Delayed and incomplete immunization of children: cross-sectional community-based survey study among population of Kyiv, Rivne, and Volyn regions of Ukraine
DOI:
https://doi.org/10.15574/SP.2025.4(148).1927Keywords:
child health, health services, immunization schedule, patient acceptance of health care, public health surveillance, vaccination refusal, vaccination coverageAbstract
Immunization is essential for preventing infectious diseases, yet timely vaccination remains a challenge globally, particularly in regions affected by war and disrupted healthcare infrastructure. Ukraine faces unique challenges, including systemic issues and vaccine hesitancy, impacting immunization timeliness.
Aim - to determine the rate and characteristics of delayed immunization and its completeness among children in three regions of Ukraine.
Material and methods. A cross-sectional, community-based survey was conducted at state and private primary healthcare facilities in Kyiv, Bucha, Rivne, and Lutsk. Data were collected via structured questionnaires, face-to-face parental interviews, and medical documentation review. Statistical analyses included descriptive statistics, chi-square tests, logistic regression, and Kaplan-Meier analysis.
Results. Out of 152 children, 64.3% were fully vaccinated, but only 50% received timely vaccinations. The significant reasons for delays included untimely healthcare visits (29.2%), vaccine hesitancy (25.8%), and acute illness (18%). The presenсe of comorbidities in children was a statistically significant risk factor for delayed immunization. Kaplan-Meier analysis illustrated notable delays, especially for older children.
Conclusion. This study identifies critical barriers to timely immunization, emphasizing the need for improved healthcare accessibility, targeted educational initiatives, and enhanced professional training. Further research is required to develop comprehensive interventions, particularly considering Ukraine's complex demographic challenges due to internal displacement of the population.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants. The informed consent was obtained from patients.
The authors declare no conflict of interest.
References
Akmatov MK, Mikolajczyk RT. (2012). Timeliness of childhood vaccinations in 31 low and middle-income countries. J Epidemiol Community Health. 66: e14. https://doi.org/10.1136/jech.2010.124651; PMid:21551179
Australian Government, Department of Health and Aged Care. Australian Immunization Handbook: National Immunisation Catch-up Calculator. https://immunisationhandbook.health.gov.au/catch-up-calculator/calculator.
Beyrer C. (2024, May 3). Assessing the Impact of Russia's Invasion of Ukraine on Health Services: Crimes of War. JAMA Health Forum. 5(5): e240924. https://doi.org/10.1001/jamahealthforum.2024.0924; PMid:38758568
Brinkmann F, Friedrichs A, Behrens GM, Behrens P, Berner R, Caliebe A et al. (2024, Apr). Prevalence of infectious diseases, immunity to vaccine-preventable diseases and chronic medical conditions among Ukrainian refugees in Germany - A cross sectional study from the German Network University Medicine (NUM). J Infect Public Health. 17(4): 642-649. Epub 2024 Feb 16. https://doi.org/10.1016/j.jiph.2024.02.003; PMid:38458134
