The Relationship Between Immunization Status and Infectious Diseases in Children: A Literature Review
DOI:
https://doi.org/10.33755/jkk.v12i3.1045Keywords:
Immunization, Infection, Immunization Status, ChildrenAbstract
Background: Infectious diseases remain the leading cause of morbidity and mortality among children. WHO data from 2023 indicate that approximately 14.5 million children worldwide are not immunized, including a significant number in Indonesia.
Objective: This study aims to analyze the relationship between immunization status and the incidence of infections in children through a literature review.
Methods: This study employed a systematic literature review approach. The literature search focused on publications from the past 10 years that were available in full text. Most of the analyzed studies used an analytical observational design. Data were collected from primary studies. Data analysis in the reviewed studies generally employed statistical tests such as the chi-square test, logistic regression, and multivariate analysis to determine the relationship between immunization status and the incidence of infections. Several large-scale studies also used logistic regression and multilevel models to control for confounding factors such as nutritional status, parental education, and access to health care.
Results: The findings indicate that the majority of studies report an association between immunization status and the incidence of infectious diseases. Children with incomplete immunizations have a higher risk of developing infections such as acute respiratory infections (ARIs) and pneumonia. Variations in results are influenced by other factors such as nutritional status, environment, and access to health care. The conclusions indicate that immunization status plays a crucial role in reducing the incidence of infectious diseases in children, although this association is influenced by various other factors.
Conclusion: The results of this analysis underscore the importance of increasing immunization coverage and adopting a comprehensive approach to the prevention of infectious diseases in children
References
1. MacDonald NE, Eskola J, Liang X, Chaudhuri M, Dube E, Gellin B, et al. Vaccine hesitancy: Definition, scope, and determinants. Vaccine. 2015 Aug 14;33(34):4161–4. doi:10.1016/j.vaccine.2015.04.036 PubMed PMID: 25896383.
2. Frenkel LD. The global burden of vaccine-preventable infectious diseases in children under 5 years of age: Implications for COVID-19 vaccination. How can we do better? Allergy and Asthma Proceedings. OceanSide Publications Inc.; 2021. p. 378–85. doi:10.2500/aap.2021.42.210065 PubMed PMID: 34474707.
3. Netea MG, Domínguez-Andrés J, Barreiro LB, Chavakis T, Divangahi M, Fuchs E, et al. Defining trained immunity and its role in health and disease. Nat Rev Immunol. June 4, 2020;20(6):375–88. doi:10.1038/s41577-020-0285-6
4. Melyani, Katarina, Andini N. The Relationship Between Immunization History, Infectious Diseases, and the Status of Toddlers in Mega Timur Village. Journal of Midwifery. 2025;15(2):1–7.
5. Rodrigues CMC, Plotkin SA. Impact of Vaccines: Health, Economic, and Social Perspectives. Frontiers in Microbiology. Frontiers Media S.A.; 2020. doi:10.3389/fmicb.2020.01526 PubMed PMID: 32760367.
6. Cao L, Zheng JS, Cao LS, Cui J, Duan MJ, Xiao QY. Factors influencing the routine immunization status of children aged 2–3 years in China. PLoS One. 2018 Oct 1;13(10). doi:10.1371/journal.pone.0206566 PubMed PMID: 30379911.
7. Muhawarman. Ministry of Health. 2025. World Immunization Week 2025: Let’s Complete Immunizations for a Healthy Generation Toward a Golden Indonesia.
8. Darmin, Rumaf F, Ningsih S, Mongilong R, Goma M, Anggaria A. The Importance of Complete Primary Immunization for Infants and Toddlers. MAPALUS Journal of Community Service. 2023;1(2):15–21.
9. Wigunarti M, Kristine Simanjuntak M, Puji Lestari D. Optimizing Complete Basic Immunization Coverage Through Community Empowerment Based on Communication, Information, and Education (KIE) and Training of Trainers (TOT). AMJPM [Internet]. 2025;4(2):257–70. Available from: http://journal.ahmareduc.or.id/index.php/
10. Dadzie LA, Ayisah C, Naabil DT, Adoboe IE, Sagbo FM, Dartey AF, et al. Determinants of incomplete childhood vaccination among children aged 0–23 months in Ghana: a facility-based cross-sectional study. BMC Pediatr. 2026 Dec 1;26(1). doi:10.1186/s12887-026-06688-8 PubMed PMID: 41782098.
