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Dutch national immunization schedule: compliance and associated characteristics for the primary series

European Journal of Pediatrics volume 176, pages 769–778 (2017)Cite this article

Abstract

In the Netherlands, the recommended priming immunization schedule for diphtheria, tetanus, pertussis and polio (DTaP-IPV) is at 2, 3 and 4 months of age. We evaluated the compliance with the recommended schedule, as well as its characteristics. We included all infants born between 2007 and 2012 who received minimally one DTaP-IPV vaccination (n = 1,061,578). Infants complied with the schedule if they received the first vaccination between 6 and 9 weeks of age, and the second and third vaccination 2–6 weeks after the first and second vaccination. We examined associations between compliance and several characteristics using log-binomial regression. Compliance for the first, second and third vaccination was 81.6, 88.3 and 84.2%, respectively. Compliance with the total recommended schedule was 64.5%, and increased from 60.1% for 2007 to 68.5% for 2012. Compliance was higher for full-term infants (65.9%), infants with normal birth weight (66.0%) and when both parents were born in the Netherlands (66.8%).

Conclusion: Delayed vaccination during the primary vaccination schedule occurs in one sixth of the Dutch children. Efforts to improve compliance should be focused in particular on preterm infants, infants with low birth weight and infants whose parents are not born in the Netherlands.

What is Known:
• A delayed start of vaccination leads to a longer period at risk for infectious diseases, e.g. pertussis
• Delayed vaccination is associated with several factors including prematurity, low birth weight, family size, birth order, low socioeconomic status and health status of the child
What is New:
• Compliance with the recommended priming immunization schedule for diphtheria, tetanus, pertussis and polio was 64.5%, and increased from 60.1% for 2007 to 68.5% for 2012
• If the first vaccination was delayed, there was a higher chance that the following vaccinations were administered ‘out-of-schedule’ as well, resulting in even a higher age at second and third vaccination.

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Abbreviations

BW:

Birth weight

CHC:

Child health clinics

DTaP-IPV-Hib-HepB:

Diphtheria, tetanus, acellular pertussis, inactivated polio, Hib and HepB

DTwcP-IPV:

Diphtheria, tetanus, whole-cell pertussis and polio

GA:

Gestational age

HepB:

Hepatitis B

Hib:

Haemophilus influenzae type b disease

NIP:

National Immunization Programme

PCV:

Pneumococcal conjugate vaccine

PR:

Prevalence ratio

SES:

Socioeconomic status

SGA:

Small for gestational age

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Acknowledgments

We would like to thank the senior consultants on immunization and screening (RIVM) for discussing the results and possible explanations for these results, Petra Oomen for extracting the dataset, Petra Woestenberg for her help in preparing the dataset and Ben Bom for his help in making the Figures.

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Affiliations

  1. Centre for Infectious Disease Control, Department of Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Postbox 1 (internal postbox 75), 3720 BA, Bilthoven, The Netherlands

    Elsemieke D. Scheepers, Alies van Lier, Ingrid H. Drijfhout, Guy Berbers, Nicoline A. T. van der Maas, Hester E. de Melker & Mirjam J. Knol

Authors
  1. Elsemieke D. Scheepers
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  2. Alies van Lier
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  3. Ingrid H. Drijfhout
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  4. Guy Berbers
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  5. Nicoline A. T. van der Maas
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  6. Hester E. de Melker
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  7. Mirjam J. Knol
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Contributions

This study was initiated by HdM and MK. Data analyses were conducted by ES under coordination of MK and AvL. ID, GB and NvdM assisted in interpretation of the data and results. ES drafted the manuscript. AvL, ID, GB, NvdM, HdM, and MK critically revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mirjam J. Knol.

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Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The manuscript does not contain clinical studies or patient data. Anonymous data from a healthcare registration were used. For this type of study, formal consent is not required.

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Communicated by Communicated by Nicole Ritz

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Scheepers, E.D., van Lier, A., Drijfhout, I.H. et al. Dutch national immunization schedule: compliance and associated characteristics for the primary series. Eur J Pediatr 176, 769–778 (2017). https://doi.org/10.1007/s00431-017-2904-1

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  • DOI: https://doi.org/10.1007/s00431-017-2904-1

Keywords

  • Vaccination
  • Vaccination timeliness
  • Vaccination compliance
  • Immunization schedule