Cutts FT, Claquin P, Danovaro-Holliday MC, Rhoda DA. (2016, Jul 29). Monitoring vaccination coverage: Defining the role of surveys. Vaccine. 34(35): 4103-4109. Epub 2016 Jun 24. https://doi.org/10.1016/j.vaccine.2016.06.053; PMid:27349841 PMCid:PMC4967442
Dolan SB, Carnahan E, Shearer JC, Beylerian EN, Thompson J, Gilbert SS et al. (2019, Mar 22). Redefining vaccination coverage and timeliness measures using electronic immunization registry data in low- and middle-income countries. Vaccine. 37(13): 1859-1867. Epub 2019 Feb 23. https://doi.org/10.1016/j.vaccine.2019.02.017; PMid:30808566 PMCid:PMC6420680
Edinboro M. (2019, Apr). Assessing Vaccine Contraindications Through the Use of the Immunization Action Coalition Screening Checklist. Workplace Health Saf. 67(4): 204. https://doi.org/10.1177/2165079919837253; PMid:30900965
Grundy J, Biggs BA. (2019, Apr 1). The Impact of Conflict on Immunisation Coverage in 16 Countries. Int J Health Policy Manag. 8(4): 211-221. https://doi.org/10.15171/ijhpm.2018.127; PMid:31050966 PMCid:PMC6499911
Hadjipanayis A, van Esso D, Del Torso S, Dornbusch HJ, Michailidou K, Minicuci N et al. (2020, Feb 5). Vaccine confidence among parents: Large scale study in eighteen European countries. Vaccine. 38(6): 1505-1512. Epub 2019 Dec 14. https://doi.org/10.1016/j.vaccine.2019.11.068; PMid:31848051
Hughes MM, Katz J, Englund JA, Khatry SK, Shrestha L, LeClerq SC et al. (2016, Feb 10). Infant vaccination timing: Beyond traditional coverage metrics for maximizing impact of vaccine programs, an example from southern Nepal. Vaccine. 34(7): 933-941. Epub 2016 Jan 11. https://doi.org/10.1016/j.vaccine.2015.12.061; PMid:26788880 PMCid:PMC4744084
Jones CE, Danovaro-Holliday MC, Mwinnyaa G et al. (2024). Routine Vaccination Coverage - Worldwide, 2023. MMWR Morb Mortal Wkly Rep. 73: 978-984. https://doi.org/10.15585/mmwr.mm7343a4; PMid:39480752 PMCid:PMC11527360
Lukusa LA, Ndze VN, Mbeye NM, Wiysonge CS. (2018). A systematic review and meta-analysis of the effects of educating parents on the benefits and schedules of childhood vaccinations in low and middle-income countries. Hum Vaccin Immunother. 14(8): 2058-2068. Epub 2018 May 14. https://doi.org/10.1080/21645515.2018.1457931; PMid:29580159 PMCid:PMC6149946
Malakhov KS. (2023, Dec 12). Insight into the Digital Health System of Ukraine (eHealth): Trends, Definitions, Standards, and Legislative Revisions. Int J Telerehabil. 15(2): e6599. PMID: 38162941; PMCID: PMC10754247. https://doi.org/10.5195/ijt.2023.6599
Ministry of Health of Ukraine. (2006). Instruction on Completing the Primary Medical Documentation Form No. 063/o "Vaccination Card". Order of the Ministry of Health of Ukraine No. 1 dated 10.01.2006. URL: https://zakon.rada.gov.ua/laws/show/z0688-06#Text.
Ministry of Health of Ukraine. (2008). On Approval of Reporting Forms for Planning and Implementing Preventive Vaccinations 'UkrVak 08'". Order of the Ministry of Health of Ukraine No. 413 dated 25.07.2008. URL: https://zakononline.com.ua/documents/show/51655___538042.
Ministry of Health of Ukraine. (2011). On the Procedure for Conducting Preventive Vaccinations in Ukraine and Control of Quality and Circulation of Medical Immunobiological Products. Order of the Ministry of Health of Ukraine No.595 dated 16.09.2011. URL: https://zakon.rada.gov.ua/laws/show/z1159-11#Text.
