Catching-up with pentavalent vaccine: Exploring reasons behind lower rotavirus vaccine coverage in El Salvador.
Rotavirus vaccine was introduced in El Salvador in 2006 and is recommended to be given concomitantly with DTP-HepB-Haemophilus influenzae type b (pentavalent) vaccine at ages 2 months (upper age limit 15 weeks) and 4 months (upper age limit 8 months) of age. However, rotavirus vaccination coverage continues to lag behind that of pentavalent vaccine, even in years when national rotavirus vaccine stock-outs have not occurred. We analyzed factors associated with receipt of oral rotavirus vaccine among children who received at least 2 doses of pentavalent vaccine in a stratified cluster survey of children aged 24-59 months conducted in El Salvador in 2011. Vaccine doses included were documented on vaccination cards (94.4%) or in health facility records (5.6%). Logistic regression and survival analysis were used to assess factors associated with vaccination status and age at vaccination. Receipt of pentavalent vaccine by age 15 weeks was associated with rotavirus vaccination (OR: 5.1; 95% CI 2.7, 9.4), and receipt of the second pentavalent dose by age 32 weeks was associated with receipt of two rotavirus vaccine doses (OR: 5.0; 95% CI 2.1-12.3). Timely coverage with the first pentavalent vaccine dose was 88.2% in the 2007 cohort and 91.1% in the 2008 cohort (p=0.04). Children born in 2009, when a four-month national rotavirus vaccine stock-out occurred, had an older median age of receipt of rotavirus vaccine and were less likely to receive rotavirus on the same date as the same dose of pentavalent vaccine than children born in 2007 and 2008. Upper age limit recommendations for rotavirus vaccine administration contributed to suboptimal vaccination coverage. Survey data suggest that late rotavirus vaccination and co-administration with later doses of pentavalent vaccine among children born in 2009 helped increase rotavirus vaccine coverage following shortages.
Ministry of Health, El Salvador.
Eduardo
E
Suarez-Castaneda
US Centers for Disease Control and Prevention, Atlanta, GA, United States; Emory University, United States.
Eleanor
E
Burnett
Ministry of Health, El Salvador.
Miguel
M
Elas
Pan American Health Organization, El Salvador.
Rafael
R
Baltrons
Consultant for the Pan American Health Organization, United States.
Lorenzo
L
Pezzoli
US Centers for Disease Control and Prevention, Atlanta, GA, United States.
Brendan
B
Flannery
Emory University, United States.
David
D
Kleinbaum
Pan American Health Organization, Washington, DC, United States.
Lucia Helena
LH
de Oliveira
Pan American Health Organization, Washington, DC, United States. Electronic address: danovaroc@who.int.
M Carolina
MC
Danovaro-Holliday
D002675:Child, Preschool; D004544:El Salvador / Q000453:epidemiology; D005260:Female; D006193:Haemophilus influenzae; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000008:administration & dosage*; D014611:Vaccination / Q000706:statistics & numerical data
D022243:Rotavirus Vaccines
El Salvador; Rotavirus vaccine; Routine vaccination; Vaccination coverage; Vaccination timeliness