2009 Vaccination Coverage Survey

Vaccination Coverage in Réunion, August–September

The objective of this survey, coordinated by the Regional Health Observatory of Réunion and conducted in collaboration with the InVS Regional Unit (Cire Indian Ocean), was to estimate vaccination coverage for recommended vaccinations among children and adults residing in Réunion. The survey used the cluster sampling method recommended by the World Health Organization (WHO) for evaluating Expanded Programmes on Immunization. Data were collected from health records by a surveyor visiting selected households. The analysis included 1,004 individuals across four age groups: 24–59 months, 7–8 years, 14–15 years, and 19–28 years. In these four categories, vaccination coverage rates were as follows: DTP: 95.9%, 78.7%, 84.9%, 68.3%; pertussis: 95.5%, 97.0%, 71.6%, 49.4%; Hib (not measured beyond age 15): 91.3%, 86.0%, 66.5%, hepatitis B: 69.1%, 71.1%, 77.8%, 86.8%, measles (2 doses): 76.6%, 94.0%, 91.3%, 70.2%, pneumococcal in 24–59 months: 76.6%, BCG: 55.1%, 96.2%, 97.9%, 98.1%. This survey made it possible to update vaccination coverage data in Réunion and to highlight coverage gaps for certain vaccines, particularly among those over 6 years of age and young adults. The authors proposed an age-based catch-up strategy. They also recommended conducting periodic surveys, particularly among young adults, to monitor vaccination practices more regularly and to raise awareness among vaccinators and the general population.

Assessment of vaccination practices and vaccination coverage among children followed by doctors in the Sentinelles network, July–September

The objective of this survey conducted by Inserm’s U707 in collaboration with the InVS was to assess vaccination coverage and the determinants of BCG vaccination among children targeted for this vaccination. Physicians in the Sentinelles network who agreed to participate received a questionnaire collecting information on their practice and on the characteristics of the last three children under 2 years of age seen in consultation. A total of 920 children were included, of whom 261 (31%) were eligible for BCG vaccination. Among these, 44 were vaccinated with BCG (59% in the Île-de-France region, 32% outside the Île-de-France region). The likelihood of being vaccinated was higher among children older than 6 months (OR = 3.4 [1.4–8.6]), among children living in the Ile-de-France region (OR = 14.7 [4.4–49.5]), among those planning to travel to a country with high tuberculosis endemicity (OR = 3.5 [1.4–8.6]), and among those considered at risk by the physician for other social reasons (OR = 19.9 [6.2–63.9]). The number of criteria from the guidelines cited by the physician (OR = 1.4 [1.1–1.9]) and the physician’s perception that tuberculosis was a common disease (OR = 2.2 [1.1–4.5]) increased the likelihood of vaccination. Possession of a degree or university qualification in infectious diseases decreased this probability (OR = 0.14 [0.1–0.4]). This study concluded that the success of the targeted BCG vaccination policy would require strengthening actions focused on the determinants identified in this study.

  • Rossignol L, Guthmann JP, Kernéis S, Aubin-Auger I, Lasserre A et al. Barriers to implementation of the new targeted BCG vaccination in France: a cross-sectional study. Vaccine 2011, 29:5232-7

Vaccination coverage among healthcare workers in French healthcare facilities. Vaxisoin national survey, April–October 2009

This survey, conducted by the InVS in collaboration with the Study Group on Healthcare Workers’ Risk of Exposure to Infectious Agents (GERES), measured recommended vaccination coverage among physicians, nurses, nursing assistants, and midwives. This was a cross-sectional survey using a two-stage, stratified random sampling method. In the first stage, 35 healthcare facilities were selected from five strata defined by facility type. In the second stage, 1,127 individuals were selected across four professions and three sectors of activity. Data collection was conducted via face-to-face interviews, supplemented by data collected from the occupational physician. From April to October 2009, 183 physicians, 110 nurses, 58 midwives, and 101 nursing assistants were included. Hepatitis B vaccine coverage was 91.7%, with no significant difference among surgical healthcare workers compared to other sectors, or among surgeons and anesthesiologists compared to physicians. For other mandatory vaccinations, coverage was 95.5% for the DTP booster and 94.9% for BCG. For recommended vaccinations, coverage was 11.4% for the 10-year DTP booster including the pertussis component, 49.7% for at least one dose of measles vaccine, 29.9% for varicella, and 25.6% for influenza. Younger healthcare workers were better vaccinated against pertussis and measles, while those working in pediatrics and maternity care were better vaccinated against influenza and pertussis. The survey concluded that healthcare workers were generally well covered by mandatory vaccinations but very poorly covered by recommended vaccinations. The authors recommended strengthening vaccination policies for these recommended vaccines and better documenting vaccination status for these vaccines across all professions.

