Recording vaccine doses administered: A global analysis of tally sheet design for infant and child immunizations

Most countries use tally sheets across immunization programmes for health workers to mark vaccine doses administered to every person, alongside home-based records, yet their design and use is poorly understood at the global level. This paper presents a multi-country analysis on routine childhood immunization tally sheet content and design sourced from the annual electronic WHO/UNICEF Joint Reporting Form on Immunization (eJRF), which collected these forms for the first time in 2024 (for 2023). Of the total submissions (N = 71) of tally sheets by reporting entities, 51 submissions met the criteria for inclusion as a valid tally sheet allowing for data extraction. The 51 tally sheets were from countries and territories across all six regions of the World Health Organization (WHO) and all four World Bank income classifications. Analysis showed heterogeneity in immunization tally sheet design, core data fields, and the extent to which the available tally sheets aligned with globally recommendations found in recent vaccine-specific and programmatic guidance related to catch-up vaccination. As national immunization programmes and vaccination schedules protect against more diseases, and thereby become more complex, fit-for-purpose tally sheet design and instructions as well as support mechanisms for health workers on tally sheet use are essential, similar to what is recommended for home-based records.