Vaccination coverage assessment in 2011 - VENICE IIIvenice.cineca.org/Final_Vaccination_Coverage_Assesment... · on vaccination coverage assessment in 2011.[3] Objective The objective

VaccinationcoverageassessmentinEU/EEA,2011

VENICEIIConsortium

August2011‐March2012

DevelopedbyWorkPackageNo.4DarinaO’FlanaganSuzanneCotterJolitaMereckiene

ContentsAbbreviations................................................................................................................................................4

Acknowledgments.........................................................................................................................................4

ISO3166‐1CountryCodes............................................................................................................................4

VENICENationalGatekeepersandContactPoints.......................................................................................5

Summary.......................................................................................................................................................6

Background...................................................................................................................................................8

Objective.......................................................................................................................................................8

Methodology.................................................................................................................................................8

StudyDesign..............................................................................................................................................8

Datacollection..........................................................................................................................................9

Datahandling............................................................................................................................................9

Dataprocessing.........................................................................................................................................9

Pilotstudy..................................................................................................................................................9

Studytime.................................................................................................................................................9

Dataanalysis..............................................................................................................................................9

Expecteddeliverables...............................................................................................................................9

Results...........................................................................................................................................................9

Responserate............................................................................................................................................9

NationalImmunisationProgramme............................................................................................................10

Frequencyofvaccinationcoveragedatacollection....................................................................................11

Vaccinationcoveragedataavailabilitybybirthcohortatthenationallevel.............................................16

Singlevaccinedosesversusfullimmunisationseries.................................................................................22

Vaccinationcoveragedataforspecialriskgroups......................................................................................26

Deliverymethodsforvaccines....................................................................................................................27

Nationalorsubnationallevel.....................................................................................................................36

Numeratorassessment...............................................................................................................................38

Vaccinationcoveragedatavalidation,feedbackandmeasureofperformanceindicators.......................42

E‐Healthsystem..........................................................................................................................................44

Immunisationregistries...............................................................................................................................45

Summaryandconclusions...........................................................................................................................51

Appendices..................................................................................................................................................54

Appendix1.Questionnaire......................................................................................................................54

Appendix2.Definitions:..........................................................................................................................69

Appendix3.AmericanStandardsforImmunisationRegistries..............................................................72

Abbreviations

ECDC EuropeanCentreforDiseasePreventionandControlEEA EuropeanEconomicAreaEU EuropeanUnionGPs GeneralPractitionersHCWs HealthCareWorkersMSs MemberStatesVENICE VaccineEuropeanNewIntegratedCollaborationEffortCINECA ConsortiumofUniversity,Bologna,ItalyWHO WorldHealthOrganization

Acknowledgments

TheVENICEProjectwouldliketotakethisopportunitytothankallthegatekeepers,contactpoints,membersofVENICEconsortiumandECDCcolleaguesfortheircontributiontothisstudyandreport.Thetimegenerouslyprovidedbyeachpersoninansweringthequestionnaireandsubsequentfollowupqueriesisgreatlyappreciated.

ISO 3166-1 Country Codes AT AustriaBE BelgiumBG BulgariaCY CyprusCZ CzechRepublicDK DenmarkEE EstoniaFI FinlandFR FranceDE GermanyGR GreeceHU HungaryIS IcelandIE IrelandIT ItalyLV LatviaLT LithuaniaLU LuxembourgMT MaltaNL TheNetherlandsNO NorwayPL PolandPT PortugalRO RomaniaSK SlovakiaSI SloveniaES SpainSE SwedenGB GreatBritain

VENICE National Gatekeepers and Contact Points Austria JeanPaulKlein,ChristinaKralBelgium PierreVanDamme,MartineSabbe,HeidiTheeten,GeertTop,BeatriceSwennenBulgaria MiraKojouharovaCzechRepublic BohumirKriz,JanKyncl,HanaOrlikova,JitkaCastkovaCyprus ChrystallaHadjianastassiou,SoteroullaSoteriouDenmark PeterHenrikAndersen,PalleValentiner‐BranthEstonia NataliaKerbo,IrinaFilippovaFinland TuijaLeinoFrance DanielLevy‐Bruhl,Jean‐PaulGuthmannGermany SabineReiterGreece TheodoraStavrouHungary ZsuzsannaMolnàrIceland ThorolfurGudnasonIreland SuzanneCotterItaly FortunatoD’Ancona,CristinaGiambiLatvia JurijsPerevoscikovsLithuania EgleSavickieneLuxemburg BerthetFrancoiseMalta TanyaMelilloTheNetherlands AliesvanLier,HesterdeMelkerNorway BeritFeiringPoland IwonaStankiewiczPortugal PaulaValente,TeresaFernandesRomania AdrianaPistol,MirceaIoanPopa,RodicaPopescuSlovakia HelenaHudecovaSlovenia AlenkaKraigher,VeronikaUcakarSpain AuroraLimia,JosefaMasaCalles,IsabelPachondelAmoSweden AnnikaLinde,IngridUhnooGreatBritain RichardPebody

Summary

Vaccinesarepowerfultoolsforprotectingourhealth.ImmunisationshaveledtothecontrolandeliminationofdiseasesinEuropethatinthepastcauseddeathanddisabilityformillionsofpeople.Immunisationcoverageisakeymeasureofimmunisationsystemperformance.NationalimmunisationprogrammesvaryacrosstheEUinrelationtothetypeofvaccinesoffered,numberofdosesforprimaryimmunisationandtimingofvaccineadminstration.Coverageratesforcompletionoftheprimaryimmunisationschedulevaryacrossthecountries.Thesenationaldifferencesmakethemonitoringofvaccineuptakeandtheevaluationofaprogramme’seffectivenessandimpactverydifficult.TheobjectiveofthissurveywastodescribeandtocollateinformationonvaccinationcoverageassessmentfordifferentvaccinesincludedintheNationalImmunisationProgrammeofeachMSandtoupdatedatacollectedinasurveyconductedin2007.AnelectronicbaseddesignofthesurveywasundertakenbyVENICEproject.CurrentlyintheVENICEprojectthereare27EUandtwoEEA(NOandIS)participatingcountries.GatekeepersineachMSentereddatadirectlyon‐line.Of29countriesinvitedtoparticipate27responded.AllparticipatingcountriesincludeDTP,Polio,MMR,HibvaccinesintheirNationalImmunisationProgrammesandroutinelyassessvaccinecoverageforthesevaccinesamongchildren.HepBimmunisationisincludedinthenationalimmunisationprogrammein21countries.Allcountriesrecommendingthisvaccineassesscoverageamongchildren.ThosecountriesthathaveroutineBCGprogrammes(n=11),MenC(n=12),Pneumococcal(n=20),VaricellaandRotavirus(n=4)vaccinesallassesschildhoodvaccinationcoverage.Inrelationofadolescentvaccination,23countriesrecommenddiphterhiaandtetanusvaccinationforadolescentsaspartoftheNationalimmunisationprogramme.Mostcountriesmonitoruptake:17countriesmonitordiphtheriavaccineuptakeand16monitortetanusvaccineuptakeroutinely;Italyconductsimmunisationclustersamplesurveyevery5years.Thirteencountriesrecommendpertussisvaccinationforadolescents,eightofwhichmonitoruptake.Elevencountriesrecommendpoliovaccinationforadolescents,threecountriesdonotassessvaccineuptake.ElevencountriesrecommendMMRvaccineforthisgroupwitheightcountriesassessinguptake.ForthetwelvecountriesthathaveincludedHPVintheirNationalimmunisationprogrammeallexceptonemonitorvaccinationcoverage.Adultsarerecommendeddiphtheriaandtetanusvaccinationin16and19countriesbutonlysixand8countriesassessvaccinationcoverageamongthisagegroup.Pertussisvaccinationisalsorecommendedinfourcountries,butmonitoriedonlyinonecountry.Vaccinationcoverageassessmentisdoneatdifferenttimeintervalsindifferentcountries,rangingfrommonthly/quarterly/halfyearly/annuallyto2‐5years.ThemajorityofMSs(abouttwothirdsofcountries)reportedassessingvaccinecoverageannually.Inonecountry(BE),thefrequencyofvaccinecoverageassessmentdiffersbetweenthedifferentcountryregions,beingundertakenatirregulartimeintervals.Twenty‐fiveofthe27participatingcountrieshavecoveragedatabybirthcohorts.Mostcountriesassessvaccinationcoverageusingthenumberofchildrenatorbyfirstorsecondbirthdayasthedenominatororthenumberofchildrenatschoolentryage.Awiderangeofotheragecohortsisusedinsomecountries.Mostcountriesdonotcollectcoveragedataforspecialsriskgroups(migrants,refugees,ethnicminorities,homeless,sociallyandeconomicallydisadvantagedgroups).Fourcountriesreportedthattheycollectdataoninfluenzavaccineuptakeamongindividualsinclinicalriskgroups;fivecountrieshavedataforHCWsforthesamevaccine.

Allcountries(n=24),excepttwoassessvaccinationcoverageaccordingvaccinesincludedtotheNationalImmunisationProgrammeatnationallevel.BEandESassessvaccinationatthesub‐national(regional)level(onecountrydidnotrespond).NineteencountriesreportedthatdataarecompatiblewithEUROSTATNUTSclassification.In14ofthemdataarecompatiblewithNUTS2orNUTS3level.Avarietyofadministrativemethods(e.g.administrative,surveysandcomputerisedrecordssystemsorcombinationofthese)areusedtocalculatevaccinationcoverage.Inthosecountrieswherethepredominantmethodisadministrative(n=17),themostcommonassessmentofnumeratoristhenumberofsubjectsvaccinated(n=16).Inthosecountrieswheresurveymethodspredominate(n=9),themostcommontypeofsurveysusedareface‐to‐faceinterviews(n=6)orschoolsurveys(n=4).Validationofvaccinationcoveragedataisdoneinjustoverhalfofcountries(n=16)usingavarietyofmethods.Themostcommonmethodreportedinhalfofthesecountriesinvolvesuseofvaccinesalesdata(n=5)followedbyrecountsofvaccinationrecords(n=5).

Differentperformanceindicators(up‐to‐dateoron‐timeimmunisation,latestartrates,drop‐offrates,validdoses)wereusedbyapproximatelyhalfofthecountries(n=14),themostcommonperformanceindicatorbeingtheproportionofchildrenwhoareup‐to‐dateonimmunisations(n=12)followedbyon‐timeimmunisation(n=10).FivecountrieshaveimplementedanE‐healthsystem;howeverinonlytwoofthesecountriesisanimmunisationcomponentincluded.Thirteencountriesplantodevelopsuchsystemwithin5years;eightcountriesplantoincludeimmunisationinthissystem.Immunisationregistriesareavailablein11countiesbutthereisvariationintermsofnationalversusregionalcoverage(fivecountrieshaveanationalregistryandsixhavesubnationalregistries),thereisalsovariationinrelationtotheagegroupscovered.Inadditionninecountriesreportedanintentiontodevelopnationalimmunisationregistries.ThisreportdemonstratesthatoftheVENICEcountriesparticipatinginthissurveyallcollect,collateandanalysevaccinationcoveragedataregularly.However,themethodstheyusetoassessvaccinationcoverageandthefrequencyofdoingsoishighlyvariable,makingcomparisondifficult.

Background Vaccinesarepowerfultoolsforprotectingourhealth.ImmunisationshaveleddtothecontrolandeliminationofdiseasesinEuropethatinthepastcauseddeathanddisabilityformillionsofpeople.Theglobaleradicationofsmallpoxandtheeliminationofpoliomyelitisfrommostregionsoftheworldareexcellentexamplesofsuccessfulvaccinationprogrammes.Europeannationalimmunisationprogrammesforchildrenincludevaccinesagainstnineto11diseases,dependingonnationalpriorities.Mostvaccinesprovidelifelongprotectionfortheimmunisedpersonbutunimmunisedpeoplealsobenefit.Pneumococcalconjugatevaccine(PCV),whichisgiventoyounginfants,alsoindirectlyprotectsunimmunisedelderlypeoplefrompneumococcalpneumoniabyreducingtheriskofgettingexposedtoaninfectedchild.Overthelastfewyears,severalnewvaccineswerelicensedforuseintheEuropeanUnion,includingvaccinesagainsthumanpapillomavirus(HPV),herpeszostervirus,androtavirus.Twonewconjugatedpneumococcalvaccinesandanewmeningococcalvaccinewereapprovedin2009and2010.[1]Immunisationcoverageisakeymeasureofthevaccinationprogrammeperformance.Informationonthemethods,materialsandtoolsusedtomeasureorestimateimmunisationcoverage,andonimmunisationcoverageatthecountrylevelvarybetweencountriesmakingcomparisonbetweenthemdifficult.[2]NationalimmunisationprogrammesalsovaryacrosstheEUandcoverageratesarelowerinsomecountriesthanothers.Thesenationaldifferencesmakethemonitoringofvaccineuptakeandtheevaluationofaprogramme’seffectivenessandimpactverydifficult.In2007,withinthefirstVENICEproject(2006‐2008),asurveywasdonetodescribethemethodsusedtocomputevaccinationcoverageintheVENICEnetworkstates.(Ref)BackgroundinformationonimmunisationprogrammesandvaccinecoverageassessmentwascollectedacrossEUandEEAMemberStates.Informationwascollectedonfrequencyofvaccinationcoverageassessmentforthevaccinesthatwererecommendedineachcountry,ageatwhichvaccinationcoverageisassessed,administrativelevelatwhichvaccinationcoverageisassessed,methodsused(administrative,orsurvey)toassesvaccinationcoverage,vaccinationcoveragedatavalidationandimmunisationregistriesweredescribed.In2010theVENICEprojectMSsagreedtoupdatetheinformationpreviouslycollectedbycarryingoutanewsurveyonvaccinationcoverageassessmentin2011.[3]

Objective

TheobjectiveofthissurveywastodescribeandtocollateinformationonvaccinationcoverageassessmentfordifferentvaccinesincludedintotheNationalImmunisationProgrammeineachMSsandupdatedatacollectedinsurveyconductedin2007.

Methodology

StudyDesignAnelectronicbaseddesignofthesurveywasundertaken.ThissurveywasacollaborativestudybetweentheEuropeanCentreforDiseasePreventionandControl(ECDC),VENICEProject(includingCINECA)andEuropeanUnion(EU)andEuropeanEconomicArea(EEA)MemberStates(MS).EachMSpreviouslyidentifiedandenrolledgatekeepers,whoareresponsibleforconductingallVENICEsurveysinsidetheircountries.CurrentlyintheVENICEprojectthereare27EUandtwoEEA(NOandIS)participatingcountries.

DatacollectionAstandardisedquestionnairewasdeveloped.Informationwassoughtonvaccinesroutinelyrecommendedineachcountryaspartofthenationalimmunisationprogramme;frequencyofvaccinationcoveragedatacollectionfordifferentagegroupsandspecialriskgroups;whethervaccinationcoveragedatawasavailablebybirthcohortatnationallevel;availabilityofvaccinationcoveragedatabysinglevaccinedosesversusfullimmunisationseries;deliverymethodsforvaccines(e.g.byprimarycarephysicians,publichealthnursesetc.)andwhetherprovided(suppliedby/paidfor/reimbursed)bytheNationalImmunisationProgramme;availabilityofvaccinationcoveragedatabynationalorsubnationallevel;availabilityofvaccinationcoveragedatacompatiblewithEUROSTATNUTS(pleaseseefootnoteundertable16)classification;descriptionofnumeratorassessment(foradministrative,surveysmethodsorimmunisationregistries);vaccinationcoveragedatavalidation;feedbacktostakeholders;andmeasurementofperformanceindicators.ThelasttwopartsofthequestionnairecontainedquestionsonimplementationofE‐Healthsystemrelatedtoimmunisationinformationandimmunisationregistries(IR).CountriesthatdidnothaveIRsatthetimeof2007surveybutintroducedandIRsubsequentlywereabletocompletethispartofquestionnaire(Appendix1).

DatahandlingTheelectronicquestionnairewasdevelopedonVENICEwebsiteinJune2011byCINECA,whichwasavailableforallparticipatingcountries(http://venice.cineca.org).TheelectronicquestionnairewasfilledinAugust/Septemberbygatekeepersineachcountryandsaved.Non‐responderswerefollowedup.ThedatawereanalysedinOctober/November2011.Datawerevalidatedbygatekeepersof19countriesinDecember2011.

DataprocessingGatekeepersineachMSentereddatadirectlyon‐line.

PilotstudyThequestionnairewaspilottestedbyfourVENICEproject‐leadingpartners:ItalianIstitutoSuperiorediSanità(ISS),theFrenchInstitutdelaVeilleSanitare(INVS),CINECAConsortiumofUniversity,Bologna,ItalyandtheIrishHealthProtectionSurveillanceCentre(HPSC).ThepilotingofthestudywasundertakeninlateJuly2011.Afterthepilotstudy,thequestionnairewasreviewedandamendedasnecessary.

StudytimeMSswereaskedtocompletetheelectronicquestionnairebetweenAugust10thandSeptember2nd2011.TheaccompanyinglettertoMSsexplainedtheobjectivesandrationaleofthestudy.

DataanalysisThedatawereanalysedusingExcel.

ExpecteddeliverablesTheexpectedoutputofthissurveyisatechnicalreportonthestatusofimmunisationcoverageassessmentinEU/EEAMSsinordertoinformpolicymakersatEuropean,EUandnationallevelwhoareworkingintheareaofvaccinationprogrammesinthememberstates.Results ResponserateOf29countriesinvitedtoparticipateinthissurvey27responded.BGandGBdidnotrespond.Datavalidation:BE,IE,CZ,DE,DK,FR,GR,IS,IT,LT,EE,LU,MT,NL,NO,SE,SI,DE,HU(n=19)

National Immunisation Programme

Thefollowingvaccinesareincludedtothenationalimmunisationprogrammes:allcountries(n=27)includeimmunisationwithDTP,Polio,HibandMMRvaccines;21and20countryincludehepatitisBandPCVvaccinesrespectively;MenCvaccineisrecommendedin12countries,BCGisincludedin11countries;fourcountriesroutinelyrecommendwithrotavirusandvaricellavaccinesandthreecountriesroutinelyrecommendinfluenzavaccinationforchildren.Mostcountriestargetadolescentsfordiphtheriaandtetanus(n=23),somecountriesalsoincludepertussiscomponent(n=13)foradolescentvaccination;poliovaccineisrecommendedforadolescentsin12countries.Foradults,tetanusvaccinationisrecommendedin19countriesand16countriesrecommenddiphtheriavaccine.TwelvecountrieshaveimplementedHPVvaccinationprogrammes.Mostcountriesrecommendadditionalvaccinesforspecialgroups:influenzavaccine(n=21),pneumococcalpolysaccharide23valentvaccine(n=15)andhepatitisBvaccine(n=19).DetailedinformationonvaccinesrecommendedineachNationalImmunisationProgramme*arepresentedintable1.Table1.VaccinationsrecommendedbyNationalImmunisationProgrammesinEU/EEAcountries,bycountryandgroup.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=27) Diphtheria Tetanus Pertussis Polio Hib HepB

BCG

MenC

MMR Var1 PCV7,

10,132

Pneumo23

Rotavirus

HPV Influenza

Children AT,CY,CZ,DK,EE,FI,FR,DE,GR,HU,IS,IE,IT,LV,LT,LU,MT,NL,NO,PL,PT,RO,SK,SI,ES,SE,BE(n=27)

AT,CY,CZ,DK,EE,FI,FR,DE,GR,HU,IS,IE,IT,LV,LT,LU,MT,NL,NO,PL,PT,RO,SK,SI,ES,SE,BE(n=27)

AT,CY,CZ,EE,FR,DE,GR,IE,IT,LV,LT,LU,MT,NL,PL,PT,RO,SK,SI,ES,BE(n=21)

EE,GR,HU,IE,LV,LT,MT,PL,PT,RO,SK(n=11)

CY,FR,DE,GR,IS,IE,IT,LU,NL,PT,ES,BE(n=12)

AT,CY,CZ,DK,EE,FI,FR,DE,GR,HU,IS,IE,IT,LV,LT,LU,MT,NL,NO,PL,PT,RO,SK,SI,ES,SE,BE(n=27)

DE,GR,LV,LU(n=4)

AT,CY,CZ,DK,FI,FR,DE,GR,HU,IS,IE,IT,LV,LT,LU,NL,NO,SK,SE,BE(n=20)

AT,FI,BE,LU(n=4)

SE,IT(n=2)

FI,HU,MT(n=3)

Adolescents AT,CY,EE,FI,FR,DE,GR,IS,IE,IT,LV,LT,MT,NO,PL,PT,RO,SK,SI,ES,SE,BE,LU(n=23)

AT,CY,CZ,EE,FI,FR,DE,GR,IS,IE,IT,LV,LT,MT,NO,PL,PT,RO,SK,ES,SE,BE,LU(n=23)

AT,FI,FR,DE,GR,IS,IE,IT,SK,ES,SE,BE,LU(n=13)

AT,CY,FI,FR,DE,GR,IS,LV,MT,NO,SK,LU(n=12)

AT,CY,CZ,EE,HU,FR,DE,GR,LV,MT,ES,BE(n=12)

AT,FR,DE,GR(n=4)

AT,CY,DK,EE,FR,DE,GR,HU,IS,IT,BE(n=11)

DE,GR,IT,ES(n=4)

DK,GR,IS,LV,NO,PT,SI,ES,SE,BE(n=10)

Adults* CY,EE,FI,FR,DE,GR,IT,LV,

CY,CZ,EE,FI,FR,DE,GR,

FR,DE,BE,LU(n=4)

CY,FR,MT,LU(n=4)

CY,HU,MT(n=3)

FR (n=1)

CY,FR,DE(n=3)

IS,LU,MT(n=3)

LT,PL,PT,RO,SK,ES,BE,LU(n=16)

IT,LV,LT,MT,PL,PT,RO,SK,ES,BE,LU,SI(n=19)

Specialgroups(e.g.riskgroups,girls,elderly)

FR,PL,PT,IE(n=4)

FR,HU,IS,PL,PT,SK,IE(n=7)

FI,FR,DE,IE(n=4)

CY,FR,DE,GR,IT,PT,IE(n=7)

CY,DE,IE,PT,SI(n=5)

CY,CZ,FI,FR,DE,GR,IS,IE,IT,LV,LT,NL,NO,PL,PT,SK,SE,BE,SI(n=19)

CY,CZ,FI,FR,IE,NO,SK,SE(n=8)

CY,FR,DE,IE,IT,PLSI(n=7)

FI,FR,DE,GR,IT,PL,PT(n=7)

FR,DE,GR,IT,PL,BE,LU,SI(n=8)

CZ,DE,IT,PL,ES,BE,SI(n=7)

