ABSTRACT
BACKGROUND: The immunization rates for some diseases, including measles, were so low in Germany in recent years that endemic outbreaks occurred. A finely detailed geographic analysis of immunization rates is necessary for the identification of under-immunized areas. METHODS: We addressed this question with the aid of regional and local data from school entrance examinations, which were made available to us by the health departments of the German federal states. These data are represented both in tabular form and with the aid of a geographical information system (GIS). RESULTS: The immunization rates for tetanus, pertussis, and poliomyelitis were high throughout Germany (96.5%, 95.6%, and 95.2%, respectively). In contrast, major variation across regions was seen in immunization rates for hepatitis B (range: 53.5% to 99.1%) and measles (52.1% to 98.3%), with higher immunization rates in areas of the former East Germany. Low immunization rates were particularly evident in some areas in the states of Bavaria and Baden-Württemberg. In some parts of Saxony (a state in the former East Germany), the official immunization recommendations differ from those of the nationwide Standing Committee on Vaccination (STIKO); as a result, these areas had a mean measles immunization rate of only 66.7% among children entering school. CONCLUSION: High immunization rates were found across Germany for tetanus, pertussis, and poliomyelitis, although the rates in some regions were lower than they should be. Stronger informational efforts must be undertaken to improve the public acceptance of immunization against hepatitis B and measles, so that these immunization rates can rise. For measles in particular, uniform nationwide recommendations might help increase the immunization rate.
Subject(s)
Bacterial Infections/prevention & control , Immunization/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Students/statistics & numerical data , Virus Diseases/prevention & control , Bacterial Infections/epidemiology , Child , Child, Preschool , Female , Germany/epidemiology , Humans , Male , Spatio-Temporal Analysis , Virus Diseases/epidemiologyABSTRACT
BACKGROUND: Vaccination rates of children in Germany are unsatisfying and regional endemic outbreaks have been reported. Few studies have analysed physicians' attitude towards vaccination. We investigated whether there is an association between physicians' attitude and vaccination coverage on the regional level for Germany. METHODS: In a representative cross-sectional survey, anonymized questionnaires were sent to random samples of all paediatricians (50%) and general practitioners (10%) in private practice in Germany. Attitude towards vaccination was operationalized in three scores. Measles and pertussis vaccination coverage rates were obtained from the 16 Federal States' Health Departments. Geographic methods and linear regression models were used for analysis. RESULTS: A total of 2010 paediatricians (response proportion: 64.1%) and 1712 general practitioners (response proportion 39.1%) were included in the analysis. We found an association of physicians' attitude towards vaccination and vaccination coverage rate (P < 0.0001). There is also an important association between vaccination coverage and the geographic location, with lower coverage rates especially in the States of former Western Germany (compared with our reference State Mecklenburg-Western Pomerania; pertussis: maximum -5.86% in Bavaria, P < 0.0001; measles: maximum -20.20% in Berlin, P = 0.0002). CONCLUSIONS: The regional association between vaccination coverage rates and physicians' attitude towards vaccination seems to be superposed by population-related variables. An increase of vaccination coverage requires better information and training of both, physicians and the general population.