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Original article

Mandatory vaccination coverage in the territory of the Mačva District in the period between 2011 and 2021

Ana Pajičić1, Aleksandra Jović-Vraneš2, Branko Vujković1
  • Institute of Public Health Šabac, Šabac, Serbia
  • University of Belgrade, Faculty of Medicine, Institute of Social Medicine, Belgrade, Serbia

ABSTRACT

Introduction: The vaccine is one of medicine’s oldest and most valuable inventions. It is a simple, safe, and effective way to protect against infectious diseases, a proven and cost-effective public health strategy that safeguards both individuals and the entire community. On the other hand, it has become a victim of its own success, as many vaccine-preventable diseases have become so rare that some people believe they have been eradicated forever, and do not understand the benefits of vaccination nor the risks of it not being conducted. This study aimed to analyze vaccination coverage throughout the Mačva District, in the period between 2011 and 2021.

Materials and methods: The study used a retrospective analysis of secondary data from annual reports submitted by community health centers, in the territory of the Mačva District, for the period between 2011 and 2021. For the purpose of this study, vaccination coverage was calculated based on the number of newborn babies in a given year. Data from community health centers are submitted to the Institute of Public Health Šabac, which is in charge of these issues for this district. Each report contains the number of individuals subject to mandatory immunization, the number of persons who have been vaccinated, as well as the percentage of vaccinated persons as compared to the number of persons who should have been vaccinated. The correlation and regression method was used to analyze the vaccination trend, i.e., the value of the Pearson correlation coefficient was interpreted and the equation of the regression line was calculated.

Results: In the Mačva District, mandatory vaccination coverage of children was observed in the period between 2011 and 2021. A negative trend was registered in vaccination coverage for all observed vaccines, except the trend related to vaccination for Haemophilus influenzae.

Conclusion: When all of the vaccines are observed together, vaccination coverage has been declining during the observed period. During 2021, not a single vaccine achieved 95% coverage. The declining trend indicates the need to promote vaccination as the safest and most effective protection against infectious diseases.


INTRODUCTION

The vaccine is one of the oldest discoveries in medicine, and the vaccination process itself is one of the most useful inventions that medicine has given to mankind. Since its introduction, in the 18th century, until today, numerous benefits of vaccination have been documented and scientifically proven. Vaccination is a simple, safe and effective of protection against certain diseases, it saves millions of lives every year. It is a proven, cost-effective public health strategy that protects both the individual and the entire community. At the same time, vaccination has become a victim of its own success, as many vaccine-preventable diseases have become so rare that some people believe they have been eradicated forever, and do not understand the benefits of vaccination nor the dangers of not being vaccinated. Current vaccination coverage rates in the WHO European Region are insufficient to ensure immunity and prevent the spread of vaccine-preventable diseases. In previous years, the rates of vaccination coverage, especially with certain vaccines, have declined in Serbia as well.

Legislation related to vaccination and the vaccination schedule

In Serbia, vaccination is regulated by the Law on Protection of the Population from Infectious Diseases (“Official Gazette of the Republic of Serbia”, No. 15/2016, 68/2020, and 136/2020), Rulebook on immunization and chemoprophylaxis (“Official Gazette of the Republic of Serbia”, No. 88/2017, 11/2018, 14/2018, 45/2018, 48/2018, 58/2018, 104/2018, 6/2021, 52/2021, and 66/2022), Rulebook on the Program of mandatory and recommended immunization of the population against certain infectious diseases (“Official Gazette of the Republic of Serbia”, No. 65/2020), Law on Medicine and Medical Devices (“Official Gazette of the Republic of Serbia”, No. 30/2010, 107/2012, 113/2017 – other law and 105/2017 – other law), Expert methodological instructions for the immunization of the population against certain infectious disease, Rulebook on reporting communicable diseases and special health issues (“Official Gazette of the Republic of Serbia”, No. 44/2017 and 58/2018), and the Manual on the monitoring of adverse events following immunization.