CY,CZ,FR,DE,GR,IS,IE,IT,SK,ES,SE,BE,LT,LU,SI(n=15)

PL(n=1)

FR,DE,GR,IE,LT,NL,PL,LU(n=8)

CY,CZ,DK,FI,FR,DE,GR,HU,IS,IE,IT,LT,NL,NO,PL,SK,SI,ES,SE,BE,LU(n=21)

*Immunisationprogramme:setofobjectives,strategies,actions,andprioritiesfortheorganiseduseofvaccinesforVPDsdefinedinyourcountry.Frequency of vaccination coverage data collection Thefrequencyofvaccinationcoverageassessmentbydifferentagegroups(children,adolescents,adults)andvaccinesacrossEUcountriesforeachvaccinationispresentedintable2,3and4.Mostcountriesindicatedthatvaccinationcoverageformostchildrenandadolescentsisassesseddannually;inLVandHUvaccinationcoverageisassessedmonthly;inIEandMT–quarterly;PTandROevery6months;FIeverytwoyears;CYeverythreeyears;GR,LU,ITevery5years.Agegroupdefinitionsinthissurvey:childrenaredefinedaschildrenaged0‐11yearsinclusive;adolescentsaredefinedaschildrenoryoungadultsaged12‐18years(inclusive);adultsaredefinedasanyoneaged19yearsandover.Table2.FrequencyofvaccinationcoverageassessmentforchildreninEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=27)

Frequency DTP Polio Hib HepB BCG MenC MMR Var1 PCV7,

10,132

Rotavirus

HPV Influenza

Monthly LV,HU(n=2) LV,HU(n=2) LV,HU (n=2) LV(n=1) LV,HU(n=2) LV,HU (n=2) LV(n=1)

HU,LV(n=2)

Quarterly IE,MT(n=2) IE,MT(n=2) IE,MT(n=2) IE,MT(n=2) IE(n=1) IE(n=1) IE,MT (n=2) IE (n=1)

Annually AT,CZ,DK,EE,FR,DE,IS,IT,LT,NL,NO,PL,SK,SI,ES,SE(n=16)

AT,CZ,DK,EE,FR,DE,IS,IT,LT,NL,NO,PL,SK,SI,ES,SE(n=16)

AT,CZ,EE,FR,DE,IT,LT,NL,PL,SK,SI,ES(n=12)

EE,MT,LT,PL,SK,FR(n=6)

FR,DE,IS,NL,ES,IT*(n=6)

AT,CZ,DK,EE,FR,DE,IS,IT,LT,NL,NO,PL,SK,SI,ES,SE(n=16)

DE,IT*(n=2)

AT,DK,FR,DE,IS,NL,NO,SK,SE,IT*(n=10)

AT(n=1)

SE(n=1)

FI,HU,MT(n=3)

Every2years FI(n=1) FI(n=1) FI(n=1) FI(n=1) FI(n=1) FI(n=1)

Every3years CY(n=1) CY(n=1) CY (n=1) CY(n=1) CY(n=1) CY(n=1) CY(n=1)

Every5years GR,LU,IT(n=3) GR,LU,IT (n=3) GR,LU,IT (n=3) GR,LU,IT(n=3)

GR (n=1) GR,LU,IT(n=3)

GR,LU,IT(n=3)

GR,IT(n=2)

GR,LU,IT(n=3)

IT (n=1)

Other,specify3

BE(n=1) BE(n=1) BE (n=1) BE (n=1) BE(n=1) BE (n=1) LU**

(n=1)BE (n=1) BE,

LU**(n=2)

Every6months PT,RO(n=2) PT,RO(n=2) PT,RO (n=2) PT,RO (n=2) PT,RO (n=2) PT(n=1) PT,RO (n=2) IT(n=1)

1Varicellavaccine2conjugate7(10,13)valentPneumococcalvaccine3including“irregularly”–forBelgium:coverageisassessedperregion,notalwaysinthesameyear,andtheassessmentshavebeenconductedatirregulartimeintervalsinFlanders(’99,2005,2008andnowisplannedin2012).InWalloniavaccinecoverageassessmenthasbeenconductedeverythreeyearssince1989(mostrecentlyin1999,2003,2006and2009).InBrusselsmostrecentlyin1995,2000and2006.InbothWalloniaandBrusselsthenextcoverageassessmentisplannedtotakeplacein2012.Basedontheseassessments,nationalvaccinationcoverageisthencalculated,usingaweightedaverageandbasedonthemidyearpopulations.4ifnotincludedintheImmunisationProgramme*IT‐Routinelyassessmentisperformedatsubnationallevelbutthedataarenotcollatedatnationallevel.**UniversalVZVvaccinationhasbeenintroduced.Table3.FrequencyofvaccinationcoverageassessmentforadolescentsinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=27)

Frequency Diphtheria Tetanus Pertussis Polio MMR HPV Var1 HepB MenC

Monthly LV(n=1) LV (n=1) LV (n=1) LV (n=1)Quarterly NO (n=1)Annually AT,EE,DE,

IS,LT,MT,NO,PL,SK,SI,ES,SE(n=12)

SK,SI,ES,SE,AT,EE,DE,IS,LT,MT,NO,PL(n=12)

AT,DE,IS,SK,SE(n=5)

AT,DE,IS,MT,NO,SK,CY,FI,GR,FR,LV(n=11)

AT,DK,EE,DE,IS,SE**(n=6)

DK,IS,SI,ES,SE,NO,FR,LU(n=8)

DE,ES (n=2) AT,CZ,EE,DE,MT,ES,HU (n=7)

AT,DE(n=2)

Every6months PT(n=1) PT(n=1) IT,PT (n=2)

Every5years IT*(n=1) IT*(n=1) IT*(n=1) IT* (n=1) IT* (n=1) IT* (n=1) IT* (n=1) IT*(n=1) IT*(n=1)

Every6years FR(n=1) FR(n=1) FR(n=1) FR (n=1) FR (n=1) FR (n=1) FR (n=1)

Occasionally GR(n=1) GR(n=1) GR(n=1) GR (n=1) GR,BE (n=2) GR,BE (n=2) GR(n=1) GR,BE (n=2) GR(n=1)

Vaccinationcoveragenotassessed

CY,FI,IE,IT,RO,BE(n=6)

RO,CY,CZ,FI,IE,IT,BE(n=7)

FI,IE,IT,ES,BE(n=5)

CY,IT,IE(n=3)

IE(n=1)

IT(n=1) CY(n=1)

1Varicellavaccine2including“irregularly”:ForBelgiumseeabove,atirregulartimeintervalsforFlanders,andeverythreeyearsforWallonia(includingdTpaboosterinadolescenceofWallonia).3ifnotincludedintheImmunisationProgramme

*IT‐anEPIclustersamplingsurveyisperformedevery5yearstoassessvaccinationcoveragefortheabovementionedvaccinesinchildrenaged12‐24monthsand15‐yearoldadolescents.**MMR2isassessedforadolescentsattheageof12‐13years.

Table4.FrequencyofvaccinationcoverageassessmentforadultsinEU/EEAcountries,byvaccine.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=27)

Frequencyofassessment

VaccinetypeDiphtheria Tetanus Pertussis MMR Influenza Pneumo

Every6months PT(n=1) PT(n=1) Annually LV,PL

(n=2)DE,LV,PL(n=3)

DE(n=1)

IS,LU,MT,DK,SI(n=5)

IS(n=1)

Every10years FR(n=1) FR(n=1) Irregularassessmentbysurveys

DE(n=1)

BE(n=1)

DE(n=1)

BE(n=1)

Absolutenumberofvaccinatedadultsavailableevery3months

EE(n=1)

EE (n=1)

Vaccinationcoveragenotassessed

CY,FI,GR,IT,LT,RO,SK,ES,BE,LU(n=10)

CY,CZ,FI,GR,IT,LT,MT,RO,SK,ES,LU(n=11)

BE,FR,LU(n=3)

BE(n=1) LT(n=1)

1including“irregularly”2ifnotincludedintheImmunisationProgrammeThedate(monthandyear)whenvaccinationcoveragedataarereadyfordatadissemination(e.g.reporttoVENICE/ECDC)isdetailedintable5.Mostcountriescollectvaccinationcoveragedataforchildren,adolescents,andadultsbyJuneofthefollowingyearaftervaccination(18,14,and11countriesrespectively).Table5.AvailabilityofvaccinationcoveragedatafordatadisseminationinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=27)

Dataavailable Children Adolescents AdultsThesameyear(N+0)

May ES,LTJune SI*July LUSeptember SE FROctober SI** November SE

Withinthefollowingyearaftervaccination(N+1)January RO,BE BE February PT PT PTMarch AT,EE,LT,LV,SK AT,EE,LT,LV,SK EE,LVApril HU,MT,NO,SI HU,MT,NO HU,MTMay ES,FI,IE ES FIJune IS,NL,DK IS,NL,DK DE,IS,NL,SK,DKAugust PL PL PLNovember IT ITDecember CY

2ndyearaftervaccination(N+2)April DE DE December CZ,FR CZ December(yearwasnotspecified) FR Notapplicable CY,RO CY,CZ,NO,RO,SE,BENotavailable GR,LU FI,GR,IE,IT,LU AT,GR,IE

N = year of vaccination *SI- VC for influenza is measured by season, for example 2010/11. **SI- VC is measured by school year, not by calendar year, for example 2010/11. Monovalentvaccinesformeasles,mumpsandrubellaarenotusedandnotavailableinthecountryin17countries(table6).Table6.Useofmonovalentvaccinesformeasles,mumps,andrubellainEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=27)Useofmonovalentvaccinesformeasles,mumpsand

rubellaCountries Total

Onlysomeofthemareused* DE,DK,FR,GR,IS,NL,SE 7Theyareavailableonlyinprivatemarket,butnotavailablefornationalvaccinationprogramme IT,LU,SK 3Notusedandnotavailableincountryatall

AT,CY,CZ,EE,ES,FI,HU,IE,LT,LV,MT,NO,PL,PT,RO,SI,BE 17

*DK,DE,NL‐Measlesandrubellamonovalentvaccineavailable;*FR,GR‐Measlesmonovalentvaccineavailable(FR‐Rouvax);*IS‐Rubellamonovalentvaccineavailable.*SE-Rubella monovalent vaccine has been available in Sweden until 2011. CommentsAT‐PCV10until2011onlyforchildrenatrisk;from2012willberecommendedforallchildren;MenA,C,W,Yvaccinationstarts2012;EE‐Vaccinationofadolescentsagainstpertussiswillbeintroducedfromthe1ofJanuary2012.FI‐Fortetanusanddiphtheriaprotectionamongadultsserosurveysarefounduseful.Nodataonthesecoverage’sarethereforesought;FR‐Frequencyisannualforchildrenaged2years(admindata)buteverysixyearsforchildrenaged6yearsand11years(schoolsurveysevery6years).Forchildrenaged2years,dataarereleased2yearsaftertheinformationiscollected(i.e.in2011forVCin2009).Themonthofdisseminationisirregularandvaries,soweputattheendoftheyear.Foradolescentsdataareprovidedbysurveysperformedevery6yearsandestimatesareavailableatyearN+2butthemonthvaries.ForinfluenzaVC,VCareavailableatthebeginningofthefollowinginfluenzaseason(i.e.September2011forVCof2010‐2011season).Rouvax(monovalentmeaslesvaccine)isusedonlyinchildrenaged6‐8monthswhohavebeenexposedtoameaslescase.ForPCV:recommendedtoallchildrenat2,4and12‐15monthsbutalsotochildren2‐5yearsatrisk(immunodepression,etc.)whohavenotbeenvaccinated.Iputtheselatestchildreninthe"children"category,notinthehighriskcategory;DE‐from2012onwardsweplantotrytouseinsuranceclaimdatatomonitortheimmunisationstatus(e.g.ofchildrenaged2years).Thesedatawillbeavailableinthesameyearofthevaccination.Annualcoveragedataforadolescentsarenotavailableforallfederalstates;IT‐ForHPVvaccination,coveragedataiscurrentlycollectedevery6monthsanddataisavailable6monthsafterdatacollection.SodataisregularlyupdatedatJuneandDecember;NL‐Sofar,forhepBonlyriskgroupshavebeenvaccinated.Forchildrenbornon01‐08‐2011andlateruniversalvaccinationwillbeapplied;PL‐WemarkedMenC,Var,Rota,HPVandINFvaccinesasincludedintheimmunisationschedule.Thosevaccinesarehowevernotrefundedandareonlyincludedinthe"recommendedvaccines"section;

SK‐SpecialgroupsinQ1.=peopleinhigherriskofinfectionandemployeesinhigherprofessionalrisk.ES‐HPVonlyrecommendedforgirls.IE‐HPVdataandMMR/TdaP‐IPVbeingsoughtsystematicallyfromadolescentprogrammein2012(foracademicyear).BE–regionalcoverageassessments;in2012oneisplannedintheFlandersRegion,WalloniaandBrusselsregionAssessmentinadults,throughNationalHealthInterviewSurvey.LU‐Question3:‐Surveyforassessmentofvaccinecoverageinchildrenisperformedonceinevery5years.Monthatwhichdataareavailableisnotrelevant.‐Coveragedataaboutinfluenzaintheelderly:afirstestimateisavailableinMayattheendoftheFluseason.DataarereadyfordisseminationinJulythesameyear.‐CoveragedataaboutHPVvaccinesgivenaccordingtotheprograminagivenyearareavailableinMaythefollowingyear.

Vaccination coverage data availability by birth cohort at the national level Vaccinationcoverageisassessedbybirthcohortsin25countries,22ofwhichcouldprovideaggregateddataannuallytoECDC;CYandGRdonothavethesedata(table7).Table7.VaccinationcoveragedataassessmentbybirthcohortinEU/EEAcountriesandavailabilitytoprovidethesedatatoECDC.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=27)

Available

Notavailable

Coveragedatabybirthcohort

AT,CZ,DE,DK,EE,ES,FI,FR,HU,BE,LUIE,IS,IT,LT,LV,MT,NL,NO,PL,PT,RO,SE,SI,SK(n=25) CY,GR(n=2)

Canprovide CannotprovideAggregateddataonannualbasistoECDC

AT,CZ,DE,DK,EE,ES,FR,HU,IE,IS,IT,LT,LV,MT,NL,NO,PL,PT,RO,SE,SK,SI(n=22) FI,LU(n=2)

BE:thisisdonealreadyforWHOEURO;shouldfitinacollaborativeagreementbetweenWHOEUROandECDCtoavoidduplicationofreportingandefforts.So,yeswecanprovidedatatoECDCifjointlyorganizedwithWHOEURO.Tableeightshowdatawhenvaccinationcoverageisavailableaftermeasurementatnationallevel. Table8.Timeperiodwhenvaccinationcoveragedataavailableatnationallevel.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=27)

Cohortvaccinationcoveragedataavailable Countries TotalWithin3monthsafterageofmeasurement AT,HU,LV,PT,RO,SK 6Within6monthsafterageofmeasurement DK,IE,IS,MT,NL,NO 6Within12monthsafterageofmeasurement EE,IT,LT,PL,SE,SI,BE 7Other* CZ,DE,ES,FI,FR,LU 6Noresponse‐CY,GR*Other:CZ‐approx.18monthsafterdateofmeasurement;FI‐Wedocoveragesurveysforasampleof1000childrenattheageof3yearsandcheckretrospectivelytheirimmunisationdatatilltheageof2years;FR‐VCdatacollectedatage2y(i.e.about20moafterthefirstvaccinations)andVCestimatesreleasedabout2yearslater(i.e.childbornin2011,assessedin2013,VCat2yearsreleasedin2015);DE‐after2yearsforschoolentryexamination,forbillingdata(seecommentQ4)inthesameyear;ES‐regionssenddatatonationallevelonceayear.

LU‐Weperformevery5yearscoveragesurveyforasampleof600childrenattheage25‐30months,andchecktheirvaccinationstatusatage2yearsaswellasthevariationsfromtherecommendedschedule.Theresultsareavailable6monthslater.

Vaccinationcoverageassessmentbybirthcohortanddetailsforsomebirthcohortspresentedintable9andsubtables9aand9b. Table9.VaccinationcoverageassessmentbybirthcohortatthenationallevelinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=27)

Birthcohort DTP Polio Hib HepB BCG MenC MMR Var1 PCV7,10,132

Rotavirus HPV Influenza

Pneumo23

**Allbirthcohortschildrelatedvaccinationsuntil(specifyage,e.g.by6years)(table9b)

AT,DK,FR,HU,IS,MT,PL,RO,SE(n=9)

AT,DK,FR,HU,IS,MT,PL,RO,SE(n=8)

AT,DK,FR,HU,IS,MT,PL,RO,SE(n=9)

AT,FR,LT,PL,RO,SE(n=6)

FR,HU,LT,RO,SE(n=5)

AT,FR,IS(n=3)

AT,DK,FR,IS,PL,RO,SE,HU(n=8)

PL(n=1) AT,DK,FR,IS,LV,HU(n=6)

AT,PL(n=2)

DK(n=1)

At12months CZ,EE,ES,IE,LT,LV,NL,PT,RO,SI,HU(n=11)

CZ,EE,IE,LV,LT,NL,PT,RO,SI,ES,HU(n=11)

CZ,EE,IE,LV,LT,NL,PT,SI,ES,HU(n=10)

CZ,EE,IE,LV,LT,PT,RO,SK,ES(n=9)

IE,LV,PL,PT,RO,SK,HU(n=7)

IE,PT,ES(n=3)

EE,IE,LV,RO(n=4)

LV (n=1) IE,LV,NL,HU(n=4)

At24months CZ,DE,EE,ES,FR,IE,IT,LT,LV,NL,NO,PT,RO,SE,SK,BE,HU(n=17)

BE,CZ,EE,FR,DE,IE,IT,LV,LT,NL,NO,PT,RO,SK,ES,SE,HU(n=17)

CZ,EE,FR,DE,IE,IT,LV,LT,NL,NO,PT,SK,ES,SE,BE,HU(n=16)

BE,CZ,EE,FR,DE,IE,IT,LV,NL,PT,RO,ES,SE(n=13)

FR,IE,LV,PT,RO,SE(n=6)

FR,DE,IE,NL,PT,ES,BE(n=7)

BE,CZ,EE,FR,DE,IE,IT,LT,NL,NO,PT,RO,SK,ES,SE,SI,HU(n=17)

DE(n=1)

FR,DE,IE,NL,NO,SK,SE,BE,HU(n=9)

BE(n=1)

At36months FI(n=1) FI(n=1)

FI (n=1)

CZ,SK(n=2)

FI (n=1) FI (n=1)

*Atschoolentry(table9a) FR,DE,LV,LT,NO,PT(n=6)

FR,DE,LV,LT,NO,PT(n=6)

DE,PT (n=2)

FR,DE,PT(n=3)

PT(n=1)

FR,DE,PT(n=3)

FR,DE,LV,LT,NO,PT,SI(n=7)

DE (n=1) DE (n=1)

***Adolescentbirthcohortvaccinations(pleasespecifytheage(oragerange)whenvaccinationcoverageisprovided)(table9b)

FR,IS,LV,LT,NO,SK,BE(n=7)

FR,IS,LV,NO,PT,SK(n=6)

IS (n=1)

CZ,EE,FR,LV,PT,ES,BE(n=7)

MT,PT(n=2)

FR,PT(n=2)

EE,FR,IS,NO,PT,BE(n=6)

IS,IT,LV,NO,PTES,SE,BE(n=8)

Adultbirthcohortvaccinations(pleasespecifytheagewhenvaccinationcoverageisprovided)(table9b)

LT,SI(n=2)

****Forarangeofbirthcohorts(pleasespecifytheagewhenvaccinationcoverageisprovided)(table9b)

DE(n=1)

DE,PT (n=2)

DE,HU,MT(n=3)

DE,PL(n=2)

DE,MT,HU(n=3)

DE (n=1) DE,PL(n=2)

PL(n=1) NO,PL(n=2)

DE,IT,PL,LU(n=4)

PL(n=1)

*****Other,specify(table FR,NL,ES,SE, FR,NL,SE,CZ, SE,LU (=2) NL,SI,LU (n=3) EE (n=1) LU (n=1) NL,SI,ES,SE,LU, CZ,LU FR,DE, CZ,DK,FR, IS

9b) CZ,LU,SI(n=7)

LU(n=5)

SI (n=6)

(n=2) NL,SI,LU(n=5)

HU,IS,IE,NL,ES(n=8)

(n=1)

Notapplicable DK,FI,IS,NO(n=4)

AT,CZ,DK,FI,DE,IS,IT,NL,NO,ES,LU(n=11)

CZ,DK,EE,FI,HU,IT,LV,LT,MT,NO,RO,SK,SE(n=13)

AT,CZ,DK,EE,FR,HU,IS,IE,IT,LV,LT,MT,NL,NO,PT,RO,SK,SI,ES,SE(n=20)

EE,FI,HU,IT,LT,MT,PT,RO,SI,ES(n=10)

CZ,DK,EE,FR,DE,HU,IS,IE,IT,LV,LT,MT,NL,NO,PT,RO,SK,SI,ES,SE(n=20)

AT,CZ,EE,FI,HU,IE,LT,MT,RO,SK(n=10)

AT,EE,LV,MT,NORO,PT,SK,SE(n=9)

AT,CZ,DK,EE,FI,FR,DE,HU,IE,IT,LV,LT,MT,NL,NO,PT,RO,SK,SI,ES,SE(n=21)

Table9a.*Ageatschoolentryandavailabilityofvaccinationcoveragedataforthesebirthcohorts:*Ageatschoolentry Countries

4,5,6,yearsdependingonfederalstateandtimeofexamination

DE Rangeofthesecohortsatschoolentry

6years FR,NO Eachbirthcohortatschoolentry7years LV Eachbirthcohortatschoolentry6or7years LT EachbirthcohortatschoolentryDidnotspecifyage PT EachbirthcohortatschoolentryTable9b.Ageforbirthcohorts:

Country Birthcohort**Maximumageforchildren’s birthcohort

AT Until15yearsDK AslongasrelevantFR‐ Assessmentisdoneineverycohortonlyonceattheageof2yearsHU Until7yearsIE 24monthsIS Until9yearsLT Onlynewborns‐ dataarecollectedforbirthcohortchildrenatageuntil12months;MT Until16yearsforDTandpolio,at2yearsforHibandhepatitisPL Until18yearsRO 2yearsSE Coveragedataarecollectedforbirthcohortchildrenatage24‐35months.BE 24months

