Overview of influenza vaccination policy in Beijing, China: Current status and future prospects

Awareness of and attitude toward COVID-19 vaccination among individuals with COPD and the strategies to overcome vaccine hesitation: A mini review

Coronavirus Disease 2019 (COVID-19) vaccines have a protective effect on individuals with chronic obstructive pulmonary disease (COPD), preventing them from developing severe illnesses and reducing the risk of hospitalization and mortality. However, the coverage rate of COVID-19 vaccination among this population is not satisfactory, which is associated with their lack of awareness of and negative attitudes toward COVID-19 vaccination, that is, vaccine hesitancy. We reviewed recent literatures on the vaccination status of COPD patients and vaccine hesitancy, described the factors related to vaccine hesitancy among COPD patients, and proposed strategies to improve the vaccine coverage, such as providing accurate and consistent vaccine information to the public, patient health education program, improving self-management capabilities, easy access to vaccination service, etc., which can hopefully help to improve patients' ability to cope with SARS-CoV-2 infection and reduce the COVID-19 related mortality.

Knowledge, attitudes, and practices (KAP) toward seasonal influenza vaccine among college students under the COVID-19 pandemic in South China

BACKGROUND

The control measures of the coronavirus disease 2019 (COVID-19) pandemic had influenced the activity of the influenza virus, and we were wondering the knowledge, attitudes, and practices (KAP) toward seasonal influenza vaccine among college students were having at the context of the COVID-19 pandemic.

METHODS

Online questionnaire survey of the college students was conducted and the data was collected anonymously, cross-sectional study were used to describe the distribution of the KAP.

RESULTS

There were 815 respondents in our study. Most participants have a high recognition of the effectiveness and safety of the influenza vaccine. However, a low awareness rate of influenza vaccine knowledge and vaccination rate (18%) against influenza was observed among college students. The education level and major would have a higher weight on the influence of KAP among the college students. Binary logistic regression analysis showed that the sex (OR = 2.163, p < .001), age (OR = 2.242, p < .001), heard of the influenza vaccine (OR = 2.655, p = .014), and "How necessary do you think vaccinating every year is?" (OR = 3.947, p < .001) of the college students were the main factors that affect the KAP on influenza vaccination.

CONCLUSIONS

Our study provided an insight into the KAP of influenza vaccine among college students in South China. The vaccination rate and acceptability of influenza vaccine in college students are higher than that in the whole population.

Identifying implementation strategies to address barriers of implementing a school-located influenza vaccination program in Beijing

BACKGROUND

The school-located influenza vaccinations (SLIV) can increase influenza vaccination and reduce influenza infections among school-aged children. However, the vaccination rate has remained low and varied widely among schools in Beijing, China. This study aimed to ascertain barriers and facilitators of implementing SLIV and to identify implementation strategies for SLIV quality improvement programs in this context.

METHODS

Semi-structured interviews were conducted with diverse stakeholders (i.e., representatives of both the Department of Health and the Department of Education, school physicians, class headteachers, and parents) involved in SLIV implementation. Participants were identified by purposive and snowball sampling. The Consolidated Framework for Implementation Research was adopted to facilitate data collection and analysis. Themes and subthemes regarding barriers and facilitators were generated using deductive and inductive approaches. Based on the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC) matching tool, practical implementation strategies were proposed to address the identified barriers of SLIV delivery.

RESULTS

Twenty-four participants were interviewed. Facilitators included easy access to SLIV, clear responsibilities and close collaboration among government sectors, top-down authority, integrating SLIV into the routine of schools, and priority given to SLIV. The main barriers were parents' misconception, inefficient coordination for vaccine supply and vaccination dates, the lack of planning, and inadequate access to knowledge and information about the SLIV. CFIR-ERIC Matching tool suggested implementation strategies at the system (i.e., developing an implementation blueprint, and promoting network weaving), school (i.e., training and educating school implementers), and consumer (i.e., engaging students and parents) levels to improve SLIV implementation.

CONCLUSIONS

There were substantial barriers to the delivery of the SLIV program. Theory-driven implementation strategies developed in this pre-implementation study should be considered to address those identified determinants for successful SLIV implementation.

