gms | German Medical Science

Background: The German Standing Committee on Vaccination (STIKO) recommends 13 vaccines to be administered within the first two years of life for primary immunization (tetanus (T), diphtheria (D), whooping cough (P), polio, hepatitis B, hib, pneumococcal disease (Pn), rotaviruses, meningococcal disease serogroup C (MenC), measles, mumps, rubella, chicken pox. High vaccination coverage is required to reach herd immunity. The evaluation of vaccination coverage is a significant part of health monitoring. So far, continuous monitoring is done by routine examination of vaccination certificates at school entrance [1] and by regular analysis of claims data from physicians registered with the statutory health insurance system [2]. These monitoring studies do not cover persons that do not present their vaccination certificates and that received no vaccination at all, respectively.

The present study is a first attempt at analyzing vaccination coverage in a large population of statutory health insured children and estimating the percentage of children without any vaccination. This was done on the basis of claims data of the German healthcare system.

Materials and methods: Database: BARMER health insurance data of about i) 56,000 children born in 2015, continually insured from birth until the end of thesecond year after birth and ii) a cohort of 46,000 children born in 2011 insured until the end of the sixth year after birth. Vaccination: All vaccinations administered in the respective time period were included and identified by the procedure codes (EBM codes) used for reimbursement. Data on date of application, kind of vaccination, use of fixed combinations of vaccines and doses was available. Primary immunization was regarded to be complete if all recommended doses of the respective vaccine were administered.

Results: About 80% of children born in 2015 had complete primary vaccination for DPT-hib-polio, Pn, measles, mumps and rubella. The vaccination rate for hepatitis B, which can be given in a six-fold combination with DPT-hib-polio, was slightly lower (76.8%). The highest rate was seen for MenC (83.3%) and the lowest rates were found for chicken pox (74.2%) and rotaviruses (63.4%).

For children born in 2011, no vaccination achieved a coverage of 90% or higher, even six years after birth. Coverage was considerably below 90% for Pn (84.7%), hib (83.9%), chicken pox (80.2%) and hepatitis (77.5%) (rotavirus vaccine not recommended before August 2013).

For 3.3% of the children born in 2015 no vaccination could be observed in the timespan until the end of the second year after birth (ranging from 2.2% in the federal state of Brandenburg to 5.3% in Bavaria). The same was true for 2.3% of the children born in 2011 and observed until the end of the sixth year after birth (ranging from 1.2% in Brandenburg to 3.5% in Bavaria).

No relevant differences in vaccination coverage could be found between male and female children.

Conclusion: The coverage of completed recommended primary immunizations within the first two years of life is insufficient, as is the coverage up to school age. For the first time, an analysis of statutory healh insurance data allowed to quantify the share of children without any vaccination. This shows that vaccination data not including unvaccinated children overestimates vaccination coverage in two-year-olds by over three percentage points (regionally up to over five percentage points). Against the background of current plans to introduce mandatory measles vaccination in Germany, the analysis of statutory health insurance data can be used to evaluate the impact of this measure on overall vaccination coverage.

Acknowledgement: The study is part of the „BARMER Drug Report 2019 („Arzneimittelreport 2019“) and was financed by BARMER.