***AdolescentsageCZ HepatitisBat14yearsofa*geEE HepB3:13‐14years.;MMR2:13‐14yearsFR Seepoint2intheCommentssection;IS Until19yearsIT ForHPV,12yearsLV 12girlsforHPV;14yearsforTd/POLIOandHepB;LT 15or16yearsMT BCGat12yearsNO 16yearsPT 14years;SK ForDTaP‐IPVvaccinationcoverageisprovidedfor13yearsoldadolescents(vaccination

isgivento12yearsoldadolescents);ES 14‐16yearsSE 12‐18years(HPVvaccine).BE Adolescents:assessmentat 13‐14yearsofa*geinFlanders.BE:(Frenchcommunity)

adolescentsat11‐12yforMMR2andHBV,at13‐14forHPV(plannedforthe2012assessment),at15‐16yfordTpa

AdultageLT,SI >65yearsBE >18years

****Range,specifyage:DE DependingonfederalstateandtimeofexaminationHU Aftertheschoolcampaign;13‐24yearsoldhepB.IT Forinfluenza>64yearsMT MMR1stdoseat18months2nddoseat4yearsNO CoverageofHPVismonitoredforallbirthcohortsthatareincludedsofar(1997,1998

AND1999)

PL DifferentagegroupsfordifferentvaccinesLU ForInfluenzaage>64years

*****Other,specify:CZ Forselecteddiseases/vaccines(e.g.influenza,PVC7,10,13)specificstudieswere

conducted;CZ‐DTPa,IPV–at11yearsofa*ge;DK Onlyriskgroupsofferedfreeinfluenzavaccine;EE BCGcoveragefortheage11monthsand29days.FR Notapplicable;DE Influenzaassessedbysurveys;HU AFTERINFLUENZASEASONIE Influenzaforelderlyestimateonlyofthoseeligibleforfreevaccinationfromhealth

services(padibygovt.);NL DTP/polioalsoat5yearsand10years,hepatitisBalsoat3days(HepB‐0),MMRalsoat

10years,HPVat14years(girlsonly),influenzaat60+yearsplusriskgroups;SI HepB5‐6years,MMR18months,HPV11‐12years;ES 14‐16yearsofa*ge;SE Coveragedataarecollectedforchildrenatage24‐35monthsandforschoolchildrenin

6thgrade(12‐13yearsold).LU Assessmentofchildhoodvaccinationcoverageevery5yearsbysurvey;yearly

assessmentofHPVcoverageingirlsaged12‐18yearsforthewholecohort.CommentsFI‐Weonlydosurveysof1000children.Thissampleisrepresentingthespecificbirthcohort.FR‐1.Atschoolentrymeansforusattheageof6yearstheyearbeforeenteringprimaryschool.Thisassessmentisdonethroughsurveysevery6years,i.e.notinallbirthcohortsbutonlyin1cohortoutof6(i.e.in2010assessmentofchildrenaged6yearsbornin2004.Thenextsurveyisperformedin2016inchildrenof6yearsbornin2010.Cohorts2005‐2009notassessedat6years.Etc.).2.Sameforadolescentbirthcohort’svaccinations.InFrance,aschoolsurveyismadeevery6yearsinpre‐adolescentsaged10‐11yearsandinadolescentsaged15years.Thatmeansthatintheseagegroups(asforchildrenaged6years),vaccinationcoverageisestimatedin1cohortoutof6.Hopethisisclear.3.InFrance,weassessVCatage=2yearsforeverycohortandforallrecommendedvaccinations.ThatiswhyIput"allbirthcohortschildrelatedvaccinations"and"at24months",hopethisiscorrect.4.Othermeans:forDTPolio=estimatesinadultsevery10years(surveys);forHPV=annualestimatesingirlsaged14yearsandin15‐23girlswithnohistoryofsexualactivity;forinfluenza=annualestimatesin65+andin<65yearswithspecialchronicconditions.5.BCG:estimatesareproducedannuallyinallbirthcohortsbutonlyinchildrenconsideredathighriskoftuberculosis(i.e.notallthechildreninthecohortarevaccinated).6.VaricellaandRotavirusarenotrecommended.Iput"notapplicable",hopethisiscorrect.7.Pneumo23recommendedto5yearsoldandabovewithspecialconditionsbutVCfiguresarenotregularlyproduced,dataonthisvaccinationislacking.Iput"notapplicable",hopethisiscorrect.IT‐Someinformationarepotentiallyavailablebecauseexistingatsubnationallevelbutnotcollectedatnationallevel(forexamplemeningococcal,pneumococcal,varicellavaccines).NL‐DTP/polioalsoat5yearsand10years,hepatitisB(sofaronlyforriskgroups)alsoat3days(HepB‐0),MMRalsoat10years,HPVat14years(girlsonly),influenzaat60+yearsandforriskgroups.UniversalhepatitisBvaccinationwasintroducedintheNetherlandsattheendofthisyear(2011)sointhefuture(birthcohorts2011/2012andyoungerthatwillbereportedforthefirsttimeintheyear2014)wewillreportcoverageforhepatitisBforallechildreninsteadofforriskgroupsonly.PL‐PCV7,10,13andPneumo23together:0‐14,15‐19,20‐64,65+Varicella,MeningococcusC,HPV:0‐19,20+Rotavirus:0y.o.Influenza:0‐4,5‐14,15‐64,65+.

BE:infantsare18‐24monthsatassessment;adolescent’scoverageisassessedaccordingtoschoolgrade

Single vaccine doses versus full immunisation series InformationonnationalvaccinationcoveragedataassessmentbyvaccineandnumberofdoseswhichcouldbeprovidedtoECDCarepresentedintable10.Vaccinecoveragedataareavailableinall25countries(FI,CYdidnotrespond)forDTP,PolioandHibvaccines;dataoncompletedimmunisationseriesat24monthsareavailableforDTPin19countriesandforPolioandHibvaccinesin20countries.AllthesecountriescouldprovidethesedatatoECDC.All25countriescollectMMRvaccinationcoveragedataforfirstdoseofvaccine,howeverthreecountries(SI,IE,IT)donotcollectMMRvaccinationcoveragedataforseconddose.ThesedataalsowouldbeavailabletoreporttoECDC.Deatiledinformationpresentedinatable10.Table10.VaccinationcoverageassessmentbynumberofdosesatthenationallevelinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=25)

Vaccinationcoveragecollected CountryDTPcoverageavailable AT,CZ,DK,EE,FR,DE,GR,HU,IS,IE,IT,

LV,LT,MT,NL,NO,PL,PT,RO,SK,ES,SI,SE,BE,LU(n=25)Firstdose EE,LV,LT,NO,BE (n=5)Everysingledose AT,DK,GR,LV,LT,NO,BE,IS,LU(n=9)Primaryimmunisationseries EE,FR,IE,LV,LT,NL,BE,IS

NO,PL,PT,RO,SK,SI,ES(n=15)Fullimmunisationseries(includingbooster)by24months

CZ,EE,DE,FR,HU,IE,IT,LV,LT,MT,NL,NO,PL,PT,RO,ES,SE,BE,LU(n=19)

Other,specify FR‐ForDT,boosterdosesnumber2(6y),3(11‐13y),4(18y).Pertussis:boosterdosenumber2at11‐13years.Adultboostersevery10years.DE‐incompleteimmunisationseries;LV‐DT7yearsand14years;NL‐DTaP‐IPV‐3at12months,DTaP‐IPV‐4at24months,DTaP‐IPV‐5at5years,DTaP‐IPV‐6at10years;PT‐Fullimmunisationseriesis5doses,measuredat7yearsofa*ge;SK‐Fullimmunisationseries(incl.booster)bytheage12years(primaryimmunisationseriesandboosterat6‐thyearand13‐thyearoflife).BE:DTPbooster2administeredat6y,assessedintheFrenchcommunityat7yandassessedinFlandersat13‐14years;dTpabooster3,administeredat14‐16years,isassessedonlyintheFrenchcommunity

Ifyes,couldyouprovidethesedataforECDC?*

AT,CZ,DK,EE,FRIT,LV,LT,MT,NL,NO,PL,PT,RO,SK,ES,SE,DE,GR,HU,IS,IE,LU,SI(n=24)

Poliocoverageavailable AT,CZ,DK,EE,FR,DE,GR,HU,IS,IE,IT,LV,LT,MT,NL,NO,PL,PT,RO,SK,ES,SI,SE,BE,LU(n=25)

Firstdose EE,LV,LT,NO,BE (n=5)Everysingledose AT,DK,GR,LV,LT,NO,BE,IS,LU(n=9)Primaryimmunisationseries EE,FR,IE,LV,LT,NL,NO,PL,PT,RO,SK,SI,ES,BE,IS(n=15)Fullimmunisationseries(includingbooster)by24months

AT,CZ,EE,DE,FR,HU,IE,IT,LV,LT,MT,NL,NO,PL,PT,RO,ES,SE,BE,LU(n=20)

Other,specify FR‐Boosterdosesnumber2(6y),3(11‐13y),4(18y).Adultboostersevery10years.DE‐incompleteimmunisationseries.

LV‐7yearsand14years;NL‐DTaP‐IPV‐3at12months,DTaP‐IPV‐4at24months,DTaP‐IPV‐5at5years,DTaP‐IPV‐6at10years;PT‐Fullimmunisationseriesis4doses,measuredat7yearsofa*ge;completevaccinationmeasuredat14yearsold;SK‐Fullimmunisationseries(incl.booster)bytheage12years(primaryimmunisationseriesandboosterat6‐thyearand13‐thyearoflife).BE:poliobooster2administeredat6y,assessedintheFrenchcommunityat7yandassessedinFlandersat13‐14years;

Ifyes,couldyouprovidethesedataforECDC?*

AT,CZ,DK,EE,FRIT,LV,LT,MT,NL,NO,PL,PT,RO,SK,ES,SE,DE,GR,HU,IS,IE,LU,SI(n=24)

MMRcoverageavailable AT,CZ,DK,EE,FR,DE,GR,HU,IS,IE,IT,LV,LT,MT,NL,NO,PL,PT,RO,SK,ES,SI,SE,BE,LU(n=25)

Firstdose AT,CZ,DK,EE,FR,DE,GR,HU,IS,IE,IT,BELV,LT,MT,NL,NO,PL,PT,RO,SK,ES,SI,SE,LU(n=25)

Seconddose AT,CZ,DK,EE,FR,DE,GR,HU,IS,BELV,LT,MT,NL,NO,PL,PT,RO,SK,ES,SE(n=22)IE,IT,SI–donotcollectvaccinationcoveragedatafor2nddoseofMMR(n=3)

Otherspecify PT‐completevaccinationalsomeasuredat14yearsold;Ifyes,couldyouprovidethesedataforECDC?*

AT,CZ,DK,EE,FR,IT,LV,LT,MT,NL,NO,PL,PT,RO,SK,ES,SE,DE,GR,HU,IS,IE,LU,SI(n=24)

Hibcoverageavailable AT,CZ,DK,EE,FR,DE,GR,HU,IS,IE,IT,LV,LT,MT,NL,NO,PL,PT,RO,SK,ES,SI,SE,BE,LU(n=25)

Firstdose EE,LV,LT,NO,BE(n=5)Everysingledose AT,DK,GR,IS,LV,LT,NO,BE,LU(n=9)Primaryimmunisationseries EE,FR,IE,LV,LT,NL,PL,PT,SK,SI,ES,BE,IS,NO(n=14)Fullimmunisationseries(includingbooster)by24months

AT,CZ,EE,DE,FR,HU,IE,IS,IT,LV,LT,MT,NL,NO,PT,RO,ES,SE,BE,LU(n=20)

Other,specify DE‐incompleteimmunisationseries;PT‐completevaccinationalsomeasuredat7yearsold;

Ifyes,couldyouprovidethesedataforECDC?

AT,CZ,DK,EE,FR,IT,LV,LT,MT,NL,NO,PL,PT,RO,SK,ES,SE,DE,GR,HU,IS,IE,LU,SI(n=24)

HepatitisBcoverageavailable AT,CZ,EE,FR,DE,GR,HU,IE,IT,LV,LT,MT,NL,PL,PT,RO,SK,SI,ES,SE,BE,LU(n=22)

Everysingledose AT,GR,LV,LT,MT,BE,LU(n=7)Primaryimmunisationseries CZ,EE,FR,DE,HU,IE,IT,LV,LT,PL,PT,RO,SK,SI,ES,BE(n=16)Other,specify DE‐incompleteimmunisationseries;

LV‐Fullimmunisationseries(includingbooster)by24months,fullimmunisationat14years;NL‐fullimmunisationat2years,hepB‐0at3days;PT‐fullimmunisationat2years,hepB‐0at3days;SE‐Fullseriesby24‐35months.HepatitisBvaccineisofferedforriskgroupchildrengenerally.Twocountiesofferthevaccinetoallchildren.

Ifyes,couldyouprovidethesedataforECDC?*

AT,CZ,EE,FR,DE,GR,HU,IE,IT,LV,LT,MT,NL,PL,PT,RO,SK,ES,SE,LU,SI(n=21)

Pneumococcalvaccine(forchildrenPCV7,PCV10,PCV13)

AT,CZ,DK,FR,DE,GR,HU,IS,IE,LV,NL,NO,PL,SK,SE,BE(n=16)

Firstdose LV,NO,BE (n=3)Everysingledose AT,DK,GR,IS,LV,NO,BE,LU(n=8)Primaryimmunisationseries FR,DE,HU,IE,IS,LV,NL,NO,SK,BE(n=10)Other,specify AT‐PCV10until2011onlyforchildrenatrisk;beginning

with2012forallchildren;CZ‐Untilnowonlyonenationalstudywasconducted.Uncertaintyaboutthefuturestudies.DE‐incompleteimmunisationseries;NL‐fullimmunisationseriesat2years;PL‐Onlynumberofdosesadministeredinagegroups.SE‐Fullseriesby24‐35months;

Ifyes,couldyouprovidethesedataforECDC?*

AT,CZ,DK,FR,DE,GR,HU,IS,IE,LV,NL,NO,PL,SK,SE,LU(n=16)

MenC AT,FR,DE,GR,IS,IE,NL,PL,PT,ES,BE,LU(n=12)Firstdose FR,DE,NL,BE(only1‐doseschedule)(n=4)Everysingledose AT,GR,IS,LU (n=4)Primaryimmunisationseries IE,PT,ES,IS(n=4)Other,specify AT‐MenC,A,W,Yvaccinationstarts2012;

DE‐vaccinationisrecommendedin2ndyearoflife,1doseissufficient;PL‐Onlynumberofdosesadministeredinagegroups;PT‐Fullimmunisationseriesis3doses,measuredat24months;completevaccinationalsomeasuredat7and14yearsold;ES‐fullimmunisationseries(includingbooster)by24months.

Ifyes,couldyouprovidethesedataforECDC?*

AT,FR,DE,GR,IS,IE,NL,PL,PT,ES,LU(n=11)

Rotavirus AT,PL,BE(n=3)Everysingledose AT,BE (n=2)Primaryimmunisationseries AT,BE(n=2)Other,specify PL‐Onlynumberofdosesadministeredinagegroups;Ifyes,couldyouprovidethesedataforECDC?*

AT,PL(n=2)

HPV DK,FR,DE,IS,IT,LV,NL,NO,PL,PT,SI,ES,SE,BE(n=14)Firstdose LV,NO,BE (n=3)Everysingledose DK,FR,IS,LV,NO,PT,SE,BE,LU(n=9)Primaryimmunisationseries DE,IT,LV,NO,SI,ES,BE,IS(n=8)Other,specify NL‐fullimmunisation series(3vaccinations)at14years;

PL‐Onlynumberofdosesadministeredinagegroups.Ifyes,couldyouprovidethesedataforECDC?*

Yes

DK,FR,IS,IT,LV,NL,NO,PL,PT,ES,SE,SI(n=12)

No DE,LU (n=2)*BEdidnotrespondtosomepartsofthesequestions.

Withregardtothenumberandtimingofdosesoftheconjugatevaccines(Hib,MenCorPCV)whichareconsiderednecessaryforcompletionoftheprimaryseriestherearedifferencesinthethenumberofdosesconsideredappropriateintheMScountries.Sixteencountriesconsiderachild,whoisnotvaccinatedwithHibvaccineduringthe1styearoflife(<12months)butwhogetsonedoseinthe2ndyearoflife(after12months)asacompeltedserie;11countriesconsideronedoseofMenCvaccineafter12monthsofa*geascocmpleted;andfivecountriesconsideronedoseofPCVvaccineafter12monthsascompleted.Five countries undertake vaccination coverage assessment for all these vaccines and eight countriesassessvaccinationcoverageforsomeofthesevaccines(table11and11a).Table11.Whetheronedoseofconjugatevaccines(Hib,MenCandPCV)isconsideredasappropriatevaccinationwhenvaccineisadministeredinthe2ndyearoflife(after12monthsofa*ge)inEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=26)Vaccine Consideredasappropriate

vaccinationNotconsideredas

appropriatevaccinationNotapplicable

Hib EE,ES,FR,GR,HU,IE,IS,IT,LT,MT,NL,NO,PL,SE,BE,SI(n=16)

AT,GY,DE,DK,LV,PT,LU(n=7)

CZ,RO,SK(n=3)

MenC CY,DE,ES,FR,GR,IE,IS,IT,NL,PT,BE(n=11)

AT(n=1)

CZ,DK,EE,HU,LT,LV,MT,NO,PL,RO,SE,SI,SK,LU(n=14)

PCV HU,IE,IT,NL,BE(n=5)

AT,CY,DE,DK,FR,GR,IS,LV,NO,SE,SK,LU(n=12)

CZ,EE,ES,LT,MT,PL,PT,RO,SI(n=9)

FI‐didnotrespond.Table11a.Vaccinationcoverageassessmentofonedoseofconjugatevaccines(Hib,MenCandPCV)inEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=26)

Onedoseincludedinassessment Countries TotalYes,forallthesevaccinations(Hib,MenC,PCV) DE,IS,NL,PT,BE 5Yes,forsomeofthesevaccinations,specify: EE,FR,IE,IT,LT,MT,NO,PL 8OnlyforHib EE,FR,IE,IT,LT,MT,NO,PL 8OnlyforMenC FR 1No,notincluded ES,SE,SI 3Idon’tknow GR,HU 2Seventeencountries(CZ,DE,DK,EE,FR,GR,IS,LT,LV,MT,NL,NO,PL,PT,SE,SK,BE)areabletolinkthe2nddoseofMMRtothefirstMMRdoseatthechildlevelsothatitisevidentthattheyhavereceivedtwodosesratherthanjustone.Fivecountries(AT,ES,HU,RO,SI)indicatedthattheyarenotabletodothis.

CommentsFR‐AllVCestimatesareproducedat24months(2years),i.e.notatoneyear.Hence,forexampleforDTP,weproduceVCbothfortheprimaryimmunisationseries(first3doses)andfortheprimary+firstbooster(4doses),butthesestwoestimatesareproducedattheageof24months(inFrancewedonotassessVCat12months).MenC:InFrancewerecommend1doseat12‐24monthswithacatch‐upbetween2and24months.Thevaccineisrecommendedandreimbursedsince2010.ForQ11itisnotclearifyouareaskingifthesevaccinesareincludedintheassessmentorifchildrenwhohavereceivedonlyonedoseafteroneyearareconsideredasappropriatelyvaccinatedintheassessment.Forex.inFrancechildrenofi.e.18monthsnotvaccinatedwithPCVbefore1yearwhor*ceiveonlyonedosearenotconsideredasappropriatelyvaccinatedbutareassessedforPCVVCat24months.DE‐Atschoolentrywemakeadistinctionbetweenfullundincompletevaccinationsaccordingtodefinedterms.

IE‐currentit*ystemsusedlocallyunabletoaccuratelyprovideinformationonchildrenwhomayhavegotjustonedoseafter12monthsofa*geforMenCandPCV.IT‐Ifocusontheavailabilityofdataatnationallevel.PL‐Theinformationonthe"complete"statusislinkedbythephysicianholdingthemedicaldocumentation.SK‐Q12.Wecanlinkthedataaccordingtobirthcohorts.ES‐Q12.SomeregionsthathaveanImmunisationRegistryareabletohavethatinformation

Vaccination coverage data for special risk groups Datarelatingtotheavailabilityofvaccinationcoveragedataforspecificriskgroupsatnationallevelarepresentedinaable12.Fourcountriescollectvaccinationcoveragedataforclinicalriskgroups,14countrieshavethesedataforelderlyandfivecountrieshaveinfluenzavaccinationdataforHCWs;inadditiontoinfluenzaFRhavevaccinationcoveragedataforhepatitisB,MMR,varicella,pertussis,diphtheria,tetanusandpoliovaccinesforHCWs;GRcollectvaccinationcoveragedataforhepatitisB,MMR,varicellaandpertussisamongmigrants.Nocountriesroutinelycollectdataonethnicminoritygroups,anthroporosphicgroups,homeless,orotherspecificgroupsatsocialoreconomicdisadvantage.Table12.VaccinationcoverageassessmentforspecificriskgroupsandavailabilityatnationallevelinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=26)

Specificgroups Notcollected HepatitisB

Influenza

MMR Varicella

Pertussis

Other,specify

Clinicalriskgroups AT,CY,CZ,DK,EE,DE,GR,IS,IE,LV,LT,MT,NO,PT,RO,SK,SI,ES,SE,BE,LU(n=21)

FR,HU,IT,NL(n=4)

Healthcareworkers

AT,CY,CZ,DK,EE,GR,IS,IE,LV,LT,MT,NL,NO,PT,RO,SK,SI,SE,BE,LU(n=20)

FR,PL(n=2)

FR,DE,HU,IT,ES(n=5)

FR(n=1)

FR‐DTandPolio(n=1)

Migrants AT,CY,CZ,DK,EE,FR,DE,HU,IS,IE,IT,LV,LT,MT,NL,NO,PL,PT,RO,SK,SI,ES,SE,BE,LU(n=25)

GR(n=1)

Refugees CY,CZ,DK,EE,FR,DE,GR,HU,IS,IE,IT,LV,LT,MT,NL,NO,PL,PT,RO,SK,SI,ES,SE,BE,LU(n=25)

AT(n=1)

AT‐polio(n=1)

Ethnicminorities(e.g.Roma,Travellers,other)

AT,CY,CZ,DK,EE,FR,DE,GR,HU,IS,IE,IT,LV,LT,MT,NL,NO,PL,PT,RO,SK,SI,ES,SE,BE,LU(n=26)

Populationsubgroups(e.g.Anthroposophic)

AT,CY,CZ,DK,EE,FR,DE,GR,HU,IS,IE,IT,LV,LT,MT,NL,NO,PL,PT,RO,SK,SI,ES,SE,BE,LU(n=26)

Homeless AT,CY,CZ,DK,EE,FR,DE,GR,HU,IS,IE,IT,LV,LT,MT,NL,NO,PL,PT,RO,SK,SI,ES,SE,BE,LU(n=26)

Sociallyandeconomicallydisadvantaged

AT,CY,CZ,DK,EE,FR,DE,GR,HU,IS,IE,IT,LV,LT,MT,NL,NO,PL,PT,RO,SK,SI,ES,SE,BE,LU(n=26)

Elderly AT,CY,CZ,DK,EE,GR,IS,MT,NO,RO,SE,BE(n=12)

FR,DE,HU,IE,IT,LT,

LV‐Tdcoverage60+;

NL,PL,SK,SI,ES,DK,IS,LU(n=14)

PT‐Td;SK‐Pneumococcalinfection.(n=3)

FI‐didnotrespond.Other,specify:FR‐ChildrenathighriskoftuberculosisvaccinatedbyBCG;IT‐Pregnantwoman;NL‐hepatitisBonlyforchildrenofwhomatleastoneparentwasborninahepatitisBendemiccountryandforchildrenofmotherswithhepatitisB;NO‐Riskgroupsincludedthose65+;PL‐studentsofmedicalschools,peoplefromthevicinityofHBVcarriersandofpatientswithhepatitisbandpeoplepreparedforproceduresperformedinextracorporealcirculation;SE‐ChildreninriskgroupfortuberculosisandhepatitisB.CommentsFR‐1.Underlyingclinicalconditions:influenzacoverageisrecordedeachyear.2.HCW:noroutinedatabutdataprovidedbyoccasionalsurveys,lastonein2009;IT‐Thecollectionofdataforsomeriskgroups(thosem*ntionedabovepluspersonnelofessentialservicesandchildrenlivingincommunity)forInfluenzaisexperimental.Influenzacoveragedataforspecialgroupsisrequestedandcollectedatnationallevel,butlessthanhalfregionsregularlyprovidethisdata;LT‐Vaccinationcoverageforinfluenzacanbecalculatedonlyforagegroup65andolderNL‐HPVonlyforgirls’hepatitisBonlyforriskgroups;PL‐VaccinecoverageatnationalleveliscollectedbyselectedhighriskgroupforhepatitisBvaccine.It'scontains:vaccinationofmedicalsecondaryschoolstudents,universitystudentsofmedicineandrelatedfields,healthcareworkers,contactswithHBVcarriers,hepatitisBcases,personswithchronicrenalfailure(withdialysespatients),chronicliverfailurecausedbyautoimmuneprocesses,metabolicfactors,alcoholabuse,HCVinfection,HIVinfectedpersons,childrenwithprimaryorsecondaryimmunedeficiency,personspreparedforinterventionsinvolvingextracorporealcirculation;SK‐Vaccinationagainstinfluenzaandpneumococcalinfectionsismonitoredinelderlyresidentsoflong‐termfacilities;SE‐Subnationaldataiscollectedforelderlyforinfluenzavaccineinsomecounties.HU‐vaccinationcoverageforinfluenzacanbecalculatedforagegroup60+and65+.

