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Immunization Gaps Among High-Risk Preterm Infants in Kazakhstan
Balzhan N Tatibekova1,2, Daniel Yakubovich3, Ademi K Sagatbayeva1
1Department of Epidemiology and Biostatistics, Astana Medical University, Astana 010000, Kazakhstan.
Insights
High-risk preterm infants in Kazakhstan show significant, ongoing gaps in childhood immunizations post-discharge. Improving vaccination strategies and care coordination is crucial for protecting vulnerable infants from preventable diseases.
Area of Science:
- Neonatal care
- Pediatric immunology
- Public health
Background:
- Neonatal intensive care advances improve preterm infant survival in Kazakhstan.
- Vulnerable preterm infants face risks from vaccine-preventable infections post-discharge due to medical exemptions and fragmented care.
Purpose of the Study:
- Assess vaccination coverage in a 10-year cohort of high-risk preterm infants.
- Identify factors (clinical, parental, organizational) linked to delayed infant immunization.
Main Methods:
- Retrospective cohort study of 331 preterm infants (2015-2024) in Astana, Kazakhstan.
- Analysis of vaccination status, medical exemptions, and reasons for delays.
- Supplementary surveys of parents, physicians, and managers explored immunization barriers.
Main Results:
- At discharge, 78.2% of infants lacked BCG or hepatitis B vaccines.
- By 24 months, only 34.1% were fully vaccinated; 49.8% remained unvaccinated.
- Measles and pertussis outbreaks affected the cohort, with severe complications including SSPE and pneumonia.
Conclusions:
- Significant and persistent immunization gaps exist for high-risk preterm infants after hospital discharge.
- Regular reassessment of medical exemptions and improved care coordination are vital.
- Strengthened catch-up immunization strategies are needed for medically vulnerable children.
Background:
Advances in neonatal intensive care in Kazakhstan have improved the survival of preterm infants, including those with very low birth weight (VLBW) and extremely low birth weight (ELBW). However, after hospital discharge, these medically vulnerable children may remain insufficiently protected against vaccine-preventable infections because of prolonged temporary medical exemptions, clinical caution, parental concerns, and fragmented coordination between specialized follow-up services and primary health care.
Objective:
This study aimed to assess vaccination coverage in a 10-year cohort of high-risk preterm infants and to identify clinical, parental, and organizational factors associated with delayed immunization.
Methods:
We conducted a retrospective cohort study of 331 high-risk preterm infants followed at a specialized pediatric center in Astana, Kazakhstan, between 2015 and 2024. Vaccination status at hospital discharge and at 24 months of chronological age, documented temporary medical exemptions, reasons for delayed or missed vaccination, and confirmed cases of pertussis and measles were analyzed. A supplementary cross-sectional survey of parents, physicians, and health care managers was conducted to further explore barriers to catch-up immunization.
Results:
At hospital discharge, 259 infants (78.2%) had not received the BCG or hepatitis B vaccine. By 24 months of age, 34.1% (n = 113) were fully vaccinated according to age, whereas 49.8% (n = 165) remained completely unvaccinated. During the observation period, 30 cases of measles and 17 cases of pertussis were recorded within the cohort, primarily during nationwide outbreaks. Among the 10 children with a history of measles before 12 months of age, 2 developed subacute sclerosing panencephalitis (SSPE), 1 developed profound hearing loss, and 1 required prolonged oxygen therapy following pneumonia. In addition, 2 children with periventricular leukomalacia (PVL) experienced clinical deterioration, while 1 infant with pertussis required hospitalization during the acute phase of illness.
Conclusion:
High-risk preterm infants in this cohort experienced substantial and persistent gaps in immunization after hospital discharge. These findings underscore the importance of regular reassessment of temporary medical exemptions, improved coordination between specialized follow-up services and primary health care, and strengthened catch-up immunization strategies for medically vulnerable children.
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