Estimating vaccination coverage in the absence of immunisation registers--the German experience.

Immunisation registers are regarded as an appropriate solution to measure vaccination coverage on a population level. In Germany- a decentralised healthcare system and data protection regulations constrain such an approach. Moreover- shared responsibilities in the process of immunisation and multiple providers form the framework for public health interventions on vaccination issues. On the national level- those interventions consist mainly of conceptualising immunisation strategies- establishing vaccination programmes- and issuing recommendations. This paper provides an overview on sources and methods for collecting appropriate coverage data at national level and their public health relevance in Germany. Methods of data collection and available information on immunisations are described for three approaches: school entrance health examination- population surveys and insurance refund claim data. School entrance health examinations allow regional comparisons and estimation of trends for a specific cohort of chi