title: Cluster-sample surveys and lot quality assurance sampling to evaluate yellow fever immunisation coverage following a national campaign, Bolivia, 2007.
abstract: OBJECTIVE
  To estimate the yellow fever (YF) vaccine coverage for the endemic and non-endemic areas of Bolivia and to determine whether selected districts had acceptable levels of coverage (>70%).
  
  
  METHODS
  We conducted two surveys of 600 individuals (25 x 12 clusters) to estimate coverage in the endemic and non-endemic areas. We assessed 11 districts using lot quality assurance sampling (LQAS). The lot (district) sample was 35 individuals with six as decision value (alpha error 6% if true coverage 70%; beta error 6% if true coverage 90%). To increase feasibility, we divided the lots into five clusters of seven individuals; to investigate the effect of clustering, we calculated alpha and beta by conducting simulations where each cluster's true coverage was sampled from a normal distribution with a mean of 70% or 90% and standard deviations of 5% or 10%.
  
  
  RESULTS
  Estimated coverage was 84.3% (95% CI: 78.9-89.7) in endemic areas, 86.8% (82.5-91.0) in non-endemic and 86.0% (82.8-89.1) nationally. LQAS showed that four lots had unacceptable coverage levels. In six lots, results were inconsistent with the estimated administrative coverage. The simulations suggested that the effect of clustering the lots is unlikely to have significantly increased the risk of making incorrect accept/reject decisions.
  
  
  CONCLUSIONS
  Estimated YF coverage was high. Discrepancies between administrative coverage and LQAS results may be due to incorrect population data. Even allowing for clustering in LQAS, the statistical errors would remain low. Catch-up campaigns are recommended in districts with unacceptable coverage.
authors.affiliation: European Programme for Intervention Epidemiology Training, European Centre for Disease Control, Stockholm, Sweden. lorenzo.pezzoli@hpa.org.uk
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pezzoli
authors.forename: Silvia
authors.initials: S
authors.lastname: Pineda
authors.forename: Percy
authors.initials: P
authors.lastname: Halkyer
authors.forename: Gladys
authors.initials: G
authors.lastname: Crespo
authors.forename: Nick
authors.initials: N
authors.lastname: Andrews
authors.forename: Olivier
authors.initials: O
authors.lastname: Ronveaux
mesh_terms: D000293:Adolescent; D000328:Adult; D001838:Bolivia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D019353:Endemic Diseases; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000592:standards*; D055810:Lot Quality Assurance Sampling; D008297:Male; D015397:Program Evaluation; D014611:Vaccination / Q000706:statistics & numerical data; D015004:Yellow Fever / Q000453:epidemiology / Q000517:prevention & control; D022341:Yellow Fever Vaccine / Q000008:administration & dosage*
chemical_list: D022341:Yellow Fever Vaccine