Measuring the Performance of Vaccination Programs Using Cross-Sectional Surveys: A Likelihood Framework and Retrospective Analysis
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{"title"=>"Measuring the performance of vaccination programs using cross-sectional surveys: A likelihood framework and retrospective analysis", "type"=>"journal", "authors"=>[{"first_name"=>"Justin", "last_name"=>"Lessler", "scopus_author_id"=>"22951309100"}, {"first_name"=>"C. Jessica E.", "last_name"=>"Metcalf", "scopus_author_id"=>"16042940100"}, {"first_name"=>"Rebecca F.", "last_name"=>"Grais", "scopus_author_id"=>"12801197700"}, {"first_name"=>"Francisco J.", "last_name"=>"Luquero", "scopus_author_id"=>"23479690100"}, {"first_name"=>"Derek A.T.", "last_name"=>"Cummings", "scopus_author_id"=>"9842706300"}, {"first_name"=>"Bryan T.", "last_name"=>"Grenfell", "scopus_author_id"=>"7004421686"}], "year"=>2011, "source"=>"PLoS Medicine", "identifiers"=>{"pui"=>"362826634", "sgr"=>"80055058328", "pmid"=>"22039353", "scopus"=>"2-s2.0-80055058328", "isbn"=>"1549-1277", "doi"=>"10.1371/journal.pmed.1001110", "issn"=>"15491277"}, "id"=>"0050a327-4198-314a-979b-081e638d910f", "abstract"=>"BACKGROUND: The performance of routine and supplemental immunization activities is usually measured by the administrative method: dividing the number of doses distributed by the size of the target population. This method leads to coverage estimates that are sometimes impossible (e.g., vaccination of 102% of the target population), and are generally inconsistent with the proportion found to be vaccinated in Demographic and Health Surveys (DHS). We describe a method that estimates the fraction of the population accessible to vaccination activities, as well as within-campaign inefficiencies, thus providing a consistent estimate of vaccination coverage.\\n\\nMETHODS AND FINDINGS: We developed a likelihood framework for estimating the effective coverage of vaccination programs using cross-sectional surveys of vaccine coverage combined with administrative data. We applied our method to measles vaccination in three African countries: Ghana, Madagascar, and Sierra Leone, using data from each country's most recent DHS survey and administrative coverage data reported to the World Health Organization. We estimate that 93% (95% CI: 91, 94) of the population in Ghana was ever covered by any measles vaccination activity, 77% (95% CI: 78, 81) in Madagascar, and 69% (95% CI: 67, 70) in Sierra Leone. \"Within-activity\" inefficiencies were estimated to be low in Ghana, and higher in Sierra Leone and Madagascar. Our model successfully fits age-specific vaccination coverage levels seen in DHS data, which differ markedly from those predicted by naïve extrapolation from country-reported and World Health Organization-adjusted vaccination coverage.\\n\\nCONCLUSIONS: Combining administrative data with survey data substantially improves estimates of vaccination coverage. Estimates of the inefficiency of past vaccination activities and the proportion not covered by any activity allow us to more accurately predict the results of future activities and provide insight into the ways in which vaccination programs are failing to meet their goals. Please see later in the article for the Editors' Summary.", "link"=>"http://www.mendeley.com/research/measuring-performance-vaccination-programs-using-crosssectional-surveys-likelihood-framework-retrosp", "reader_count"=>71, "reader_count_by_academic_status"=>{"Unspecified"=>4, "Professor > Associate Professor"=>5, "Librarian"=>1, "Researcher"=>17, "Student > Doctoral Student"=>2, "Student > Ph. D. Student"=>11, "Student > Postgraduate"=>1, "Other"=>5, "Student > Master"=>14, "Student > Bachelor"=>5, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>2, "Professor"=>2}, "reader_count_by_user_role"=>{"Unspecified"=>4, "Professor > Associate Professor"=>5, "Librarian"=>1, "Researcher"=>17, "Student > Doctoral Student"=>2, "Student > Ph. D. 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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/364508", "https://ndownloader.figshare.com/files/364562", "https://ndownloader.figshare.com/files/364598", "https://ndownloader.figshare.com/files/364633", "https://ndownloader.figshare.com/files/364657", "https://ndownloader.figshare.com/files/364707", "https://ndownloader.figshare.com/files/364757", "https://ndownloader.figshare.com/files/364798"], "description"=>"<div><h3>Background</h3><p>The performance of routine and supplemental immunization activities is usually measured by the administrative method: dividing the number of doses distributed by the size of the target population. This method leads to coverage estimates that are sometimes impossible (e.g., vaccination of 102% of the target population), and are generally inconsistent with the proportion found to be vaccinated in Demographic and Health Surveys (DHS). We describe a method that estimates the fraction of the population accessible to vaccination activities, as well as within-campaign inefficiencies, thus providing a consistent estimate of vaccination coverage.