BCG vaccination coverage among children born after the suspension of mandatory vaccination and followed in maternal and child health centers (PMI) in France, April–June 2009

The objective of this survey was to estimate BCG vaccination coverage among children followed in PMI centers, born after the suspension of mandatory vaccination and targeted for this vaccination. It was conducted by the InVS in collaboration with the Departmental PMI Services of the General Councils. This was a national, stratified, inter-regional survey in which children were selected through a multi-stage random sampling process. Information was collected by the consulting physician using a structured questionnaire. BCG coverage was 89.8% in the Île-de-France region and 61.7% outside the Île-de-France region. This survey showed that two years after the change in vaccination policy, BCG vaccination coverage was high, though suboptimal, among children receiving care at maternal and child health clinics in the Ile-de-France region. However, coverage was insufficient among those receiving care at maternal and child health clinics outside the Ile-de-France region. The survey concluded that it was necessary to continue efforts to disseminate vaccination recommendations and improve practical training for physicians in the administration of the intradermal BCG vaccine.

Vaccination coverage among health students on clinical rotations in AP-HP hospitals in 2009. Studyvax survey, March–July 2009

This cross-sectional survey was conducted by the Cochin Pasteur Clinical Vaccinology Research Center in collaboration with the InVS among a sample of medical, nursing, and midwifery students on clinical rotations at a hospital within the Assistance Publique – Hôpitaux de Paris network. All midwifery students from the 15 hospitals with maternity wards were surveyed, while medical and nursing students were selected through a three-stage random sampling process in 10 hospitals. Data were collected through face-to-face interviews and verified using health records. A total of 432 students were included. Vaccination coverage rates for mandatory vaccines were 95.9% for the final DTP booster, 93.6% for BCG, and 91.8% for at least 3 doses of hepatitis B. For recommended vaccinations, coverage rates were 44% for the pertussis booster at ages 11–13 or 16–18, 39.6% for influenza, and 79.3% for the first dose of measles. This survey demonstrated that among health students subject to the same recommendations as practicing healthcare professionals, coverage was high for mandatory vaccinations but clearly insufficient for recommended vaccinations. The authors recommended better adherence to vaccination guidelines in this population.

Vaccination coverage among school-aged children and adolescents in French Guiana, March

The survey was conducted by the InVS Regional Unit (Cire Antilles-Guyane) in collaboration with the ARS of French Guiana, the Regional Education Office, the Pasteur Institute of French Guiana, the French Red Cross, and the General Council of French Guiana. The objective was to estimate vaccination coverage for recommended vaccinations among children in three grade levels (1st grade, 6th grade, 9th grade). All children enrolled in the relevant grades at schools in French Guiana were surveyed. Data on vaccination status were collected using a standardized questionnaire administered by school health personnel based on the student’s health or vaccination record. The sample sizes were 3,655, 3,174, and 2,392 children in each grade level. Vaccination coverage rates for students in CP, 6th, and 9th grades were as follows (respectively for these three grade levels): BCG: 95.3%, 91.7%, 89.2%, DTP: 28.9%, 33.3%, 69.6%, Pertussis: 92.6%, 61.4%, 63.7%, Hib: 76.9%, 47.3%, 19.8%, Hepatitis B: 79.4%, 78.4%, 67.5%, MMR 2 doses: 82.8%, 86.2%, 84.5%, Yellow fever: 94.7%, 82.9%, 87.8%. The authors of this survey compared the results with those of a survey conducted in French Guiana among the general population in 2000 and noted, while highlighting the methodological differences between the two surveys, significant changes in vaccination coverage for MMR, yellow fever, hepatitis B, and Hib, for which a marked improvement in coverage was observed, particularly in inland areas. They concluded that it was necessary to continue efforts to further improve vaccination coverage for all vaccines and to achieve the objectives set by the Pan American Health Organization (PAHO) during the development of the action plan for the Expanded Program on Immunization (EPI) in French Guiana.

  • Vaccination coverage among children and adolescents in French Guiana: results of the school-based survey in first-grade, sixth-grade, and ninth-grade classes, 2009 (Report currently being finalized; will be available on the InVS website in the first half of 2012).

Pneumococcal and tetanus vaccination coverage among residents of nursing homes for the elderly in Burgundy and Franche-Comté, January

The objective of this survey conducted by the InVS Regional Unit (Cire Centre-Est) in collaboration with epidemiologists from the InVS Vaccine-Preventable Diseases Unit was to assess pneumococcal and tetanus vaccination coverage among individuals aged 65 and older who are eligible for vaccination recommendations and reside in nursing homes in Burgundy and Franche-Comté. This was a cross-sectional study of a representative sample of 500 individuals selected through a two-stage random sampling procedure. Fifty facilities were randomly selected in the first stage, while in the second stage, 10 residents were selected by simple random sampling from each selected facility. Vaccination data were collected from medical records by an investigator on site. The average age of the residents was 86 years, and three-quarters of them were women. More than one-third of the residents were eligible for pneumococcal vaccination. Pneumococcal vaccination coverage among these at-risk residents was 27%. Tetanus vaccination coverage among residents was 44%. This study highlighted low pneumococcal and tetanus vaccination coverage among residents of long-term care facilities for the elderly in Burgundy and Franche-Comté. The authors recommended initiatives to promote these vaccinations in order to prevent the risk of infection from these two diseases among elderly people living in institutions.