In the territory of the Mačva District, vaccination is carried out in community health centers in Loznica, Krupanj, Vladimirci, Bogatić, Šabac, Koceljeva, Ljubovija, and Mali Zvornik.

Infectious diseases against which mandatory active immunization of persons of a particular age is carried out are as follows: tuberculosis, diphtheria, tetanus, polio, whooping cough (pertussis), measles, rubella, mumps, hepatitis B, diseases caused by Haemophilus influenzae type b, diseases caused by Streptococcus pneumoniae (as of January 2018).

Sequence of administering vaccines, according to age, implemented in line with the mandatory vaccination schedule (Table 1)

Table 1. Sequence of administering vaccines, according to age

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Vaccination is carried out with vaccines and/or immunoglobulins of human origin, immunobiological preparations containing specific antibodies, and monoclonal antibodies.

The implementation of mandatory vaccination does not require the written consent of the person who is the legal representative of the child/person deprived of legal capacity. Mandatory vaccination cannot be refused, except in the case of a temporary or permanent contraindication, which is determined by a medical doctor or an expert team competent for making decisions on contraindications.

The organization and implementation of vaccination is carried out by the competent health institutions and health workers, according to the plan made on the basis of needs assessment.

The examination of the person that is to be vaccinated, the vaccination itself, as well the required record keeping of the administered vaccinations, is carried out by a medical doctor. The Institute of Public Health, i.e., its branch competent for the particular territory/region is in charge of supervising the implementation of vaccination.

Children of preschool and younger school age, as well as adolescents aged 10 – 18 years, are continuously vaccinated as part of regular wellness check-ups and follow-up examinations, in accordance with the Rulebook on immunization [4].

Public health benefits of vaccination

According to the Centers for Disease Control and Prevention (CDC), vaccination has been listed as the first among the ten major public health achievements of the twentieth century. Vaccination is one of the most effective, efficient, and cost-effective measures of public health intervention. Vaccination prevents between two and three million deaths per year. Vaccinating babies by the age of two is the best way to protect against serious childhood diseases, as well as to reduce child mortality.

Vaccination has reduced the overuse of antibiotics and the resistance to these drugs. It increases the life expectancy of the population and reduces absenteeism from work due to illness. Vaccination promotes equality for all, as it is accessible to all classes of society.

STUDY AIM

The aim of this study is to analyze coverage of mandatory vaccination throughout the Mačva District in the eleven-year period, from 2011 to 2021.

MATERIALS AND METHODS

Retrospective analysis of secondary data presented in the annual reports of the community health centers located in the Mačva District, for the period between 2011 and 2021, were used in the study. Data related to mandatory vaccination coverage for the observed period were analyzed.

There are eight community health centers located in the Mačva District: Community Health Center Šabac, Community Health Center Loznica, Community Health Center Bogatić, Community Health Center Vladimirci, Community Health Center Koceljeva, Community Health Center Krupanj, Community Health Center Mali Zvornik, Community Health Center Ljubovija. Data from community health centers are submitted to the Institute of Public Health Šabac, which is in charge of these issues for this district. Each report needs to include the following:
◆ number of persons subject to mandatory immunization
◆ number of vaccinated persons
◆ percentage of vaccinated persons as compared to the number of persons who should have been vaccinated.

For the purpose of this study, vaccination coverage was calculated based on the number of newborns in a given year.

Coverage was observed for the following vaccines: vaccine for tuberculosis, polio vaccine, vaccine for diphtheria, tetanus, and pertussis (Di-Te-Per), vaccine for Haemophilus influenzae, Hepatitis B vaccine, and the MMR vaccine.

Statistical data processing was performed using the IBM SPSS Statistics version 23 software. The data are presented in tables and graphs.

The correlation and regression method was used to analyze the vaccination trend, i.e., the value of the Pearson correlation coefficient was interpreted and the equation of the regression line was calculated. For the graphic display of these results, a scatter diagram was used, wherein the regression line was drawn.

The results were considered statistically significant if the significance (p-value) was less than or equal to 0.05.

