Immunization coverage rate by vaccine for each vaccine in the national schedule

Percent of the target population that has received the last recommended dose for each vaccine recommended in the national schedule by vaccine. This should include all vaccines within a country’s routine immunization schedule (e.g., Bacillus Calmette–Guérin (BCG); polio; pneumococcal conjugate vaccine (PCV); rotavirus; diphtheria, tetanus, pertussis-Hepatitis B-Haemophilus influenzae type B vaccine (DTP-HepBHib); measles (MCV); rubella; human papilloma virus (HPV); tetanus toxoid (TT); influenza; and others as determined by the national schedule).


The number of individuals in the target group for each vaccine that has received the last recommended dose in the series. For vaccines in the infant immunization schedule, this would be the number of children aged 12–23 months who have received the specified vaccinations before their first birthday.


The total number of individuals in the target group for each vaccine. For vaccines in the infant immunization schedule, this would be the total number of infants surviving to age one.


Age, place of residence, sex, socioeconomic status.

DTP1-DTP3 dropout rate, MCV1-MCV2 dropout, full immunization coverage where possible.


Example of a national schedule is:

  • At birth: BCG, HepB, oral polio vaccine
  • At 6, 10 and 14 weeks: DTP-HepB-Hib, PCV, rotavirus, oral polio vaccine (with one dose of inactivated polio vaccine)
  • At 9 months: measles
  • At 18 months measles
  • For adolescents: HPV
  • TT: multiple
  • For persons aged over 60 years: influenza.

For survey data, the vaccination status of children aged 12–23 months is used for vaccines included in the infant immunization schedule, collected from child health cards or, if there is no card, from recall by the care-taker.


Household surveys

Facility information systems


Child immunization is one of the most cost-effective public health interventions for reducing child morbidity and mortality. The ultimate goal of immunization programs is to reduce the incidence of vaccine-preventable diseases in children by attaining high levels of coverage with potent vaccines administered at the appropriate ages (and recommended intervals between doses for multiple dose vaccines).

Estimates of vaccination coverage among children are used to monitor vaccination services, to guide disease eradication and elimination programmes and as indicators of health system performance.


Immunization coverage rates are usually based on routine data derived from tally sheets that are filled out at the health facility level. Coverage
rates can vary greatly by source of data. Users have to be aware, therefore, of the strengths and limitations of each data source in order to make sense of any data.

The indicator is only a measure of completion of the recommended immunization schedule, and does not measure protection. The impact of immunization on disease is dependent on the timing and number of doses received, as well as the efficacy of vaccine. The indicator does not reflect whether vaccines are given at the recommended ages or at the recommended minimum interval of four weeks between consecutive doses of DTP and OPV (and HEPB and Hib, if included in national definitions).

Information can usually be derived from population-based surveys. Surveys are expensive and done infrequently; so this indicator can only be estimated every 3-5 years (though in some countries, such as Bangladesh, it is estimated every two years). The absence of vaccination cards limits the reliability of this indicator. Care should be taken when designing cluster surveys to ensure representation and to avoid selection bias by following the protocol.


Pediatric care, Immunization, Reproductive Health, Child health, Adolescent health

World Health Organization (WHO). 2015 Global Reference List of 100 Core Health Indicators.; 2015. http://apps.who.int/iris/bitstream/10665/173589/1/WHO_HIS_HSI_2015.3_eng.pdf

World Health Organization. Nutrition Landscape Information System (NLIS). Country Profile Indicators: Interpretation Guide. Geneva, Switzerland; 2010. http://apps.who.int/iris/bitstream/10665/44397/1/9789241599955_eng.pdf

Gage AJ, Ali D, Suzuki C. A Guide for Monitoring and Evaluating Child Health Programs. MEASURE Evaluation. Carolina Population Center, University of North Carolina at Chapel Hill.; 2005. http://www.coregroup.org/storage/documents/Workingpapers/ms-05-15.pdf

 

Further information and related links

Countdown to 2015. Monitoring maternal, newborn and child health: understanding key progress indicators. Geneva: World Health Organization; 2011 (Retrieved from http://apps.who.int/iris/bitstream/10665/44770/1/9789241502818_eng.pdf).