Delivery methods for vaccines Themainmethodsofvaccinationdelivery(e.g.byprimarycarephysicians,publichealthnursesetc.)forvaccinesprovided(suppliedby/paidfor/reimbursed)bytheNationalImmunisationProgrammeforeachspecifiedpopulation(children<3yearsofa*ge;pre‐schoolandschoolchildren;>65yearsofa*ge,clinicalriskgroups;HCWs,migrants,refugees)aredescribedinatable/s13and13a.

Table13.Mainmethodsofvaccinationdeliveryprovidedbyestimatesofproportions(%)ofeachgroupinvolvedforvaccinesincludedtotheNationalImmunisationProgrammeinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=26)

Children<3yearsofa*ge(%)

Country

PrimarycarephysicianPublichealth

vaccinationservices

HospitalsSchoolhealthservices

Public PrivatePublic Private

AT 0 90 10 0 0 0CY NA 57 43 NA NA NACZ 5 95 0 0 0 0DK 99 0 0 1 0 0FR 10 90 0 0 0 0DE NA 98 1 1 NA NAGR 30 70 NA NA NA NAHU 99 0.5 0 0.5 0 0IS 0 0 100 0 0 0IE 0 100 1 0 0 0IT NA NA 100 NA NA NALV 99 1 NA 99 1 NALU 0 100 NA 0 0 NAMT 0 10 90 0 0 0NL 0 0 100 0 0 0NO NK NK 100 NK NK NKPL 65 5 10 15 5 0PT NA NA 0.95 NK NK NARO 90 10 NA NA NA NASK 99 NA NA 1 NA NASI 100 NA NA NA NA NASE NA NA 100 NA NA NABE NA 20 80 ‐ ‐ NA

EE,ES,LT‐Notavailable(NA)ornotknown(NK).IE‐BCGisonlyvaccinegivenbypublichealthvaccinationserviceroutinely.InoutbreakspublichealthservicesmayvaccinatechildrenwhowerenotvaccinatedbyGPsBEapproximationbasedonregionalpercentages/primarycarephysicianincludespediatrician

Pre‐schoolchildren(%)

Country

Primarycarephysician Publichealthvaccinationservices

Hospitals Schoolhealthservices

Public PrivatePublic Private

AT 0 90 10 0 0 0CZ 5 95 0 0 0 0DK 99 0 0 1 0 0FR 5 95 0 0 0 0DE NA 95 3 1 1 NAGR 30 70 NA NA NA NAHU 99 0.5 0 0.5 0 0

IS 0 0 100 0 0 0IE 0 20 80 0 0 0IT NA NA 100 NA NA NALV 99 1 NA NA NA NALU 0 100 NA 0 0 0MT 0 10 90 0 0 0NL 0 0 100 0 0 0NO NK NK 100 NK NK NKPL 75 5 10 5 5 0PT NA NA 0.95 NA NA NARO 90 10 NA NA NA NASK 100 NA NA NA NA NASI 100 NA NA NA NA NASE NA NA 100 NA NA NA

EE,LT,CY,BE,ES‐Notavailable(NA)ornotknown(NK).IE‐schoolhealthservicesarethesameasthepublichealthvaccinationservices.BEapproximationbasedonregionalpercentages/primarycarephysicianincludespediatrician

Schoolagechildren(%)

Country

PrimarycarephysicianPublichealth

vaccinationservices

HospitalsSchoolhealthservices

Public PrivatePublic Private

AT 0 0 10 0 0 90CZ 5 95 NA NA NA NADK 99 0 0 1 0 0FR 0 95 0 0 0 5DE NA 95 3 1 1 NAGR 30 70 NA NA NA NAHU 0 0 0 0 0 100IS 0 0 10 0 0 90IE 0 20 80 0 0 0IT NA NA 100 NA NA NALV 86 1 NA NA NA 13LU 0 100 NA 0 0 0MT 0 15 0 0 0 85NL 0 0 100 0 0 0NO NK NK NK NK NK 100PL 75 5 10 3 2 0PT NA NA 0.99 NA NA NARO NA NA NA NA NA 100SK 100 NA NA NA NA NASI NA NA NA NA NA 100SE NA NA NA NA NA 100BE 30 NA 70

CY,EE,LT,ES‐Notavailable(NA)ornotknown(NK).IE‐estimatesofHPVuptakefor12yearsoldsatendofschoolyear.Tobeavailable2012.PT‐privateprimarycareclinics.

RO‐incaseoflowvaccinationcoverageoroutbreaksvaccinationcampaignsismadebyGP'sorpublichealthservices.BEapproximationbasedonregionalpercentages/primarycarephysicianincludespediatrician

≥65yearsofa*ge(%)

Country

Primarycarephysician Publichealthvaccinationservices

HospitalsOther

Public PrivatePublic Private

DK 50 50 0 0 0 NAFR 0 100 0 0 0 NADE NA 100 NA NA NA NAHU 98 0 0 2 0 NAIS 50 50 0 0 0 NAIE 0 96 0 1 0 3IT 60 NA 40 NA NA NALV 99 1 NA NA NA NALU 0 100 NA 0 0 NAMT 0 40 60 0 0 NANL 0 100 0 0 0 NAPL 85 5 5 5 0 NAPT NA NA 1 NA NA NASK 70 NA NA NA NA 30SI 70 NA 30 NA NA NA

AT,BE,CY,CZ,GR,EE,LT,ES,SE,NO,RO‐Notavailable(NA)ornotknown(NK).IE‐longtermresidentsofnursinghomesorinstitutionsarevaccinatedinthesefacilitiesusually,exactnumberunknown.SK‐Socialcarefacilities.

Clinicalriskgroup(%)

Country

PrimarycarephysicianPublichealth

vaccinationservices

HospitalsSchoolhealthservices

Other

Public PrivatePublic Private

DK 50 50 0 0 0 0 NAFR 0 100 0 0 0 0 NADE NA 98 NA 1 1 NA NAIE 0 98 0 2 0 0 NALV 0 0 NA 100 NA NA NALU 0 100 NA 0 0 0 NAMT 0 5 95 0 0 0 NANL 0 0 0 0 0 0 100PL 50 5 30 10 5 0 NAPT NA NA 0.7 0.3 NA NA NASK 90 NA NA 10 NA NA NA

LT,IT,GR,HU,IS,NO,RO,SI,ES,SE,BE,EE,AT,CY‐Notavailable(NA)ornotknown(NK).IE‐nodataonhighrisk,sometimesalsovaccinatedbyhospitalteam(e.g.indialysisunits)NL‐Influenzabyprivateprimarycarephysician,hepatitisBbypublichealthvaccinationservices.

Healthcareworkers(%)

Country

Primarycarephysician

Publichealth

vaccinationservices

Hospitals Medic/Paramedicschoolhealthservices

Occupationalhealthservices

Other

Public PrivatePublic Private

FR 0 30 10 0 0 0 60 NADE NA 30 NA NA NA NA 70 NAHU 5 0 0 0 0 0 95 NAIS 0 0 50 50 0 0 0 NAIE 0 1 0 0 0 1 98 NAMT 0 0 0 99 1 0 0 NANL 0 0 0 0 0 0 0 100PL 30 3 0 50 15 0 2 NAPT NA NA 0.5 NA NA NA 0.5 NASK 50 NA NA NA NA NA 50 NABE 100

LV,LT,LU,GR,IT,NO,RO,SI,ES,SE,AT,CY,CZ,DK,EE‐Notavailable(NA)ornotknown(NK).IE‐nodata‐thisisanestimate.LU‐SeasonalvaccinationNL‐vaccinationisarrangedbycompany/institutesnotthroughNIPsowedonotknowifitisdonebyGPorinstitutethem.BEexceptphysicians

Migrants(%)

Country

PrimarycarephysicianPublichealth

vaccinationservices

HospitalsSchoolhealthservices

Other

Public PrivatePublic Private

DE 30 70 NA NA NA NA NAIS 20 0 80 0 0 0 NAIE 2 97 0 0 0 1 NALU 0 100 NA 0 0 0 NAMT 0 0 100 0 0 0 NANL 0 0 0 0 0 0 NAPL 70 0 20 10 0 0 NAPT NA NA 1 NA NA NA NASK 100 NA NA NA NA NA NA

AT,CY,CZ,DK,EE,FR,GR,HU,IT,LV,LT,NO,RO,SI,ES,SE,BE‐Notavailable(NA)ornotknown(NK).IE‐estimate—publichealthservicesonlyforschoolagedchildren(schoolvaccinationteamsmainly.

Refugees(%)

Country

PrimarycarephysicianPublichealth

vaccinationservices

HospitalsSchoolhealthservices

Other

Public PrivatePublic Private

DE 50 50 NA NA NA NA NAIS 20 0 80 0 0 0 NAIE 1 98 1 0 0 0 NA

LU 0 100 NA 0 0 0 NAMT 0 0 100 0 0 0 NANL 0 0 100 0 0 0 NAPL 70 0 20 10 0 0 NAPT NA NA 1 NA NA NA NASK NA NA NA NA NA NA 100

HU,IT,LV,LT,GR,NO,RO,SI,ES,SE,BE,AT,CY,CZ,DK,EE,FR‐Notavailable(NA)ornotknown(NK).FI‐noresponseinalltablesabove.IE‐refugeeswouldhaveaccesstofreehealthcarefromprivateGPscontractedtoprovideservice,somemighthaveGPserviceprovidedbypublichealthserviceatasylumresidenceSK‐asylumfacilities.Table13a.Vaccinationcoverageassem*ntbypopulationgroups(e.g.children<3yearsold,scoolchildren,HCWs,clinicalriskgroups,migrantsandetc.)indicatedintable/s13anddeliverymethod(e.g.privatevspublic;primarycare,hospitals,shoolhealthserviceandetc.)usedtoadministervaccines.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=26)

CountriesYes,forallindicatedabove AT,CY,DK,EE,ES,GR,HU,IS,IT,LT,LV,PT,SI(n=13)Yes,onlyforpublic(notprivate)healthsector(primarycare,hospitals)

FR,MT,PL,RO (n=4)

Yes,onlyforprivatesector(primarycare,hospitals)

‐

Yes,forschools ‐No CZ,DE,IE,NL,NO,SE,SK,BE,LU(n=9)Ifno,pleasedescribe CZ‐Dataareobtainedfromprimarycarephysicians;

DE‐Germanydoesnotroutinelyassesscoverageofspecifictargetgroups;IE‐datanotsystematicallycollectedformostgroups,unlessreimbursem*ntsoughtfromgovernmentfunding;NL‐notincluded:migrants(exceptriskgroupshepatitisB),refugees,healthcareworkers;NO‐Allvaccinesincludedinthechildhoodimmunisationprogrammeisincludedintheroutineassessmentofvaccinationcoverage;SK‐Vaccinationcoverageisroutinelymonitoredonlyforchildrenandadolescentsandforelderlyinlong‐termfacilities;SE‐dataisnotcollectedforeachpopulationlistedabove.BE:vaccinationcoverageisroutinelyassessedonlyforinfantsandadolescents;forthoseallvaccinatorsareincludedLU‐onlyvaccinesincludedinthechildhoodimmunisationprogrammeandintheelderly;

Amongtheparticipatingcountries19statedthattheyhadawebsitethatprovidesinformationonvaccinecoveragefortheircountry(linkstopublishedreportsprovidedintable14).Inninecountriesthesereportsarealsopublishedinprinted/hardcopyversion.

Table14.WebsiteaddressprovidinginformationonvaccinecoverageinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=27)

CountriesNo AT,CY,CZ,FI,GR,MT,PT,RO(n=8)

Yes DE,DK,EE,ES,FR,HU,IE,IS,IT,LT,

LU,LV,NL,NO,PL,SE,SI,SK,BE(n=19)Publishedreportsonvaccinationcoverage(hardcopies;printedreports)

DE,DK,FR,HU,IS,LV,NL,PL,BE(n=9)

Vaccinationcoveragedatapublishedonwebsite

DE,EE,ES,FR,HU,IE,IT,LT,LU,LV,NL,NO,PL,SE,SI,SK,BE,IS,DK(n=19)

Countries LinktopublishedreportsEE http://www.terviseamet.ee/fileadmin/dok/Nakkushaigused/immuno

prof/2010/holmatus_2010.xlsFR www.invs.sante.frDE http://www.rki.de/cln_110/nn_199624/DE/Content/Infekt/EpidBull/A

rchiv/2011/16__11,templateId=raw,property=publicationFile.pdf/16_11.pdf

HU http://www.oek.hu/oek.webIE http://www.hpsc.ie/hpsc/A‐

Z/VaccinePreventable/Vaccination/ImmunisationUptakeStatistics/IS http://landlaeknir.is/IT http://www.salute.gov.it/malattieInfettive/paginaInternaMenuMalatt

ieInfettive.jsp?id=811&menu=strumentieserviziLV http://www.lic.gov.lv/statistikas‐dati?p=8987LT http://www.ulac.lt/downloads/2010m_apzvalga.pdfLU http://www.sante.public.lu/fr/catalogue‐publications/rester‐bonne‐

sante/vaccinations/index.htmlNL http://www.rivm.nl/bibliotheek/rapporten/210021014.pdf

Geographicalpresentationofsub‐nationalvaccinationcoverage:http://zorgatlas.nl/preventie/vaccinaties‐en‐screening/

NO http://www.norgeshelsa.no/norgeshelsa/http://www.fhi.no/eway/default.aspx?pid=233&trg=MainArea_5661&MainArea_5661=5631:0:15,5119:1:0:0:::0:0http://nesstar.shdir.no/khp/index.jsp

PL http://www.pzh.gov.pl/oldpage/epimeld/index_p.htmlSK www.uvzsr.skSI http://www.ivz.si/Mp.aspx?ni=96&pi=5&_5_id=357&_5_PageIndex=0

&_5_groupId=210&_5_newsCategory=&_5_action=ShowNewsFull&pl=96‐5.0.

ES http://www.mspsi.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/coberturas.htm

SE http://www.smittskyddsinstitutet.se/amnesomraden/vaccinationer/statistik‐for‐det‐allmanna‐vaccinationsprogrammet/vaccinationsstatistik‐fran‐barnavardcentraler/http://www.smittskyddsinstitutet.se/amnesomraden/vaccinationer/statistik‐for‐det‐allmanna‐vaccinationsprogrammet/vaccinationsstatistik‐fran‐skolorna/

DK http://www.ssi.dk/English/News/EPI‐NEWS/2011/No%2018%20‐%202011.aspx(HPV)http://www.ssi.dk/English/News/EPI‐NEWS/2011/No%2019%20‐%202011.aspx(PCV)http://www.ssi.dk/English/News/EPI‐NEWS/2011/No%2020%20‐%202011.aspx(DTaP‐IPV/Hib)http://www.ssi.dk/English/News/EPI‐NEWS/2011/No%2021%20‐%202011.aspx(MMR)

BE Flanders:http://www.zorg‐en‐gezondheid.be/Wallonia:http://www.sante.cfwb.be/fileadmin/sites/dgs/upload/dgs_super_editor/dgs_editor/documents/Publications/vacc/2009_CVac_nourrissons.pdfBrussels:http://www.observatbru.be/documents/graphics/rapports‐externes/enquete‐de‐couverture‐vaccinale‐des‐enfants‐de‐18‐a‐24‐mois‐en‐region‐de‐bruxelles‐capitale.pdf

CY‐informationonvaccinecoverageisprovidedintheannualreportoftheministryofhealth;GR‐report;PT‐Internalreportsandpublicpresentationsinscientificmeetings;RO‐feedbackprovidedusingdifferentchannelsofdissemination:publications,oralpresentations,meetings.CommentsCY‐WewouldliketomentionthateveryyearacoveragesurveyiscarriedoutbytheSchoolHealthServices,amongthechildrenofspecificagegroup.Thisisdoneforsupplementaryvaccination,exceptforthe14yearsoldstudentsthatcanbevaccinatedintheschoolforDTadults’vaccine.Unfortunatelywearenotabletoestimateanypercentageaswecannotmeasurethepercentagefromtheprivatesector.EE‐HealthcaresysteminEstoniaisprivate.FR‐1.<3years:about90%aredonebyprivatedoctorsandabout10%inMCHclinics(basedonlocalunpublishedestimations).Thereisaverysmallproportionperformedinvaccinationclinics,traveler’sclinics,etc.butthisrepresentsanextremelylowpercentageandexactfiguresarenotknown.ThepercentageofchildrenwhoarevaccinatedinMCHatthepreschoolleveldecreasesandaroughlyguessis5%.2.Atschool,schoolservicesdovaccinatebutthisdoesnotrepresentalargepercentage(schoolsperformcatchupinchildrennotvaccinatedbytheirfamily(usuallyprivate)doctor.3.HCW:Inpublic(majority)hospitalsandclinics,theoccupationaldoctorsvaccinate90%ofHCW.Oppositetothat,inprivate(minority)hospitalsandclinics90%ofHCWarevaccinatedbytheirprivate(familydoctor).Finally,asmallpercentage(personnelofkindergarden,MCHclinics,etc.)isvaccinatedbypublichealthservicesfromthetown/city.Therearenovalidatedfiguresondistributionofvaccinationsamongsectorsbutareasonableguessisthat60%arevaccinatedbytheoccupationaldoctor,30%bytheprivatedoctorsand10%bythepublichealthservices.4.VaccinationCoveragedataofInVSWebsite:aspecificspacehasbeendedicatedtoVCin2011,althoughthisiscurrentlybeingtestedandisnotyetpublic,willbeaccessiblebeforetheendof2011.

IE‐generally,privateGPsadministermostvaccines.Theywillbereimbursedforvaccinesthatarepartofroutineprogramme.Forschoolagedvaccinespublichealthteamswillgointoschoolsinmostareastoprovidevaccine,butsomeareasmayrequestGPstodothisontheirbehalf(andthentheyarereimbursed).InthoseareasthatdonothaveschoolprogrammetheGPsarepaidtogivethesevaccines.MT‐thereissomeinformationontheWHOwebsite.NL‐Forchildrenthatareborntooearlyvaccinationsaresometimesgiveninthehospital.Vaccinationofhealthcareworkersisarrangedbycompany/institute(sometimesthroughinstitutethemselves,sometimesbyreimbursingvaccinationbyGPorhospital).Wedonothavenationalinformationonthecoverage.Forinfluenza,theNIPiscoordinatedbypublichealthvaccinationservicebutvaccinationitselfisconductedbytheGP's.PL‐Theofficialestimateisnotavailableincountry.Thepresentedestimationwasbasedonourteamconsultations.ES‐ThereissomevariabilitydependingontheRegionandwedonotaskforthisinformationatnationallevel.Itisdifficulttoputsomefigureforthewholecountry.