</p> <h3>Methods and Findings</h3><p>We developed a likelihood framework for estimating the effective coverage of vaccination programs using cross-sectional surveys of vaccine coverage combined with administrative data. We applied our method to measles vaccination in three African countries: Ghana, Madagascar, and Sierra Leone, using data from each country's most recent DHS survey and administrative coverage data reported to the World Health Organization. We estimate that 93% (95% CI: 91, 94) of the population in Ghana was ever covered by any measles vaccination activity, 77% (95% CI: 78, 81) in Madagascar, and 69% (95% CI: 67, 70) in Sierra Leone. “Within-activity” inefficiencies were estimated to be low in Ghana, and higher in Sierra Leone and Madagascar. Our model successfully fits age-specific vaccination coverage levels seen in DHS data, which differ markedly from those predicted by naïve extrapolation from country-reported and World Health Organization–adjusted vaccination coverage.</p> <h3>Conclusions</h3><p>Combining administrative data with survey data substantially improves estimates of vaccination coverage. Estimates of the inefficiency of past vaccination activities and the proportion not covered by any activity allow us to more accurately predict the results of future activities and provide insight into the ways in which vaccination programs are failing to meet their goals.</p> <h3></h3><p> <em>Please see later in the article for the Editors' Summary</em></p> </div>", "links"=>[], "tags"=>["measuring", "vaccination", "programs", "cross-sectional", "retrospective"], "article_id"=>132048, "categories"=>["Cancer", "Biotechnology", "Immunology"], "users"=>["Justin Lessler", "C. Jessica E. Metcalf", "Rebecca F. Grais", "Francisco J. Luquero", "Derek A. T. Cummings", "Bryan T. Grenfell"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001110.s001", "https://dx.doi.org/10.1371/journal.pmed.1001110.s002", "https://dx.doi.org/10.1371/journal.pmed.1001110.s003", "https://dx.doi.org/10.1371/journal.pmed.1001110.s004", "https://dx.doi.org/10.1371/journal.pmed.1001110.s005", "https://dx.doi.org/10.1371/journal.pmed.1001110.s006", "https://dx.doi.org/10.1371/journal.pmed.1001110.s007", "https://dx.doi.org/10.1371/journal.pmed.1001110.s008"], "stats"=>{"downloads"=>28, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Measuring_the_Performance_of_Vaccination_Programs_Using_Cross_Sectional_Surveys_A_Likelihood_Framework_and_Retrospective_Analysis/132048", "title"=>"Measuring the Performance of Vaccination Programs Using Cross-Sectional Surveys: A Likelihood Framework and Retrospective Analysis", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2011-10-25 00:34:08"}
  • {"files"=>["https://ndownloader.figshare.com/files/719993"], "description"=>"<p>The left <i>y</i>-axis presents the proportion of the total target population, while the right <i>y</i>-axis shows the proportion vaccinated as a proportion of the accessible population, ρ. A value of ψ = 0 indicates “perfect” vaccine distribution, where every dose of vaccine reaches an individual not yet vaccinated in this activity, ψ = 1 indicates vaccine distribution equivalent to “vaccination at random,” and values of ψ greater than one indicate even worse performance.</p>", "links"=>[], "tags"=>["vaccination"], "article_id"=>390355, "categories"=>["Biotechnology", "Infectious Diseases", "Immunology"], "users"=>["Justin Lessler", "C. Jessica E. Metcalf", "Rebecca F. Grais", "Francisco J. Luquero", "Derek A. T. Cummings", "Bryan T. Grenfell"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001110.g001", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Expected_coverage_of_a_vaccination_activity_based_on_the_values_of_968_and_961_/390355", "title"=>"Expected coverage of a vaccination activity based on the values of ψ and ρ.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-10-25 00:05:55"}