Optimization of Elderly Influenza and Pneumococcal Immunization Programs in Beijing, China Using Health Economic Evaluations: A Modeling Study

(1) Background: Currently, residents ≥ 60 and ≥65 years old in Beijing, China, are eligible for free influenza and pneumococcal polysaccharide vaccines (PPSV23), respectively. The present study aimed to assess the cost-effectiveness of current and alternative strategies of dual influenza and PPSV23 vaccination among the elderly in Beijing. (2) Methods: We developed a Markov state-transition model to compare the costs and the quality-adjusted life years (QALYs) associated with four influenza and PPSV23 vaccination strategies among the elderly in Beijing. The strategies were as follows: (1) no vaccination; (2) only flu vaccine for people ≥ 60 years old; (3) flu vaccine for people ≥ 60 years old and PPSV23 for people ≥ 65 years old; and (4) dual influenza vaccines and PPSV23 for people ≥ 60 years old. Incremental costs and QALYs were quantified to determine the optimal option. If dominant strategies emerged, the Chinese gross domestic product per capita in 2021 (80,976 CNY) was used as the willingness-to-pay (WTP) threshold to covert QALYs into the monetary equivalent. (3) Results: The current program saved costs and increased QALYs compared to no vaccination or flu vaccine-only strategies. However, extending free PPSV23 to people ≥ 60 years old saved 0.35 CNY additionally while increasing QALYs marginally compared with the current policy. Results were robust in all sensitivity analyses. (4) Conclusion: Beijing's current dual influenza and pneumococcal vaccination program was cost-effective among the elderly compared with the preceding policies of no vaccination and flu-only immunization programs. However, the program can further save money while enhancing the population health by extending PPSV23 to all people ≥ 60 years old.

Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

BACKGROUND

Underdiagnosis and undertreatment pose major barriers to optimal management of chronic obstructive pulmonary disease (COPD) in China.

OBJECTIVE

The REAL trial was performed to generate reliable information on real-world COPD management, outcomes and risk factors among Chinese patients. Here, we present study outcomes related to COPD management.

DESIGN

It is a 52-week, prospective, observational, multicentre study.

METHODS

Outpatients (aged ⩾40 years) enrolled from 50 secondary and tertiary hospitals across six geographic regions of China were followed up for 12 months, with two onsite visits and by telephone every 3 months following baseline.

RESULTS

Between June 2017 and January 2019, 5013 patients were enrolled and 4978 included in the analysis. Mean [standard deviation (SD)] age was 66.2 (8.9) years, the majority of patients were male (79.5%) and mean (SD) time since COPD diagnosis was 3.8 (6.2) years. The most common treatments at each study visit were inhaled corticosteroids/long-acting beta-agonists (ICSs/LABAs; 28.3-36.0%), long-acting muscarinic antagonists (LAMAs; 13.0-16.2%) and ICS/LABA + LAMA (17.5-18.7%), but up to 15.8% of patients at each visit received neither ICS nor long-acting bronchodilators. The use of ICS/LABA, LAMA and ICS/LABA + LAMA differed across regions and hospital tiers; up to fivefold, more patients received neither ICS nor long-acting bronchodilators in secondary (17.3-25.4%) versus tertiary hospitals (5.0-5.3%). Overall, rates of nonpharmacological management were low. Direct treatment costs increased with disease severity, but the proportion of direct treatment costs incurred due to maintenance treatment decreased with disease severity.

CONCLUSION

ICS/LABA, LAMA and ICS/LABA + LAMA were the most frequently prescribed maintenance treatments for patients with stable COPD in China, although their use differed between region and hospital tier. There is a clear need for improved COPD management across China, particularly in secondary hospitals.

REGISTRATION

The trial was registered on 20 March 2017 (ClinicalTrials.gov identifier: NCT03131362; https://clinicaltrials.gov/ct2/show/NCT03131362).

PLAIN LANGUAGE SUMMARY

Treatment patterns in patients with COPD in ChinaBackground: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by progressive and irreversible airflow limitation. In China, many patients with this disease do not receive a diagnosis or appropriate treatment.Objective: This study aimed to generate reliable information on the treatment patterns among patients with COPD in China to help inform future management strategies.Study design and methods: Patients (aged ⩾40 years) were enrolled from 50 hospitals across 6 regions of China and physicians collected data over the course of 1 year during routine outpatient visits.Results: The majority of patients were receiving long-acting inhaled treatments, which are recommended to prevent worsening of the disease. Up to 16% of patients in this study, however, did not receive any of these recommended treatments. The proportion of patients who received long-acting inhaled treatments differed across regions and hospital tiers; there were about five times more patients in secondary hospitals (about 25%) who did not receive these treatments compared with those in tertiary hospitals (about 5%). Guidelines recommend that pharmacological treatment should be complemented by nondrug treatment, but this was only received by a minority of patients in this study. Patients with higher disease severity incurred greater direct treatment costs compared with those with milder disease. Maintenance treatment costs made up a smaller proportion of overall direct costs for patients with higher disease severity (60-76%) compared with patients with milder disease (81-94%).Conclusion: Long-acting inhaled treatments were the most frequently prescribed maintenance treatments among patients with COPD in China, but their use differed between region and hospital tier. There is a clear need to improve disease management across China, especially in secondary hospitals.