RESULTS

Tuberculosis

In the observed period, the highest vaccination coverage for tuberculosis throughout the Mačva District territory was achieved in 2017 and was 98.26%, while the lowest percentage of vaccination was in 2015, amounting to 94.82%, which shows that there were no great oscillations in this period (Graph 1).

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Graph 1. Trend of vaccination coverage for tuberculosis in the period between 2011 and 2021

The Vladimirci municipality had the highest number of vaccinated persons in 2013 and 2017, when the compliance was 100%, and the lowest coverage was in 2019, when it was 90.91%.

In the Koceljeva municipality, in 2018, coverage was 100%, and the lowest coverage was in 2021, amounting to 84.00%.

The Krupanj municipality did not have full coverage in any year, the highest coverage was recorded in 2014 (99.09%) and the lowest coverage was in 2020, 91.53%.

The Loznica municipality had the highest vaccination coverage in 2015, when it was 98.97%, while the lowest coverage in this municipality was of 96.01%, recorded in 2018.

The Ljubovija municipality had 100% vaccination coverage in six years of the observed period, namely: 2011, 2012, 2013, 2017, 2019, and 2020. The lowest coverage was 87.21%, and it was recorded in 2015.

In the Mali Zvornik municipality, complete vaccination coverage was recorded in 2012, 2014, 2016 and 2019. The lowest coverage was in 2017, and it was 96.00%.

The Šabac municipality had the best vaccination coverage in 2017, when it was 100%, while the lowest percentage of vaccination was recorded in 2020, at 96.64%.

We found a strong negative trend (r = - 0.513), but it is not statistically significant (p = 0.107), (Graph 1).

Equation: Vaccination percentage = - 0.183 * year + 465.844

Polio

The highest vaccination coverage for polio, in the period we observed for the territory of the Mačva District, was recorded in 2012 and it amounted to 99.37%, while the lowest percentage of vaccination was in 2021 amounting to 84.74%, which was not a significant difference in the number of vaccinations (Graph 2).

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Graph 2. Trend of vaccination coverage for polio, in the Mačva District by municipality, 2011 – 2021

During the first part of the observed period, the Bogatić municipality had a high percentage of vaccinations, in 2011 and 2018 the coverage was as high as 100%, but in the last two years there has been a significant decrease in the number of vaccinations – in 2020 it amounted to 48.62%, while in 2021, there were 41.49% of vaccinations, which is less than half of the planned vaccinations.

The Vladimirci municipality recorded complete vaccination coverage for polio in six out of the eleven years of the observation period, and the lowest vaccination percentage was in 2014, a total of 88.82%.

The Koceljeva municipality had a 100% coverage in the first and last of the observed years, 2011 and 2021, while the lowest number of vaccinations was recorded in 2017, at 94.12%.

The Krupanj municipality had very slight deviations: in 2016, when vaccination coverage was 99.36%, in 2018, when the coverage was 99.45%, and in 2021, when the coverage was 99.22%, while in all other years of the observed period, vaccination coverage was 100%.

In the Loznica municipality, complete vaccination coverage was recorded for two years, in 2011 and 2021. The lowest coverage was in 2020, when 96.06% of the planned number of vaccinations was carried out.

The Ljubovija municipality had maximum vaccination coverage in years: 2011, 2012, 2019, 2020, and 2021. The lowest coverage was in 2017 amounting to 96.50%.

The Mali Zvornik municipality recorded complete vaccination coverage in 2013, 2017, 2018, 2019, and 2021. A decrease in the number of vaccinations was recorded in 2016 and it amounted to 84.92%.

During the observed period, the Šabac municipality did not record a 100% vaccination coverage in any of the years. The best result was recorded in 2012, when the vaccination percentage was 99.54%, while coverage was the lowest in 2021 with a vaccination percentage of 84.74%.

We found a moderate negative trend (r = - 0.633), which is statistically significant (p = 0.035), (Graph 2).

