Home-based Vaccination Card Prevalence

Last updated: 30 April 2014

The site is currently under development.

Home-based vaccination records (e.g., vaccination cards) are an inexpensive yet effective instrument for systematically recording the vaccines received by an individual. Moreover, the card can enhance health professionals’ ability to make clinical decisions, empower parents/caregivers in the health care of their children, and support public health monitoring. Unfortunately, vaccination cards are too often underutilized or inappropriately used by parents and health care workers and therefore does not always fulfil their intended purpose.  


Vaccination cards also support the collection of data for uses other than direct clinical care or delivery of vaccines, such as for quality management and public health monitoring. Periodic coverage surveys, through which information is collected directly from a sample of households, are one way in which immunization coverage of young children is monitored. Within these surveys, vaccination or child health cards available in the household are used to collect documented information on vaccination services received by children. In the absence of an available or completed card, surveys often collect information based on maternal recall, though there is mixed evidence regarding the validity and reliability of recall relative to health records or immunization cards. Despite the importance of cards to monitoring, the reliance on cards as a source of immunization data will almost certainly underestimate coverage until the proportion of cardholders is more nearly equal the proportion of children immunized [Fisher and Vaessen. Int Health News Abstract 1987; 8(6): 1, 4.], further reinforcing the need to improve issuance, maintenance and utilization of cards.

A repository of cards can be found at www.immunizationcards.org.

This purpose of this site is to maintain the prevalence of home-based vaccination cards based on Multiple Indicator Cluster Surveys (MICS) or Demographic and Health Surveys (DHS) for the period 2000-2013.  If the information posted here is incorrect or information is missing, please send an e-mail to immunization [at] unicef [dot] org (to the attention of David Brown) with a short note of explanation.

Figure. Latest national estimated prevalence of home-based vaccination cards based on MICS or DHS survey results for the 
period 2000-2013

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

As of 30 April 2014, 102 countries are represented on the above map with a MICS or DHS survey result for vaccination record prevalence.  A total of 20 of the 102 countries latest estimated national home-based vaccination record prevalence was < 50%; 35 countries had a prevalence between 50-74.9%; 32 countries had a prevalence between 75-89.9%; and 15 countries had a prevalence between 90-99.9% (median = 73%; 25%-tile = 57; 75%-tile = 84).  Of the 55 countries with an estimated national home-based vaccination record prevalence <75%, 27 countries were located in the World Health Organization (WHO) African Region, 7 were in the Eastern Mediterranean Region, 6 were in the Region of the Americas, and 5 were in each of the South-East Asia, European and Western Pacific Regions.  By United Nations Children's Fund (UNICEF) regional classifications, 17 countries with prevalence <75% were located in West and Central Africa, 12 in East and Southern Africa, 7 in East Asia and Pacific, 6 in the Region of the Americas and Caribbean, 5 each in the CEE/CIS and South Asia Regions, and 3 in the Middle East and North Africa Region.  

More than half (55%) of the estimated global birth cohort (based on 2012 revision of World Population Prospects release from UNPD) resides in countries with a vaccination record prevalence < 75% based on the most recent MICS or DHS survey result for the period 2000-2013.

Table. National estimated prevalence of home-based vaccination records based on MICS or DHS survey results for the period 2000-2013

HH, household
p, indicates results obtained from a preliminary survey report

Note: Prevalences obtained as reported in the survey reports.  In general, prevalences are not reported by household wealth quintile in preliminary reports. MICS reports do not include the standard error of the prevalence of home-based vaccination records seen. Prevalences based on a small (<25) number of observations, and therefore unstable, are reported in parentheses.

Related reading material

Brown DW. Child immunization cards: essential yet underutilized in national immunization programmes. Open Vaccine J 2012;5:1-7.  Available online at http://benthamopen.com/contents/pdf/TOVACJ/TOVACJ-5-1.pdf

Brown DW, Gacic-Dobo M, Young S. Home-based child vaccination records -- a reflection on form. Vaccine 2014;32:1775-7. Available online at http://www.sciencedirect.com/science/article/pii/S0264410X14001613

Brown DW: Home-based vaccination records and hypothetical cost-savings due to avoidance of re-vaccinating children. J Vaccines Immun 2014;2(1):1-3. Available online at http://www.nobleresearch.org/downloadfile.aspx?file=articles%5C2053-1273-2014-e1.pdf 

Disclaimer: The findings and views expressed herein are those of the author(s) alone and do not necessarily reflect those of their respective institutions. All reasonable precautions have been taken to verify the information contained herein. However, the material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the site administrator(s) or their employer be liable for damages arising from its use.