Predictors of Influenza Vaccination among Chinese Middle School Students Based on the Health Belief Model: A Mixed-Methods Study

Influenza vaccination rates among Chinese middle school students are low. This study aims to explore the influencing factors of vaccination among middle school students and promote vaccination. We conducted a mixed-methods study, integrating a questionnaire survey among 9145 middle school students in four cities in China and semi-structured interviews with 35 middle school students to understand their attitudes and perceptions toward vaccination based on the Health Belief Model. We found the overall vaccination rate was 38.2% (3493/9145), with students in Beijing, boarding at school, or senior high school showing higher values than their counterparts (p < 0.05). Multiple logistic regression results showed that non-boarding (OR = 0.46, 95%CI: 0.42−0.51) and perceived barriers (OR = 0.97, 95%CI: 0.96−0.98) were unfavorable factors for influenza vaccination, whereas perceived susceptibility (OR = 1.07, 95%CI: 1.05−1.08), perceived benefits (OR = 1.02, 95%CI: 1.01−1.04), cues to action (OR = 1.08, 95%CI: 1.05−1.11), and self-efficacy (OR = 1.04, 95%CI: 1.02−1.07) were facilitators. Qualitative results indicated that positive health beliefs, school, and the home environment contribute to vaccination. In conclusion, the influenza vaccination rate among middle school students remains low. The concerns about the safety and potential side effects of vaccines are the main barriers to vaccination, underscoring the need for strengthening communication, education, and information among students and their teachers/parents.

Immunogenicity of a trivalent influenza vaccine and persistence of induced immunity in adults aged ≥60 years in Taizhou City, Zhejiang Province, China, during the 2018-2019 season

Yearly administration of influenza vaccine with recommendations can help control seasonal influenza epidemics in adults aged ≥60 years. Here, we describe the results of a prospective study observing the immunogenicity and persistence of induced immunity of a trivalent inactivated split-virion influenza vaccine (TIV) in adults aged ≥60 years during the 2018–2019 season in Taizhou City, Zhejiang Province in China. A total of 422 participants completed the study period. Vaccinated participants (284) received a single dose of TIV, but unvaccinated participants (138) didn’t receive any vaccine. Study participants vaccinated with TIV had significantly higher GMTs of Hemagglutination Inhibition (HI) antibodies against AH1N1, AH2N3, and B/Victoria strains (all p < .0001) at day 30 post-vaccination compared with unvaccinated participants, but the antibody response to the B/Victoria strain was the weakest. Rates of seroprotection and seroconversion were generally higher in the TIV-vaccinated group. At day 180 post-vaccination, the seroconversion rates (95%CI) in the vaccinated group were 99.6% (99.0%–100.3%), 97.9% (96.2%–99.6%), and 68.3% (62.9%–73.8%) for antibodies against three influenza strains, respectively; these rates were significantly different compared with unvaccinated group only for strains AH3N2 and B/Victoria (p = .002 and p < .0001, respectively). These results confirm that in adults aged ≥60 years, a single dose of TIV can induce a protective immune response against influenza, but the protective HI antibody levels induced against strain B/Victoria do not persist through 6 months.

Cost-effectiveness analysis of quadrivalent seasonal influenza vaccines in Beijing: A modeling analysis

BACKGROUND

Since 2007, Beijing has offered a free trivalent influenza vaccine (TIV) for residents aged ≥ 60 years and school students. The quadrivalent influenza vaccine (QIV) was administered to school children in 2018 and will be administered to elderly adults in the future. In addition, health care workers (HCWs) who are involved in the prevention and control of COVID-19 were included in the program in 2020. This study aimed to analyze the cost-effectiveness of a comprehensive list of combined strategies of TIV and QIV for school children, elderly adults, and HCWs to identify the most cost-effective strategy.

METHODS

A decision tree was developed to compare 1-year outcomes of TIV vs. QIV in three risk groups: school children, elderly adults, and HCWs. The outcome was incremental cost per quality-adjusted life-year (QALY). Probabilistic sensitivity analyses and scenario analyses were developed to assess the robustness of the results.

RESULTS

From the perspective of society, this study found that the introduction of QIVs can be cost-effective for any and all targeted groups with a willingness-to-pay threshold of 3-fold GDP per capita. Among all programs, program H (all school children, elderly adults, and HCWs received the QIV) showed a 79% probability of being cost-effective with an incremental cost-effectiveness ratio (ICER) of 13,580 (95% CI: 13,294, 13,867) US$/QALY and was the preferred option in the base case scenario.

CONCLUSION

The introduction of QIVs to school children, elderly adults, or HCWs is likely to be cost-effective, either separately or collectively. The introduction of QIV to school children, elderly adults, and health care workers simultaneously showed the highest probability of being cost-effective and was the preferred option.