Equation: Vaccination percentage = - 0.829 * year + 1768.259

Di-Te-Per

The vaccination coverage for diphtheria, tetanus and pertussis (Di-Te-Per), in the observed period, for the Mačva District, was the best in 2011 and it amounted to 99.15%, while the lowest percentage was recorded in 2021, when it was 88.00%, which does not represent a significant deviation (Graph 3).

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Graph 3. Trend of vaccination coverage for diphtheria, tetanus and pertussis, in the Mačva District by municipality, 2011 – 2021

In the Bogatić municipality, 100% vaccination coverage was recorded in 2011, 2014 and 2018, and the lowest coverage was recorded in 2021, amounting to 80.91%.

The Vladimirci municipality had maximum vaccination coverage in 2011, 2012, 2016, 2017, 2018 and 2019. In 2014, the coverage was the lowest, amounting to 89.36%.

In the first and the last year of the observed period, the Koceljeva municipality had a 100% vaccination coverage, while the lowest percentage of vaccination was registered in 2013, and it was 87.50%.

In the Krupanj municipality, during the eleven-year observation period, complete vaccination coverage was recorded for six years, namely: 2011, 2012, 2014, 2015, 2017, and 2019. The lowest vaccination coverage was recorded in 2022, and it was 72.81%.

In the Loznica municipality, a 100% vaccination coverage was recorded in 2011, 2013, and 2014, while the lowest vaccination percentage was 94.13%, recorded in 2021.

In the Ljubovija municipality, in years: 2011, 2012, 2013, 2019, 2020, and 2021, maximum vaccination coverage was recorded, while in 2017, the lowest value of 96.50% was recorded.

In the Mali Zvornik municipality, 100% vaccination coverage was recorded for years: 2013, 2014, 2017, 2018, and 2019. The lowest result was recorded in 2021, amounting to 80.65%.

The municipality of Šabac did not record a 100% vaccination coverage in any year. The highest coverage was in 2012, and it was 99.37%, while the lowest coverage was recorded in 2021, when it was 88.00%.

We found a moderate negative trend (r = - 0.557), but it is not statistically significant (p = 0.075), (Graph 3).

Equation: Vaccination percentage = - 0.535 * year + 1175.898

Haemophilus influenzae

In the period between 2011 and 2021, vaccination coverage for Haemophilus influenzae in the territory of the Mačva District, was the best in 2019, when it amounted to 99.34%. The lowest compliance was recorded in 2012, when it was 79.18%, while in all other years the result did not drop below 94.81% (Graph 4).

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Graph 4. Trend of vaccination coverage for Haemophilus influenzae, in the Mačva District by municipality, 2011 – 2021

In the Bogatić municipality, the lowest vaccination coverage was recorded in 2012, at 78.22%, and the highest percentage of vaccination was recorded in years: 2011, 2019, and 2021, and it was 100%.

The Vladimirci municipality had the best vaccination result in 2014, when the coverage was 100%, while the lowest number of vaccinations was recorded in 2012, namely 82.71%.

In the Koceljeva municipality, during seven years, out of a total of eleven, vaccination coverage was 100%, i.e., in the period between 2014 and 2019, as well as in 2021. The smallest number of vaccinations was registered in 2011, amounting to 92.63%.

In 2011, 2017, and 2021, the Krupanj municipality had the maximum number of vaccinations, and in 2012, the vaccination coverage was the lowest, amounting to 81.03%.

In the Loznica municipality, complete coverage was recorded in 2013, 2014, 2015, 2017, and 2018, while the smallest number of vaccinations, amounting to a coverage of 68.36% was recorded in 2012.

Except for 2012, when 77.53% of the planned population was vaccinated, the Ljubovija municipality had a 100% vaccination coverage in all other years of the observed period.

In the Mali Zvornik municipality, vaccination was carried out completely in 2011, 2013, 2016, and 2019, while in 2012, 77.63% of the planned population was vaccinated, which was the lowest percentage for this municipality in the observed period.

In the Šabac municipality, the highest vaccination coverage of 100% was recorded in 2016, and the lowest was in 2012, at 74.70%.

