The Danish childhood immunisation programme 2019-2021

Go to Danish report: Børnevaccinationsprogrammet 2019-2021 - statusrapport

Summary of annual report on the Danish childhood immunisation programme 2019-2021

Childhood immunisation programme coverage remained stable and high in 2019-2021

Although 2020 and 2021 were marked by the COVID-19 epidemic, childhood immunisation programme coverage generally remained stable during the period.

For some vaccines, a slight decline in the number of vaccines administered was seen in the weeks during the lockdown in spring 2020, with programme coverage returning to its normal level by the end of the year. In addition, coverage of the second dose of the MMR vaccine administered to children aged 4 grew from 89% in 2018 to 93% in 2021, approaching the 95% target recommended by the WHO to reach herd immunity.

It is also worth highlighting the high HPV vaccine coverage among boys. Despite the fact that the HPV vaccine for boys was not permanently included in the childhood immunisation programme until 2019, 89% of boys born in 2008 have received their frst dose of the HPV vaccine. This means that the coverage among boys is almost the same as the coverage among girls who have been included in the programme since 2009. 91% of girls born in 2008 have received their frst dose of the HPV vaccine. This is a very high coverage rate, and the hope is that it will continue to increase in the future.

Initiatives to maintain high childhood immunisation programme coverage

In the period 2019-2021, several initiatives were launched to strengthen childhood immunisation programme coverage. The goal was to increase immunisation at the recommended age and to increase awareness of the availability of the vaccines among the intended target groups.

Among these initiatives are the courses ofered by the Danish Health Authority to train health visitors to become immunisation ambassadors. The purpose was to improve health visitors’ ability to engage in a dialogue with parents about the benefts of the childhood immunisation programme. During 2020 and 2021, the Danish Health Authority held several well-attended courses.

Another initiative concerned the expansion of the existing reminder scheme from 2014 to ensure that more children are vaccinated on time. Since 2014, parents have received a written reminder if their child has not yet received one or more of the vaccines ofered by the childhood immunisation programme. From 1 August 2019, the scheme was expanded and changed so that parents receive a written reminder when it is time for their child to be vaccinated and when the vaccination time has passed.

Furthermore, in 2021, Statens Serum Institut prepared a report examining which groups of children do not follow the childhood immunisation programme to the same extent as other children of the same age. The aim of the study was to reduce health inequality. The fndings of the study showed a lower likelihood of the child being vaccinated if the child does not live with their parents, attends a privately funded school or a school for children with special needs, is an immigrant or has parents who are unemployed, have a low level of education and/or have low-income jobs. The fndings of the study can improve the focus of future recommendations and initiatives.

In 2017, the Danish Health Authority, the Danish Cancer Society and the Danish Medical Association launched the joint information campaign Stop HPV – stop livmoderhalskræft (Stop HPV – stop cervical cancer), which was later renamed to Stop HPV – bliv vaccineret (Stop HPV – get vaccinated) following the inclusion of boys in the programme in 2019. The aim of the initiative  was to provide nuanced and evidence-based information about the HPV vaccine and increase immunisation coverage, as a signifcant decline in coverage was observed over a period of time due to negative media reports and consequent widespread concern about potential adverse reactions among parents. The information campaign ended in late 2021 after having successfully restored HPV immunisation coverage. The Danish Health Authority will, however, continue to focus on doubts and concerns about the vaccines offered by the childhood immunisation programme.

New childhood immunisation recommendations

In 2021, the childhood infuenza immunisation programme and COVID-19 immunisation programme were introduced. Both immunisation programmes were temporary, but it has now been decided that children aged 2-6 will also be ofered the infuenza vaccine during the next infuenza season.

The Danish Health Authority based its recommendation on a comprehensive health technology assessment (HTA) of infuenza programme and the extraordinary situation with the COVID-19 epidemic and the risk of a severe infuenza epidemic due to reduced levels of immunity in the population as a result of few infuenza cases in the 2020/21 season.

The COVID-19 immunisation programme began in December 2020 and at the time it included people over the age of 16. In June 2021, the programme was expanded by the Danish Health Authority, now recommending that children aged 12-15 also be vaccinated against COVID-19, and in November of the same year children aged 5-11 were also included in the programme following an in-depth professional review.

The infuenza vaccine ofer was available to children aged 2-6 from 1 October 2021 to 15 January 2022 and had relatively low coverage of around 30%, corresponding to approximately 109,000 children. In March 2022, COVID-19 vaccine coverage was 80% among children aged 12-15 and 46% among children aged 5-11. In comparison, the total primary COVID-19 immunisation coverage among people over the age of 5 was 87%.

In connection with the introduction of the two vaccination ofers, the Danish Health Authority carried out questionnaire surveys and interviews among parents of children in the relevant age groups in order to gain insight into the parents’ attitudes towards vaccinating their children against COVID-19 and infuenza. Among other things, the fndings of the studies showed that among parents who were reluctant to vaccinate their children, the reluctance mainly stemmed from concerns about potential adverse reactions and the belief that natural immunity is preferable. Conversely, parents who were
willing to vaccinate their children were motivated by a desire to prevent their children and the rest of the family from being infected and prevent the children’s well-being and everyday life from being impacted due to having to stay at home in case of an infection.

Monitoring reports of suspected adverse reactions to the vaccines in the childhood immunisation programme

In the period 2019-2021, the Danish Medicines Agency received an average of 613 reports a year of suspected adverse reactions to the vaccines in the childhood immunisation programme. This figure has remained relatively stable since 2017. The vast majority of the adverse reaction reports concerned reactions at the injection site and other known adverse reactions such as fever, dyssomnia, headache and fatigue.

In 2021, the Danish Medicines Agency also received 47 reports of suspected adverse reactions following infuenza vaccinations among children aged 2-6 and 366 reports of suspected adverse reactions following COVID-19 vaccinations among children aged 5-15. Among other things, the Danish Medicines Agency has received reports of seven cases of myocarditis after COVID-19 vaccination. The cases have been investigated in depth, and they refect a rare but known adverse reaction, and the general adverse reaction profle in the 5-15 age group is comparable to that observed in the rest of the population.

Patient safety incidents can provide important learning

In the period 2019-2021, 399 patient safety incidents were reported for the vaccines in the childhood immunisation programme. A review of the patient safety incidents can provide important insight into workfows, organisation and vaccine storage, etc., and based on the review preventive measures can be developed to prevent recurrences.

The three most frequently reported incidents were: ‘Wrong vaccine administered’ (235 patient safety incidents), ‘Same vaccine administered multiple times’ (42 patient safety incidents) and ‘Interval between vaccine doses too short’ (27 patient safety incidents). In most cases, the consequence of the patient safety incident was that the child needed an additional dose of the vaccine, which in some cases required an additional visit to the doctor.

General decline in disease levels in 2019-2021

In 2019-2021, a general decline in disease levels was observed for most of the diseases covered by the childhood immunisation programme. The decline was particularly pronounced in the number of reported cases of pertussis (whooping cough) and measles. The primary reason for the decline is presumably a knock-on efect of the handling of the COVID-19 epidemic with infection control measures and periodic lockdowns.