The Current Status of Vaccine Uptake and the Impact of COVID-19 on Intention to Vaccination in Patients with COPD in Beijing

Background

SARS-CoV-2 tends to cause more severe disease in patients with COPD once they are infected. We aimed to investigate the rates of influenza, pneumococcal and COVID-19 vaccination uptake in patients with COPD and to determine whether the COVID-19 pandemic and widespread vaccination against COVID-19 had any impact on the intention to accept influenza vaccines in these patients.

Methods

We conducted a multi-center and cross-sectional survey in seven tertiary hospitals in Beijing and consecutively recruited outpatients with COPD from June 1st to July 30th, 2021. The survey included patient’s clinical characteristics, uptake of influenza, pneumococcal and COVID-19 vaccination, vaccine knowledge, attitude towards vaccines, and the change of intention to receive influenza vaccination after COVID-19 epidemic and COVID-19 vaccination in Beijing.

Results

A total of 264 patients were enrolled. The rate of COVID-19 vaccination during the study period was 39.0%. The rates of influenza vaccination in the past season and pneumococcal vaccination in the past year were 22.7% and 5.7%, respectively. Of the patients who had not received COVID-19 vaccination (n = 161), only 16.2% reported that COVID-19 vaccination was recommended by clinicians, while 23.5% had no knowledge regarding COVID-19 vaccination. About 51.1% of the patients reported that their intention to receive influenza vaccination was influenced by the COVID-19 pandemic. COVID-19 vaccination was independently associated with a positive change in intention to receive influenza vaccination.

Conclusion

The coverage rate of COVID-19 vaccination among patients with COPD in Beijing was 39.0%, and that of influenza and pneumococcal vaccination was very low. The COVID-19 pandemic and the COVID-19 vaccination campaign showed a significant, positive impact on patients with COPD in terms of influenza vaccination. Improving awareness of the effectiveness and safety of vaccines among both healthcare professionals and patients could increase vaccination coverage in patients with COPD.

Impact of a community-based health education intervention on awareness of influenza, pneumonia, and vaccination intention in chronic patients

The study aimed to examine the impact of a community-based health education intervention on the awareness and attitude of influenza and Streptococcus pneumoniae vaccination in patients with chronic diseases. We selected study participants from two counties in Jiaxing City, Zhejiang Province. We conducted a household baseline survey with quarterly follow-up and health education for all chronic disease patients in the area. A total of 720 patients with chronic diseases were included in two rounds of questionnaire surveys before and after a year-long health education related to the influenza and Streptococcus pneumoniae vaccination. Before the community education, 59.9% and 59.6% of study participants self-report the awareness of the hazards of influenza and pneumonia, respectively; while only 17.7% and 6.0% study participants self-reported awareness of the influenza or pneumonia vaccination, respectively; the self-reported vaccination rates were 1.3% and 0% for influenza and pneumonia, respectively. One year after the intervention, all rates were increased significantly, but the influenza vaccination rate was still far below the WHO minimum target level (75%). The main reason for not getting vaccinated reported by study participants was that participants thought they were in good health and would not become sick easily. There was no statistically significant difference between the impacts of health care practitioners’ and general practitioners’ recommendations for vaccination. Continued and pertinent health education has a significant impact on influenza and pneumonia vaccination in patients with chronic diseases.

Potential public health impact of the adjuvanted recombinant zoster vaccine among people aged 50 years and older in Beijing

Herpes zoster (HZ) is a painful, unilateral rash which occurs upon reactivation of latent varicella zoster virus due to age-related immunity decline or immuno-suppression. In 2019, the recombinant zoster vaccine (RZV) was the first vaccine to be approved in China for HZ prevention. This study aimed to estimate the potential public health impact of RZV vaccination, compared with the status quo of no vaccination, in individuals ≥50 years of age (YOA) in Beijing, by adapting the published ZOster ecoNomic Analysis (ZONA) model. We considered 5% and 50% vaccination coverage for the private market (near-term post-launch) and mass vaccination (long-term) settings respectively. In the base-case analysis of both market settings, second-dose compliance was set to 80%. Coverage and second-dose compliance rates were varied under scenario and sensitivity analyses. In the base case, mass vaccination with RZV was estimated to prevent 435,681 HZ cases, 51,558 postherpetic neuralgia (PHN) cases, and 15,703 cases of other HZ-related complications in the overall ≥50 YOA cohort over their remaining lifetime, compared with no vaccination. Under the same base-case scenario, 14,247 hospitalizations and 1,031,387 outpatient visits could be avoided. The 50-59 YOA cohort had the highest contributions to the overall reduction in HZ cases, its complications and related healthcare resource utilization. Results were robust under numerous scenario and sensitivity analyses. This analysis demonstrates the potential of RZV vaccination to substantially reduce the public health burden of HZ among individuals ≥50 YOA, and may inform appropriate vaccination strategies for HZ prevention, particularly in urban settings within China.