We found a moderate positive trend (r = 0.281), but it is not statistically significant (p = 0.402), (Graph 4).

Equation: Vaccination percentage = 0.479 * year + 870.293

Hepatitis B

During the observed period, in the territory of the Mačva District, vaccination coverage for the hepatitis B vaccine was the best in 2013, when it was 98.70% of the planned population, while the lowest vaccination coverage was recorded in 2021, and it was 93.83% (Graph 5).

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Graph 5. Trend of vaccination coverage for Haemophilus influenzae, in the Mačva District by municipality, 2011 – 2021

In the Bogatić municipality, in four years out of the observed eleven, a one hundred percent vaccination coverage was recorded, namely in: 2011, 2013, 2014, and 2015, while the lowest vaccination coverage was recorded in 2017, when it was 81.85%.

In the Vladimirci municipality, in 2020, coverage was 100%, while the lowest percentage of vaccination was 91.07%, in 2014.

The Koceljeva municipality had a 100% vaccination coverage in 2012, 2013, 2014, 2015, 2018, 2020, and 2021, while the lowest vaccination coverage was recorded in 2016, at 86.52%.

In the Krupanj municipality, complete vaccination was carried out in 2012, 2013, 2017 and 2021, and the lowest percentage of vaccination was recorded in 2020, namely 77.50%.

In the Loznica municipality, the highest percentage of vaccination was recorded in 2014, 2016, and 2018, when 100% coverage was achieved, and the lowest percentage of vaccination was recorded in 2021, when 95.40% of the planned population was vaccinated.

In the Ljubovija municipality, during the observed period, vaccination coverage was 100% for all eleven years.

The Mali Zvornik municipality had a 100% vaccination coverage in 2011, 2013, 2015, and 2017, and the lowest vaccination coverage was recorded in the last year of the observed period, 2021, when 80.77% of the planned population were vaccinated.

In the Šabac municipality, complete vaccination coverage was recorded in 2016, while in 2021, the coverage was 82.17%.

We found a strong negative trend (r = - 0.704), which is statistically significant (p = 0.016), (Graph 5).

Equation: Vaccination percentage = - 0.300 * year + 700.114

MMR

In the observed period, MMR vaccination coverage was the lowest in 2021, amounting to 87.50%, while the highest coverage was recorded in 2011, when 99.34% of the planned population was vaccinated (Graph 6).

GRAFIKON 6

In the Bogatić municipality, the best vaccination result was achieved in 2013, 2020, and 2021, when vaccination coverage was 100%, while the lowest coverage was in 2015, and it was 77.06%.

In the Vladimirci municipality, the best vaccination coverage was in 2011, when 99.17% of the planned population was vaccinated, and the lowest coverage was in 2021, when 70.00% of them were vaccinated.

In the Koceljeva municipality, during the observed eleven-year period, vaccination coverage was complete in years: 2011, 2012, 2013, 2014, 2015, 2016, 2017, 2019 and 2021. In 2018, 90.59% of the planned population was vaccinated, and in 2020, the coverage was 98.30%.

In the Krupanj municipality, in 2011, 2012 and 2018, vaccination coverage was the highest, i.e., 100%, and in 2016, it was the lowest, at 85.61%.

The Loznica municipality had a 100% vaccination coverage during the five years of the observed period, namely the years: 2011, 2014, 2016, 2018 and 2020. The lowest coverage was recorded in 2019, when 94.41% of the planned population was vaccinated.

In the Ljubovija municipality, vaccination was carried out completely in 2015, 2019, 2020, and 2021, while the lowest percentage of vaccination was in 2014, amounting to 94.83%.

The Mali Zvornik municipality had a 100% vaccination coverage in years: 2011, 2012, 2013, and 2016, while the lowest coverage was recorded in 2021, amounting to 81.52%.

In the Šabac municipality, the highest percentage of vaccination was achieved in 2011, namely 99.69% of the planned population, while the lowest coverage was in 2021, namely 67.19%.

We found a moderate negative trend (r = - 0.598), but it is not statistically significant (p = 0.052), (Graph 6).

