The Danish Childhood Vaccination Programme 2023

The vaccination uptake in the childhood vaccination programme remained high in 2023

Vaccination uptake in the Danish childhood vaccination programme remains high across the programme, However, there is still some work to be done before we fully meet the coverage targets for the individual vaccinations.

Initiatives to maintain a high vaccination uptake in the Danish childhood vaccination programme

In 2023, several initiatives were launched to maintain and strengthen uptake in the childhood vaccination programme.

One example was a collaboration between the Danish Health Authority and Mino Denmark. In 2023, the Danish Health Authority and Mino Denmark together held six events (Mino Talks) to address and reduce the inequality in health for people from ethnic minority groups. Mino Talks focused on the free HPV vaccination programme, cancer screening programmes, access to the Danish healthcare system, and the inequality that ethnic minorities may encounter in the healthcare system. With regard to HPV vaccination, the purpose of the events was primarily to inform about HPV vaccination, and the diseases that HPV infection can cause and to debunk existing myths about HPV vaccination.

Another initiative was the arrangement of education days for health visitors. In 2023, the Danish Health Authority continued the project and held four education days for the country's health visitors in Ishøj, Næstved, Middelfart, and Herning, respectively. The programme of the education days was expanded with additional information about HPV vaccination and the diseases that HPV vaccination prevents. The programme included presentations about other diseases that the childhood vaccination programme protects against, the Danish Vaccination Register (DDV) and its use, and the importance of vaccination at the recommended time.

Statens Serum Institut has completed two register-based studies, one of them finding a positive effect of the new proactive reminder scheme compared to the reactive scheme where parents receive a reminder after the recommended time of vaccination, and the other one investigating which factors (determinants) are associated with low HPV vaccination coverage among girls. The results of the latter study showed that there are big differences in coverage between municipalities with the lowest coverage found to be in Copenhagen and certain islands. Furthermore, that the probability of not being vaccinated was higher among girls whose parents had a short education and low income, girls who did not live with both of their parents, girls attending special schools, and girls of foreign origin.

Special conditions pertaining to the Danish childhood vaccination programme in 2023

In 2023, there were several special conditions pertaining to the childhood vaccination programme. Children aged 2-6 years were again offered vaccination against influenza, and the offer of pertussis vaccination for pregnant women was temporarily reintroduced in 2023 and made permanent in January 2024.

Children aged 2-6 years have been offered influenza vaccination in the last three seasons. In the 2021/22 season the uptake was 29%, in the 2022/23 season it was 22%, and in the just-ended season, there was Børnevaccinationsprogrammet – årsrapport 2023 11 a further decrease in uptake to 16%. Statens Serum Institut conducted a register-based study, which found that the youngest children (2-3 years) and children with chronic diseases had higher vaccination uptake. Additionally, an evaluation consisting of a questionnaire survey and qualitative interviews showed that parents in the latest season had become less concerned about influenza infection and were less willing than before to have their children vaccinated for the sake of protecting others.

Due to the declining support for the programme, the Danish Health Authority believes that there would be a need to allocate a significant amount of resources and make an extraordinary effort to increase uptake among children in order to achieve the desired effect of the influenza vaccination, and that this cannot be prioritized within the existing framework. The offer of influenza vaccination for children aged 2-6 years will therefore not be continued for healthy children without vulnerabilities in the 2024 season. Vulnerable children are still included in the programme and are encouraged to accept the offer of influenza vaccination.

In 2023, pertussis vaccination was offered free of cost to pregnant women in the second and third trimester from January 1 to March 31 and again from August 1 to December 31. During the first period of three months, approximately 6,200 pregnant women were vaccinated against pertussis, and in the second period of four months – in which there was a pertussis epidemic – the number of vaccinated women was approximately 16,600. As of January 2024, the vaccination offer was made permanent.

Global disease outbreaks of concern in 2023

In Denmark, there is good control of infectious diseases preventable by vaccination. However, in other parts of Europe and the rest of the world, there are still challenges in getting enough people vaccinated to obtain control over these diseases.

After a period with fewer cases of measles during and after the COVID-19 pandemic, the number of reported measles cases increased significantly in the WHO European Region. Hence, there were more than 30,000 cases and five deaths in 2023.

Most countries are currently declared polio-free, but Afghanistan and Pakistan still experience cases of "wild-type" poliovirus. However, in 2023, cases of polio caused by vaccine-derived virus types 1 and 2 were reported primarily in Africa, but also in Israel and Indonesia. International spread of these virus types was recorded in 2022, but with no further spread or cases of polio in Western countries during 2023.

Monitoring reports of suspected side effects to the vaccines in the childhood vaccination programme

In 2023, the Danish Medicines Agency received a total of 228 reports of suspected side effects in children due to vaccines included in the childhood vaccination programme. The total annual number of reports on side effects in children has decreased since 2016. Most reports of suspected side effects to childhood vaccines are nonserious and involve mild to moderate reactions after vaccination. The same applies to reports on side effects of pertussis vaccines for pregnant women.

Except for Gardasil® (Statens Serum Institut. Determinanter for vaccination. 2024; Available at: https://www.ssi. dk/vaccinationer/determinanter-for-vaccination), for which a safety signal in regard to granuloma has been detected, no signals have been detected or confirmed that have given rise to changes in the safety information for the vaccines in the Danish childhood vaccination programme in 2023.

The Danish Medicines Agency has had a special focus on monitoring suspected side effects after influenza vaccination of children aged 2-6 years. In 2022, over 70,374 vaccine doses against influenza were administered to children aged 2-6 years. In the same period, the Danish Medicines Agency received a total of 27 reports of suspected side effects after influenza vaccination of that target group.

Patient safety incidents can provide important learning

In the first half of 2023, 59 adverse events with vaccines in the childhood vaccination programme were reported. Reporting of adverse events is used locally for learning in the municipality, region, private hospital, or hospice where the event occurred. They are subsequently anonymised and sent to the Danish Patient Safety Authority, which uses the adverse events for learning in the national healthcare system. In most cases, the consequence of the adverse event was that the patient needed an extra vaccination, which in some cases required an extra visit to the doctor.