Dual influenza and pneumococcal vaccination was associated with lower short-term risks of all-cause and acute respiratory hospitalizations among the elderly in Shenzhen, China: a retrospective cohort study

The present study evaluated the real-world effectiveness of influenza and pneumococcal dual-vaccination among Chinese elderly, the evidence on which was absent. Outpatient and inpatient claims databases from Jan 1, 2015 to Apr 1, 2017 of persons at least 60 years old in Shenzhen, China were merged with electronic records of influenza vaccines and 23-valent pneumococcal polysaccharide vaccines (PPSV23) from Oct 1, 2016 - May 31, 2017. Individuals who were vaccinated with influenza between Nov 1 and Dec 31, 2016 and received PPSV23 30 days within the date of influenza vaccination were defined as the vaccinated group. A control group consisted of individuals that received neither of the vaccines was constructed by matching on year of birth, sex, and district. The two outcomes were all-cause and acute respiratory hospitalizations. Difference-in-difference (DiD) logistic regressions that were proceeded with an entropy balancing (EB) process were used to analyse the effectiveness of dual-vaccination. A total of 48,116 eligible individuals were identified in the vaccinated group, which were matched by 93,692 individuals in the control group. The EB-DiD analyses estimated that dual-vaccination was associated with lower short-term risks of all-cause (odds ratio: 0.59, CI: 0.55-0.63) and acute respiratory (odds ratio: 0.49, CI: 0.41-0.59) hospitalizations.

Barriers to influenza vaccination among different populations in Shanghai

BACKGROUND

Seasonal influenza vaccination coverage remains low in most areas of China. Its influencing factors and barriers in various populations receiving influenza vaccinations need to be well understood to promote vaccination.

METHODS

A cross-sectional survey was conducted with residents in 48 communities. Vaccination status in the 2018-2019 influenza season and reasons for or against vaccination were surveyed. The potential factors influencing vaccination uptake were determined using bivariate logistic regression.

RESULTS

In total, 1301 of the 11053 respondents received an influenza vaccine during the 2018-2019 season with a coverage rate of 11.8% (95% CI, 11.2-12.4). The vaccine coverage was highest among children (26.6%, 95%CI: 24.8-28.5), followed by adults (8.2%, 95%CI: 7.4-9.0) and elderly people (7.3%, 95%CI: 6.5-8.1) (p < .001). Those with chronic underlying conditions all had higher vaccine coverage than did those without for different groups (p < .001). Among the three groups, the most common reason for being unvaccinated was worrying about the side effects (45.0%), believing they were healthy and did not need to get vaccinated (42.2%), and lack of influenza vaccine awareness (48.3%). Low education level and lack of awareness were identified as predictors of low coverage rate.

CONCLUSION

Influenza vaccination coverage is low among different populations in Shanghai. Our study highlights the need for appropriate influenza vaccination strategies and programmes targeting different populations.

Factors impacting self-pay pediatric vaccine utilization in China: a large-scale maternal survey

OBJECTIVES

Utilization of self-pay vaccines worldwide is very low, especially in China; the reasons for this are unclear. We aimed to identify factors that impact the decision among Chinese mothers to utilize self-pay vaccines for their children.

METHODS

Mothers who were hospitalized at two hospitals in Zhanjiang City and who agreed to participate by completing the required questionnaire were eligible for this study.

RESULTS

In total, 7518 respondents (n = 7592) completed the questionnaire and were included in this survey. The self-pay option was largely elected by mothers with one child, compared with those who had two or more children. Similarly, utilization by workers at government agencies and organizations was higher than that among factory workers or unemployed respondents. Mothers with a college degree or above had higher utilization than those with a high school level education or lower. The main issues affecting maternal decisions to utilize self-pay pediatric vaccines were safety, the protective effect, and the high cost.

CONCLUSION

Mothers with higher socioeconomic status were more inclined to self-pay for pediatric vaccines. Steps taken to enhance public awareness about the safety and protective benefits of self-pay vaccines, as well as lowering their cost will likely encourage broader utilization of these vaccines.

The intentions to get vaccinated against influenza and actual vaccine uptake among diabetic patients in Ningbo, China: identifying motivators and barriers

BACKGROUND

Health authorities recommend influenza vaccination to diabetic patients. Nevertheless, the vaccination coverage of adults was low in China. This study aimed to estimate influenza vaccination intentions and actual uptake among diabetic patients in China and identify the motivators and barriers associated with vaccination.

METHODS

During Nov 2016-Jan 2017, 1960 diabetic patients were invited to participate in the investigation about influenza vaccination based on health belief model (HBM). To link vaccination intention to behavior, a follow-up survey was conducted to collect vaccination records of the 2016-2017 season. Predictors of the motivation to obtain influenza vaccination were assessed using logistic regressions.