National or sub national level coverage data Twenty‐sixcountriesrespondedtothisquestion,ofwhich24collectnationalvaccinationcoveragedataforDTP,Polio,HiBandMMRvaccines.Inaddition,BEassessestetanusvaccinationcoveragedataamongadultsthroughhealthinterviewsurveys.Nineteencountriescollectdataforthesamevaccinesatregionallevel;14countriescollectdatafordiphtheria,pertussis,polioand13countriesreportedthattheyhaveadatafortetanusandHibvaccinesatlocallevel.Eighteenand14countriesassessvaccinationMMRcoveragedataatregionalandlocallevelrespectively.WithregardtoPCVvaccination17,14,andeightcountriesassessvaccinationcoverageatnational,regional,andlocallevelrespectively.Table15.Vaccinecoverageassessmentbydifferentvaccinesonnationalandsub‐nationallevelinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=26)

Level Diphtheria Tetanus Pertussis Polio Hib HepB BCG MenC MMR Var HPV

Rota

PCV7,10,13

Pneumo23

Influenza

National

National AT,CY,CZ,DK,EE,FR,DE,GR,HU,IS,IE,IT,LV,LT,LU,MT,NL,NO,PL,PT,RO,SK,SI,SE(n=24)

AT,CY,CZ,DK,EE,FR,DE,GR,HU,IS,IE,IT,LV,LT,LU,MT,NL,NO,PL,PT,RO,SK,SI,SE,BE*(n=25)

AT,CY,CZ,DE,EE,FR,GR,HU,IE,IS,IT,LT,LU,LV,MT,NL,NO,PL,RO,SE,SI,SK,DK,PT(n=24)

AT,CY,CZ,DE,DK,EE,FR,GR,HU,IE,IS,IT,LT,LU,LV,MT,NL,NO,PL,PT,RO,SE,SI,SK(n=24)

CY,CZ,DE,EE,FR,GR,HU,IE,IT,LT,LU,LV,MT,NL,PL,PT,RO,SE,SI,SK(n=20)

EE,FR,GR,HU,IE,LT,LV,MT,PL,PT,RO,SE,SK(n=13)

AT,CY,DE,FR,GR,IE,IS,IT,LU,NL,PL,PT(n=12)

AT,CY,CZ,DE,DK,EE,FR,GR,HU,IE,IS,IT,LT,LU,LV,MT,NL,NO,PL,PT,RO,SE,SI,SK(n=24)

CY,DE,GR,IT,LU,LV,PL(n=7)

DE,DK,FR,IS,IT,LV,NL,NO,PL,PT,SE,SI,LU(n=13)

AT,PL,LU(n=3)

AT,CY,DE,DK,FR,GR,HU,IE,IS,LU,LV,NL,NO,PL,SE,SK,IT(n=17)

DE,LU,BE(n=3)

CZ,DE,DK,FR,HU,IT,LT,LU,MT,NL,NO,PL,SI,SK,BE(n=15)

Subnational:

Regional

AT,CZ,DK,FR,DE,HU,IE,IT,LV,NL,NO,PL,PT,SK,SI,ES,SE,BE,LT(n=19)

BE,AT,CZ,DK,FR,DE,HU,IE,IT,LV,NL,NO,PL,PT,SK,SI,ES,SE,LT(n=19)

AT,CZ,DE,DK,ES,FR,HU,IE,IT,LV,NL,NO,PL,PT,SE,SI,SK,BE,LT(n=19)

BE,AT,CZ,DE,DK,ES,FR,HU,IE,IT,LV,NL,NO,PL,PT,SE,SI,SK,LT(n=19)

AT,CZ,DE,DK,ES,FR,HU,IE,IT,LV,NL,NO,PL,PT,SE,SI,SK,BE,LT(n=19)

BE,AT,CZ,DE,ES,FR,HU,IE,IT,LV,NL,PL,PT,SE,SI,SK,LT(n=17)

FR,HU,IE,LV,PL,PT,SE,SK,LT(n=9)

AT,DE,ES,FR,IE,IT,NL,PL,PT,BE(n=10)

AT,CZ,DE,DK,ES,FR,HU,IE,IT,LV,NL,NO,PT,SE,SI,SK,BE,LT(n=18)

DE,IT,LV,PL(n=4)

DK,ES,IT,LV,NL,NO,PL,PT,SE,SI,BE(n=11)

BE,AT,PL(n=3)

BE,AT,DE,DK,FR,HU,IE,IT,LV,NL,NO,PL,SE,SK(n=14)

SE(n=1)

DK,HU,IT,PL,SI,ES,SE(n=7)

Local EE,FR,DE,HU,IE,IT,NL,NO,PT,RO,SK,SE,DK,LT(n=14)

EE,FR,DE,HU,IE,IT,NL,NO,PT,RO,SK,SE,DK,LT(n=13)

DE,EE,FR,HU,IE,IT,NL,NO,PT,RO,SE,SK,DK,LT(n=14)

DE,EE,FR,HU,IE,IT,NL,NO,PT,RO,SK,DK,LT(n=13)

DE,EE,FR,HU,IE,IT,PT,RO,SE,SK,LT(n=11)

EE,FR,HU,IE,PT,RO,SE,SK,LT(n=9)

DE,FR,IE,IT,NL,PT(n=6)

DE,EE,FR,HU,IE,IT,NL,NO,PT,RO,SE,SK,DK,LT(n=14)

DE,IT(n=2)

IT,NL,NO,PT,SE,DK(n=6)

IT(n=1)

DE,FR,HU,IT,NL,NO,SE,SK(n=8)

IT(n=1)

HU,IT(n=2)

FI‐Noresponse*BE:onlyadultdataonnationallevelbyhealthinterviewsurveyIT:annuallyassessmentofvaccinationcoveragebyadministrativemethodisperformedforDTP,polio,Hib,HepB,MMR,Influenzaatnationalandregional/locallevel,butonlyatregional/locallevelforMenC,VarandPCVvaccinations.Forallthesevaccines,asurveyisperformedatnationalandregionallevelevery5years.HPVvaccinationcoverageisassessedatnationalandregional/locallevelevery6monthsbyadministrativemethod.

CompatibilityandavailabilityofvaccinationcoveragedataamongcountriesaccordingtoEUROSTATNUTS*classificationispresentedinatable16.VaccinationcoveragedatathatiscompatiblewithEUROSTATNUTSclassificationavailablein19countries.ThemostappropriateleveltoreportdatatoECDCspecifiedbymostcountries(n=17)wouldbelevelNUTS2orNUTS3.Table16.VaccinecoveragedatacompatibilitywithEUROSTATNUTS*classificationinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=25)

VaccinationcoveragedatacompatibilitywithEUROSTATNUTS*classification Countries

Datacompatible

AT,CY,CZ,EE,ES,FR,GR,IE,IT,LT,LV,PL,PT,RO,SE,SK,DK,LU,HU(n=19)

Datanotcompatible DE,IS,MT,NL,NO,SI(n=6)Ifno,defineyoursubnationalclassification:DK‐subnationalunitsaregeographicregionsDE‐federalstatesreachingfrom600.000to17millioninhabitantsIS‐NospecificclassificationusedMT‐nosubnationaldatathecountryistwosmallNL‐province(NUTS2)andmunicipality(LAU2)NO‐County(NUTS3)andmunicipality(LAU2)SI‐9healthregions

PossibleNUTSlevelreporttoECDC CountriesLAULevel1 EE,SKLAULevel2 NL,NONUTS1 GR,BENUTS2 IT,PL,PT,BENUTS3 CZ,FR,HU,IE,IS,LT,LV,RO,SE,DKOther(nonNUTS): CY,DE,ES,MT,SICY‐nationalcoverageonly DK‐geographicregions DE‐federalstates MT‐Notavailable SI‐9healthregions ES‐byRegion Mostappropriateleveltobeused LAULevel1 EE,SKLAULevel2 NUTS1 NUTS2 ES,FR,GR,IT,NL,PL,PTNUTS3 CZ,HU,IE,IS,LT,LV,NO,RO,SE,DKOther(nonNUTS): CY,DE,MT,SICY‐nationalcoverageonly DK‐probablygeographicregions DE‐federalstates MT‐Notavailable SI‐9healthregions FInotresponded.*AccordingEUROSTATNUTSlevelsmeans:NUTS1:3‐7millions/NUTS2:800.000–3millions/NUTS3:150.000–800.000.Thereisalso,twootherlevelsofLocalAdministrativeUnits(LAU)havebeendefined(LAUlevel1

(formerlyNUTSlevel4)/LAUlevel2(formerlyNUTSlevel5)).Thelowestlevel(LAU2)consistsofmunicipalitiesorequivalentunitsinthe27EUMemberStates.IfyouneedmoreinformationpleaseusethelinktotheEUROSTATNUTSlevels:http://epp.eurostat.ec.europa.eu/portal/page/portal/nuts_nomenclature/correspondence_tables/national_structures_euCommentsCZ‐CzechRepublic:NUTS1=1(CzechRepublic)NUTS2=8(notrepresentativeforadministrativeunits)NUTS3=14(14administrativeRegions)LAUlevel1=86(86administrativeDistricts);DK‐wearenotsuretowhatextendthegeographicregionscanbeconvertedtoNUTSlevels;FR‐1.Wemeanbylocalforthedepartment,whichisthelevelbelowtheregion.2.InFrancewehave22regions(NUTS2)and100departments(NUTS3);IT‐Dataarecurrentlycollectedonapaperformatnationallevel;MT‐OurdatahasneverbeenclassifiedusingtheNUTSclassificationasournumbersaresmall;NL‐Itdependsonwhatyouwanttodowiththesedata.IfyouwanttomakemapstoseeriskatboundariesofcountriesLAUlevel2mightbebestbutNUTS2mightalsobesufficient?Anyway,thesystemtouploaddatamustbeuser‐friendly(notlikethisquestionnaire....).ForinfluenzaandhepatitisBwemightnotbeabletoprovidethisdetailedinformation;PT‐HealthministryusesNUTS2differentfromtheones;ES‐notexactlyNUTsbutRegions,eachregionhavedifferentfigureofinhabitants.Q18:someregionsareinsidethecategorizationofNUTs1andsomeareNUTs2...(NUTs1=4;NUTS2=10;NUTs3=3.BE:regions:FlandersandWalloniaNUTS1;BrusselsNUTS2LU‐notabletoprovideinformationonLAUlevel1or2;countrypopulationiscomparabletoaNUTS3level.

Numerator assessment Themethods(administrative,surveyorcomputerizeimmunisationregistries(CIR))anddetailedinformationusedtoassessthenumeratorforDTPvaccinesarepresentedinTable17.

Table17.Method(s)usedanddetailstoassesstheDTPnumeratorinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=26)

Vaccines

Methodused

Methoddidnotused

Notapplicable

Diphtheria,Tetanus,Pertussis(DTP)numeratorassessment

Administrativemethod*

AT,CZ,DE,EE,ES,FR,HU,IT,LT,LV,PL,PT,RO,SE,SI,SK,IS(n=17)

CY,FI,GR,IE,LU,MT,NL,NO,DK(n=9)

BE(n=1)

Aggregatecollectionofno.ofvaccinesadministered

AT,EE,FR,HU,IT,LT,LV,PL,PT,RO,SI,SK,ES(n=13)

SE ,DE,CZ,DK(n=4)

Aggregatecollectionofno.ofvaccinesdistributed

AT,FR,LT,RO (n=4)

DE,DK,EE,ES,HU,IT,LV,PL,PT,SE,SI,SK,CZ(n=13)

Thenumberofsubjectsvaccinatedfromvaccinationservicesorprimarycarephysicians

AT,CZ,DE,EE,FR,HU,IT,LT,LV,PL,PT,RO,SI,SK,IE,IS(n=16)

ES,SE,DK(n=3)

Thenumberofsubjectsvaccinatedfromschoolordaycarerecords

DE,EE,PT,RO,SE,IS(n=6)

AT,DK,ES,FR,HU,IT,LT,LV,PL,SI,SK(n=11)

CZ(n=1)

Other:DK‐Casebaseddataoneachchildvaccinated;

EE‐Thenumberofsubjectsvaccinatedfromhospitals;FR‐Vaccinereimbursem*ntdata.

SamemethodsusedinallsubnationalunitsYes,inallsubnationalunits AT,CZ,DE,EE,FR,HU,IT,LT,LV,PL,PT,RO,SE,SI,SK,IE,IS(n=17)Yes,insomesubnationalunits ES(n=1)

Surveymethod

CY,FI,FR,DE,GR,IT,LU,RO,BE(n=9)

MT,NL,NO,PL,PT,SK,SI,ES,SE,AT,CZ,DK,EE,HU,IS,IE,LV,LT(n=18)

Ifyes,specify: Household CY,FR(n=2) Telephone FR,DE(n=2) Mail FI,LU(n=2) Face‐to‐face CY,FR,DE,GR,IT,BE(n=6) Focusgroups DE(n=1) Schoolsurvey FR,DE,BE,GR(n=4) Other RO(n=1) Ifsurveyconductedatregular

intervalsYes

CY,FI,FR,DE,IT,LU,RO(n=7) GR(2006),IS(n=2)Detailsoffrequency:Annually FI,DE(n=2) Each5years IT,LU(n=2) Other:CY‐Every3years.Schoolsurveysarecarriedouteveryyearbutrelatedtospecificvaccines.FR‐every6yearsforschoolsurveysinchildren6,11‐13and15yearsold,every10yearsforpopulationsurveysinadults.RO‐biannuallyBE- In the French community we have an annual school survey according a 3 year cycle for 7-8 year old,11-12 y and 15-16 year In Flanders there are only face to face interviews, frequency as mentioned earlier.

Computerisedrecordsystems**

Computerisedimmunisationregistries

DK,IS,IE,IT,MT,NL,NO,PT,ES,BE(n=10)

AT,CY,CZ,EE,FI,FR,DE,GR,HU,LV,LT,LU,PL,RO,SK,SI,SE(n=17)

Bothnationaland

subnational National Subnational None

Childhood IS,NL,NO,DK(n=4) MT(n=1)ES,IE,IT,PT,BE(n=5)

Adolescents IS,NL,NO,DK(n=4) MT(n=1)ES,IT,PT,BE(n=4) IE(n=1)

Adults IS(n=1) ES,IT,NL,PT,BE(n=5) DK,MT,NO,IE(n=4)

Elderly IS(n=1) DK(n=1)ES,IT,NL,PT,BE(n=5) MT,NO,IE(n=3)

IfthesamemethodsbeingusedinallsubregionsYes,insomesubnationalunits

IT(n=1)

Yes,inallsubnationalunits DK,NO,PT,IS(n=4)

Other: ES,IE,MT,NL(n=4)IE‐differentregionsusedifferentCIRsystemsMT‐NotapplicableNL‐subnationalsystemscanbedifferentES‐eachRegionhaveadifferentsystemBE:CIRinFlandersonly*Administrativemethodsemployaggregatedata.Informationisnotretrievableonspecificindividual.**Computerisedimmunisationregistriesholdinformationoneachindividual.Themethods(administrative,surveyorcomputerizedimmunisationregistries(CIR))anddetailedinformationusedtoassessthenumeratorforothervaccinesarepresentedinTable19.Allcountries(exceptES)reportedthattheyhavethesamemonitoringmethodsforothervaccinesasforDPT.DetailedinformationondifferencesforMMRvaccinemonitoringinESispresentedinTable20.Table19.Method/susedanddetailstoassessnumeratorforothervaccinesincomparisontoDTPinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=26)

Vaccines

Thesamemethod/susedasforDTPvaccine

DifferentmethodsusedthanforDTPvaccine

Measles AT,CY,CZ,DK,EE,FR,DE,GR,HU,IS,IE,IT,LV,LT,LU,MT,NL,NO,PL,PT,RO,SK,SI,SE,BE(n=25)

ES (n=1)

Mumps AT,CY,CZ,DK,EE,FR,DE,GR,HU,IS,BEIE,IT,LV,LT,MT,NL,NO,PL,PT,RO,SK,SI,SE,LU(n=25)

ES‐seebelow;thesameasformeasles.

Rubella AT,CY,CZ,EE,FR,DE,GR,HU,BE,NOIE,IS,IT,LV,LT,MT,NL,PL,PT,RO,SK,SI,SE,IE,LU(n=25)

ES‐seebelow;thesameasformeasles.

HepB AT,CY,CZ,DE,EE,FR,GR,IE,IT,LT,LV,MT,NL,PL,PT,RO,SE,SI,SK,BE,LU,HU(n=22)

ES‐seeabove;sameasabovevaccines.

Polio AT,CY,CZ,DE,DK,EE,FR,GR,HU,IE,IS,IT,LT,LV,MT,NL,NO,PL,PT,RO,SE,SI,SK,BE,LU(n=25)

ES‐seeabove;sameasDTP.

HiB AT,CY,CZ,DE,DK,EE,FR,GR,HU,IE,IS,IT,LT,LV,MT,NL,NO,PL,PT,RO,SE,SI,SK,BE,LU(n=25)

ES‐sameasDTPforinfants;

Varicella CY,DE,GR,LV(n=4) PL‐Numberofdosesadministered;MT‐givenintheprivatesectoronly;recordsnotkept.IT‐forthisvaccination,nationalcoverageisassessedevery5yearsbysurveymethod.

PCV7,10,13 AT,CY,DE,DK,FR,GR,HU,IE,IS,LV,BE,NL,NO,SE,SK,LU(n=16)

PL‐Numberofdosesadministered;IT‐forthisvaccination,nationalcoverageisassessedevery5yearsbysurveymethod.

Pneumo23 LV(n=1) ES‐differentbyRegion

MenC AT,CY,DE,FR,GR,IE,IS,NL,PT,BE,LU(n=11)

ES‐sameasDTP;PL‐Numberofdosesadministered.IT‐forthisvaccination,nationalcoverageisassessedevery5years

bysurveymethod.HPV

DK,FR,IS,IT,LV,NL,NO,PT,SI,BE(n=10)

DE‐Surveyorsoldvaccines;ES‐sameasDTPforadolescents;PL‐Numberofdosesadministered;IE‐in2012willbeinCIR.SE‐Vaccinationswillberegisteredinacomputerisedregistry.

BCG EE,FR,GR,HU,LT,LV,MT,PL,PT,RO,SE,SK(n=12) IE‐notallareashaveBCGinformationonIIS‐thereforecannotmeasureit.

Rotavirus AT,BE(n=2) PL‐Numberofdosesadministered.FInotresponded.Table20.Method/susedanddetailstoassessnumeratorformeasles,mumpsandrubellainES(DifferentfromDTPassessmentpresentedinthetableabove).VaccinationcoverageassessmentsurveyinEurope,August2011.(n=1)

MethodusedtoassessnumeratorforMMRvaccine Comments

Measles,mumps,rubellatreatedasDTP? DifferentfromDTPAdministrativemethod YesAggregatecollectionofno.ofvaccinesadministered

Yes

Aggregatecollectionofno.ofvaccinesdistributed NoThenumberofsubjectsvaccinatedfromschoolordaycarerecords

Yes

Other NoIfadministrativemethodsused,isthesamemethodsbeingusedinallsubnationalunits?

Yes,in somesubnationalunits

Surveyused NoComputerisedimmunisationregistries YesChildhood SubnationalAdolescents,adults,elderly NotapplicableIfcomputerisedrecordsystemsused,isthesamemethodsbeingusedinallsubregions?

Other: sameasDTP

CommentsAT‐PCV10until2011onlyforchildrenatrisk;beginningwith2012forallchildren;MenA,C,W,Yvaccinationstarts2012.FR‐1.Wesupposethatyouareaskingallmethodsusedandnotthemainone.ForexampleDTPcoverageinchildren24monthsofa*geisassessedthroughadministrativedata,forolderchildrenandadultsdataareprovidedbysurveys,hencethetwomethodsarementioned,hopethisisthecorrectwayoffillingin.2.Surveymethodsdiffer.Theseareschoolbasedforchildrenandpopulationbasedforadults.Thelattercombineface‐to‐faceinterviewsandtelephoneinterviews.HCWdataarecollectedthroughpersonalinterviewsperformedthroughsurveysperformedinhealthcaresettings.3.Whatdoyoumeanexactlybyhouseholdsurvey.Isupposeitisasurveywhereyouinterviewpersonslivinginahouse.Thenthiscanbeatelephonesurveyoraface‐to‐facesurvey,correct.Q21.Assessonlychildhoodvaccinations,thisthatmeansthatmethodsusedformeasuringVCinadultsarenotconcerned?(i.e.inFrancesurveystomeasureDTcoverage).PT‐Theexistentcomputerisedrecordsystemisbeingupdatedandsoonalllevels(local,regionalandnational)willbeusingit.RO‐registryunderimplementation.

Vaccination coverage data validation, feedback and measure of performance indicators Of27respondingcountries16validatevaccinationcoveragedata.Ofthese,sixcountriesreportedthattheydoitroutinelyforalldataandthreecountriesdoitroutinelyatdefinedtimes;fivecountriesvalidatevaccinationcoverageforsomeandtwocountriesvalidatedataforalloccasionallyaspartofresearch(table21). Table21.Vaccinationcoveragedatavalidation,feedbackandmeasureofperformanceindicatorsinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=27)

Datavalidation,feedback Countries Yes NoDoesyourcountryvalidatevaccinecoveragedata?

