Abstract
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.
Table of Contents
Background
Methods
Results
Discussion
Conclusions
Future Directions
Tables
Figures
References
Appendix: Models and Modeling Strategy
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