RESULTS

1914 diabetic patients completed the survey. 46.13% participants reported intentions to be vaccinated against influenza and 7.84% actually received vaccination. In the multivariate models, while all the domains of HBM constructs were associated with intentions, age, increasing numbers of comorbidity, urban residents, perceived susceptibility, perceived benefits, free vaccination, and vaccination history displayed positive associations with vaccine uptake while increasing income and perceptions of barriers were negative predictors of vaccine uptake. Besides, interactions between perceived susceptibility and healthcare workers' (HCW's) recommendation, perceived severity and benefits, perceived severity and health-seeking behaviors, perceived benefits, and influence of family/friends had a significant positive effect modification on the vaccine uptake.

CONCLUSION

To improve diabetic patients' influenza vaccination and close the intention-behavior gap, multipronged strategies are required not only to increase vaccination intention by promoting HCW's recommendation to improve perceptions about influenza vaccination but also facilitate a follow through on initial intentions by implementing free influenza vaccination program funded by the government.

Recommendations for influenza and Streptococcus pneumoniae vaccination in elderly people in China

Influenza and pneumonia can be prevented by vaccination, but they remain major causes of morbidity and mortality in age-related diseases. In most areas of China, the rates of influenza and pneumococcal vaccination are relatively low and public awareness of vaccination remains insufficient. Thus, it is essential to recommend influenza and Streptococcus pneumoniae vaccination to elderly people in clinical practice. Based on recently published studies and related documents issued by several vaccination authorities, such as the World Health Organization, the National Health and Wellness Committee, the Chinese Center for Disease Control and Prevention, the US Centers for Disease Control and Prevention, and the US Advisory Committee on Immunization Practices, we propose official recommendations for influenza and S pneumoniae vaccination in elderly people in China.

Determinants of Parental Intentions to Vaccinate Kindergarten Children Against Seasonal Influenza in Xiamen, China

Seasonal influenza epidemics occur almost every year, and children under 6 years of age constitute one of the most susceptible groups. While free vaccinations are offered to preschool children in some large cities in China, Xiamen lacks a free vaccination policy and other effective policies aimed at increasing parents' acceptance of the vaccine. Using the health belief model (HBM), we sought to: (1) investigate the determinants of parents' intentions to vaccinate their kindergarten children against seasonal influenza if the free policy were implemented, and (2) explore the possible interaction effects between "cues to action" and "perceived susceptibility" and/or "perceived severity." A total of 1350 parents with kindergarten children were selected by stratified random sampling from half the population in Xiamen, of whom 1211 responded effectively to our survey. Scobit models with testing for interactions among the key concepts of the HBM were used to investigate factors associated with parents' intentions to vaccinate their children. In total, 85.1% of 1211 parents reported that they were willing to vaccinate their children if free influenza vaccinations were offered, although only 37 children (3.1%) had received influenza vaccination in the previous year, and 261 (21.6%) had been vaccinated since birth. Parents' perceived susceptibility (AOR = 1.77), perceived benefits (AOR = 3.12), perceived barriers (AOR = 0.38) and cues to action (AOR = 3.54) in terms of childhood vaccination against influenza were significantly associated with their vaccination intentions. The only observed interaction effect was between perceived susceptibility and cues to action (AOR = 1.57), which had additive effects on strengthening parental intentions to vaccinate their children. Our findings can be used as a basis for formulating government strategies aimed at improving influenza vaccination coverage among children in kindergarten and guiding culturally informed primary prevention efforts among their parents.

Immunogenicity and safety of a trivalent inactivated influenza vaccine produced in Shenzhen, China versus a comparator influenza vaccine: a phase IV randomized study

Seasonal influenza causes substantial morbidity and mortality in China, which largely results from limited vaccine accessibility and poor vaccination coverage. Since 2013, Sanofi Pasteur's facilities in Shenzhen, China have produced a trivalent inactivated influenza vaccine (Shz-IIV3) for each influenza season according to Chinese pharmacopeia requirements. However, the immunogenicity of Shz-IIV3 has not been compared to existing Chinese trivalent inactivated influenza vaccines (IIV3s). Here, we describe the results of a phase IV, observer-blind, randomized study to evaluate whether the immunogenicity of Shz-IIV3 was non-inferior to a comparator IIV3 (Hualan Biological Engineering Inc) also manufactured and licensed in China. Healthy adults aged 18-59 years were randomly assigned in a 1:1 ratio to receive a single 0.5-mL intramuscular injection of the 2017-2018 Northern Hemisphere formulation of Shz-IIV3 (n = 800) or the comparator IIV3 (n = 799). Between baseline and day 28 after vaccination, hemagglutination inhibition titers for the three vaccine strains increased by at least 4-fold and were of similar magnitude in Shz-IIV3 and comparator IIV3 recipients. The rate of seroconversion or significant increase in titers was 62% to 92% in Shz-IIV3 recipients, and 63% to 91% in comparator IIV3 recipients. Post-vaccination hemagglutination inhibition titers and seroconversion rates for Shz-IIV3 were statistically non-inferior to the comparator IIV3 for all three influenza vaccine strains. Rates of solicited and unsolicited vaccine-related adverse events were similar between the two vaccine groups. These results demonstrated that Shz-IIV3 was as immunogenic and safe in adults as a comparator Chinese IIV3, and support the continued use of Shz-IIV3 in China.