11. Nova F, Ompusunggu F, Kartika L. Barriers to the Implementation of Routine Childhood Immunization in Indonesia. MAHESA: Malahayati Health Student Journal. May 16, 2023;3(3):770–88. doi:10.33024/mahesa.v3i3.9975
12. Lestari D, Pastuty R, Amanda A. Community Empowerment Through Increased Immunization Visit Participation as an Effort to Achieve Healthy and High-Quality Children. Jurnal Peduli Masyarakat. 2025;7(6):247–53.
13. Asrina A, Kurniasih NID. The Relationship Between Maternal Education and Infant Immunization and the Incidence of Acute Respiratory Infections. JOURNAL OF MIDWIFERY SCIENCE. 2024;4(1). doi:10.54816/jms.v3i1.1062
14. Setiawan I, Paulus O, Firmansyah Y, Hendsun H. The Effect of a History of COVID-19 Infection on Adverse Events Following Moderna Vaccination. Health Journal. 2022;10(2). doi:10.25047/jkes.v10i2.325
15. Higgins JPT, Soares-Weiser K, López-López JA, Kakourou A, Chaplin K, Christensen H, et al. Association of BCG, DTP, and measles-containing vaccines with childhood mortality: A systematic review. theBMJ. 2016;355:1–13. doi:10.1136/bmj.i5170 PubMed PMID: 27737834.
16. Risdiana R, Putri EIADK. Factors Influencing the Incidence of Pneumonia in Toddlers at the Wamena Jayawijaya Regional General Hospital Pediatric Ward. MAHESA: Malahayati Health Student Journal. 2025;5(12). doi:10.33024/mahesa.v5i12.19830
17. Friski Pratama, Dwi Agustian Faruk Ibrahim, Wenna Araya. Analysis of Individual Factors Affecting the Incidence of Respiratory Tract Infections in Toddlers at the Menteng Community Health Center (UPTD Puskesmas), Palangka Raya. Borneo Nursing Journal (BNJ). 2025;8(1). doi:10.61878/bnj.v8i1.235
18. Refialdinata J, Indah. The Relationship Between Nutritional Status and Basic Immunization Status and the Incidence of Pneumonia in Toddlers at the Lubuk Begalung Community Health Center in Padang. Jurnal Kesehatan Lentera ’Aisyiyah. 2025;8(1):53–29.
19. Safitri N, Lajuna L, Juliastuti J, Ramli N, Yushida Y. The Relationship Between a Complete History of Basic Immunization and the Incidence of Stunting in Toddlers. THE JOURNAL OF Mother and Child Health Concerns. Oct 6, 2025;4(7):516–24. doi:10.56922/mchc.v4i7.1357
20. Triola S, Retensiano Atasa L, Ayu Hamama Pitra D, Ashan H. Risk Factors for Acute Respiratory Tract Infections Among Toddlers in the Service Area of the Bukit Sileh Community Health Center, Lembang Jaya Subdistrict, Solok Regency, in 2021. Scientific Journal [Internet]. 2022;1(2):79–86. Available from: http://journal.scientic.id/index.php/sciena/issue/view/2
21. Fatahillah H, Andarini I, Hidayah D. The Association Between BCG Vaccination and Pulmonary Tuberculosis in Toddlers at Dr. Moewardi Regional General Hospital. Plexus Medical Journal. 2022;1(1):18–23.
22. Hasibuan R, Ginting NAR. Why Children Are Not Brought in for Immunization: A Qualitative Investigation at Posyandu in Medan. Indonesian Health Promotion Publication Media. Dec 1, 2023;6(12):2478–87. doi:10.56338/mppki.v6i12.4161
23. Afriansyah E, Fitriyani L. The Relationship Between a Complete Basic Immunization History and a History of Infectious Diseases and the Incidence of Stunting in Toddlers > 5 Years of Age in Depok City in 2023. MAHESA: Malahayati Health Student Journal. July 16, 2023;3(8):2282–9. doi:10.33024/mahesa.v3i8.10768
24. Sutriyawan A, Kurniawati R, Rahayu S, Habibi J. The Relationship Between Immunization Status and History of Infectious Diseases and the Incidence of Stunting in Toddlers: A Retrospective Study. Journal of Midwifery. Oct 2020;8(2):1–9.
