Self-reported poliomyelitis vaccination and documentation in adults indicates high uptake: a digital German epidemic...

On 12 December 2024, the Standing Committee on Vaccination (STIKO) recommended universal polio catch-up vaccination for children and adolescents up to 16, urging parents to check their children's immunization status following detections of vaccine-derived poliovirus in wastewater. The Robert Koch Institute (RKI) also advised healthcare professionals to ensure vaccination coverage in priority groups. Regional health authorities, called on all citizens to review their vaccination records to address any immunization gaps. We investigated vaccine uptake (documented / recalled) to improve estimates of immunity against poliovirus among the German population and gain insights into the proportion of undocumented vaccines.

We conducted a survey in December 2024 using the eResearch System PIA (Prospective Monitoring and Management-App) to collect data on self-reported vaccine uptake among a German cohort. We calculated the frequency of vaccinations that were documented and undocumented, as well as the types of vaccines and the number of doses received. Vaccination status was classified as received ≤ 2 doses versus ≥ 3 doses of any polio-containing vaccine. We applied survey weights to calculate frequencies according the general German population (by age, sex, region) and logistic regression to examine the relationships between the vaccinations that were not documented but recalled, and the factors associated with these undocumented vaccinations.

Among 1,124 participants who completed the survey on vaccination uptake, 1,097 (96.9%) participants stated to have a vaccination record. A total of 823/1,124 (74.3%) reported having a vaccination record, where at least one poliomyelitis vaccine was documented, whereas 233 (19.0%) participants recalled at least one poliomyelitis vaccination without documentation or vaccination record. Of 1,124, 68 participants (6.7%) did not report any polio vaccination neither documented nor recalled without documentation. Among the 823 participants with documented vaccination and at least one vaccination, 592 (75.1%) received at least three doses of a poliomyelitis vaccine, with a decline in older age groups, less than three doses were reported by 164 (17.6%), and the remaining 7.3% (n = 67) did not have information on the number of doses administered. Of 2,768 documented vaccine doses, 898 (29.9%) were oral poliovirus vaccines (OPV) and 704 (26.2%) were inactivated poliovirus vaccines (IPV). In 1,166 vaccines (43.9%), the type could not be derived by the participants from the vaccination record. The odds of having a recalled vaccination (not documented) was higher in male and the older age groups compared to females and younger participants.

We found similar poliomyelitis vaccination uptake compared to other data sources e.g., of the Robert Koch Institute (RKI). Vaccine-derived immunity to poliomyelitis may be underestimated based on vaccination records only. There is a need to address potential gaps in health literacy and vaccination documentation. Efforts should be made to conduct continuous seroprevalence surveys in the population in response to emerging public health threats and deduce parameters to inform modelling infection dynamics in specific outbreak scenarios.

The PCR-4-ALL cohort was registered in the German Clinical Trials Register on the 3rd of September 2024 (DRKS00034763).