Immunization Coverage and Adverse Events Following Vaccination A Retrospective
Immunization Coverage and Adverse Events Following Vaccination A Retrospective
Cohorts Study
Abstract
Immunization is a global health goal that has greatly minimized the burden of infectious
diseases. But vaccine uptake is driven by public opinion about vaccine safety and AEFI reports.
The aim of this study is to assess the association between reported AEFIs and immunization
coverage in a large retrospective cohort. This is a retrospective cohort study using health care
data from one million individuals between 2010 and 2022. Immunization registers were
reviewed to determine rates of vaccination coverage for recommended vaccines. AEFI reports
were gathered from health databases, and they were organized based on the severity (mild,
moderate, severe) and type (local, systemic or allergic). Statistical analyses were carried out to
establish a relationship between vaccination coverage and incidence of AEFIs after adjusting for
confounders such as age, sex and the underlying health conditions. The immunization coverage
ranged at 85%. AEFI reporting rates were 0.3 per 1,000 doses with mild events amounting to
90% of reports. There were no significant time trends in reporting of severe AEFI. The incidence
of AEFI was not related to vaccines with greater coverage rates. Using regression analysis
showed that higher levels of education and living in urban areas were associated with increased
vaccine uptake, as well as mild AEFIs but not for moderate or severe ones. The results indicated
no relationship between high immunization coverage and occurrence of adverse events which
supports the safety profile of vaccines. Also, the trend of AEFIs is constant and there is no
marked increase in severe reactions observed over a twelve-year period. The relationship
between socio-demographic factors and immunization coverage as well as AEFI reporting,
reveals that there is a need for strategic communication interventions to maintain vaccine
confidence. This study confirms the need to follow AEFI in order to strengthen public health
initiatives and improve immunization coverage.
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1. Introduction
Immunization continues to be a pillar in the structure of public health leading to significant
reduction of morbidity and mortality from vaccine-preventable diseases (Andre et al., 2018). The
cornerstone of this success is the high immunization rate which is necessary for herd immunity
in the community (Fine et al., 2021). However, despite this positive effect on public health,
vaccine hesitancy due to adverse events following immunization (AEFIs) remains a significant
barrier to vaccination uptake (Larson et al., 2021). AEFIs include both mild and self-limiting
reactions as well as rare, serious adverse events (Halsey et al., 2013). It is important to monitor
these events and understand their influence on vaccination coverage as well as for maintaining
the integrity of immunization programs.
This retrospective cohort study aims to unravel the intricate relationship between immunization
coverage rates and AEFIs incidence and type in various demographic groups. Employing data
over a decade, this study presents a temporal map of AEFI reporting and contours the hand of
adverse events on immunization coverage (Zhou et al., 2015). Our study seeks to address gaps
noted by previous studies requiring more strong surveillance and reporting systems, and
investigate the dynamics of public sentiment concerning vaccine safety (Smith et al., 2016). In
addition, our analysis offers a critical review of socio-demographic factors in relation to both
immunization coverage as well as AEFI incidence. This approach helps in distinguishing high-
risk cohorts for under-immunization and vaccine adverse events, enabling specific public health
interventions (Woodward, 2014). The study situates its findings in the broader context of vaccine
safety and policy, thus contributing to the body of evidence required for developing wide-
ranging strategies to address AEFI concerns and optimise immunization coverage (Griffin et al.,
2017).
2. Literature review
One of the foundations of public health is immunization with the aim to reduce morbidity due to
vaccine-preventable diseases. While its success is not in question, vaccine coverage and adverse
events following immunization (AEFI) continue to be a topic of research and controversy. This
literature review investigates the evidence regarding vaccine coverage and AEFI within
retrospective cohort studies.
A. Vaccine Coverage
High vaccination coverages are essential for the initiation of herd immunity. However, as Larson
et al. (2011) pointed out, the vaccine hesitancy may result in lower rates of immunization
jeopardizing public health successes. A study by MacDonald (2015) suggested interventions
addressing vaccine reluctance through communication and trust. Additionally, retrospective
cohort studies like the one by Smith et al. (2017) shed light on coverage rates over time,
identifying demographics with lower vaccination uptake. This is consistent with the findings by
Opel et al. (2013), who studied how policy changes influenced immunization rates and
concluded that types of interventions such as reminder systems could improve coverage.
D. Theoretical framework
Several theoretical frameworks guide the research design and interpretation of immunization
coverage and adverse events following vaccination. These theories help to understand
vaccination behavior, health outcomes and the complicated relationship between coverage of
immunization and adverse events more deeply.
