Motivation Is Crucial for Immunization Success.

On reading the comprehensive study reported by Weigel et al. regarding nationwide immunization rates of children starting school in 2012 I could not help noticing that after Bavaria and Baden–Wurttemberg, North Rhine–Westphalia is among the federal states with the greatest variations for the individual immunizations (1). I am a pediatrician working in hospital in the Warendorf rural district, one of the two rural districts in North Rhine–Westphalia where immunization rates of more than 95% are the norm for all vaccines, and I wish to draw attention to several factors that may be crucial for achieving these outstanding results and that may serve as a model for other regions. In 2007 and 2008, immunization rates for poliomyelitis and hepatitis B in the Warendorf district with its primarily rural population were above 95%; the rates for measles were 92% and 93% (G. Fleissner-Busse, Gesundheitsamt [public health authority] Warendorf, personal communication). The latter had also risen to above 95% by 2012. These high immunization rates, which compare well in the intrastate and national comparisons, may be explained, among other factors, by the fact that all 17 pediatricians working in the rural district actively implement the STIKO recommendations. A further possible reason for the high vaccination rates in the Warendorf district may be the fact that, in a setting of 22–25% of children with a migration background, we succeeded in achieving identical rates to those in children without a migration background or even slightly higher rates (up to 2 percentage points higher). This is in stark contrast to the results of the KiGGS study [the German Health Interview and Examination Survey for Children and Adolescents], for example, in which the proportion of migrants was comparable but the immunization rates were 1–7% lower (2, 3).