Equation: Vaccination percentage = - 0.593 * year + 1289.995

DISCUSSION

During the observed period, from 2011 to 2021, a negative trend was recorded in the coverage of vaccination for all of the observed vaccines, except for the trend related to vaccination for Haemophilus influenzae [8],[9],[10],[11],[12],[13],[14],[15],[16],[17].

Analysis of tuberculosis vaccination (BCG) showed a moderate negative trend, but no statistically significant change in the trend of vaccination, from 2011 to 2021. For polio vaccination, a moderate negative trend was found, which was statistically significant. Vaccination against diphtheria, tetanus and pertussis (DiTe-Per) had a moderate negative trend, but it was not statistically significant. Analyzing vaccination trends for Haemophilus influenzae, it was determined that the coverage had a positive trend, but it was not statistically significant. Vaccination for hepatitis B showed a strong negative trend, which was statistically significant. The results of vaccination for measles mumps and rubella (MMR), in the observed period, also show that there was a moderate negative trend, but that it was not statistically significant.

When we compare the implementation of planned vaccination in the Mačva District in relation to the implementation of vaccination in the territory of the Republic of Serbia, we get the following results:

The vaccination coverage for tuberculosis in the Mačva District, during all the observed years, was lower, as compared to the national average [8],[9],[10],[11],[12],[13],[14],[15],[16],[17].

During 2021, in the Republic of Serbia, the immunization of newborns against tuberculosis was carried out with the BCG vaccine. The coverage of this vaccination was 98.2%, with only the coverage in the Bor District being below 95%, while in all the other districts, it was above that percentage.

The coverage value achieved in Central Serbia was 98%, and in Vojvodina it was 98.9% [5].

Until 2020, polio vaccination coverage was above the national average, after which year it dropped from 99% to 91.79%, and an even lower coverage was recorded in 2021, amounting to 84.74%. In 2021, the vaccination coverage for polio was registered in Serbia at 90.8%, which is below the target value (95%) [8],[9],[10],[11],[12],[13],[14],[15],[16],[17]. As for vaccination coverage with the combined pentavalent vaccine, looking at the results by district, in the course of 2021, only in four districts (Kolubara District, Nišava District, Pirot District, and Jablanica District) was the target coverage of 95% of vaccinated children, out of the planned number, achieved [5].

Vaccination with the Di-Te-Per vaccine had a higher coverage than the average recorded for the Republic of Serbia, but in the last year of the observed period, that coverage dropped to 88% [8],[9],[10],[11],[12],[13],[14],[15],[16],[17]. Vaccination of the planned population with the combined pentavalent vaccine was carried out in the Republic of Serbia, in 2021, with a coverage of 90.8% (estimated 91.5%).

Vaccination coverage with the pentavalent vaccine, which was carried out in the central part of Serbia, was 90.6% of the planned children, while the estimated coverage, based on the number of live births in 2020, was 91.3%.

In Vojvodina, the vaccination of the planned population with the combined pentavalent vaccine, carried out in 2021, covered 91.4% of the planned children [8]. The estimated coverage, according to the number of live births, in Vojvodina, in 2020, was 92% [9].

Observed by districts, the vaccination coverage with the combined pentavalent vaccine in 2021 was 95% and above in only four districts (Pirot District, Kolubara District, Jablanica District, and Nišava District), while coverage of less than 90% was registered in nine districts (Raška District, Zaječar District, Pčinja District, Braničevo District, Rasina District, Šumadija District, the City of Belgrade, West Bačka District, and South Bačka District). The lowest coverage was registered in the territory of the Raška District, which was 81.3% [5].

Vaccination coverage for Haemophilus influenzae in the territory of the Mačva District, every year, except for 2012, was above the average registered for the Republic of Serbia. The analysis of vaccination coverage in 2021 included an analysis of the pentavalent combined vaccine [8],[9],[10],[11],[12],[13],[14],[15],[16],[17].

