The Impact of Upper Age Limits, Timeliness Adherence, and Program Flexibility on Rotavirus Vaccine Coverage in El Salvador Open Access

Burnett, Eleanor Mary (2014)

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In 2006, El Salvador was one of the first countries to introduce a second generation two-dose rotavirus vaccine series in the routine immunization schedule to prevent diarrhea, which is the only vaccine with recommended upper age limits. Previous studies, including a national immunization coverage survey in 2011, have reported lower coverage for rotavirus vaccine than pentavalent vaccine recommended for administration at the same ages; this analysis further investigates reasons for this difference in coverage. To assess the upper age limits' impact on coverage, we analyzed data from 2,250 children ages 24-59 months in a 2011 nationally representative cross-sectional immunization coverage survey. We investigated the proportion of unvaccinated children, reasons for non-vaccination with rotavirus vaccine, timing and co-administration of pentavalent and rotavirus vaccines, and associated factors.There was a 6.3% difference in first dose coverage and a 13.6% difference in second dose coverage between rotavirus and pentavalent vaccines. Receipt of pentavalent vaccine after 104 days of age was associated with not receiving rotavirus vaccine(OR: 0.2). Adherence to the recommended age of administration for the first dose of pentavalent vaccine increased from the 2007 to the 2008 and 2009 birth cohorts (2008 OR: 1.6; 2009 OR: 1.6). Co-administration of rotavirus vaccine with pentavalent vaccine decreased in the 2009 birth cohort. This analysis suggests that adherence to age limits for rotavirus vaccine administration was associated with lower coverage for rotavirus compared to other routine infant immunizations, but may have improved timeliness of vaccination before the nationwide vaccine shortage in 2009. Increased rotavirus vaccination following the shortage indicated flexibility and adaptability of the national immunization program to maintain rotavirus vaccine coverage.

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Background Methods Results Discussion Conclusions Future Directions Tables Figures References Appendix: Models and Modeling Strategy

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