Rotavirus vaccine coverage and factors associated with uptake using linked data: Ontario, Canada

PLoS One. 2018 Feb 14;13(2):e0192809. doi: 10.1371/journal.pone.0192809. eCollection 2018.


Background: In August 2011, Ontario, Canada introduced a rotavirus immunization program using Rotarix™ vaccine. No assessments of rotavirus vaccine coverage have been previously conducted in Ontario.

Methods: We assessed vaccine coverage (series initiation and completion) and factors associated with uptake using the Electronic Medical Record Administrative data Linked Database (EMRALD), a collection of family physician electronic medical records (EMR) linked to health administrative data. Series initiation (1 dose) and series completion (2 doses) before and after the program's introduction were calculated. To identify factors associated with series initiation and completion, adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated using logistic regression.

Results: A total of 12,525 children were included. Series completion increased each year of the program (73%, 79% and 84%, respectively). Factors associated with series initiation included high continuity of care (aOR = 2.15; 95%CI, 1.61-2.87), maternal influenza vaccination (aOR = 1.55; 95%CI,1.24-1.93), maternal immmigration to Canada in the last five years (aOR = 1.47; 95% CI, 1.05-2.04), and having no siblings (aOR = 1.62; 95%CI,1.30-2.03). Relative to the first program year, infants were more likely to initiate the series in the second year (aOR = 1.71; 95% CI 1.39-2.10) and third year (aOR = 2.02; 95% CI 1.56-2.61) of the program. Infants receiving care from physicians with large practices were less likely to initiate the series (aOR 0.91; 95%CI, 0.88-0.94, per 100 patients rostered) and less likely to complete the series (aOR 0.94; 95%CI, 0.91-0.97, per 100 patients rostered). Additional associations were identified for series completion.

Conclusions: Family physician delivery achieved moderately high coverage in the program's first three years. This assessment demonstrates the usefulness of EMR data for evaluating vaccine coverage. Important insights into factors associated with initiation or completion (i.e. high continuity of care, smaller roster sizes, rural practice location) suggest areas for research and potential program supports.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child, Preschool
  • Cohort Studies
  • Confidence Intervals
  • Electronic Health Records
  • Family Practice
  • Female
  • Health Information Interoperability
  • Humans
  • Immunization Programs* / statistics & numerical data
  • Infant
  • Infant, Newborn
  • Information Storage and Retrieval
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Odds Ratio
  • Ontario
  • Rotavirus Infections / prevention & control
  • Rotavirus Vaccines / therapeutic use*


  • Rotavirus Vaccines

Grant support

This work was funded by Public Health Ontario (PHO). This study was also supported by the Institute for Clinical Evaluative Sciences (ICES). Both PHO and ICES are funded by annual grants from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Astrid Guttmann receives salary support from a Canadian Institutes for Health Research Applied Chair in Reproductive and Child Health Services and Policy Research. Karen Tu and Jeff Kwong are supported by Clinician Scientist Awards from the Department of Family and Community Medicine at the University of Toronto. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES, PHO, or MOHLTC is intended or should be inferred. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.