---
title: "Coverage and adherence to the German childhood vaccination schedule: KUNO-Kids results"
id: "pubmed-42759250"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42759250"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42759250/"
doi: "10.1016/j.vaccine.2026.129164"
published_at: "2026-10-24T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Coverage and adherence to the German childhood vaccination schedule: KUNO-Kids results
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42759250
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42759250/)
- **DOI:** [10.1016/j.vaccine.2026.129164](https://doi.org/10.1016%2Fj.vaccine.2026.129164)
- **Published At:** 2026-10-24T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The KUNO-Kids health study provided both cross-sectional (n = 2,044) and longitudinal (n = 583) data from German birth cohorts 2015–2020. - Investigators assessed vaccination coverage, catch-up vaccination, and completion of the full primary immunization series at 6 months, 2 years, and 4 years of age. - At 24 months, coverage for individual recommended vaccines remained below the **90-95%** targets set by STIKO and WHO. - Vaccination coverage rose between the 2- and 4-year assessments for all vaccines in the cohort. - Vaccines requiring multiple first-year doses showed lower coverage (hexavalent vaccine 71–76%) compared with vaccines started around 12 months and requiring fewer doses (MMR 86–87%). - Among children incompletely vaccinated at 2 years, catch-up by 4 years was greater for **MMR** than for the **hexavalent vaccine**. - Completion of the entire recommended schedule was achieved in only 50–55% of children at the 6-month and 2-year follow-ups; this increased to 59–76% by 4 years. - The authors observed that schedule complexity in the first year of life may contribute to lower adherence and suggested implementing reminder systems and health education targeted to that age group. - Data sources and cohort definitions were reported; the abstract did not provide granular methods such as exact inclusion/exclusion criteria, vaccine dosing schedules, or statistical test results in the abstract text.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 18. # Coverage and adherence to the German childhood vaccination schedule: results from the KUNO-Kids health study [Margarida Arede](https://pubmed.ncbi.nlm.nih.gov/?term=Arede+M&cauthor_id=42759250)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42759250/#full-view-affiliation-1 "Bavarian Health and Food Safety Authority, State Institute for Health II - Task Force for Infectious Diseases, Infectious Disease Epidemiology, Surveillance and Modelling Unit \(GI-TFI2\), München, Germany; ECDC Fellowship Programme, Field Epidemiology Path \(EPIET\), European Centre for Disease Prevention and Control \(ECDC\), Stockholm, Sweden. Electronic address: margarida.arede@lgl.bayern.de."), [Susanne Brandstetter](https://pubmed.ncbi.nlm.nih.gov/?term=Brandstetter+S&cauthor_id=42759250)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42759250/#full-view-affiliation-2 "University Children's Hospital Regensburg \(KUNO\), University of Regensburg, Klinik St. Hedwig, Regensburg, Germany; Research and Development Campus Regensburg \(WECARE\), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany."), [Andreas Beyerlein](https://pubmed.ncbi.nlm.nih.gov/?term=Beyerlein+A&cauthor_id=42759250)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42759250/#full-view-affiliation-3 "Bavarian Health and Food Safety Authority, State Institute for Health II - Task Force for Infectious Diseases, Infectious Disease Epidemiology, Surveillance and Modelling Unit \(GI-TFI2\), München, Germany."), [Michael Kabesch](https://pubmed.ncbi.nlm.nih.gov/?term=Kabesch+M&cauthor_id=42759250)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42759250/#full-view-affiliation-2 "University Children's Hospital Regensburg \(KUNO\), University of Regensburg, Klinik St. Hedwig, Regensburg, Germany; Research and Development Campus Regensburg \(WECARE\), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany."), [Angela Köninger](https://pubmed.ncbi.nlm.nih.gov/?term=K%C3%B6ninger+A&cauthor_id=42759250)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42759250/#full-view-affiliation-4 "University Clinic of Gynaecology and Obstetrics, Hospital St. Hedwig of the Order of St. John, Regensburg, Germany."), [Christian Apfelbacher](https://pubmed.ncbi.nlm.nih.gov/?term=Apfelbacher+C&cauthor_id=42759250)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42759250/#full-view-affiliation-5 "Institute of Social Medicine and Health System Research, Medical Faculty, Otto Von Guericke University Magdeburg, Magdeburg, Germany."), [Merle M Böhmer](https://pubmed.ncbi.nlm.nih.gov/?term=B%C3%B6hmer+MM&cauthor_id=42759250)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42759250/#full-view-affiliation-6 "Bavarian Health and Food Safety Authority, State Institute for Health II - Task Force for Infectious Diseases, Infectious Disease Epidemiology, Surveillance and Modelling Unit \(GI-TFI2\), München, Germany; Institute of Social Medicine and Health System Research, Medical Faculty, Otto Von Guericke University Magdeburg, Magdeburg, Germany.") Affiliations Expand ### Affiliations * 1 Bavarian Health and Food Safety Authority, State Institute for Health II - Task Force for Infectious Diseases, Infectious Disease Epidemiology, Surveillance and Modelling Unit (GI-TFI2), München, Germany; ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Electronic address: margarida.arede@lgl.bayern.de. * 2 University Children's Hospital Regensburg (KUNO), University of Regensburg, Klinik St. Hedwig, Regensburg, Germany; Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany. * 3 Bavarian Health and Food Safety Authority, State Institute for Health II - Task Force for Infectious Diseases, Infectious Disease Epidemiology, Surveillance and Modelling Unit (GI-TFI2), München, Germany. * 4 University Clinic of Gynaecology and Obstetrics, Hospital St. Hedwig of the Order of St. John, Regensburg, Germany. * 5 Institute of Social Medicine and Health System Research, Medical Faculty, Otto Von Guericke University Magdeburg, Magdeburg, Germany. * 6 Bavarian Health and Food Safety Authority, State Institute for Health II - Task Force for Infectious Diseases, Infectious Disease Epidemiology, Surveillance and Modelling Unit (GI-TFI2), München, Germany; Institute of Social Medicine and Health System Research, Medical Faculty, Otto Von Guericke University Magdeburg, Magdeburg, Germany. * PMID: **42759250** * DOI: [ 10.1016/j.vaccine.2026.129164 ](https://doi.org/10.1016/j.vaccine.2026.129164) Free article Item in Clipboard # Coverage and adherence to the German childhood vaccination schedule: results from the KUNO-Kids health study Margarida Arede et al. Vaccine. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Vaccine Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Vaccine%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Vaccine%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42759250/) . 2026 Oct 24:92:129164. doi: 10.1016/j.vaccine.2026.129164. Epub 2026 Sep 18. ### Authors [Margarida Arede](https://pubmed.ncbi.nlm.nih.gov/?term=Arede+M&cauthor_id=42759250)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42759250/#short-view-affiliation-1 "Bavarian Health and Food Safety Authority, State Institute for Health II - Task Force for Infectious Diseases, Infectious Disease Epidemiology, Surveillance and Modelling Unit \(GI-TFI2\), München, Germany; ECDC Fellowship Programme, Field Epidemiology Path \(EPIET\), European Centre for Disease Prevention and Control \(ECDC\), Stockholm, Sweden. Electronic address: margarida.arede@lgl.bayern.de."), [Susanne Brandstetter](https://pubmed.ncbi.nlm.nih.gov/?term=Brandstetter+S&cauthor_id=42759250)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42759250/#short-view-affiliation-2 "University Children's Hospital Regensburg \(KUNO\), University of Regensburg, Klinik St. Hedwig, Regensburg, Germany; Research and Development Campus Regensburg \(WECARE\), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany."), [Andreas Beyerlein](https://pubmed.ncbi.nlm.nih.gov/?term=Beyerlein+A&cauthor_id=42759250)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42759250/#short-view-affiliation-3 "Bavarian Health and Food Safety Authority, State Institute for Health II - Task Force for Infectious Diseases, Infectious Disease Epidemiology, Surveillance and Modelling Unit \(GI-TFI2\), München, Germany."), [Michael Kabesch](https://pubmed.ncbi.nlm.nih.gov/?term=Kabesch+M&cauthor_id=42759250)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42759250/#short-view-affiliation-2 "University Children's Hospital Regensburg \(KUNO\), University of Regensburg, Klinik St. Hedwig, Regensburg, Germany; Research and Development Campus Regensburg \(WECARE\), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany."), [Angela Köninger](https://pubmed.ncbi.nlm.nih.gov/?term=K%C3%B6ninger+A&cauthor_id=42759250)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42759250/#short-view-affiliation-4 "University Clinic of Gynaecology and Obstetrics, Hospital St. Hedwig of the Order of St. John, Regensburg, Germany."), [Christian Apfelbacher](https://pubmed.ncbi.nlm.nih.gov/?term=Apfelbacher+C&cauthor_id=42759250)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42759250/#short-view-affiliation-5 "Institute of Social Medicine and Health System Research, Medical Faculty, Otto Von Guericke University Magdeburg, Magdeburg, Germany."), [Merle M