Vaccination status of children in Switzerland

Despite being recognized as one of the most effective public health measures, vaccination has
become increasingly controversial as more parents and doctors question the effectiveness and
purpose of this preventive measure, with heightened emphasis on adverse events [Abrahamson
and Pickering, 2002; Campion, 2002]. The goals of our study were to determine immunization
coverage and examine factors influencing vaccination behaviors in 3 different age groups in each
canton by collecting vaccination cards and questionnaires between 1999 and 2003. National
coverage estimates for 3 doses of diphtheria (Di or D), tetanus (Te or T), pertussis (Per or P),
poliomyelitis (Pol) and Haemophilus influenzae type B (Hib) and combined dose of measles (M),
mumps (M), and rubella (R), or simply MMR, were: over 91% for Di, Te, Per, Pol and Hib and
around 81% for MMR for toddlers; they were more than 92%, for 4 doses of Di, Te and Pol,
60.9% and 26.6% for 4 doses of Per and Hib, respectively, and 87% for one dose of MMR for
children at school entry. For children at school departure, coverage estimates at 5 doses of Di, Te
and Pol was over 81% and around 50% for 2 doses of MMR (approximately 93% for 1 dose).
Hepatitis B coverage ranged between 2.3% and 88.3% with the mean at 1 dose being 46.3%, for
2 doses at 40.8%, and 3 doses at 25.9%. Due to methodological difficulties, comparison of
coverage for schoolchildren among the cantons should be done with caution. Comparison of
coverage for toddlers for MMR at one dose and Di, Te, and Pol at 3 doses with those from 1991
and 1998 revealed that coverage has remained relatively unchanged. However, for Per and Hib at
3 and 4 doses and 4 doses of Di, Te, and Pol, coverage levels have increased, with the uptake of
Hib being most apparent, climbing from 77% in 1998 to 91% in our survey at 3 doses and from
47% to 79% at 4 doses.
Vaccination coverage is significantly better in cantons where French or Italian is the predominant
language spoken as compared to their German counterparts, particularly for MMR. Cantons
supplementing their school health services with cantonally employed school nurses or
“Lungenliga” nurses have improved vaccination coverage as compared to those working only
with school doctors. Parental use of alternative medicine is found most often to be strongly
associated with low vaccination coverage, cutting across cantonal differences and types of
vaccines while being more influential by parents of younger kids. Nationality follows suit, with
Swiss children having lower MMR and higher Di and Pol coverage levels than those of foreign
background. Approximately 90% of all those who completed a questionnaire indicated that they
have information concerning vaccination. Of these, 67% are satisfied with what they have, while
17% are not happy, 7% remained undecided and 8% refrained from answering. Future
vaccination campaigns should address the latter 3 groups to effectively increase immunization
coverage.
Finally, doctors are one of the most important resources for parents for obtaining information
regarding vaccination; however, parents prefer that doctors actively share this information, rather
than having to request for it from the doctors themselves. Parents of schoolchildren increasingly
rely on school physicians for this information as their children get older. Health insurance should
also share more information with parents while information distributed by the media is less
desired. Parental attitudes towards vaccination and perception of the dangers of the childhood
preventable diseases and vaccine safety and efficacy are significantly associated with coverage.
Our results show that the most significant predictors of a child being UTD with the recommended
vaccination plan is if parents agree that they follow the doctor’s recommendation, believe in the
effectiveness of vaccination, and think that as many children as possible should be vaccinated for
the benefit of the community. In contrast, toddlers whose parents thought there was too much
social pressure to vaccinate their children and have concerns about possible side effects from
vaccines are less likely to be vaccinated as compared to those who disagree.
In summary, children in Switzerland are sub-optimally vaccinated. Immunization coverage is
affected by demographic and political factors, attitudes towards vaccination and perceptions of
the dangers of the disease, as well as information available to the parents and healthcare
providers. Future vaccination campaigns must address these factors, while providing clear and
transparent resources to the parents and healthcare professionals.