AT,DK,DE,IE,IS,IT,LV,LT,LU,NL,NO,PL,PT,RO,ES,HU(n=16)

SE,CY,CZ,EE,FI,FR,GR,MT,SK,SI(n=10)

Ifyes,isvaccinationcoveragedatavalidationdoneLUdidnotrespondedRoutinely(atdefinedtimetimes)forall

AT,IT,LT,NO,PT,HU(n=6)

Routinely(atdefinedtimes)forsome(e.g.sample)

DE,PL,LU(n=3)

Occasionallyforsomeaspartofresearch

DK,IE,IS,LV,NL(n=5)

Occasionallyforallaspartofresearch

ES,RO(n=2)

Ifyes,pleaseindicatewhatmethodisusedtodoso:Vaccinesales AT,DE,DK,LT,LU(n=5) ES,IE,IT,LV,NL,PL,PT,RO,NO(n=9)WHODataQualitySelfAssessmenttool

LU,RO (n=2) AT,DE,DK,ES,IE,IT,LT,LV,NL,NO,PL,PT(n=12)

Recountsofvaccinationrecords AT,LV,NL,PL,PT,IS (n=5) DE,DK,ES,IE,IT,LT,LU,NO,RO (n=9)Other: DK‐dataanalysisfore.g.doubleentry,vaccinegiventwice,ageattimeofvaccinationetc.DE‐insuranceclaimdateandviceversaIE‐contactwithGPstovalidatecoveragesometimes(notroutine).IT‐EPIClustersamplingsurveysNO‐Validationoftheinformationinthecomputerizedsystem.PL‐Annualcomparisonofnumberofvaccinationcardsheld comparedtonumberofinhabitants,bybirthcohortandNUTS‐2PT‐numberofdosesdistributedHU‐atnationallevelroutinely,annualcomparisonofnumberofvaccinationcardsheldcomparedtonumberofinhabitants,bybirthcohortandNUTS‐3;atlocalleveloccasionally,visitGPsandhealthvisitorstovalidatecoverageES‐nationalserologicalsurveyin1996DescribebrieflyforwhichvaccinesandthefrequencyAT‐annuallyforallpurchasedvaccinesbypublicsectorDK‐allchildhoodvaccinesandinfluenza vaccinesDE‐esp.fornewlyintroducedvaccinelikevaricella,pneumococcal,meningococcalIE‐recentstudyforMenCandHibboosterIT‐allvaccinesforchildrenandadolescents,every5yearsLV‐ItwasdonetwiceseveralyearsagoNL‐irregularlyNO‐Allvaccinesincludedinthechildhoodimmunisationprogramme,yearlyPL‐Allvaccines,atleastannually

RO‐asaboveES‐allincludedinthevaccinationscheduleBE–withsalesandsero‐surveys/comparisonFacetofaceandcomputerizedorderingsystem.LU‐allvaccinesincludedinthechildhoodimmunisationschedule,every5yearsOf27countries17indicatedthattheyprovide(print/distribute)orhaveavailableonthewebfordownload,astandardauthoriisedvaccinationrecordthatparents/guardianscankeeponthevaccinationhistoryofthechild;eightcountriesreportedthattheyhavestandardhealthcareprovidervaccinationrecords.Table22.AvailabilityofstandardauthorisedvaccinationrecordinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=27)

Have DonothavePersonalimmunisationrecord(forparents/guardiansofthechild)

CZ,DK,FR,GR,IE,IS,LT,LU,LV,MT,NL,NO,PT,RO,SI,BE,HU(n=17)

AT,CY,DE,EE,ES,FI,IT,PL,SE,SK(n=10)

Healthcareproviderrecord(e.g.Generalpractitioner,immunisationoffice)

IS,LT,LV,NL,PL,RO,BE,HU(n=8)

AT,CY,CZ,DE,DK,EE,ES,FR,GR,IE,IT,MT,NO,PT,SE,SI,SK(n=17)

FIdidnotrespondBE:Flandersonly,forWalloniaplannedin2012‐2013 Of27countries16indicatedthattheyassessvaccinationcoverage(routinelyorsometimes).Differentperformanceindicatorsareusedtoassessvaccinationcoverage:up‐todateforimmunisationisusedby12countries;on‐timeimmunisationisusedbytencountries;latestartratesindicatoranddropoffratesindicatorsisusedbyeightandsevencountriesrespectively;validdosesindicatorisusedbysixcountries. Table23.AssessmentofimmunisationcoverageperformanceindicatorsinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=27)

Immunisationcoverageassessment

Countries

Never SI,ES,SE,AT,CY,CZ,DE,GR,IT,MT,PL(n=11)Notroutinelybutifneeded IE,RO(n=2)Yes,routinely DK,EE,FI,FR,HU,LV,LT,LU,NL,NO,PT,SK,BE,IS(n=14)Performanceindicatorsused

assessingvaccinationcoverage(n=14)

Use

Didnotuse

Up‐to‐dateimmunisationDK,FI,FR,IE,LU,NL,NO,PT,RO,SK,BE,IS(n=12) EE,HU,LT,LV(n=4)

On‐timeimmunisationDK,BE,EE,FI,HU,LT,LU,LV,NL,RO(n=10)

FR,IE,NO,PT,SK(n=5)

Latestartrates DK,EE,FI,HU,LT,LV,NL,BE(n=8) FR,IE,LU,NO,PT,RO,SK(n=7)Drop‐offrates DK,FI,HU,LT,LV,NL,BE(n=7) EE,FR,IE,LU,NO,PT,RO,SK(n=8)Validdoses DK,FI,NL,NO,SK,BE(n=6) EE,FR,HU,IE,LT,LU,LV,PT,RO(n=9)BE:onaregionallevelFourcountries(DE,LT,LU,PT)indicatedthattheyhaveagreedstandardsforimmunisationcoverageassessment(AppendixAforAmericanStandardsasanexample).

CommentsEE‐RegulationoftheMinisterofSocialAffairsnr116,17.11.2003setsdata,whichshouldberecordedtothe"immunisationbook"orelectronicdatabase:‐nameofpatient‐ageofpatient‐nameofvaccine,serianumber,dateofexpire‐dateofadministrationthesameregulationsetsformofthePassportofImmunisatiom.DE‐wehaveanagreementbetweenallfederalstatesaboutcompleteandincompletevaccinationcoverageNL‐Vaccinationrecordonlyavailableforimmunisationservices,notforGP.Wehaveastandardanalysismethodthatisexplainedinouryearlyreport(inDutch).

E-Health system Of27surveyrespondingcountriesfourreportedthattheircountryhasimplementedane‐Healthsystemonanationallevel.Ofthesefourcountries,twocountries(EE,IS)reportedthatimmunisationquestionsareincluded.In13countries,thereareplanstointroducee‐Healthsystemwithin5years;ineightofwhichtheimmunisationwillbeincluded.Detailsarepresentedinatable24.Table24.E‐HealthsysteminEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=27)

E‐Healthsystemimplemented

E‐Healthsystemnotimplemented

E‐healthsystemimplemented AT,EE,MT,IS CY,CZ,DE,DK,ES,FR,GR,HU,IE,IT,LT,LV,NL,NO,PL,PT,RO,SE,SI,SK,LU

Immunisationincluded EE,IS MT,ATAccesstoPublicHealthOfficial IS EEDataatindividuallevel IS Aggregated IS Nationallevel ISSubnational IS,BE Other

PlanstointroduceE‐Healthsystem

NoplanstointroduceE‐Healthsystem

IntroductionofE‐Healthsystemwithin5years

CY,CZ,DK,ES,GR,HU,IT,LT,LV,PT,SE,SK,LU

DE,FR,IE,NL,NO,PL,RO,SI

Immunisationwillbeincluded CY,DK,HU,LV,PT,SE,SK,LU CZ,ES,GR,IT,LTAccessedtoimmunisationdataforPublicHealthOfficials

CY,DK,HU,LV,PT,SE SK

PlanneddataavailabilityinE‐Healthsystem

DidnotplandataavailabilityinE‐Healthsystem

Dataavailabilityatindividuallevel DK,PT,LV,SE

‐

Aggregateddataavailability LV,SE ‐Dataavailabilityatnationallevel DK,LV,SE ‐Dataavailabilityatsubnational DK,LV,SE ‐Notknown CY,HU,SK ‐FI‐didnotrespond

Comments AT‐studystarted2011CY‐ThiscanonlybedoneiftheNewNationalHealthSystemislaunchedandwearenotsurehowisexactlygoingtobe.IT‐InItalythereisnotane‐healthsystemcoveringwholecountry,butsomeinitiativeshavebeenperformedorplanned.Acommonserviceforbookingsanitaryvisits/checksandane‐systemfortransmittingmedicalcertificatesassessingabsencefromjobfordiseaseareactiveatthenationallevel.Electronicpatientsummaryande‐prescriptionarebeingexperimentedinsomeRegions.Fordetails(websiteinItalian):http://www.salute.gov.it/eHealth/paginaMenuEHealth.jsp?lingua=italiano&menu=iniziativeNL‐Q26:Idonotknowwhatismeantwiththesequestionsone‐healthsystem?Q31:allvaccineesareincludedautomaticallyintheimmunisationregistryunlesstheyindicatethattheyobjecttoregistration(occursseldom).SK‐Implementationofe‐healthsystemisinthecompetenceoftheMinistryofHealthoftheSlovakRepublic.Dataonimmunisationstatusofapersonshouldbejustonepartofit.Thecompletionofthewholee‐healthsystemimplementationisestimatedfortheyear2016.Furtherinformationcanbefoundonwww.health.gov.sk.Currentlyanotherseparateimmunisationregistryisnotplannedtobeimplemented.Wedohavelegislationpassedforprotectionofpersonaldatawhenelectronicallyoperatedbutthisisgenerallegislationnotspecificallyaimedattheimmunisationdata.LU‐detailsonthefutureeHealthsystem,anddataaccess&availabilityarestilltobedetermined.EE‐IISinEstoniaisformallyoperatingfromJanuary2011.IISexistsintheframeofthee‐healthsystem(TIS).Immunisationregisterisdirectlyconnectedwithmedicalrecords(history)ofeachpatientandotherregisters(EstonianCommunicableDiseasesRegister,RegisterofPopulation).Takingintoaccountthefactthattechnicalability(PC,software,connectionwithTIS)ofdifferentmedicalcarefacilitiesvariesalot,onlyasmallnumberofmedicalcarefacilitieshavejoinedtheimmunisationregister.ThemajorityOffamilydoctorshavenotyetjoinedTIS.Atthemomentit`spossibletoextractdataconcerningonlyacertainpatientfromIIS.However,itisnotpossibletoextractaggregateddata,becausethestatisticalmoduleisinthestageofdevelopment. Immunisation registries Of27countriesthatrespondedtothisquestionfourcountriesreportedthattheyhaveanimmunisationregistryatnationallevel;sixcountrieshaveimmunisationregistriesatsub‐nationallevel.Onecountry(IS)indicatedthatthereisimmunisationregistryatbothnationalandsubnationallevel.Ninecountriesindicatedthattheyplantodevelopanationalimmunisationregistry.Detailsonimmunisationregistriesimplementationpresentedintable25.

Table25.ImmunisationregistriesinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=26)

Yes NoNationalcomputerisedimmunisationregistry

Nationalcomputerisedimmunisationregistryimplemented

DK,IS,MT,NL,NO(n=5) AT,BE,CY,CZ,DE,EE,ES,FI,FR,GR,HU,IE,IT,LT,LU,LV,PL,PT,RO,SE,SI,SK(n=22)

Subnationalcomputerisedimmunisationregistryimplemented

DE,ES,IE,IT,PT,BE,IS(n=7) AT,CY,CZ,EE,FI,FR,GR,HU,LT,LU,LV,PL,RO,SE,SI,SK(n=16)

%Countrycovered (sub‐national)DE <25%IE,IT,PT >75%ES 25‐ 50%BE 60%IS >95%

IntentiontodevelopanationalimmunisationregistryNationalcomputerizedimmunisationregistryimplementationisplanned

AT,EE,FI,HU,LU,LV,RO,SI,IE(n=9)

CY,CZ,FR,GR,LT,PL,SE*,SK(n=8)

Notknown AT,FI,HU,LU,SI (n=5)EE Jan2013 LV 2013 RO 2012

Of17countriesthathavealreadyorintendtoimplementanationalimmunisationregistrytencountriesstatedthattheircountryhaslegislationrelatingtoimmunisationregistries,whichensuresprivacyandconfidentialityinrelationtotheuseoftheseregistries.Table26.LegislationrelatingtoimmunisationregistrieswhichaddressedprivacyandconfidentialityissuesrelatingtotheuseoftheseregistriesinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=17)

Legislationexist LegislationdonotexistCountries AT,DK,IS,IT,MT,NL,NO,PT,RO,ES

(n=10)EE,DE,HU,IE,LV,SI,LU(n=7)

Institutionirresponsible toensurethislegislationAT AustrianFederalChancelleryDK NationalDataAuthority(DanishDataProtectionAgency)IS thechiefepidemiologistIT AspecialnationalagencyforeverymatterconcerningprivacyLU CommissionNationalepourlaProtectiondesdonne?esMT DataProtectionOfficerNL RIVMNO TheDataInspectorate(Datatilsynet)PT,RO UnknownES healthauthoritiesBE FederalGovernment(privacycommission) Ofsevencountriespresentedinatable27,fourofthemspecifiedthat,dataentrytotheimmunisationsystemiscompulsoryforchildrenandinthreeforadults;intwocountriesdataentryiscompulsoryforchildhoodvaccinationbutvoluntaryforadultsvaccination.InBEdataentryisvoluntaryforboth,childrenandadultsintable27.Table27.Immunisationdataentrytonationalprogramme(voluntaryorcompulsory)inEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=7)Country

Childhoodvaccinationdataentry

Adultvaccinationdataentry

DK Compulsory CompulsoryIS Compulsory CompulsoryMT Compulsory VoluntaryNL Compulsory CompulsoryIE Compulsory NotrelevantNO Compulsory VoluntaryBE voluntary voluntaryIn16countriesaconsentformfromthevaccinee/parent/legalguardianisnotrequiredforinclusionontheimmunisationregistry(AT,DE,DK,EE,IE,IS,IT,LV,MT,NL,NO,PT,RO,SI,BE,HU);ESspecifiedthatverbal

consentisrequired.Al17countriesreportedthatconfidentialityprotected(AT,DE,DK,EE,ES,HU,IE,IS,IT,LU,LV,MT,NL,NO,PT,RO,SI,BE).Of17countrieswithimmunisationregistries,tenreportedthattheyhaveagreedacoredatasetfortheCIR(in12ofthemdataareagreedfornationalandintwocountriesforsubnationallevels)(table29).Table29.Agreedcoredatasetforyourimmunisationregistry/iesinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=17)

AgreedCIRcoredataset

DidnotagreedCIRcore

datasetCountries DK,EE,IE,IT,LV,MT,NO,PT,RO,SI ES,AT,DE,HU,IS,LU,NLNational DK,EE,IE,IT,LV,MT,NO,PT,RO,SI,IS Subnational

IS,BE

Of17countriesrespondingtothisquestion,13countriesreportedthatthenameofpatient(i.e.first,middleandlastnames)anduniqueidentifyingnumber/personalidentifierisrecordedinthesystem.Anumbertoidentifyallhealthsystemencountersisusedin12countries.Thesetwouniqueidentifiersarethesameintencountries. Table30.DatarecordedinimmunisationregistriesinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=17)

Countriesthathave/recordfollowingdata

Countriesthatdidnot

have/recordfollowingdata

Yes,variesbysubnationallevel

NamesrecordedEE,ES,IE,IS,IT,LV,MT,NL,NO,PT,RO,SI,BE(n=13)

AT,DE,DK,HU(n=4)

Uniqueidentifyingnumber/personalidentifier

DK,EE,ES,IS,IT,LV,MT,NL,NO,PT,RO,SI,BE(n=13)

AT,DE,HU(n=3)

IE(n=1)

Uniqueidentifyingnumberforallhealthsystemencounters

DK,EE,ES,IS,IT,LV,MT,NO,PT,RO,SI,BE(n=12)

AT,DE,HU,IE,NL(n=5)

Isthisthesamenumberasabove

DK,ES,IS,IT,LV,MT,NO,PT,SI,BE(n=10) EE,RO(n=2)

Ifnot,canthedataforthedifferentencountersbelinked ‐ ‐

Allagegroups(children/adults/adolescents)arecoveredintheCIRinsevencountries.Intheremainingtencountries,agegroupscoveredbyimmunisationregistriesvary(table31).

Table31.AgegroupscoveredinimmunisationregistriesinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=17)

Agegroup(s)coveredbyimmunisationregistries CountriesAllages(children/adolescents/adults) DK,IS,LV,NO,PT,SI,BE(n=7)Allchildren/adolescents(<18years) EE,NL(n=2)Children<7years HU(n=1)Children/adolescents<16years AT,MT(n=2)Variesbysubnationallevel DE,ES,IT(n=3)Other: IE,LU,RO(n=3)IE‐upto24monthstypically LU‐Notapplicable‐Registrynotyetdeveloped RO‐forthebeginningwestartwithunder5butinfutureallpersonalvaccinationhistory BE‐fortheFrenchCommunityinBelgiumitwillbelimitedto<20yearoldpopulation,versusallagesinFlanders.Accesstodifferentmedicalstaffgroupstothedatainimmunisationregistriespresentedintable32.Table32.AccesstotheinformationontheimmunisationregistriesinEU/EEAcountries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=17)

Accesstotheimmunisationregistryexists

Accesstotheimmunisationregistrydoesnotexist

Yes,variesbysubnationallevel

MinistryofHealthAT,LV,RO(n=3)

DK,EE,ES,HU,IE,IS,IT,MT,NL,NO,SI(n=11)

DE,BE(n=2)

VaccinationservicesAT,LV,RO,IS,IT(n=5)

DK,EE,HU,IE,MT,NL,NO,SI(n=8)

ES,DE,BE(n=3)

PublicHealthDoctorsHU,IS,IT,NO,PT,RO,SI(n=7)

AT,DE,DK,EE,LV,MT,NL(n=7)

ES,IE,BE(n=3)

PublicHealthNursesHU,IS,IT,LV,NO,PT,SI(n=7)

AT,DE,DK,EE,MT,NL,RO(n=7)

ES,IE,BE(n=3)

Primarycarestaff(physicians/nurses)‐public

DE,HU,IS,LV,PT,RO,SI(n=7)

AT,DK,EE,IE,IT,MT,NL,NO(n=8)

ES,BE(n=2)

Primarycarestaff(physicians/nurses)‐ private

EE,IS,LV,RO,SI(n=5)

AT,DE,DK,HU,IE,IT,MT,NL,NO,PT(n=10)

ES,BE(n=2)

Hospitalstaff‐publicHU,IS,LV,RO,SI(n=5)

AT,DE,DK,EE,IE,IT,MT,NL,NO(n=9)

ES,PT(n=2)

Hospitalstaff‐privateEE,IS,LV,RO,SI(n=5)

AT,DE,DK,ES,HU,IE,IT,MT,NL,NO(n=10)

PT(n=1)

Vaccinee/Parent/LegalGuardianEE,IS,LV,PT,NO*(n=5)

AT,DE,DK,ES,HU,IE,IT,MT,NL,NO,RO,SI(n=12)

MedicalProductsAgency AT,DE,DK,EE,ES,HU,IE,IS,IT,LV,MT,NL,NO,PT,RO,SI(n=16)

NationalImmunisationProgramme LV,SI,DK,IS,NO(n=5)AT,DE,EE,ES,HU,IE,IT,MT,NL,PT,RO(n=11)

BE(n=1)

Other:DK‐specificprojectswithascientificpurposesuchasregistrystudiesLV‐HealthInspectorate

* Since 1.12.11 the vaccinees /parents/legal guardian has access to the information registered on them or their children. **PublichasnoaccesstodatabaseinBelgium.Adversevaccinerelatedeventsarerecordedintheimmunisationregistryinsixof17countries;twocountrieshavealinkagewithadverseeventdatabase.Elevencountriesreportedthatimmunisationinformationcouldbeavailableforvaccinee.Detailedinformationonimmunisationinformationcapabilitiesavailableintable33.Table33.Capabilitiesofimmunisationregistries.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=17)

Capabilitiesinimmunisationregistryexist

Capabilityinimmunisation

registrynotexist

Capabilitiesexist,butvariesby

subnationallevel

Capabilitiesexist

onlytohealthcareprovider

Yes,toboth

Adverseevents(AE)recorded

EE,LV,MT,PT,RO,SI(n=6)

AT,DE,DK,IE,IS,LU,NL,NO,HU(n=9)

ES,IT,BE(n=3)

LinkagewithAEdatabase IS,NO(n=2)

AT,DE,DK,IE,IT,LU,NL(n=7) ES(n=1)

Linkagewithsurveillancedata

DK,EE,IS,LV,NO(n=5)

AT,DE,HU,IE,IT,LU,MT,NL,PT,RO,SI(n=11) ES(n=1)

Reportvaccinefailures DK,LV,MT,NL(n=4)

AT,DE,EE,HU,IE,IS,IT,LU,PT,RO,SI,NO(n=12) ES(n=1)

CIRmanagesvaccineinventories HU,NL,PT(n=3)

AT,DE,DK,EE,IE,IS,LU,LV,MT,NO,RO,SI(n=12) ES,IT(n=2)

CIRissuesnotifications

AT,DE,DK,EE,HU,LU,NO,SI(n=8) ES,IT(n=2) RO(n=1)

IE,IS,LV,MT,NL,PT(n=6)

CIRusedforstatisticalpurposes

DK,EE,IS,IT,LV,MT,NL,NO,PT,RO,SI(n=11)

AT,DE,LU,HU(n=4)

ES,IE(n=2)

CIRproviderecordtovaccinee

DK,EE,IS,IT,LV,MT,NL,NO,PT,RO,SI(n=11)

AT,DE,HU,IE,LU(n=5)

ES(n=1)

CIRfeedbacktohealthproviders

DK,IS,LV,MT,NL,NO,PT,RO,SI(n=9)

AT,DE,EE,IT,LU,HU(n=6) ES,IE(n=2)

Theterminologytoreportonagesdiffersbetweencountries.Inordertoavoidanymisunderstandingthequestionwasaskedatthetimeofsurvey(August2011):“Fordatacollectionpurpose,yousaythatagirlborninJanuary1999is12yearsold(shehascelebratedher12thbirthday)or13yearold(sheislivingher13thyearoflife)”.Allrespondingcountries(exceptIT)indicatedthatintheircountrytheageofthechildisdefinedasthenumberofbirthdaysthechildhascelebratedsincebirth(withbirthbeing“0”).Theresponsesareindicatedinatable34.

NL‐DoctorsandnursesworkingforEPIhavelimitedaccess,NIPfullaccessNO‐Somegeneralpractitionersandvaccinationserviceshasaccesstotheinformationintheregistry.RO‐eachdoctorforhisownvaccineeslist,onlynationalcanseeall

Table34.Useofterminologywithregardtotheageofachildwhohascelebratedher12thbirthday–whatageisshe?.VaccinationcoverageassessmentsurveyinEurope,August2011.(n=24)Terminologyused Countries12yearsold(shehascelebratedher12thbirthday)

AT,CY,CZ,DE,DK,EE,ES,FR,GR,HU,IE,IS,LT,LV,MT,NL,NO,PL,PT,RO,SE,SI,SK,BE,LU

13yearsold(sheislivingher13thyearoflife) ITFIdidnotrespond.

Summary and conclusions ThisreportdemonstratesthatamongsttheVENICEcountriesparticipatinginthissurveyallMSscollectcollateandanalysevaccinationcoveragedataregularly.However,themethodstheyusetoassessvaccinationcoverageandthefrequencyofdoingsoishighlyvariable,makingcomparisondifficult.VaccinationsincludedtotheNationalimmunisationProgrammesandvaccinationcoverageassessmentChildren

Allcountriesof27countriesthatrespondedtosurveyincludeDTP,Polio,MMR,HibintheirNationalImmunisationProgrammesandassessvaccinecoverageforthesevaccines.ImmunisationwithHepBvaccineisincludedin21countries;vaccinationcoverageisassessedinallofthem.ThosecountriesthathaveroutineBCG(n=11),MenC(n=12),Pneumococcal(n=20),VaricellaandRotavirus(n=4)vaccinationprogrammesallassessvaccinationcoverage.

AdolescentsOf27countries23includeinDiphtheriaandTetanusvaccinationintheirnationalimmunisationprogrammes;sixandsevencountriesdonotmonitorvaccinationcoverageamongthispopulation,althoughItalyconductEPIclustersamplingsurveysevery5years.Amongthe13countriesthatrecommendpertussisvaccination,fivedonotmonitoruptakeinthispopulation.Elevencountriesrecommendpoliovaccinationforthisgroupbutthreecountriesdonotassessvaccineuptake.ElevencountriesrecommendMMRvaccineforthisgroup,butthreecountriesdonotassessuptake.ThosecountriesthathaveincludedHPVintoNationalimmunisationprogramme(n=12)allexceptone(IE)monitorvaccinationcoverage.IEplanstoobtaincoveragedatain2012.

