Improved coverage and timing of childhood vaccinations in two post-Soviet countries, Armenia and Kyrgyzstan.
BACKGROUND
Timing of childhood vaccinations has received close attention in many countries. Little is known about the trends in correctly timed vaccination in former Soviet countries. We examined trends in vaccination coverage and correct timing of vaccination in two post-Soviet countries, Armenia and Kyrgyzstan, and analyzed factors associated with delayed vaccinations.


METHODS
We used data from the Demographic and Health Surveys; the surveys were conducted in 2000 (n = 1726), 2005 (n = 1430) and 2010 (n = 1473) in Armenia and in 1997 (n = 1127) and 2012 (n = 4363) in Kyrgyzstan. We applied the Kaplan-Meier method to estimate age-specific vaccination coverage with diphtheria, tetanus and pertussis (DTP) vaccine and a measles-containing vaccine (MCV). A Cox proportional hazard regression with shared frailty was used to examine factors associated with delayed vaccinations.


RESULTS
Vaccination coverage for all three doses of the DTP vaccine increased in Armenia from 92 % in 2000 to 96 % in 2010. In Kyrgyzstan, DTP coverage was 96 % and 97 % in 1997 and 2012, respectively. Vaccination coverage for MCV increased from 89 % (Armenia, 2000) and 93 % (Kyrgyzstan, 1997) to 97 % (Armenia, 2010) and 98 % (Kyrgyzstan, 2012). The proportion of children with correctly timed vaccinations increased over time for all examined vaccinations in both countries. For example, the proportion of children in Armenia with correctly timed first DTP dose (DTP1) increased from 46 % (2000) to 66 % (2010). In Kyrgyzstan, the proportion of correctly timed DTP1 increased from 75 % (1997) to 87 % (2012). In Armenia, delays in the third DTP dose (DTP3) and MCV vaccinations were less likely to occur in the capital, whereas in Kyrgyzstan DTP3 and MCV start was delayed in the capital compared to other regions of the country. Also, in Armenia living in urban areas was associated with delayed vaccinations.


CONCLUSIONS
Vaccination coverage and timing of vaccination improved over the last years in both countries. Further efforts are needed to reduce regional differences in timely vaccinations.
Helmholtz Centre for Infection Research, Braunschweig, Germany. aparna.schweitzer@dzne.de.
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Schweitzer
Helmholtz Centre for Infection Research, Braunschweig, Germany. gerard.krause@helmholtz-hzi.de.|Hannover Medical School, Hannover, Germany. gerard.krause@helmholtz-hzi.de.
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Krause
Helmholtz Centre for Infection Research, Braunschweig, Germany. frank.pessler@twincore.de.|TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany. frank.pessler@twincore.de.
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Pessler
Helmholtz Centre for Infection Research, Braunschweig, Germany. manas.akmatov@twincore.de.|TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany. manas.akmatov@twincore.de.
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Akmatov
D000293:Adolescent; D001136:Armenia / Q000453:epidemiology; D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data; D002675:Child, Preschool; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007115:Immunization Schedule; D007223:Infant; D007707:Kyrgyzstan / Q000453:epidemiology; D008297:Male; D032541:Mass Vaccination / Q000458:organization & administration*; D008458:Measles Vaccine / Q000008:administration & dosage*
D015721:Diphtheria-Tetanus-Pertussis Vaccine; D008458:Measles Vaccine