Böhmer](https://pubmed.ncbi.nlm.nih.gov/?term=B%C3%B6hmer+MM&cauthor_id=42759250)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42759250/#short-view-affiliation-6 "Bavarian Health and Food Safety Authority, State Institute for Health II - Task Force for Infectious Diseases, Infectious Disease Epidemiology, Surveillance and Modelling Unit \(GI-TFI2\), München, Germany; Institute of Social Medicine and Health System Research, Medical Faculty, Otto Von Guericke University Magdeburg, Magdeburg, Germany.") ### Affiliations * 1 Bavarian Health and Food Safety Authority, State Institute for Health II - Task Force for Infectious Diseases, Infectious Disease Epidemiology, Surveillance and Modelling Unit (GI-TFI2), München, Germany; ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Electronic address: margarida.arede@lgl.bayern.de. * 2 University Children's Hospital Regensburg (KUNO), University of Regensburg, Klinik St. Hedwig, Regensburg, Germany; Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany. * 3 Bavarian Health and Food Safety Authority, State Institute for Health II - Task Force for Infectious Diseases, Infectious Disease Epidemiology, Surveillance and Modelling Unit (GI-TFI2), München, Germany. * 4 University Clinic of Gynaecology and Obstetrics, Hospital St. Hedwig of the Order of St. John, Regensburg, Germany. * 5 Institute of Social Medicine and Health System Research, Medical Faculty, Otto Von Guericke University Magdeburg, Magdeburg, Germany. * 6 Bavarian Health and Food Safety Authority, State Institute for Health II - Task Force for Infectious Diseases, Infectious Disease Epidemiology, Surveillance and Modelling Unit (GI-TFI2), München, Germany; Institute of Social Medicine and Health System Research, Medical Faculty, Otto Von Guericke University Magdeburg, Magdeburg, Germany. * PMID: **42759250** * DOI: [ 10.1016/j.vaccine.2026.129164 ](https://doi.org/10.1016/j.vaccine.2026.129164) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract In Germany, the childhood vaccination schedule in 2015-2020 included 13 vaccines, for which primary immunization series was recommended to be completed by 24 months of age. Childhood vaccination coverage is monitored through health insurance claims data and pre-school entry examinations. These cross-sectional systems provide limited information on individual vaccination trajectories, catch-up vaccination, and completion of the recommended vaccination schedule. We used cross-sectional (n = 2044) and longitudinal (n = 583) data from the KUNO-Kids health study (KKHS) from Regensburg, Germany (birth cohorts 2015-2020). We assessed vaccination coverage, catch-up vaccination, and completion of the entire primary immunization series according to the schedule recommended by the German Standing Committee on Vaccination (STIKO) at three follow-up time-points: 6 months, 2 years, and 4 years. Analyses included only children eligible for each assessment. At the 2-year follow-up, our cohort's vaccination coverage for all individual recommended vaccines remained below the 90-95% targets set by STIKO and the World Health Organization for 24 months of age. Vaccination coverage for all vaccines increased between the 2- and 4-year follow-up assessments for all vaccines. Coverage was lower for vaccines requiring multiple doses during the first year of life, such as the hexavalent vaccine (71-76%), than for vaccines initiated around 12 months of age and requiring fewer doses, such as MMR (86-87%). Among children with incomplete vaccination at 2 years, catch-up by 4 years was higher for MMR than for the hexavalent vaccine. Completion of the entire recommended vaccination schedule was achieved by only 50-55% of children at the 6-month and 2-year follow-ups but increased to 59-76% by the 4-year follow-up. Despite considerable catch-up before school entry, schedule adherence remained suboptimal, suggesting that vaccination schedule complexity in the first year of life may influence adherence. Interventions targeting this age group, including vaccination reminder systems and health education initiatives, should be implemented. **Keywords:** Catch-up vaccination; Childhood vaccination schedule; Vaccination adherence; Vaccination completion. Copyright © 2026. Published by Elsevier Ltd. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ## Similar articles * [ Coverage disparities and delayed immunization: Assessing 12-month vaccination completion in Canadian children using data from a digital immunization platform. ](https://pubmed.ncbi.nlm.nih.gov/40404591/) Serhan M, Nilormi A, Ntacyabukura B, Atkinson K, Ducharme R, Hawken S, Ramsay T, Ang J, Wilson K.Serhan M, et al.Hum Vaccin Immunother. 2025 Dec;21(1):2506286. doi: 10.1080/21645515.2025.2506286. Epub 2025 May 22.Hum Vaccin Immunother. 2025.PMID: 40404591Free PMC ar
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