Determinants of healthcare workers' willingness to recommend the seasonal influenza vaccine to diabetic patients: A cross-sectional survey in Ningbo, China

Background: Seasonal influenza vaccine uptake among diabetic patients is low in China. Recent studies showed healthcare workers'(HCWs') recommendation is an effective way to promote influenza vaccination. This study aimed to assess HCWs' willingness to recommend influenza vaccine to diabetic patients and identify the predictors of this willingness. Methods: During Dec 2016-Jan 2017, a self-administered questionnaire on perceptions, attitudes and practices related to influenza vaccination for diabetic patients was distributed to 1370 HCWs in 20 hospitals and 20 community health centers in Ningbo. Predictors of HCWs' willingness to recommend influenza vaccine were analyzed by logistic regressions. Results: Of 1340 HCWs who completed the survey, 58.13%(779/1340) participants reported willingness to recommend influenza vaccine to diabetic patients. Factors positively associated with the recommendation willingness included awareness of national influenza vaccination guideline(OR: 6.33; 95%CI: 4.66-8.60) and regional reimbursement policy(OR: 1.62; 95%CI: 1.19-2.20), training on influenza and diabetes (OR: 1.65; 95%CI: 1.21-2.23), influenza vaccination history(OR: 1.35; 95%CI: 1.01-1.79), beliefs in vaccine effects on reducing serious consequences(OR: 1.38; 95%CI: 1.01-1.91), reduction in hospitalization costs(OR: 1.43; 95%CI: 1.05-1.94) caused by influenza, and more than 10 years of practitioner experience(OR: 1.60; 95%CI: 1.04-2.46). Worries about side-effects of influenza vaccine were identified as the barriers of recommendation. Conclusion: The present study demonstrates that knowledge about national guideline and reimbursement policies, training programs, perceptions about effectiveness and safety of influenza vaccine increase HCWs' willingness to recommend the influenza vaccination to diabetic patients. These measures should be taken to ensure HCWs' role in the administration of influenza vaccination among diabetic patients.

The 2015-2016 influenza epidemic in Beijing, China: Unlike elsewhere, circulation of influenza A(H3N2) with moderate vaccine effectiveness

BACKGROUND

While the 2015-2016 influenza season in the northern hemisphere was dominated by A(H1N1)pdm09 and B/Victoria viruses, in Beijing, China, there was also significant circulation of influenza A(H3N2) virus. In this report we estimate vaccine effectiveness (VE) against influenza A(H3N2) and other circulating viruses, and describe further characteristics of the 2015-2016 influenza season in Beijing.

METHODS

We estimated VE of the 2015-2016 trivalent inactivated vaccine (TIV) against laboratory-confirmed influenza virus infection using the test-negative study design. The effect of prior vaccination on current VE was also examined.

RESULTS

Of 11,000 eligible patients included in the study, 2969 (27.0%) were influenza positive. Vaccination coverage was 4.2% in both cases and controls. Adjusted VE against all influenza was 8% (95% CI: -16% to 27%): 18% (95% CI: -38% to 52%) for influenza A(H1N1)pdm09, 54% (95% CI: 16% to 74%) for influenza A(H3N2), and -8% (95% CI: -40% to 18%) for influenza B/Victoria. The overall VE for receipt of 2015-2016 vaccination only, 2014-2015 vaccination only, and vaccinations in both seasons was -15% (95% CI: -63% to 19%), -25% (95% CI: -78% to 13%), and 18% (95% CI: -11% to 40%), respectively.

CONCLUSIONS

Overall the 2015-2016 TIV was protective against influenza infection in Beijing, with higher VE against the A(H3N2) viruses compared to A(H1N1)pdm09 and B viruses.

Influenza illness averted by influenza vaccination among school year children in Beijing, 2013-2016

BACKGROUND

The benefit of school-based influenza vaccination policy has not been fully addressed in Beijing.

OBJECTIVES

To evaluate the benefit of school-based influenza vaccination policy launched in Beijing.