  • {"files"=>["https://ndownloader.figshare.com/files/720229"], "description"=>"<p>Estimated proportion of the population accessible by any vaccination activity (ρ), within-activity inefficiency (ψ), and routine vaccination opportunity rate (λ) for Ghana, Madagascar, and Sierra Leone.</p>", "links"=>[], "tags"=>["vaccination", "within-activity", "inefficiency", "sierra"], "article_id"=>390583, "categories"=>["Biotechnology", "Infectious Diseases", "Immunology"], "users"=>["Justin Lessler", "C. Jessica E. Metcalf", "Rebecca F. Grais", "Francisco J. Luquero", "Derek A. T. Cummings", "Bryan T. Grenfell"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001110.t003", "stats"=>{"downloads"=>1, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Estimated_proportion_of_the_population_accessible_by_any_vaccination_activity_961_within_activity_inefficiency_968_and_routine_vaccination_opportunity_rate_955_for_Ghana_Madagascar_and_Sierra_Leone_/390583", "title"=>"Estimated proportion of the population accessible by any vaccination activity (ρ), within-activity inefficiency (ψ), and routine vaccination opportunity rate (λ) for Ghana, Madagascar, and Sierra Leone.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2011-10-25 00:09:43"}
  • {"files"=>["https://ndownloader.figshare.com/files/720185"], "description"=>"<p>In some cases a card was present, but the date of vaccination was not recorded.</p>", "links"=>[], "tags"=>["dhs", "contrasting", "percent", "reported", "vaccinated", "ascertained", "vaccination"], "article_id"=>390535, "categories"=>["Biotechnology", "Infectious Diseases", "Immunology"], "users"=>["Justin Lessler", "C. Jessica E. Metcalf", "Rebecca F. Grais", "Francisco J. Luquero", "Derek A. T. Cummings", "Bryan T. Grenfell"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001110.t002", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Details_of_DHS_data_contrasting_numbers_and_percent_reported_vaccinated_by_age_as_ascertained_by_vaccination_cards_as_reported_by_mothers_and_from_either_source_/390535", "title"=>"Details of DHS data, contrasting numbers, and percent reported vaccinated by age as ascertained by vaccination cards, as reported by mothers, and from either source.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2011-10-25 00:08:55"}
  • {"files"=>["https://ndownloader.figshare.com/files/720260"], "description"=>"<p>Timing, administrative coverage, and estimated coverage of routine and supplemental vaccination activities for Ghana, Madagascar, and Sierra Leone.</p>", "links"=>[], "tags"=>["supplemental", "vaccination", "activities", "sierra"], "article_id"=>390617, "categories"=>["Biotechnology", "Infectious Diseases", "Immunology"], "users"=>["Justin Lessler", "C. Jessica E. Metcalf", "Rebecca F. Grais", "Francisco J. Luquero", "Derek A. T. Cummings", "Bryan T. Grenfell"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001110.t001", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Timing_administrative_coverage_and_estimated_coverage_of_routine_and_supplemental_vaccination_activities_for_Ghana_Madagascar_and_Sierra_Leone_/390617", "title"=>"Timing, administrative coverage, and estimated coverage of routine and supplemental vaccination activities for Ghana, Madagascar, and Sierra Leone.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2011-10-25 00:10:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/720119"], "description"=>"<p>Proportion vaccinated by age in (A) Ghana, (B) Madagascar, and (C) Sierra Leone. Points connected by solid lines are the window-smoothed (age ±5 mo) estimates of vaccine coverage as measured by the most recent DHS survey (blue), as predicted by naïve application of WHO coverage estimates (green), and as fit using our approach (red) in a population with the same age distribution as the DHS data. Shaded regions represent 95% confidence intervals on the window-smoothed estimate calculated as described in <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001110#s2\" target=\"_blank\">Methods</a>.</p>", "links"=>[], "tags"=>["estimates", "age-specific", "vaccination"], "article_id"=>390474, "categories"=>["Biotechnology", "Infectious Diseases", "Immunology"], "users"=>["Justin Lessler", "C. Jessica E. Metcalf", "Rebecca F. Grais", "Francisco J. Luquero", "Derek A. T. Cummings", "Bryan T. Grenfell"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001110.g003", "stats"=>{"downloads"=>1, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_DHS_and_model_estimates_of_age_specific_vaccination_coverage_/390474", "title"=>"DHS and model estimates of age-specific vaccination coverage.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-10-25 00:07:54"}