AdultsFrom16and19countrieswhereimmunisationofadultswithdiphtheriaandtetanusvaccineisrecommendedtenand11countriesrespectivelydonotassessvaccinationcoverage.Pertussisvaccinationisrecommendedinfourcountries,butmonitoredinonlyone.

Frequencyofvaccinationcoverageassessment

Differentvaccinationcoverageassessmenttimeintervalsareusedindifferentcountriesrangingfrommonthly/quarterly/halfyearly/annuallyto2‐5years.ThemajorityofMSs(abouttwothirdsofcountries)reportedassessingvaccinecoverageannually.Inonecountry(BE),thefrequencyofvaccinecoverageassessmentdiffersbyregion,withirregulartimeintervals.

Vaccinationcoveragedataavailabilitybybirthcohort

Twentyfiveofthe27countrieshavecoveragedatabybirthcohorts.Mostofcountriesassessingvaccinationcoverageusepopulationatorbyfirstorsecondbirthdayandalsoageatschoolentryfortheagespecificdenominators.Awiderangeofotheragecohortsisusedinsomecountries.

Vaccinationcoveragedatabyspecialriskgroups

Mostcountriesdonotcollectcoveragedataforspecialsriskgroups(migrants,refugees,ethnicminorities,homeless,sociallyandeconomicallydisadvantagedgroups).Fourcountriesreportedcollectingdataforinfluenzaforclinicalriskgroups;fivecountrieshavedataforHCWsforthesamevaccine.

AdministrativelevelatwhichvaccinationcoverageisassessedAllcountries(n=24),excepttwo,assessnationalvaccinationcoverageofthosevaccinesincludedintheNationalImmunisationProgramme.BEandESassessvaccinationatsub‐national

(regional)level.NineteencountriesreportedthatdataarecompatiblewithEUROSTATNUTSclassification.In14ofthemdataarecompatiblewithNUTS2()n=7orNUTS3level.

Methodsusedtofornumeratorassessment

Avarietyofadministrativemethods(e.g.administrative,surveysandcomputerisedrecordssystemsorcombinationofthese)areusedtocalculatevaccinationcoverage.Inthosecountrieswherethepredominantmethodisadministrative(n=17),themostcommonlyusednumeratoristhenumberofsubjectsvaccinated(n=16).Inthosecountrieswheresurveymethodspredominate(n=9),themostcommontypeofsurveysusedareface‐to‐faceinterviews(n=6)orschoolsurveys(n=4).

Vaccinationcoveragedatavalidationandusedofperformanceindicators

Validationofvaccinationcoveragedataisdoneinjustoverhalfofcountries(n=16)usingavarietyofmethods.Themostcommonmethodreportedinhalfofthesecountriesinvolvesuseofvaccinesalesdata(n=5)followedbyrecountsofvaccinationrecords(n=5).Differentperformanceindicators(up‐to‐dateoron‐timeimmunisation,latestartrates,drop‐offrates,validdoses)wereusedbyapproximatelyhalfofthecountries(n=14),themostcommonperformanceindicatorbeingtheproportionofchildrenwhoareup‐to‐dateimmunised(n=12)followedbyon‐timeimmunisation(n=10).

E‐Healthsystem

FivecountrieshaveimplementedE‐healthsystem;howeveronlyintwoofthemimmunisationcomponentisincluded.Thirteencountriesplantodevelopsuchsystemwithin5years;eightcountriesplantoincludeimmunisationinthissystem.

Immunisationregistries

• Immunisationregistriesareavailablein11countiesbutvaryregardingadministrativelevelcovered(fivecountrieshaveregistryatnationalandsixonsubnationallevel)andalsobyagegroupscovered.Inadditionninecountrieshaveintentiontodevelopnationalimmunisationregistries.

• Ofthe17countriesthathavealreadyimplementedorplantodevelopandimmunisationregistry,themajorityofcountries(n=13)have(orwillhave)namedpatientandpersonalidentifiers(oruniquehealthsystemencounternumber);tencountrieshavelegislationtoensureprivacyandconfidentialityinrelationtotheiruse.

ReferenceList

[1] ECDC.Immunisation‐Spotlight2011.Vaccines–powerfultools.Challenges.http://ecdc.europa.eu/en/healthtopics/spotlight/Spotlight_immunisation/Pages/challenges.aspx.2011.

[2] WHO.Immunisationsurveillance,assessmentandmonitoring.Immunisationcoverage.http://www.who.int/immunization_monitoring/routine/immunization_coverage/en/index.html.7‐11‐2011.

[3] VENICEnetwork.Reportonthevaccinationcoverageassessment.http://venice.cineca.org/Final_Report_I_WP3.pdf.2012.

Appendices

Appendix1.Questionnaire

NATIONAL DATA STANDARDS FOR VACCINATION COVERAGE ASSESSMENT QUESTIONNAIRE

PleaseReturnQuestionnaireby‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐,2011

COUNTRY: Gatekeeper:______________________________________________________

NAMEOFPERSONWHOFILLSQUESTIONNAIRE(IFDIFFERENTFROMABOVE): ________________________

CONTACTEMAIL:____________________________________________________Wekindlyaskyoutocompletethisquestionnaireinordertomakeupdatesforthevaccinationcoverageassessmentsurveywhichwasconductedin2007.Theobjectiveofthissurveyistofinalisethe“Consensusdocumentfordatacollectiononvaccinationcoverage”,whichwasdiscussedontheVENICEprojectmeetinginStockholminDecemberlastyear.ThefollowingquestionsrelatetoimmunisationcoveragecollectedatthenationallevelforrecommendedvaccinesineachcountryImmunisationProgramme.Dataobtainedfromtheprevioussurveyareprovided(prefilled)whereitwaspossibletodoso.Youareaskedtoupdatetheinformationiftherehavebeenchangessincethelastsurvey.Therearealsosomenewquestions(ormodifiedquestions),whicharemarkedinred.Pleasecompletethenewquestionsfullyandcheckprefilledquestions(whichshouldbemodifiedifrequired).Thelastpartofquestionnaire,whichisnotverylong,relatestoquestionsonImmunisationRegistries(IR).Weknowthatyou(orsomeofyou)recentlycompletedthesurveyonImmunisationInformationSystemsforECIISnetwork.However,wekindlyaskyoutoreviewthispartofquestionnaireforthisspecificsurveyasitisprefilledwithdatainordertoseeifitisstillcorrectforyourcountry.CountriesthatdidnothaveIRsatthetimeofsurveyin2007,butintroducedIRafterarewelcometocompletethispartofquestionnaire.

NationalImmunisationProgrammeQ1.Pleasetick(√)whichofthefollowingvaccinationsarerecommendedinyourcountriesNationalImmunisationProgramme*:*Immunizationprogramme:setofobjectives,strategies,actionsandprioritiesfortheorganiseduseofvaccinesforVPDsdefinedinyourcountry.

Diphtheria

Tetanus

Pertussis

Polio Hib HepB

BCG MenC

MMR Var1 PCV7,10,132

Pneumo23

Rotavirus

HPV Flu

Children Adolescents Adults* Specialgroups(e.g.riskgroups,girls,elderly)

Notincluded FrequencyofvaccinationcoveragedatacollectionQ2.VaccinationcoveragebydifferentagegroupsInthefollowing3sectionsagegroupsaredefinedforthissurveyspecifically‐theagegroupdefinitionsmaynotreflecttheagegroupmonitoredinyourcountry‐pleasetickeachtableasnecessary(ifHPVuptakemonitoredforages11‐12years,thentickHPVboxinbothQ2aandQ2b)Agegroupdefinitionsinthissurvey:Childrenaredefinedaschildrenaged0‐11yearsinclusiveAdolescentsaredefinedaschildrenoryoungadultsaged12‐18years(inclusive)Adultsaredefinedasanyoneaged19yearsandoverQ2a.Pleasetick(√)thefrequencythatvaccinationcoverageisassessedforCHILDRENvaccinationsinyourcountryforeachofthefollowing:

Frequency DTP

Polio Hib HepB BCG MenC MMR Var1 PCV7,10,132

Rotavirus

HPV Influenza

Monthly Quarterly Annually Every2years Every3years

Every5years Other,specify3___________

Notapplicable4

Vaccinationcoveragenotassessed

1Varicellavaccine2conjugate7(10,13)valentPneumococcalvaccine3including“irregularly”4ifnotincludedintheImmunisationProgrammeQ2b.Pleasetick(√)thefrequencythatvaccinationcoverageisassessedforADOLESCENTS(usually12years+)vaccinationsinyourcountryforeachofthefollowing:

Frequency Diphtheria Tetanus

Pertussis

Polio MMR HPV Var1 HepB Other,Ifotherspecify__________

Monthly Quarterly Annually Every2years Every3years Every5years Other,specify2___________

Notapplicable3 Vaccinationcoveragenotassessed

1Varicellavaccine2including“irregularly”3ifnotincludedintheImmunisationProgrammeQ2c.Pleasetick(√)thefrequencythatvaccinationcoverageisassessedforADULTSvaccinationsinyourcountryforeachofthefollowing:

Frequency Diphtheria Tetanus Pertussis Influenza Pneumo23 Other,Ifotherspecify__________

Monthly Quarterly Annually Every2years Every3years Every5years Other,specify1___________

Notapplicable2 Vaccinationcoveragenotassessed

1including“irregularly”2ifnotincludedintheImmunisationProgrammeQ3.Pleasespecifythedate(ormonthofthenextyear)whenvaccinationcoveragedataarereadyfordatadissemination(e.g.reporttoVENICE/ECDC)?

Vaccinationcoverageforchildren________________

Vaccinationcoverage foradolescents________ Vaccinationcoverageforadults(Influenza)_________ Vaccinationcoverageforothervaccines,pleasespecify_________________Q4.Aremonovalentvaccinesformeasles,mumpsandrubellaareusedinyourcountry?

1Yes,allthreemonovalentproductsareused1Onlysomeofthemareused(pleasespecify_____)1Theyareavailableonlyinprivatemarket,butnotavailablefornationalvaccination

programme1Notusedandnotavailableincountryatall

Commentsforthissection______________________________VaccinationcoveragedataavailabilitybybirthcohortatthenationallevelQ5.Isvaccinationcoverageassessedbybirthcohortsinyourcountry?

1Yes1No

Q6.Ifyes,couldyourcountryprovide(beabletoprovide)aggregateddatatoECDConanannualbasis?1Yes1No

Q7.Howtimelyisvaccinationcoveragedata?(inotherwords,when/howsoonaftertheageofuptakemeasurementisdataavailableatnationallevel) Cohortvaccinationcoveragedataavailable: 1Within3monthsafterageofmeasurement 1Within6monthsafterageofmeasurement 1Within12monthsafterageofmeasurement 1Other,pleasespecify__________________Q8.Pleasetick(√)foreachofthefollowingvaccinationsifvaccinationcoverageisassessedfor/at(Morethanoneoptionmaybeappropriate).

Birthcohort Children/Adolescents AdultsDTP Poli

oHib

Hep.B BCG MenC

MMR

Var1

PCV7,10,132

Rotavirus

HPV

Influenza

Pneumo23

Allbirthcohortschildrelatedvaccinationsuntil____(specifyage,e.g.by6years)

At12months At24months

At36months Atschoolentry* Adolescentbirthcohortvaccinations______(pleasespecifytheage(oragerange)whenvaccinationcoverageisprovided)

Adultbirthcohortvaccinations_____(pleasespecifytheagewhenvaccinationcoverageisprovided)

Forarangeofbirthcohorts_______(pleasespecifytheagewhenvaccinationcoverageisprovided)

Other,specify______________ Notapplicable

*Ifyes,atschoolentrypleasespecifyage(e.g.4,5yearsor6,7years)atschoolentry_______*Ifyes,atschoolentry,specifyifvaccinationcoveragedataareassessedforeachbirthcohortorrangeofthesecohorts? 1Eachbirthcohortaboveatschoolentry 1Rangeofthesecohortsatschoolentry 1Childrenatschoolentry,independentlyonthebirthcohort 1Other,specify_____________Commentsforthissection______________________________SinglevaccinedosesversusfullimmunisationseriesQ9.Pleaseindicate(tick(√))forwhichofthefollowingvaccinations,vaccinationcoveragedataiscollected:(morethanoneoptionmaybeappropriate)Vaccine VaccinationcoveragecollectedDTP 1Firstdose

1Everysingledose1Primaryimmunisationseries1Fullimmunisationseries(includingbooster)by24months1Other,specify__________1NotapplicableIfyes,couldyouprovidethesedataforECDC?Yes/No

Polio 1Firstdose1Everysingledose1Primaryimmunisationseries1Fullimmunisationseries(includingbooster)by24months1Other,specify__________1NotapplicableIfyes,couldyouprovidethesedataforECDC?Yes/No

MMR 1Firstdose1Seconddose1Otherspecify________1Notapplicable1Ifyes,couldyouprovidethesedataforECDC?Yes/No

HepatitisB 1Everysingledose1Primaryimmunisationseries1Other,specify__________1NotapplicableIfyes,couldyouprovidethesedataforECDC?Yes/No

Hib 1Firstdose1Everysingledose1Primaryimmunisationseries

1Fullimmunisationseries(includingbooster)by24months1Other,specify__________1NotapplicableIfyes,couldyouprovidethesedataforECDC?Yes/No

Pneumococcalvaccine(forchildrenPCV7,PCV10,PCV13)

1Firstdose1Everysingledose1Primaryimmunisationseries1Other,specify__________1NotapplicableIfyes,couldyouprovidethesedataforECDC?Yes/No

MenC 1Firstdose1Everysingledose1Primaryimmunisationseries1Other,specify__________1NotapplicableIfyes,couldyouprovidethesedataforECDC?Yes/No

Rotavirus 1Firstdose1Everysingledose1Primaryimmunisationseries1Other,specify__________1NotapplicableIfyes,couldyouprovidethesedataforECDC?Yes/No

HPV 1Firstdose1Everysingledose1Primaryimmunisationseries1Other,specify__________1NotapplicableIfyes,couldyouprovidethesedataforECDC?Yes/No

Q10.WithregardtovaccinationswithconjugatevaccinesHib,MenCandPCV,ifachild,notvaccinatedduringthe1styearoflife(<12months),getsonedoseinthe2ndyearoflife(after12months)e,ishe/sheconsideredasageappropriatelyvaccinatedinyourcountry?Vaccine VaccinationstatusHib Yes/No/NotapplicableMenC Yes/No/NotapplicablePCV Yes/No/NotapplicableQ11. IfYES,arechildrenwhohavereceivedonedoseafter12monthsofa*ge included intheroutinelyvaccinationcoverageassessment?

1Yes,forallthesevaccinations1Yes,forsomeofthesevaccinations,specify__________1No1Idon’tknow1Notapplicable

Q12.IfyoumeasurevaccinationcoverageforMMRreceivedatthetimeof2nddoseadministration,areyouabletolinkthisdataatthechildleveltoMMRdose1sothatitisevidentthattheyhavereceivedtwodosesratherthanjustone?

1Yes1No

Commentsforthissection______________________________

VaccinationcoveragedataforspecialriskgroupsQ13.Arevaccinecoveragedatacollectedforspecificriskgroupsandavailableatnationallevel?Ifyes,pleaseindicatewhichgroupsforwhichvaccines.Specificgroups Hepatitis

BInfluenza MMR Varicella Pertussis Other,

specifyHealthcareworkers

Underimmunisedindividuals(allcategoriesbelow):

Migrants Refugees Ethnicminorities(e.g.Roma,Travellers,other)

Populationsubgroups(e.g.Anthroposophic)

Homeless Sociallyandeconomicallydisadvantaged

Elderly Other,specify____ Commentsforthissection______________________________DeliverymethodsforvaccinesQ14.Foreachpopulationspecifiedpleasedescribethemainmethodsofvaccinationdelivery(e.g.byprimarycarephysicians,publichealthnursesetc.)forvaccinesprovided(suppliedby/paidfor/reimbursed)bytheNationalImmunisationProgramme.Pleaseprovideestimatesofproportionsofeachgroupinvolved.

Population

Primarycarephysician*

Publichealthvaccinationservices*(estimated%ofdelivery)

Hospitals*

Schoolhealthservices*(estimated%ofdelivery)

Other*specify________Public**

(estimated%ofdelivery)

Private**(estimated%ofdelivery)

Public**(estimated%ofdelivery)

Private**(estimated%ofdelivery)

<3yearsofa*ge Preschool Schoolage ≥65yearsofa*ge Highriskgroup Healthcareworkers Migrants Refugees Notapplicable Other,specify

*Sumofallshouldnotexceed100%.E.g.Ifinyourcountryvaccinationsaredeliveredbyprimarycarephysiciansandinhospitals,pleasetickthemandindicatee.g.90%and10%respectively.Choosenotapplicableforothers.**Withineachsetting,bothpublicandprivateservicesmaybeavailable.Pleaseindicatetheproportionofvaccinationsdoneinprivateversuspublic,thesumofwhichshouldnotexceed100%foranyonesetting.E.g.Primarycarephysicians:70%public;30%private;Hospitals:100%public.Q14.1Areallvaccinationsdeliveredbytheadministratorsofvaccines,asindicatedaboveinquestion(Q4.table),includedintheroutineassessmentofvaccinationcoverage?

1Yes,forallindicatedabove1Yes,onlyforpublic(notprivate)healthsector(primarycare,hospitals)1Yes,onlyforprivatesector(primarycare,hospitals)1Yes,forschools1No1Ifno,pleasedescribe

Q15.Doesyourcountryhaveawebsiteaddressprovidinginformationonvaccinecoverageforyourcountry? Yes 1 No 1Ifyes,pleasespecify

1Publishedreportsonvaccinationcoverage(hardcopies;printedreports)1Vaccinationcoveragedatapublishedonwebsite

1Other,specify_________Ifpublishedonwebsite,pleaseprovidelinktothesereports_________________Ifno,isthereanyothermechanismusedtoinformvaccinationprovidersorthepublic?Specify_____________Commentsforthissection______________________________NationalorsubnationallevelQ16.Pleasetick(√)atwhichlevelimmunizationcoverageforthefollowingvaccinesisassessed?(Morethanoneoptionmaybeappropriate)

Level Diphtheria

Tetanus

Pertussis

Polio Hib HepB

BCG MenC

MMR

Var

HPV

Rota

PCV7,10,13

Pneumo23

Flu

National Subnational: Regional Local NotApplicable

Q17.AreavailablevaccinationcoveragedatainyourcountrygeographicallyaggregatedinaclassificationcompatiblewithEUROSTATNUTS*classification?

Yes/NoIfno,pleasedefineyoursubnationalclassification(i.e.subnationalunitsforthevaccinationcoveragedatacollectionpurpose,ifany)_________________________

Q18.Towhatsub‐nationallevelcouldyourcountryreportvaccinationcoveragedatatoVENICE/ECDC?(pleasespecify)

NUTS1/NUTS2/NUTS3/LAUlevel1/LAUlevel2/otherifNUTSclassificationisnotused,specify

Q19.Inyouropinionwhichisthemostappropriateleveltobeusedinyourcountrytoprovideanappropriatesubnationalvaccinationcoveragedata?(example:inItalyNUTS1=5,NUTS=21,NUTS3=107;themoreappropriateNUTSlevelforvaccinationcoveragedatacollectionpurposeisNUTS2)

NUTS1/NUTS2/NUTS3/LAUlevel1/LAUlevel2/otherifNUTSclassificationisnotused,specify

*AccordingEUROSTATNUTSlevelsmeans:NUTS1:3‐7millions/NUTS2:800.000–3millions/NUTS3:150.000–800.000.Thereisalso,twootherlevelsofLocalAdministrativeUnits(LAU)havebeendefined(LAUlevel1(formerlyNUTSlevel4)/LAUlevel2(formerlyNUTSlevel5)).Thelowestlevel(LAU2)consistsofmunicipalitiesorequivalentunitsinthe27EUMemberStates.IfyouneedmoreinformationpleaseusethelinktotheEUROSTATNUTSlevels:http://epp.eurostat.ec.europa.eu/portal/page/portal/nuts_nomenclature/correspondence_tables/national_structures_euCommentsforthissection______________________________NumeratorassessmentQ20.Foreachofthefollowingvaccinespleaseindicatethemethodusedtoassessthenumeratorinthefollowingquestion.Youwillthenbeaskedtospecifyfurther.Q20.1ForDiphtheria,Tetanus,Pertussis(DTP)whichmethoddoesyourcountryusetomeasurethenumeratorinassessingvaccinecoverage

a)Administrative(excludingcomputerisedrecords) Yes 1 No 1 b)Surveys Yes 1 No 1

c)Computerisedimmunisationregistries Yes 1 No 1

(Administrativemethodsemployaggregatedata.Informationisnotretrievableonspecificindividual.Computerisedimmunisationregistriesholdinformationoneachindividual)Whicheverofa/b/c/isselectedthenthecorrespondingtablewillopenupbelowaftertickingyes/no.Answer either a)Pleaseindicatewhichofthefollowingadministrativemethodsareused?

Ifadministrativemethodsused,isthesamemethodsbeingusedinallsubnationalunits? 1Yes,inallsubnationalunits

Administrative AnswerAggregatecollectionofno.ofvaccinesadministered Yes/noAggregatecollectionofno.ofvaccinesdistributed Yes/noThenumberofsubjectsvaccinatedfromschoolordaycarerecords Yes/no/not

applicableOther,ifotherpleasedescribe Yes/no

1Yes,insomesubnationalunits 1Other,specify__________Or b)Pleaseindicatewhichoftypeofsurveyisused?Surveys AnswerHouseholdsurvey Yes/noTelephoneinterview Yes/noMailsurvey Yes/noFacetofaceinterview Yes/noFocusgroups Yes/noSchoolsurvey Yes/noOther,ifotherpleasedescribe Yes/noArethesesurveysconductedatregularintervals Yes 1 No 1Ifyes,pleasegivedetailsoffrequency?DropdownmenuselectionIfNo,whenwasthelastsurveyconducted?DropdownmenuselectionOrc)Pleaseindicateatwhichlevelcomputerisedrecordsystemsareused?