Vaccination for hepatitis B, in the territory of the Mačva district, if we exclude the year 2012, had a higher coverage than the national average. Immunization of children during the first year, which is carried out against hepatitis B, was implemented in 2021, with a coverage of 89.1%, observed at the national level, while the estimated coverage was 89.7% [8],[9],[10],[11],[12],[13],[14],[15],[16],[17]. Coverage related to Central Serbia was 88.5%, while coverage in Vojvodina was 90.6%. When analyzing hepatitis B vaccination coverage by district, 95% coverage was not reached in any district, and twelve districts had a coverage lower than 90%. The Zaječar District (77.9%) and Raška district (79.3%) had the lowest coverage for this vaccination [5].

In the territory of the Mačva District, vaccination with the MMR vaccine showed a decrease in coverage during the last years of the observed period. Also, at the national level, coverage constantly decreased in the observed period [8],[9],[10],[11],[12],[13],[14],[15],[16],[17]. Vaccination for measles, mumps and rubella with the combined MMR vaccine, in the territory of the Republic of Serbia, in 2021, was carried out with a coverage of 74.8% (in 2020, the coverage was 78.1%), i.e., with an estimated coverage of 75.2%. Vaccination coverage in Central Serbia was 75.8%, while in Vojvodina it was even lower, namely 72.1% of the planned children. When MMR vaccination coverage is observed by district, no district achieved 95% coverage, and 90% coverage was achieved in only three districts out of a total of twenty-five, namely: Bor in central Serbia, and North Banat District and North Bačka District in Vojvodina. Coverage lower than 80% was registered in the territory of nine districts, and the lowest was in the South Bačka District (46.8%), Rasina District (65.7%), and Raška District (66.4%) [5].

We compared vaccination coverage for Hungary, Romania, Bulgaria, as well as for two economically developed countries (Italy and France), for the period between 2009 and 2019, with the coverage in the territory of the Republic of Serbia in this period, in order to compare the results of immunization in Serbia with other countries [6]. Data on vaccine coverage in the region, for all countries in the aforementioned publication, are not as yet available for 2020, so as to make comparison possible, which is why comparison was made regarding data for 2019. The presented tuberculosis vaccine coverage shows that Italy does not routinely immunize, and neither does France, as of 2011. As compared to the presented countries, Serbia has a high coverage of newborns with the BCG vaccine, which is above the average for the European Region. The trend for OPV/ IPV3 and DTP/DTaP3 in Serbia showed a tendency of having continuous values, until 2012, when slightly lower values were recorded in the observed period. They then varied during 2014 and 2015, and subsequently remained above the average values registered in the European Region. While a downward trend was recorded in Italy, which was around the average for the European Region, Romania recorded the lowest value of 88% for OPV/IPV3, in the observed period. Hungary showed a continuous, very high coverage of MMR vaccination, while coverage values for 2019 in other countries were below the European average (95%), with the lowest ones registered in Romania and France (90%). Serbia registered a coverage of 88%.

In the Republic of Serbia, immunization against hepatitis B started in mid-2005, with certain difficulties. Hungary and Italy recorded an exceptionally high coverage, which was maintained. The registered coverage in the Republic of Serbia of 91%, in 2019, was within the average values for the European Region. Immunization against diseases caused by Haemophilus influenzae type b began in the Republic of Serbia at the end of 2006, with certain difficulties, and in 2019, a 95% coverage was recorded. High coverage was recorded by almost all of the observed countries, with values that were above the average for the European Region (79%) [8],[9],[10],[11],[12],[13],[14],[15],[16],[17].

CONCLUSION

◆ In the territory of the Mačva district, coverage of children with mandatory vaccination was observed in the period between 2011 and 2021.

◆ For all vaccines, a negative trend was recorded in the vaccination coverage of children over the years.

◆ The only vaccine whose coverage increased was the vaccine against Haemophilus influenzae.

◆ When all the vaccines are observed together, it can be seen that vaccination coverage has declined during the observed period.

◆ In 2021, no vaccine achieved a 95% coverage.

