ABSTRACT
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.
Subject(s)
Rotavirus Infections/epidemiology , Rotavirus Infections/prevention & control , Rotavirus Vaccines/administration & dosage , Child, Preschool , El Salvador/epidemiology , Female , Haemophilus influenzae , Humans , Immunization Schedule , Infant , Infant, Newborn , Male , Vaccination/statistics & numerical dataABSTRACT
While assessing immunization programmes, not only vaccination coverage is important, but also timely receipt of vaccines. We estimated both vaccination coverage and timeliness, as well as reasons for non-vaccination, and identified predictors of delayed or missed vaccination, for vaccines of the first two years of age, in El Salvador. We conducted a cluster survey among children aged 23-59 months. Caregivers were interviewed about the child immunization status and their attitudes towards immunization. Vaccination dates were obtained from children immunization cards at home or at health facilities. We referred to the 2006 vaccination schedule for children below two years: one dose of BCG (Bacillus Calmette-Guérin) at birth; rotavirus at two and four months; three doses of pentavalent - DTP (diphtheria-tetanus-pertussis), hepatitis B, and Haemophilus influenzae type b (Hib) - and of oral poliomyelitis vaccine (polio) at two, four, and six months; first MMR (measles-mumps-rubella) at 12 months; and first boosters of DTP and OPV at 18 months. Timeliness was assessed with Kaplan-Meier analysis; Cox and logistic regression were used to identify predictors of vaccination. We surveyed 2550 children. Coverage was highest for BCG (991%; 95% CI: 98.8-99.5) and lowest for rotavirus, especially second dose (86.3%; 95% CI: 84.2-88.4). The first doses of MMR and DTP had 991% (95% CI: 98.5-99.6) and 977% (95% CI: 970-985), respectively. Overall coverage was 837% (95% CI: 81.4-86.0); 96.4% (95% CI: 95.4-97.5), excluding rotavirus. However, only 26.7% (95% CI: 24.7-28.8) were vaccinated within the age interval recommended by the Expanded Programme on Immunization. Being employed and using the bus for transport to the health facility were associated with age-inappropriate vaccinations; while living in households with only two residents and in the "Paracentral", "Occidental", and "Oriental" regions was associated with age-appropriate vaccinations. Vaccination coverage was high in El Salvador, but general timeliness and rotavirus uptake could be improved.
Subject(s)
Immunization Programs/statistics & numerical data , Immunization Schedule , Vaccination/statistics & numerical data , Child, Preschool , El Salvador , Female , Humans , Infant , Male , Rotavirus Vaccines/administration & dosage , Vaccines/administration & dosageABSTRACT
Se estudiaron retrospectivamente 25 casos de tétanos atendidos en el Instituto Nacional de Pediatría (INP) comprendidos de Enero/80 a Enero/85, y se compararon los resultados con los publicados por países latinoamericanos, principalmente con los datos obtenidos en el Hospital de Niños Benjamín Bloom (HNBB) de la República de El Salvador, Centro América. Fue más frecuente el tétanos neonatal en un 60% (15/25) principalmente de los estados de Morelos 9/25 y Guerrero 8/25. Las complicaciones más importantes fueron: Sepsis 8/25 y alteraciones respiratorias 8/25. La mortalidad en el INP fue de 28%. Se revisó la tasa de mortalidad a nivel latinoamericano, osciló desde 0.1 x 100,00 hab. en Cuba, hasta 2.4 x 100,00 hab. en Surinam. El HNBB señala una mortalidad del 7.6% en los tétanos neonatal. El número reducido de casos encontrados, no es representativo de la realidad nacional, y se requiere un estudio que comprenda las áreas geográficas, en donde las características socioeconómicas y culturales de la comunidad, aumentan la tasa de frecuencia de esta enfermedad