Mokhort H, Kovalchuk A, Sokolovska O, Higgs S. (2018, Dec). Contribution of Vaccination to the Reduction of Infectious Mortality in Ukraine in the Second Half of the 20th and Early 21st Century: A Comparative Population-Based Study of the Dynamics and Structure of Infectious Mortality and Incidence. Viral Immunol. 31(10):695-707. Epub 2018 Oct 9. https://doi.org/10.1089/vim.2018.0054; PMid:30300573 PMCid:PMC6362321
Odone A, Gianfredi V, Sorbello S, Capraro M, Frascella B et al. (2021, Oct 3). The Use of Digital Technologies to Support Vaccination Programmes in Europe: State of the Art and Best Practices from Experts' Interviews. Vaccines (Basel). 9(10): 1126. https://doi.org/10.3390/vaccines9101126; PMid:34696234 PMCid:PMC8538238
O'Leary A. (2023, Mar 1). Polio has recently been detected in places like London, New York, Ukraine and Israel-but what does it really mean to the global eradication effort? Int Health. 15(2): 111-112. https://doi.org/10.1093/inthealth/ihac066; PMid:36342124 PMCid:PMC9977210
Rasmussen AL. (2020, Dec 18). Vaccination Is the Only Acceptable Path to Herd Immunity. Med. 1(1): 21-23. https://doi.org/10.1016/j.medj.2020.12.004; PMid:33521750 PMCid:PMC7831753
Rivero I, Raguindin PF, Buttler R, Martinon-Torres F. (2019, Sep). False Vaccine Contraindications Among Healthcare Providers in Europe: A Short Survey Among Members of The European Society of Pediatric Infectious Diseases. Pediatr Infect Dis J. 38(9): 974-976. https://doi.org/10.1097/INF.0000000000002401; PMid:31261366
Rodyna R. (2019, Nov). Measles situation in Ukraine during the period 2017-2019. European Journal of Public Health. 29; Suppl 4: ckz186.496. https://doi.org/10.1093/eurpub/ckz186.496
Scobie HM, Edelstein M, Nicol E, Morice A, Rahimi N, MacDonald NE et al. (2020, Oct 27). Improving the quality and use of immunization and surveillance data: Summary report of the Working Group of the Strategic Advisory Group of Experts on Immunization. Vaccine. 38(46): 7183-7197. Epub 2020 Sep 17. https://doi.org/10.1016/j.vaccine.2020.09.017; PMid:32950304 PMCid:PMC7573705
Shattock AJ, Johnson HC, Sim SY, Carter A, Lambach P, Hutubessy RCW et al. (2024, May 25). Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. Lancet. 403(10441): 2307-2316. https://doi.org/10.1016/S0140-6736(24)00850-X; PMid:38705159
Tal O, Ne'eman Y, Sadia R, Shmuel R, Schejter E, Bitan M. (2021, Nov 2). Parents' attitudes toward children's vaccination as a marker of trust in health systems. Hum Vaccin Immunother. 17(11): 4518-4528. Epub 2021 Oct 6. https://doi.org/10.1080/21645515.2021.1971472; PMid:34613882 PMCid:PMC8828148
Tchoualeu DD, Fleming M, Traicoff DA. (2023, May 11). A systematic review of pre-service training on vaccination and immunization. Vaccine. 41(20): 3156-3170. Epub 2023 Apr 15. https://doi.org/10.1016/j.vaccine.2023.03.062; PMid:37069032 PMCid:PMC10410287
Ukrainian Public Health Center. (2025). Infectious morbidity of the population of Ukraine. Report on selected infectious and parasitic diseases as for March 2025. URL: https://phc.org.ua/kontrol-zakhvoryuvan/inshi-infekciyni-zakhvoryuvannya/infekciyna-zakhvoryuvanist-naselennya-ukraini.
Verster JC, Kraneveld AD, Garssen J. (2022, Dec 20). The Assessment of Immune Fitness. J Clin Med. 12(1): 22. https://doi.org/10.3390/jcm12010022; PMid:36614822 PMCid:PMC9821524
Walton S, Cortina-Borja M, Dezateux C, Griffiths LJ, Tingay K, Akbari A et al. (2017). Measuring the timeliness of childhood vaccinations: using cohort data and routine health records to evaluate quality of immunisation services. Vaccine. 35: 7166-7173. https://doi.org/10.1016/j.vaccine.2017.10.085; PMid:29132992 PMCid:PMC5720480
WHO. (2021). European Immunization Agenda 2030. Copenhagen: WHO Regional Office for Europe; Licence: CC BY-NC-SA 3.0 IGO. URL: https://www.who.int/europe/publications/i/item/9789289056052.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Modern pediatrics. Ukraine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