◆ The downward trend indicates the need for promoting vaccination as the safest and most effective protection against infectious diseases.

◆ A more proactive health and educational approach is needed in the local community, as well as in counseling centers in the course of family planning, with accompanying media support, so as to raise the awareness of the general population about the importance of vaccination.

  • Conflict of interest:
    None declared.

Informations

Volume 4 No 4

December 2023

Pages 389-404
  • Keywords:
    vaccination, vaccination coverage, trend, public health
  • Received:
    02 October 2023
  • Revised:
    31 October 2023
  • Accepted:
    08 November 2023
  • Online first:
    25 December 2023
  • DOI:
  • Cite this article:
    Pajičić A, Jović Vraneš A, Vujković B. Mandatory vaccination coverage in the territory of the Mačva district in the period between 2011 and 2021. Serbian Journal of the Medical Chamber. 2023;4(4):387-402. doi: 10.5937/smclk4-46880
Corresponding author

Ana Pajičić
Institute of Public Health Šabac
1 Jovana Cvijića Street, 15000 Šabac, Serbia
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.



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7. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2020. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202020.pdf [HTTP]

8. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2021. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20izvestaj%20o%20sprovedenoj%20imunizaciji%202021.pdf [HTTP]

9. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2019. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202019.pdf [HTTP]

10. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2018. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202018.pdf [HTTP]

11. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2017. godine. [Internet]. Pristupljeno 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202017.pdf [HTTP]

12. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2016. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202016.pdf [HTTP]

13. 1Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2015. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202015.pdf [HTTP]

14. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2014. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202014.pdf [HTTP]

15. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2013. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202013.pdf [HTTP]

16. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2012. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202012.pdf [HTTP]

17. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“, Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2011. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202011.pdf [HTTP]

1. Bogdanović Radovan. Vakcine i vakcinacija: Značaj za zdravlje naroda s osvrtom na stanje u Srbiji. Scripta pediatrica, 2018.

2. Unicef. [Internet stranica]. Unicef: [Ažurirano: 2022 May 4, citirano: 9. 10. 2022.]. Pristupljeno: 03.06.2022. Dostupno na: https://www.unicef.org/serbia/znanje-stavovi-i-prakse-u-vezi-sa-imunizacijom-pregled. [HTTP]

3. Zavod za javno zdravlje Šabac. [Internet stranica]. Pristupljeno: 08.08.2022. Dostupno na: http://www.zjz.org.rs/kalendar-vakcinacije-2 [HTTP]

4. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut”. Stručno-metodološko uputstvo za sprovođenje obavezne i preporučene aktivne imunizacije stanovništva. [Internet]. Pristupljeno: 08.08.2022. Dostupno na: https:// www.batut.org.rs/download/SMUzaRedovnuImunizaciju2022.pdf [HTTP]

5. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut”. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2021. godine, tabele. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/index.php?content=2489 [HTTP]

6. WHO. [Internet]. WHO Vaccine-Preventable Diseases: Monitoring system, 2019 global summary. [Ažurirano: 4. 5. 2022.; citirano: 10.10. 2022.]. Pristupljeno: 09.10.2022. Dostupno na: http://www.who.int/whosis. [HTTP]

7. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2020. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202020.pdf [HTTP]

8. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2021. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20izvestaj%20o%20sprovedenoj%20imunizaciji%202021.pdf [HTTP]

9. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2019. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202019.pdf [HTTP]

10. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2018. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202018.pdf [HTTP]

11. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2017. godine. [Internet]. Pristupljeno 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202017.pdf [HTTP]

12. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2016. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202016.pdf [HTTP]

13. 1Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2015. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202015.pdf [HTTP]

14. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2014. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202014.pdf [HTTP]

15. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2013. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202013.pdf [HTTP]

16. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2012. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202012.pdf [HTTP]

17. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“, Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije 2011. godine. [Internet]. Pristupljeno: 15.11.2022. Dostupno na: https://www.batut.org.rs/download/izvestaji/Godisnji%20imunizacija%202011.pdf [HTTP]


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