VaccineTargetGroups Childhood Subnational/national/national+subnational/none/notapplicable

Adolescents Subnational/national/national+subnational/none/notapplicable

Adults Subnational/national/national+subnational/none/notapplicable

Elderly Subnational/national/national+subnational/none/notapplicable

Ifcomputerisedrecordsystemsused,isthesamemethodsbeingusedinallsubregions? 1Yes,inallsubnationalunits 1Yes,insomesubnationalunits 1Other,specify__________Q21.Isvaccinationcoverageforallrecommendedchildhoodvaccinationsmeasuredwiththesamemethodologyasyouprovidedabove(e.g.DTP)Vaccine VaccinationcoveragemethodsmeasurmentMeasles Yes/No

IfNO,thesamequestionsasQ20.1willopen.Mumps Yes/No/Ifno,pleasedescribe_________Rubella Yes/No/Ifno,pleasedescribe_________HepB Yes/No/Ifno,pleasedescribe_________Polio Yes/No/Ifno,pleasedescribe_________Hib Yes/No/Ifno,pleasedescribe_________Varicella Yes/No/Ifno,pleasedescribe_________PCV&7,10,13 Yes/No/Ifno,pleasedescribe_________Pneumo23 Yes/No/Ifno,pleasedescribe_________

MenC Yes/No/Ifno,pleasedescribe_________HPV Yes/No/Ifno,pleasedescribe_________BCG Yes/No/Ifno,pleasedescribe_________Rotavirus Yes/No/Ifno,pleasedescribe_________Commentsforthissection______________________________Vaccinationcoveragedatavalidation,feedbackandmeasureofperformanceindicatorsQ22.Doesyourcountryvalidatevaccinecoveragedata? Yes 1 No 1Ifyes,isvaccinationcoveragedatavalidationdone1Routinely(atdefinedtimetimes)forall1Routinely(atdefinedtimes)forasome(e.g.sample)1Occasionallyforallaspartofresearch1Occasionallyforsomeaspartofresearch1Other_______________Ifyes,pleaseindicatewhatmethodisusedtodoso:Vaccinesales Yes 1 No 1WHODataQualitySelfAssessmenttool Yes 1 No 1Recountsofvaccinationrecords Yes 1 No 1Other Yes 1 No 1Ifother,pleasedescribe__________________________________________________Describebrieflyforwhichvaccinesandthefrequency________________________Q23.Doesyourcountryprovide(print/distribute)orhaveavailableonthewebtobedownloaded,astandardauthorisedvaccinationrecord?Pleasespecify: Personalimmunisationrecord(forparents/guardiansofcthechild) Yes 1 No 1 Healthcareproviderrecord(e.g.Generalpractitioner,immunisationoffice) Yes 1 No 1 Q24.Doesyourcountryroutinelyorsometimesassessimmunisationcoverageperformanceindicators(detailedinnextquestion)?

1Yes,routinely1Yes,sometimes1Notroutinelybutifneeded1Never

Ifyes,pleaseindicatewhichoftheperformanceindicatorslistedbelowyourcountryusesforassessingimmunisationcoverage.(Pleaseseeglossaryforexplanations)Up‐to‐dateimmunisation Yes 1 No 1On‐timeimmunisation Yes 1 No 1Latestartrates Yes 1 No 1Drop‐offrates Yes 1 No 1ValidDoses Yes 1 No 1 Other_______________________________________________________________Q25.Doesyourcountryhaveagreedstandardsforimmunisationcoverageassessment?

PleaseseeAppendixAforAmericanStandardsasanexample.

Yes 1 No 1Ifyesandthisisinanylanguagepleaseattachbyemailto[emailprotected]orfaxto0035318561299Ifno,pleasegotoQ26.Commentsforthissection______________________________E‐HealthsystemQ26.Hasyourcountryimplementedane‐Healthsystemcoveringwholecountry? Yes 1 No 1Ifyes,isimmunisationquestionsareincludedtothatsystem?

Yes 1 No 1Ifyes,doespublichealthofficialshaveanaccess(receivedata)tothesedata?

Yes 1 No 1Ifyesifthesedataareavailableat(tickallthatapplies): 1Individuallevel

1Asaggregated1Nationallevel1Subnationallevel1Other,specify_____

Comments______________________________________Ifno,toQ26.Doesyourcountryhaveaplantointroducee‐Healthinthenearestfuture(5years)? Yes 1 No 1Ifyes,willitcontainanimmunisatione‐Healthcomponent? Yes 1 No 1Ifyes,willpublichealthofficialswillhaveaccesstothisinformation? Yes 1 No 1Ifyes,willthesedatabeavailableat: 1Individuallevel

1Asaggregateddataonly1AvailableatNationallevel1AvailableatSubnationallevel1Other,specify_____

Comments______________________________________ Immunisation registries

Q27.Doesyourcountryhave?

a)anationalcomputerisedimmunisationregistry?Yes1No 1

ifyesgotoQ29ifnoanswerpartb)

b)subnationalcomputerisedimmunisationregistry?

Yes 1 No 1ifnogotoQ28.

ifyesgotoQ29

Q28.Doesyourcountryintendtodevelopanationalimmunisationregistry?

Yes 1 No 1

ifno,gotoQ46 ifyesgotoQ28aandcompletetheremainderofthequestionnaire

Q28a.Ifyes,whendoyouenvisageanationalstartupdate?

Pleaseinsertdropdownmenuwithmonthandyear Alsopleaseinsert“notknown”option Q29.Doesyourcountryhavelegislationauthorisingimmunisationregistriesensuringprivacyandconfidentialityinrelationtotheuseofsuchregistries?

Yes 1 No 1

Q29a.Ifyes,whoischargedwithensuringlegislationisappliedandmonitored?______________________________________________________________

Q30. For those countries who have an immunisation registry, is data entry completed by health provider (public health doctor, public nurse, primary care physician etc.) healthprovider Yes 1 No 1 other Yes 1 No 1

ifother,pleasespecify_________________________________Q30a.pleaseindicateiftheimmunisationdataentryrelatedtonationalprogrammeisvoluntaryorcompulsory

Childhoodvaccinationprogram Voluntary/Compulsory/NotapplicableAdultvaccinationprogram Voluntary/Compulsory/Notapplicable

Q31.Isconsentfromthevaccinee/parent/legalguardianrequiredforinclusionontheimmunizationregistry?

Yes 1 No 1Ifyes,inwhatformisconsentgiven?

Verbalconsent Yes 1 No 1 Signedofficialimmunizationform Yes 1 No 1

Signedconsentbutnotonofficialform Yes 1 No 1Q32.Isconfidentialityofdataprotectedbycurrentlegislationinyourcountry?

Yes 1 No 1Q33.Doesyourcountryhaveagreedcoredatasetforyourimmunisationregistry(orregistries)? Yes 1 No 1Ifyes,isthisagreementis:

1National 1Subnational 1VariesamongsubnationalunitsIfyes,pleaseattachviaemail[emailprotected]orfaxto0035318561299inanylanguage.Q34.Doesyourcountryrecordnamedpatient(i.e.first,middleandlastnames)dataonyourregistry?

Yes 1 No 1

Q35.Doesyourcountryuseauniqueidentifyingnumber/personalidentifierinyourregistry(orregistries)? Yes 1 No 1Q36.Doyouhaveauniqueidentifyingnumberforallhealthsystemencountersinyourcountry? Yes 1 No 1Q36a.Ifyes,isthisthesamenumber? Yes 1 No 1 Ifnot,canthedataforthedifferentencountersbelinked?

Yes 1 No 1Q37.Whatagesarecoveredintheregistry(Dropdownmenu) 1Allages(children/adolescents/adults)1Children<5years1Children<6years1Children<7years1Children/adolescents<16years1Allchildren/adolescents(<18years)1Variesbysubnationallevel1Other,specify_____________

Q38.Whohasaccesstotheinformationontheregistry?MinistryofHealth Yes 1 No 1 Publichealthdoctors Yes 1 No 1Publichealthnurses Yes 1 No 1Primarycarestaff(physicians/nurses):

Public Yes 1 No 1Private Yes 1 No 1

Hospitalstaff:Public Yes 1 No 1Private Yes 1 No 1

Vaccinee/Parent/LegalGuardian Yes 1 No 1 VaccineManufacturers Yes 1 No 1MedicalProductsAgency Yes 1 No 1NationalImmunisationProgramYes 1 No 1Other______________________________________ Q39.Areadversevaccinerelatedeventsrecordedintheregistry?

Yes 1 No 1

Q39a.Ifnot,istheregistrycapableoflinkingtoadverseeventdatabases? Yes 1 No 1

‐Q40.Istheimmunisationregistrycapableoflinkingwithvaccinepreventablediseasereportingi.e.surveillancedata?

Yes 1 No 1Q40a.Canthesesystemsdetectandreportvaccinefailures?

Yes 1 No 1Q41.Istheimmunisationregistrycapableofmanagingvaccineinventories?

Yes 1 No 1

Q42.Cantheimmunisationregistryissuereminderandrecallnotificationsto? Vaccinee Yes 1 No 1Healthcareprovider Yes 1 No 1 Q43.Cantheimmunisationregistrybeusedforstatisticalpurposes?

Yes 1 No 1Q44.Canthesystemprovideinformationtothevaccineeonimmunisations(eg.obtainrecordofcompletedvaccinations)?

Yes 1 No 1Q45.Cantheregistrybeasourceoffeedbackinformationtohealthproviders?

Yes 1 No 1Q.46Werealisethatdifferentterminologyisusedforindicatingages.Inordertoavoidanymisunderstanding,wekindlyaskyoutoanswertothefollowingquestion.Fordatacollectionpurpose,yousaythatagirlborninJanuary1999is:

112yearold(shehascelebratedher12thbirthday)113yearold(sheislivingher13thyearoflife)

Thankyouverymuchforyourtime.

Appendix2.Definitions:Fullimmunisationseries–recipientreceivedprimaryimmunisationandboosterdosebytheage24monthsandisconsideredappropriatelyvaccinatedforageaccordingtoImmunisationScheduleintheMSsImmunisationprogramme.Primaryimmunisationseries–therecipientreceivedappropriatenumberofdosesattheappropriateminimaltimeintervalsinaccordancewithofficialrecommendations(numberofdosesrequiredaspartofprimaryimmunisationserieswillvaryaccordingtocountriesImmunisationScheduleoftheMSsImmunisationprogramme).Boosterdose‐therecipientreceivedonedoseofvaccinewithrelevanttimeintervalforthatvaccineafterprimaryimmunisationseriesinordertoraiseantibodiesbacktoprotectivelevels.Fullimmunisationseries=primaryimmunisationseries+booster.(mainlyforinactivatedvaccines)Singledose‐therecipientreceivedonedoseofvaccinethatcanbecombinationofvaccines(e.g.DTP,onedoseofhexavalentvaccinee.g.DTP,Polio,Hib,HepB)orhaveonlyoneantigen(e.g.MenC).Multidosevaccines‐vaccinethatrequiretwoormoredosesofthesamevaccinefordevelopmentofadequateandpersistingantibodyresponse.Combinationvaccinesaredevelopedtoprotectmorethanoneinfection.Theterm“combinedvaccines”mayalsobeusedtodescribethemixtureoftwoseparatevaccinesinasinglevialpriortoadministrationorvaccinesthatareseparatelymanufacturedbutcombinedintooneproductduringthefinalpackagingstages.Polyvalentvaccinesagainstmultiplestrainsorserotypesofthesameinfectiousagentarenotconsideredtobecombinationvaccines.Ageappropriatevaccinations‐therecipientwhor*ceivedalldosesofvaccinesbyadefinedageasspecifiedbytheImmunizationScheduleoftheMsImmunisationProgram.Definitionofa*geinthissurveye.g.12yearoldwemeanthatthisisapersonwhocelebratedthe12thbirthdayandthispersonwillbeaccountedas12yearoldby12years,11monthsand29or30daysaccordingmonthofbirth(bythenext13thbirthday).Theagelimitbetweenchildandadolescentinthissurveydefinedasadolescentrecipientofvaccine>12years.Theagelimitbetweenadolescentandadultdefineinthissurveyasadultrecipientofvaccine>18years.Vaccinefailure‐iswhenanorganismdevelopsadiseaseinspiteofbeingvaccinatedagainstit.Primaryvaccinefailureoccurswhenanorganism'simmunesystemdoesnotproduceenoughantibodieswhenfirstvaccinated.Secondaryvaccinefailureoccurswhenenoughantibodiesareproducedimmediatelyafterthevaccination,butthelevelsfallovertime.Whileantibodylevelsalwaysfallovertime,thiswouldbeamorerapidlossofimmunitythanexpectedforthatvaccine.http://en.wikipedia.org/wiki/Vaccine_failureRecommendedvaccines–wemeaninthissurveyvaccinesthatareincludedinyourcountriesofficialImmunisationProgramme.

Up‐to‐dateimmunisationisdefinedasthereceiptofthefullnumberofdosesbytheassessedageaccordingtorecommendationsoftheNationalAdvisoryCommitteeonImmunisation.(E.g.assessedat12monthsor24months)

On‐timeimmunisationisdefinedasage‐specificreceiptofimmunisationduringacceptabletimeperiodsaccordingtorecommendationsoftheNationalAdvisoryCommitteeonImmunisation.Measuredinsomeareasasmedianageinmonthsatreceiptofeachvaccinedose.

Latestartrates%infantswhodon’thavefirstdosebycertainage.

Drop–offrates%childrenwithDTP1at6months‐%withDTP3at12months.

Validdoses%dosesthatwereadministeredwhenthechildhadreachedtheminimumageforthevaccine,andwereadministeredwiththeproperspacingbetweendosesaccordingthenationalschedule.Underimmunised(hardtoreach)individuals(orgroupsofindividuals)aredefinedas:1.Hardcoreopponents(e.g.personsopposedtoimmunisationbasedonreligiousorphilosophicalbeliefs),2.Theinadequatelyinformed(e.g.parentswhoseekmoreinformationthatwhatisroutinelyprovided)and3.Thosewithdecreasedaccesstothehealthsystem(e.g.migrantsandethnicminorities).http://www.euro.who.int/__data/assets/pdf_file/0007/79036/E86885.pdfMigrant‐theperson(orgroups)whom*ovefromonecountryorlocalitytoanother.http://www.google.com/search?hl=en&rls=com.microsoft:en‐US&defl=en&q=define:Migrants&sa=X&ei=x9yRTefQM8u4hAeUkMmgDw&sqi=2&ved=0CBoQkAEARefugee‐isapersonwhohasbeenforcedtoleavehisorherhomeandseekrefugeelsewhere.UndertheUnitedNationsConventionRelatingtotheStatusofRefugeesof1951,arefugeeismorenarrowlydefined(inArticle1A)asapersonwho"owingtoawell‐foundedfearofbeingpersecutedforreasonsofrace,religion,nationality,membershipofaparticularsocialgroup,orpoliticalopinion,isoutsidethecountryofhisnationality,andisunabletoor,owingtosuchfear,isunwillingtoavailhimselfoftheprotectionofthatcountry".http://en.wikipedia.org/wiki/RefugeesEthnicminorities‐agroupthathasdifferentnationalorculturaltraditionsfromthemajorityofthepopulation.http://www.thefreedictionary.com/ethnic+minorityHomeless‐categorizestheconditionofpeoplewithoutaregulardwellingbecausetheyareunabletoacquire,maintainregular,safe,andadequatehousing,orlack"fixed,regular,andadequatenighttimeresidence.http://en.wikipedia.org/wiki/HomelessE‐Healthsystem‐meanstheElectronicHealthRecord,whichallowsthesharingofnecessaryinformationbetweencareprovidersacrossmedicaldisciplinesandinstitutions.http://www.hc‐sc.gc.ca/hcs‐sss/ehealth‐esante/index‐eng.phpSociallyandeconomicallydisadvantaged‐TheU.S.governmentdefines“sociallyandeconomicallydisadvantaged”individualsundertheSmallBusinessAct(15USC637)as:(5)Sociallydisadvantagedindividualsarethosewhohavebeensubjectedtoracialorethnicprejudiceorculturalbiasbecauseoftheiridentityasamemberofa*groupwithoutregardtotheirindividualqualities.

(6)(A)Economicallydisadvantagedindividualsarethosesociallydisadvantagedindividualswhoseabilitytocompeteinthefreeenterprisesystemhasbeenimpairedduetodiminishedcapitalandcreditopportunitiesascomparedtoothersinthesamebusinessareawhoarenotsociallydisadvantaged.IndeterminingthedegreeofdiminishedcreditandcapitalopportunitiestheAdministrationshallconsider,butnotbelimitedto,theassetsandnetworthofsuchsociallydisadvantagedindividual.http://womeninbusiness.about.com/od/smallbusinessfunding/a/sbadefsociodis.htmAnthroposophy:Knowledgeofthenatureofman.AspiritualandmysticaldoctrinethatgrewoutoftheosophyandderivesmainlyfromthephilosophyofRudolphSteiner,Austriansocialphilosopher(1861‐1925).(Webster,3ded)ChildrenattendingSteinerschoolsoftenhaveananthroposophic(holistic)lifestyleinwhichsomeimmunizationsareavoidedorpostponed.HealthCareWorkers‐TheAssociationofNationalHealthOccupationalPhysicians(ANHOPS)guidanceonImmunisationofhealthcareworkersdefinesthreecategoriesofhealthcareworkers:

1. Clinicalandotherstaff,includingthoseinprimarycare,whohaveregular,clinicalcontactwithpatients.Thisincludesstaffsuchasdoctors,dentistsandnurses,paramedicalprofessionalssuchasoccupationaltherapists,physiotherapists,radiographers,ambulanceworkersandporters,andstudentsinthesedisciplines;

2. Laboratoryandotherstaff(includingmortuarystaff)whohavedirectcontactwithpotentiallyinfectiousclinicalspecimensandmayadditionallybeexposedtopathogensinthelaboratory.Thisincludesthoseinacademic(orcommercialresearch)laboratorieswhohandleclinicalspecimens.Theydonotnormallyhavedirectcontactwithpatients;

3. Non‐clinicalancillarystaffwhomayhavesocialcontactwithpatients,butnotusuallyofaprolongedorclosenature.Thisgroupincludesreceptionists,wardclerksandotheradministrativestaffworkinginhospitalsandprimarycaresettingsandmaintenancestaffsuchasengineers,gardeners,cleaners,etc.Thesestaffmaybeexposedtootherspecificoccupationalriskswhichrequiretheirownsurveillanceprogrammes.

http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733758763

Appendix3.AmericanStandardsforImmunisationRegistries.NationalImmunizationProgram,2001Immunizationregistryminimumfunctionalstandardshttp://www.cdc.gov/vaccines/programs/iis/stds/min‐funct‐std‐2001.htmStandard#1Electronicallystoredataonallapprovedcoredataelements.Definition:theregistry’scomputerdatabasecontainfieldsforallNVAC∗‐approvedcoredataelements.Theseelementsare:patientname(first,middleandlast);patientbirthdate;patientsex;patientbirthstate/country;mother’sname(firstmiddlelastandmaiden);vaccinetype;vaccinemanufacturer;vaccinationdate;andvaccinelotnumber.∗NVACNationalVaccineAdvisoryCommittee,UnitedStates.Standard#2Establisharegistryrecordwithin6weeksofbirthforeachnewbornchildborninthecatchmentareaStandard#3EnableaccesstoandretrievalofimmunizationinformationintheregistryatthetimeoftheencounterStandard#4Receiveandprocessimmunizationinformationwithin1monthofvaccineadministrationStandard#5ProtecttheconfidentialityofhealthcareinformationDefinition:theregistryhaswrittenconfidentialitypoliciesandproceduresinplaceandimplemented.AccesstoregistryinformationislimitedandaudittrailsaremonitoredStandard#6EnsurethesecurityofhealthcareinformationDefinition:theregistryhaswrittensecuritypoliciesandproceduresinplaceandimplemented,includingadministrativeandtechnicalpracticesandphysicalsafeguardstoprotecthealthcareinformation.Standard#7ExchangeinformationusingHealthLevelSeven(HL7)standardsThisstandardusesacommonformattoallowregistriestoexchangeinformationwhenneededandallowsdisparatesystemstotalktooneanother.Thestandardalsodefinesvocabularyformanufacturersandvaccinenames.Standard#8Automaticallydeterminetheroutinechildhoodimmunization(s)needed,incompliancewithcurrentACIPrecommendations,whenanindividualpresentsforascheduledimmunizationStandard#9Automaticallyidentifyindividualsdue/lateforimmunization(s)toenabletheproductionofreminder/recallnotificationsStandard#10Automaticallyproduceimmunizationcoveragereportsbyproviders,agegroupsandgeographicareasStandard#10Produceofficialimmunizationrecords

Standard#12PromoteaccuracyandcompletenessofregistrydataDefinition;Theregistryhasdevelopedandimplementedadataqualityprotocoltocombineallavailableinformationrelatingtoaparticularindividualintoasingle,accurateimmunizationrecord

Vaccination coverage assessment in 2011 - VENICE IIIvenice.cineca.org/Final_Vaccination_Coverage_Assesment... · on vaccination coverage assessment in 2011.[3] Objective The objective - [PDF Document] (2024)

FAQs

How to measure vaccine coverage? ›

Local, state, and federal health departments use surveys and other data sources such as immunization information systems (IISs) to estimate vaccination coverage (the proportion of children receiving vaccinations) and identify where additional efforts are needed to increase vaccination coverage.

Learn More Now ›

What is the formula for vaccination coverage? ›

The estimate of immunization coverage is derived by dividing the total number of vaccinations given by the number of children in the target population, often based on census projections.

State	% of population with at least one dose	% fully vaccinated
CA	85.2%	74.2%
CO	82.2%	72.4%
CT	>95%*	81.8%
DE	86.3%	71.8%

Which state has the least vaccinated children? ›

Which states have the lowest vaccination rates?

Alaska, 62.7%
West Virginia, 63.5%
Louisiana, 65.7%
New Jersey, 69.3%
Georgia, 69.8%

Nov 9, 2023

Read The Full Story ›

How is the vaccination rate calculated? ›

Administrative coverage with a given vaccine is calculated as the number of doses administered in a specified target group divided by the estimated target population.

Discover More Details ›

How are vaccines measured? ›

Vaccine effectiveness is generally measured by comparing the frequency of health outcomes in vaccinated and unvaccinated people. Absolute vaccine effectiveness is a term that can be applied when the study compares vaccinated people to unvaccinated people.

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What is the immunization coverage assessment? ›

The primary objective of an immunization coverage survey is to provide a coverage estimate for selected vaccines or a set of vaccines (fully vaccinated for age) among infants, children and/or women of childbearing age, etc.

How to calculate vaccine estimation? ›

The calculation can be summarised using the equation shown below: Annual vaccine needs = pt x dn x ic x wf.

Get More Info ›

What is the formula to calculate vaccine efficacy? ›

To estimate vaccine protective efficacy, defined as VE = 1 - ARV/ARU where ARV is the disease attack rate in the vaccinated group and ARU is the disease attack rate in the controls, investigators have used both cohort and case-control designs.

Show Me More ›

Vaccination coverage assessment in 2011 - VENICE IIIvenice.cineca.org/Final_Vaccination_Coverage_Assesment... · on vaccination coverage assessment in 2011.[3] Objective The objective - [PDF Document] (2024)

FAQs

How to measure vaccine coverage? ›

Which state has the least vaccinated children? ›