25. Imdad A, Ahmed Z, Bhutta ZA. Vitamin A supplementation for the prevention of morbidity and mortality in infants one to six months of age. Cochrane Database of Systematic Reviews. September 28, 2016;2017(2). doi:10.1002/14651858.CD007480.pub3
26. Li X, Mukandavire C, Cucunubá ZM, Echeverria Londono S, Abbas K, Clapham HE, et al. Estimating the health impact of vaccination against ten pathogens in 98 low- and middle-income countries from 2000 to 2030: a modeling study. The Lancet. January 2021;397(10272):398–408. doi:10.1016/S0140-6736(20)32657-X
27. Fenta SM, Biresaw HB, Fentaw KD, Gebremichael SG. Determinants of full childhood immunization among children aged 12–23 months in sub-Saharan Africa: a multilevel analysis using Demographic and Health Survey data. Trop Med Health. Dec 1, 2021;49(1). doi:10.1186/s41182-021-00319-x
28. Wahl B, Gupta M, Erchick DJ, Patenaude BN, Holroyd TA, Sauer M, et al. Changes in full immunization inequalities among Indian children aged 12–23 months: an analysis of household survey data. BMC Public Health. 2021 Dec 1;21(1). doi:10.1186/s12889-021-10849-y PubMed PMID: 33933038.
29. Jil JPM. Immunization status of children aged 12–23 months in Jonglei State, South Sudan: a cross-sectional epidemiological study. Pan African Medical Journal. 2022;41. doi:10.11604/pamj.2022.41.258.31637 PubMed PMID: 35734325.
30. Ozawa S, Clark S, Portnoy A, Grewal S, Stack ML, Sinha A, et al. Estimated economic impact of vaccinations in 73 low- and middle-income countries, 2001–2020. Bulletin of the World Health Organization. September 1, 2017;95(9):629–38. doi:10.2471/BLT.16.178475 PubMed PMID: 28867843.
31. Solis-Soto T, Paudel D, Nicoli F. Relationship between vaccination and nutritional status in children: Analysis of recent demographic and health surveys. Demogr Res. 2020;42:1–14. doi:10.4054/demres.2020.42.1
32. Samaria D, Simanungkalit SF. Differences in the Intention to Receive the Human Papillomavirus (HPV) Vaccine for Cervical Cancer Prevention Among Women with Different Types of Decision-Making Roles. Nursing Current: Journal of Nursing. 2025;13(2). doi:10.19166/nc.v13i2.9788
33. Omar M, Muhsen K. A narrative review of nonspecific effects of pediatric vaccines on child mortality and morbidity. Human Vaccines and Immunotherapeutics. Taylor and Francis Ltd.; 2021. p. 5269–83. doi:10.1080/21645515.2021.1996150 PubMed PMID: 34847820.
34. Pollard AJ, Bijker EM. A guide to vaccinology: from basic principles to new developments. Nat Rev Immunol. Feb 22, 2021;21(2):83–100. doi:10.1038/s41577-020-00479-7
35. Plotkin SA. Correlates of Protection Induced by Vaccination. Clinical and Vaccine Immunology. July 2010;17(7):1055–65. doi:10.1128/CVI.00131-10
36. Fine P, Eames K, Heymann DL. “Herd Immunity”: A Rough Guide. Clinical Infectious Diseases. April 1, 2011;52(7):911–6. doi:10.1093/cid/cir007
37. Muspitaningrum EM, Fibrila F, Triwijayanti Y, Martini M. Education on the Importance of Immunization for Infants in the Seputih Banyak Community Health Center Area, Seputih Banyak Subdistrict, Central Lampung Regency. RENATA: Journal of Community Service for All of Us. Nov. 22, 2025;3(3). doi:10.61124/1.renata.216
38. Akbar Z, Renaldi R, Dewi O, Rany N, Hamid A. Behavioral Practices for the Prevention of Acute Respiratory Infections in the Service Area of the Bunut Community Health Center, Pelalawan Regency. Journal of Community Health. 2023;9(1). doi:10.25311/keskom.vol9.iss1.1127.












