Global Routine Vaccination Coverage, 2010

Morbidity and Mortality Weekly Report. 2011;60(44):1520-1522. 

In This Article

Abstract and Introduction

Introduction

The Expanded Program on Immunization was established by the World Health Organization (WHO) in 1974 to ensure universal access to routinely recommended childhood vaccines. Six vaccine-preventable diseases initially were targeted: tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis, and measles. In 1974, fewer than 5% of the world's infants were fully immunized;[1] by 2005, global coverage with the third dose of diphtheria-tetanus-pertussis (DTP) vaccine (DTP3) was 79%, but many children, especially those living in poorer countries, still were not being reached. That year, WHO and the United Nations Children's Fund (UNICEF) developed the Global Immunization Vision and Strategy (GIVS), with the aim of decreasing vaccine-preventable disease–related morbidity and mortality by improving national immunization programs.[2] One goal of GIVS was for all countries to achieve 90% national DTP3 coverage by 2010. This report summarizes the status of vaccination coverage globally and regionally in 2010 and progress toward meeting the GIVS goal. In 2010, 130 (67%) countries had achieved 90% DTP3 coverage, and an estimated 85% of infants worldwide had received at least 3 doses of DTP vaccine. However, 19.3 million children were not fully vaccinated and remained at risk for diphtheria, tetanus, and pertussis and other vaccine-preventable causes of morbidity and mortality; approximately 50% of these children live in India, Nigeria, and the Democratic Republic of Congo. Despite the overall improvement in vaccination coverage during the past 37 years, routine vaccination programs need to be strengthened globally, especially in countries with the greatest numbers of unvaccinated children.

Coverage with routinely administered vaccines is used as a measure of program performance and population immunity, and is assessed as the percentage of children who have received the appropriate number of doses of a recommended vaccine during the first year of life. Administrative coverage estimates, derived by dividing the number of vaccine doses reported administered to the target population by the estimated number of persons in the target population, are reported annually to WHO and UNICEF by WHO member states, and can be supplemented by special coverage surveys and other published and unpublished data.[3] WHO and UNICEF derive national estimates of vaccination coverage through a country-by-country review of the best available data.[4] These estimates are published annually on the WHO website* and are updated after publication if additional data become available. DTP3 coverage by age 12 months serves as the primary indicator of immunization program performance; however, coverage with other recommended vaccines, including the third dose of polio vaccine and the first dose of measles-containing vaccine (MCV1), are additional indicators of program strength.

In 2010, estimated global DTP3 coverage among children aged <12 months was 85%, representing 109.4 million immunized children (Table), slightly higher than the estimated coverage in 2009 (82%).[3] DTP3 coverage in 2010 ranged from 77% in the African and South-East Asian WHO regions to 96% in the Western Pacific and European regions. Of 193 WHO member states, 130 (67%) met the 2010 GIVS target of ≥90% national DTP3 coverage. Fifty-nine (30%) member states reported achieving a second GIVS target of ≥80% DTP3 coverage in every district. Estimated DTP3 coverage was 80%–89% in 30 (16%) countries, 70%–79% in 15 (8%) countries, and <70% in 18 (9%) countries. Of the 19.3 million children who had not received DTP3 during the first year of life, three countries accounted for approximately half of undervaccinated children: India (37%), Nigeria (9%), and the Democratic Republic of Congo (5%) (Figure). Ten countries accounted for 69% of undervaccinated children.

Figure.

Estimated number of children who had not received 3 doses of diphtheria-tetanus-pertussis vaccine during the first year of life among 10 countries with the largest number of undervaccinated children, by country, and cumulative percentage of all undervaccinated children worldwide, 2010

Estimated global coverage was 90% for Bacille Calmette-Guérin vaccine, 86% for the third dose of polio vaccine, and 85% for MCV1 (Table). Coverage varied by WHO region, and was highest in the European (96%), Western Pacific (96%), and American (93%) regions. By the end of 2010, a total of 179 countries (including parts of India and Sudan) had introduced hepatitis B (HepB) vaccine in routine vaccination programs; 93 (52%) of these countries had a recommendation to administer the first dose of vaccine within 24 hours of birth to prevent perinatal hepatitis B virus transmission. Coverage with 3 doses of HepB vaccine (HepB3) was 75% globally and ranged from 52% to 91% by region (Table). Coverage with Haemophilus influenzae type b (Hib) vaccine, which had been introduced in 169 countries (including parts of Sudan, Philippines, and Belarus) by 2010, was 42% globally and ranged from 9% to 92% by region. Rotavirus vaccine and pneumococcal conjugate vaccine (PCV) had been introduced in 28 and 55 countries, respectively; however, too few countries reported data to permit robust estimates of global or regional coverage. Among the 38 countries with reported coverage for the third dose of PCV by 2010, a total of 24 (63%) had estimated coverage of ≥80%, including 17 (45%) with coverage of ≥90%.

* Additional information available at http://www.who.int/entity/immunization_monitoring/data/coverage_estimates_series.xls.
Among 156 (81%) member states that routinely administer Bacille Calmette-Guérin vaccine for tuberculosis.

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