagen: WHO/Europe; 2014. [Accessed 12 Feb 2020]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0007/255679/WHO_EVAP_UK_v30_WEBx.pdf
  24. Institute of Public Health of Serbia. “Dr Milan Jovanovic Batut”. Report on conducted immunization in the Republic of Serbia in 2015. Serbian. [Accessed 13 Feb 2020]. Available from: http://www.batut.org.rs/download/izvestaji/Imunizacija%202015.pdf
  25. Ristić M, Vukas A, Medić S, Petrović V. Reasons for non-immunization of children in AP Vojvodina, Serbia. Prev Ped.2017;3(1-2):57-62.
  26. World health Organization (WHO). Ten Threats to Global Health in 2019.Geneva: WHO; 2019. [Accessed 16 Feb 2020]. Available from: https://www.who.int/news-room/feature-stories/ten-threats-to-global-health-in-2019
  27. MacDonald NE, SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161-4.  https://doi.org/10.1016/j.vaccine.2015.04.036  PMID: 25896383 
  28. Badur S, Ota M, Öztürk S, Adegbola R, Dutta A. Vaccine confidence: the keys to restoring trust. Hum Vaccin Immunother. 2020;16(5):1007-17.  https://doi.org/10.1080/21645515.2020.1740559  PMID: 32298198 
  29. Karafillakis E, Larson HJ, ADVANCE consortium. The benefit of the doubt or doubts over benefits? A systematic literature review of perceived risks of vaccines in European populations. Vaccine. 2017;35(37):4840-50.  https://doi.org/10.1016/j.vaccine.2017.07.061  PMID: 28760616 
  30. Ferro A, Odone A, Siddu A, Colucci M, Anello P, Longone M, et al. Monitoring the web to support vaccine coverage: results of two years of the portal VaccinarSì. Epidemiol Prev. 2015;39(4) Suppl 1;88-93. PMID: 26499422 
  31. Ames HM, Glenton C, Lewin S. Parents’ and informal caregivers’ views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence. Cochrane Database Syst Rev. 2017;2(2):CD011787.  https://doi.org/10.1002/14651858.CD011787.pub2  PMID: 28169420 
  32. Karafillakis E, Dinca I, Apfel F, Cecconi S, Wűrz A, Takacs J, et al. Vaccine hesitancy among healthcare workers in Europe: A qualitative study. Vaccine. 2016;34(41):5013-20.  https://doi.org/10.1016/j.vaccine.2016.08.029  PMID: 27576074 
  33. Paterson P, Meurice F, Stanberry LR, Glismann S, Rosenthal SL, Larson HJ. Vaccine hesitancy and healthcare providers. Vaccine. 2016;34(52):6700-6.  https://doi.org/10.1016/j.vaccine.2016.10.042  PMID: 27810314 
  34. Dubé E, Gagnon D, Nickels E, Jeram S, Schuster M. Mapping vaccine hesitancy--country-specific characteristics of a global phenomenon. Vaccine. 2014;32(49):6649-54.  https://doi.org/10.1016/j.vaccine.2014.09.039  PMID: 25280436 
  35. Jarrett C, Wilson R, O’Leary M, Eckersberger E, Larson HJ, SAGE Working Group on Vaccine Hesitancy. Strategies for addressing vaccine hesitancy - A systematic review. Vaccine. 2015;33(34):4180-90.  https://doi.org/10.1016/j.vaccine.2015.04.040  PMID: 25896377 
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