METHODS

Using existing surveillance and immunization data, we developed a dynamic transmission model to assess the impact of influenza vaccination in school-going children. The outcome was defined as the averted number of medically attended influenza illnesses and the prevented disease fraction to all children aged 5-14 years for the 2013/14, 2014/15, and 2015/16 seasons.

RESULTS

We estimated that during the three consecutive influenza seasons, the averted number of medically attended influenza illnesses among children aged 5-14 years was around 104 000 (95% CI: 101 000-106 000), 23 000 (95% CI: 22 000-23 000), and 21 000 (95% CI: 21 000-22 000), respectively. Corresponding prevented fractions to all children aged 5-14 years were 76.3%, 38.5%, and 43.9%.

CONCLUSIONS

In Beijing, school-based vaccinations reduced a substantial number of medically attended influenza illnesses despite seasonal variation in the prevented fraction. This is strong supportive evidence for the continuation of school-based vaccination programs to reduce the influenza burden in this age group.

Knowledge, attitudes and practices related to the influenza virus and vaccine among older adults in Eastern China

BACKGROUND

This study aims to assess the association between socio-demographic and health characteristics of older adults in Eastern China and knowledge, attitudes, and practices (KAP) about the influenza virus and vaccine.

METHODS

A prospective cohort of 1506 older adults (aged ≥60 years) was enrolled from November to December 2015 in Jiangsu Province. We examined the association between demographics, health and functional status, and cognitive impairment at enrollment with awareness of influenza virus and vaccine and KAP items focused on five Health Belief Model domains. At a 12-month follow-up interview we assessed change in awareness and readiness to be vaccinated.

RESULTS

One in five older adults was aware of the influenza virus (21%) or vaccine (20%); even fewer reported having at least "a little" knowledge of the virus and vaccine (7% and 4%, respectively); less than 1% reported ever receiving an influenza vaccine. Retirement, higher education and income, and normal cognitive status were consistently associated with both awareness and knowledge of influenza virus. The odds of having at least "a little" knowledge of the vaccine was 2.9-fold (95% CI = 1.6-5.3) higher among older adults with at least some secondary schooling. Among the 108 with knowledge of the virus, 55% said they "worry about getting the flu this season." Among the 73 with knowledge of the vaccine, 92% believed the vaccine was at least somewhat effective and less than half (43%) thought that influenza vaccination was safe. At a 12-month follow-up interview, 33% (442/1333) increased from no knowledge to at least "a little".

CONCLUSIONS

If and when influenza vaccines become widely available to older adults in China, our results indicate that influenza vaccination campaigns with basic information on the virus and vaccine could be beneficial for all older adults, especially those with less education and/or more cognitive impairment.

Factors associated with the uptake of seasonal influenza vaccination in older and younger adults: a large, population-based survey in Beijing, China

OBJECTIVES

The present study aimed to estimate the influenza vaccination coverage rate in Beijing, China, and identify its determinants in older and younger adults.

METHODS

A survey was conducted among Chinese adults using a self-administered, anonymous questionnaire in May-June 2015. The main outcome was seasonal influenza vaccination uptake. Multivariate logistic regression models were performed to identify factors associated with uptake.

RESULTS

A total of 7106 participants completed the questionnaire. The overall coverage rate was 20.6% (95% CI 19.7% to 21.5%) in the 2014/2015 influenza season. Lower education (older adults: OR 1.6; 95% CI 1.2 to 2.1; younger adults: OR 1.9; 95% CI 1.4 to 2.6), having a chronic illness (older adults: OR 1.9; 95% CI 1.5 to 2.4; younger adults: OR 1.4; 95% CI 1.2 to 1.7) and recommendations from healthcare workers (older adults: OR 5.4; 95% CI 3.9 to 7.4; younger adults: OR 4.5; 95% CI 3.7 to 5.4) were positively associated with uptake; perceived side effects of vaccination had a negative impact (older adults: OR 0.6; 95% CI 0.4 to 0.7; younger adults: OR 0.8; 95% CI 0.7 to 1.0). Perceived susceptibility to influenza (OR 1.5; 95% CI 1.2 to 2.0) and awareness of the free influenza vaccine policy (OR 1.9; 95% CI 1.2 to 2.9) were only associated with vaccine uptake in older adults, while perceived effectiveness of vaccination (OR 2.2; 95% CI 1.7 to 2.8) was only a predictor for younger adults. Older adults were more likely to receive recommendations from healthcare professionals and perceive the severity of seasonal influenza, and less likely to worry about side effects of vaccination.

CONCLUSION

The influenza vaccination coverage rate was relatively low in Beijing. Apart from free vaccinations for older adults, age disparity in the rate between older and younger adults (48.7% vs 16.0%) may be explained by differing professional recommendations and public perceptions. Vaccination campaigns targeting increasing professional recommendations and public perceptions should be implemented in the coming years.