Dose-specific childhood vaccine refusal in Balıkesir, Türkiye (2024): a population-based surveillance analysis

Mandatory documentation exposed substantial under-ascertainment of parental refusal in performance-based records. Refusal is disproportionately clustered at booster and later-childhood visits, with MMR-II approaching herd-immunity margins. Programmatically, pediatric booster encounters are key leverage points for targeted counseling, and sustained, transparent surveillance as enabled by the new policy, is essential for early signal detection and response.