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An approach for estimating vaccination coverage for communities using school-level data and population mobility information.

ABSTRACT: Childhood vaccination data are made available at a school level in some U.S. states. These data can be geocoded and may be considered as having a high spatial resolution. However, a school only represents the destination location for the set of students that actually reside and interact within some larger areal region, creating a spatial mismatch. Public school districts are often used to represent these regions, but fail to account for private schools and school of choice programs. We offer a new approach to estimate childhood vaccination coverage rates at a community level by integrating school level data with population commuting information. The resulting mobility-adjusted vaccine coverage estimates resolve the spatial mismatch problem and are more aligned with the geographic scale at which public health policies are implemented. We illustrate the utility of our approach using a case study on diphtheria, tetanus, and pertussis (DTP) vaccination coverage for kindergarten students in California. The modeled community-level DTP coverage estimates yield a statewide coverage of 92.37%, which is highly similar to the 92.44% coverage rate calculated from the original school-level data.

SUBMITTER: Delamater PL

PROVIDER: S-EPMC6641576 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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An approach for estimating vaccination coverage for communities using school-level data and population mobility information.

Delamater Paul L PL Leslie Timothy F TF Yang Y Tony YT Jacobsen Kathryn H KH

Applied geography (Sevenoaks, England) 20160505

Childhood vaccination data are made available at a school level in some U.S. states. These data can be geocoded and may be considered as having a high spatial resolution. However, a school only represents the destination location for the set of students that actually reside and interact within some larger areal region, creating a spatial mismatch. Public school districts are often used to represent these regions, but fail to account for private schools and school of choice programs. We offer a n ...[more]

PMID: 31327881

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Project description:BackgroundMandated vaccination for school attendance is a growing strategy internationally. Our aim was to investigate the effects of implementing school vaccination mandates on pediatric population vaccine coverage.MethodsIn this systematic review, we searched MEDLINE, Embase, CINAHL, the Education Resources Information Center (ERIC) and the PAIS Index for empirical studies of implementation of a primary or secondary school vaccination requirement published in any language through March 2019 with vaccination rates as an outcome. We sought additional studies by consulting experts, reference lists and grey literature sources. Included studies were too heterogeneous for meta-analysis; thus, we extracted data using a standardized rubric and synthesized the results narratively.ResultsAmong the 4232 citations obtained, 20 studies met the inclusion criteria. Eighteen were conducted with US data, 1 with Italian data, and 1 with Australian data. Four studies examined school-entry mandates, and 16 examined adolescent requirements. An uncontrolled before-after design was used in 10 studies, cross-sectional analysis in 7, a retrospective cohort design in 2, and a prospective cohort in 1. In many cases, increased documentation of coverage followed the addition of new requirements. The exception to this was human papillomavirus vaccination mandates, which were highly controversial, in the United States. The studies contained notable risks of bias, with cointerventions rarely acknowledged or accounted for, and subpopulations often excluded. A substantial risk of ecological fallacy existed for most studies.InterpretationVaccination mandates appear largely associated with increased vaccination coverage, but it is not possible to attribute causality to the mandate in most studies. High-quality implementation research that uses whole-population coverage data and takes into consideration cointerventions, confounders, clustering of unvaccinated populations and context is required.

Project description:BackgroundIn Australia in 2017, 89% of 15-year-old females and 86% of 15-year-old males had received at least one dose of the HPV vaccine. However, considerable variation in HPV vaccination initiation (dose one) across schools remains. It is important to understand the school-level characteristics most strongly associated with low initiation and their contribution to the overall between-school variation.MethodsA population-based ecological analysis was conducted using school-level data for 2016 on all adolescent students eligible for HPV vaccination in three Australian jurisdictions. We conducted logistic regression to determine school-level factors associated with lower HPV vaccination initiation (< 75% dose 1 uptake) and estimated the population attributable risk (PAR) and the proportion of schools with the factor (school-level prevalence).ResultsThe factors most strongly associated with lower initiation, and their prevalence were; small schools (OR = 9.3, 95%CI = 6.1-14.1; 33% of schools), special education schools (OR = 5.6,95%CI = 3.7-8.5; 8% of schools), higher Indigenous enrolments (OR = 2.7,95% CI:1.9-3.7; 31% of schools), lower attendance rates (OR = 2.6,95%CI = 1.7-3.7; 35% of schools), remote location (OR = 2.6,95%CI = 1.6-4.3; 6% of schools,) and lower socioeconomic area (OR = 1.8,95% CI = 1.3-2.5; 33% of schools). The highest PARs were small schools (PAR = 79%, 95%CI:76-82), higher Indigenous enrolments (PAR = 38%, 95%CI: 31-44) and lower attendance rate (PAR = 37%, 95%CI: 29-46).ConclusionThis analysis suggests that initiatives to support schools that are smaller, with a higher proportion of Indigenous adolescents and lower attendance rates may contribute most to reducing the variation of HPV vaccination uptake observed at a school-level in these jurisdictions. Estimating population-level coverage at the school-level is useful to guide policy and prioritise resourcing to support school-based vaccination programs.