  • {"files"=>["https://ndownloader.figshare.com/files/720057"], "description"=>"<p>If ψ = 0, then each vaccine dose reaches an individual not yet covered by this activity until the entire accessible population is vaccinated (800 individuals in this example). For higher values of ψ, each additional dose delivered into the system has a reduced chance of reaching an individual not yet covered by this activity.</p>", "links"=>[], "tags"=>["vaccinated", "vaccination", "batch", "100", "doses", "hypothetical", "individuals"], "article_id"=>390411, "categories"=>["Biotechnology", "Infectious Diseases", "Immunology"], "users"=>["Justin Lessler", "C. Jessica E. Metcalf", "Rebecca F. Grais", "Francisco J. Luquero", "Derek A. T. Cummings", "Bryan T. Grenfell"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001110.g002", "stats"=>{"downloads"=>2, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_expected_number_of_additional_people_vaccinated_in_a_vaccination_activity_per_batch_of_100_vaccine_doses_delivered_in_a_hypothetical_population_of_1_000_individuals_where_961_8202_8202_0_8_/390411", "title"=>"The expected number of additional people vaccinated in a vaccination activity per batch of 100 vaccine doses delivered, in a hypothetical population of 1,000 individuals where ρ = 0.8.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-10-25 00:06:51"}

PMC Usage Stats | Further Information

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  • {"month"=>"4", "scanned-page-browse"=>"0", "cited-by"=>"0", "abstract"=>"2", "full-text"=>"8", "year"=>"2012", "pdf"=>"7", "unique-ip"=>"14", "figure"=>"1", "scanned-summary"=>"0", "supp-data"=>"0"}
  • {"scanned-page-browse"=>"0", "month"=>"5", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"7", "unique-ip"=>"7", "pdf"=>"6", "year"=>"2012", "figure"=>"0", "scanned-summary"=>"0", "supp-data"=>"0"}
  • {"month"=>"6", "scanned-page-browse"=>"0", "cited-by"=>"0", "abstract"=>"1", "full-text"=>"11", "year"=>"2012", "pdf"=>"8", "unique-ip"=>"10", "figure"=>"0", "scanned-summary"=>"0", "supp-data"=>"0"}
  • {"unique-ip"=>"9", "full-text"=>"9", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2012", "month"=>"7"}
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  • {"unique-ip"=>"16", "full-text"=>"19", "pdf"=>"8", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2012", "month"=>"10"}
  • {"unique-ip"=>"6", "full-text"=>"7", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2012", "month"=>"12"}
  • {"unique-ip"=>"9", "full-text"=>"8", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"1"}
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  • {"unique-ip"=>"6", "full-text"=>"5", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"7"}
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  • {"unique-ip"=>"12", "full-text"=>"11", "pdf"=>"8", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"11", "cited-by"=>"0", "year"=>"2013", "month"=>"9"}
  • {"unique-ip"=>"5", "full-text"=>"4", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"10"}
  • {"unique-ip"=>"6", "full-text"=>"5", "pdf"=>"1", "abstract"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"11"}
  • {"unique-ip"=>"6", "full-text"=>"5", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2013", "month"=>"12"}
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  • {"unique-ip"=>"14", "full-text"=>"17", "pdf"=>"7", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"1", "year"=>"2014", "month"=>"2"}
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  • {"unique-ip"=>"10", "full-text"=>"8", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"5"}
  • {"unique-ip"=>"6", "full-text"=>"5", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"6"}
  • {"unique-ip"=>"10", "full-text"=>"13", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"2", "year"=>"2014", "month"=>"4"}
  • {"unique-ip"=>"9", "full-text"=>"7", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"7"}
  • {"unique-ip"=>"11", "full-text"=>"11", "pdf"=>"7", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"8"}
  • {"unique-ip"=>"11", "full-text"=>"20", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"1", "cited-by"=>"0", "year"=>"2014", "month"=>"9"}
  • {"unique-ip"=>"10", "full-text"=>"19", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"6", "cited-by"=>"1", "year"=>"2014", "month"=>"10"}
  • {"unique-ip"=>"6", "full-text"=>"5", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"11"}
  • {"unique-ip"=>"3", "full-text"=>"3", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2014", "month"=>"12"}
  • {"unique-ip"=>"23", "full-text"=>"22", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"1"}
  • {"unique-ip"=>"22", "full-text"=>"22", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"2"}
  • {"unique-ip"=>"17", "full-text"=>"16", "pdf"=>"7", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"3"}
  • {"unique-ip"=>"17", "full-text"=>"17", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"4"}
  • {"unique-ip"=>"19", "full-text"=>"22", "pdf"=>"6", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"5"}
  • {"unique-ip"=>"19", "full-text"=>"17", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"6"}
  • {"unique-ip"=>"17", "full-text"=>"17", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2015", "month"=>"7"}
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Relative Metric

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