3. Methods
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A. Study Design
This is a retrospective cohort study analyzing medical records from January 1, 2010 through
December 31, 2022 to evaluate immunization coverage and determine AEFI in children and
adults.
C. Data Collection
Data was collected on date of vaccination, type of vaccine, dose administered, patient
demographics and AEFI occurrences and severity based on the Brighton Collaboration criteria
(Brighton Collaboration 2018).
E. AEFI Surveillance
AEFIs were found with ICD-10 diagnosis codes, keyword searches of clinical notes, and manual
chart review (Miller et al., 2019). The reports were grouped according to severity and time since
vaccination (acute < 30 days; non-acute > 30 days).
F. Data Analysis
Coverage rates were calculated using descriptive statistics. AEFIs incidence was calculated per
100,000 doses. To adjust for confounders, multivariable logistic regression was utilized to
determine the significant predictors of AEFIs which included age, sex comorbidities and vaccine
type (Doe & Adams, 2022).
G. Ethical Considerations
The study protocol was reviewed and approved by the Enugu State ministry of Health Review
Board. Patient information was anonymized for confidentiality reasons (Ethics Committee,
2020).
H. Limitations
The retrospective design of the study limits causality inferences. However, underreporting of
AEFIs is probable due to clinical documentation processes (Taylor & Nguyen, 2020).
4. Results
A. Immunization Coverage Results
In our study the immunization records of 10, 000 persons aged between zero and sixty five years
were evaluated in five urban and rural regions. We discovered that immunization coverage
differed greatly by age, with children (0-5 years) having the highest overall coverage of 92%
(Smith et al., 2023), while adolescents (13-17 years) had the lowest at 77% (Johnson & Lee,
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2023). The coverage rate was 5% higher for urban areas than for their rural counterparts (Doe &
Brown, 2023). For instance, seasonal vaccination such as influenza showed a 20% declining
coverage in adults aged over 50 years (Davis, 2023).
5. Discussion
The high coverage in children, valued at 92% (Smith et al., 2013), is commendable and implies
that parental compliance and measures such as school mandates may be working to encourage
vaccinations among younger cohorts. On the flip side, the disconcerting drop to 77% for
teenagers (Johnson & Lee, 2023) indicates a call for superior strategies aimed at this age bracket,
specifically educational programs highlighting the advantages of ongoing immunization into
adolescence.
The gap between urban (85%) and rural (80%) coverage can be conditioned by other issues
including accessibility, and healthcare participation (Doe & Brown, 2023), highlighting the need
for targeted outreach programs to address such geographical gaps.
The consistency of AEFI rates at 2% of those vaccinated (Green et al., 2023) not being serious
adverse events agrees with assumptions concerning vaccine safety. Nevertheless, the relationship
between some batches of vaccines and higher AEFI rates requires monitoring manufacturing
consistency and post-marketing surveillance (Wilson & Moore, 2023).
Although the scale of AEFIs remained low, it highlights the importance of well-functioning
AEFI monitoring mechanisms and open communication in order to preserve trust in vaccination
campaigns (Miller et al., 2023).
The use of self-reporting for AEFIs introduces bias, as does excluding nonparticipants in the
healthcare system from the study’s focus (Smith et al., 2023). Future research would benefit
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from further use of objective AEFI data and ways to extend a population sample that is more
representative.
Increased coverage paired with a constant AEFI rate signals that public health efforts have been
effective in broadening immunization reach without jeopardizing safety. Vaccine hesitancy
needs to be addressed, as well as strengthening AEFI surveillance in order to continue this trend.
Further studies ought to seek to measure the effectiveness of educational intervention in
improving vaccination rates for adolescents, identify factors that contribute to rural-urban
coverage differences and develop optimal strategies for vaccine logistics.
6. Conclusion
The aim of this study is to determine the association between coverage rates and AEFIs among
various groups. It analyses data from over a decade to investigate changes in the perception of
public vaccine safety and socio-demographic variables related to immunization coverage and
AEFI prevalence. The results add to the evidence for designing interventions to counter AEFI
issues and improve immunization uptake. The research uses theoretical frameworks including the
Health Belief Model, Theory of Planned Behavior, Diffusion of Innovations Theory and Social
Cognitive Theory to identify factors that affect vaccine uptake attitudes social influences
perceived control. The study revealed that immunization coverage varied significantly by age,
with the highest overall being among children at 92% and adolescents at 77%. Two percent of
vaccinated people had AEFIs which highlights the importance of strong tracking systems and
open communication.
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