Project description:BackgroundMortality rates from cervical cancer demonstrate deep inequality in health between richer and poorer populations. Over 310 000 women died of this preventable disease in 2018, mostly in low-income and middle-income countries (LMICs) where screening and treatment are beyond the capacity of health systems. Immunisation against human papillomavirus (HPV) offers a primary prevention strategy, but rates of vaccination uptake are unclear. Understanding coverage levels and factors affecting uptake can inform immunisation strategies.ObjectivesThe aim of this study is to evaluate the status of HPV vaccination coverage from nationally reported indicators and to estimate global coverage in a single year cohort of vaccine-eligible girls.DesignThis study provides quantitative population-level estimates of important global health indicators. Using data from the Global Cancer Observatory and WHO/UNICEF, incidence of and mortality from cervical cancer and HPV vaccination coverage are described for countries, categorised by income group. Characteristics of LMICs achieving high coverage are explored using selected development indicators from World Bank sources. Global HPV immunisation coverage is calculated and its impact on cervical cancer mortality estimated.ResultsIncidence and mortality for cervical cancer correlate with poverty. Whilst all WHO member states report high infant measles vaccination rates, fewer than half report on HPV vaccination. Even amongst high-income countries, coverage varies widely. In upper-middle-income countries, there is a trend for higher coverage with increased health spending per capita. Four LMICs report good coverage levels, all associated with external funding. Global HPV immunisation coverage for 2018 is estimated at 12.2%. Of the global cohort of 61 million 15-year-old girls in 2018, 7000 are likely to die from cervical cancer, almost all in LMICs.ConclusionsCountries in all income groups must devise strategies to achieve and maintain higher levels of HPV immunisation. For all but the richest, affordability remains a barrier.

Project description:BackgroundSince 2013, the National Malaria Control Programme in mainland Tanzania and the Zanzibar Malaria Elimination Programme have implemented mass insecticide-treated net (ITN) distribution campaigns, routine ITN distribution to pregnant women and infants, and continuous distribution through primary schools (mainland) and community leaders (Zanzibar) to further malaria control efforts. Mass campaigns are triggered when ITN access falls below 40%. In this context, there is a need to monitor ITN access annually to assess whether it is below threshold and inform quantification of ITNs for the following year. Annual estimates of access are needed at the council level to inform programmatic decision-making.MethodsAn age-structured stock and flow model was used to predict annual net crops from council-level distribution data in Tanzania from 2012 to 2020 parameterized with a Tanzania-specific net median lifespan of 2.15 years. Annual nets-per-capita (NPC) was calculated by dividing each annual net crop by mid-year council projected population. A previously fit nonparametric conditional quantile function for the proportion of the population with access to an ITN (ITN access) as a function of NPC was used to predict ITN access at the council level based on the predicted NPC value. These estimates were compared to regional-level ITN access from large household surveys.ResultsFor regions with the same ITN strategy for all councils, predicted council-level ITN access was consistent with regional-level survey data for 79% of councils. Regions where ITN strategy varied by council had regional estimates of ITN access that diverged from the council-specific estimates. Predicted ITN access reached 60% only when "nets issued as a percentage of the council population" (NPP) exceeded 15%, and approached 80% ITN access when NPP was at or above 20%.ConclusionModelling ITN access with country-specific net decay rates, council-level population, and ITN distribution data is a promising approach to monitor ITN coverage sub-regionally and between household surveys in Tanzania and beyond.

Dataset Information

An approach for estimating vaccination coverage for communities using school-level data and population mobility information.

Publications

An approach for estimating vaccination coverage for communities using school-level data and population mobility information.

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