Two-dose seasonal influenza vaccine coverage and timeliness among children aged 6 months through 3 years: An evidence from the 2010-11 to the 2014-15 seasons in Zhejiang province, east China

Timeliness of routine childhood vaccination in 103 low-and middle-income countries, 1978-2021: A scoping review to map measurement and methodological gaps

Empiric studies exploring the timeliness of routine vaccination in low-and middle-income countries (LMICs) have gained momentum in the last decade. Nevertheless, there is emerging evidence suggesting that these studies have key measurement and methodological gaps that limit their comparability and utility. Hence, there is a need to identify, and document these gaps which could inform the design, conduct, and reporting of future research on the timeliness of vaccination. We synthesised the literature to determine the methodological and measurement gaps in the assessment of vaccination timeliness in LMICs. We searched five electronic databases for peer-reviewed articles in English and French that evaluated vaccination timeliness in LMICs, and were published between 01 January 1978, and 01 July 2021. Two reviewers independently screened titles and abstracts and reviewed full texts of relevant articles, following the guidance framework for scoping reviews by the Joanna Briggs Institute. From the 4263 titles identified, we included 224 articles from 103 countries. China (40), India (27), and Kenya (23) had the highest number of publications respectively. Of the three domains of timeliness, the most studied domain was 'delayed vaccination' [99.5% (223/224)], followed by 'early vaccination' [21.9% (49/224)], and 'untimely interval vaccination' [9% (20/224)]. Definitions for early (seven different definitions), untimely interval (four different definitions), and delayed vaccination (19 different definitions) varied across the studies. Most studies [72.3% (166/224)] operationalised vaccination timeliness as a categorical variable, compared to only 9.8% (22/224) of studies that operationalised timeliness as continuous variables. A large proportion of studies [47.8% (107/224)] excluded the data of children with no written vaccination records irrespective of caregivers' recall of their vaccination status. Our findings show that studies on vaccination timeliness in LMICs has measurement and methodological gaps. We recommend the development and implement of guidelines for measuring and reporting vaccination timeliness to bridge these gaps.

Influenza Vaccination: Effectiveness, Indications, and Limits in the Pediatric Population

Influenza vaccine is considered the most effective way to prevent influenza. Nonetheless, every year vaccine coverage is lower than recommended in the pediatric population. Many factors are supposed to contribute to this phenomenon such as the uncertainty about the indication for vaccination, and the suboptimal vaccine-effectiveness in pediatric age, especially in the youngest children. In this review we discuss the effectiveness, indications, and limits of influenza vaccination in the pediatric population based on the most recent evidences.

Low awareness of influenza vaccination among pregnant women and their obstetricians: a population-based survey in Beijing, China

We assessed how an awareness of influenza vaccination might influence both the willingness of pregnant women to be vaccinated and the readiness of obstetricians to recommend antenatal influenza vaccination in Beijing, China. From March to April 2016, we surveyed pregnant women who were attending antenatal clinics at eight hospitals in Beijing, along with obstetricians at the same clinics. Demographic, attitudinal, and behavioral information regarding influenza vaccination were collected using structured questionnaires. Consent and completed questionnaires were obtained from 988 of 1009 pregnant women and 165 of 173 obstetricians. Only 113 (11.4%) pregnant women reported being willing to receive an influenza vaccine during their pregnancies. Willingness to receive an influenza vaccination was positively associated with ever having a history of vaccination or influenza (aOR=6.74, 95%CI: 1.72-26.4, P=0.006), perceiving benefits of vaccination (aOR=1.67, 95%CI: 1.00-2.79, P=0.050), and having a higher level of influenza knowledge (aOR=82.2, 95%CI: 21.7-311.1, P<0.001). Among obstetricians, only 19.4% reported being willing to recommend influenza vaccination to their pregnant patients and 15.2% reported knowledge that influenza vaccination during pregnancy was recommended by China's National Health Commission. Neither pregnant women nor their obstetricians were aware of Chinese government recommendations that antenatal influenza vaccination should be encouraged and provided. Pregnant women and their obstetricians were ill-informed of the relevant evidence. It is in emergent need to train and disseminate the updated evidence on influenza vaccination to obstetricians. It also warranted more high-quality trials regarding influenza vaccination during pregnancy to address public concern.

Seasonal Influenza Vaccine Acceptance among Pregnant Women in Zhejiang Province, China: Evidence Based on Health Belief Model

Background: Reasons for acceptance of seasonal influenza vaccine (SIV) vaccination among pregnant women in China are poorly understood. We assessed the intention to accept SIV among pregnant women in Zhejiang province, by using a self-administrated structured questionnaire developed on the basis of health belief model (HBM). Methods: From 1 January to 31 March 2014, pregnant women with ≥12 gestational weeks who attended antenatal clinics (ANCs) at public hospitals in 6 out of 90 districts were surveyed using a self-administered questionnaire that covered knowledge, attitudes, and beliefs related to SIV vaccination and influenza infection. We examined the associations between the acceptance of SIV vaccination and the demographic factors and HBM constructs using the logistic regression model, calculating the adjusted odds ratio (AOR). Results: Of the 1252 participants, 76.28% were willing to receive the SIV vaccination during their current pregnancy. High levels of perceived susceptibility of influenza (AOR = 1.75 (95%CI: 1.36–2.08)), high levels of perceived severity of influenza (AOR = 1.62 (95%CI: 1.25–1.95)), high level of perceived benefits of vaccination (AOR = 1.97 (95%CI: 1.76–2.21)), and high levels of cues to action were positively associated with the acceptance of SIV vaccination among pregnant women (AOR = 2.03 (95%CI: 1.70–2.69)), while high level of perceived barriers of vaccination was a negative determinant (AOR = 0.76 (95%CI: 0.62–0.94)). Conclusions: Poor knowledge and negative attitude towards SIV were associated with the poor acceptance of SIV. Health providers’ recommendations were important to pregnant women’s acceptance of SIV. Health education and direct communication strategies on SIV vaccination and influenza infection are necessary to improve the acceptance of SIV vaccination among pregnant women.

Relationship between receipt of substitutable for-fee vaccines and completion of the expanded programme on immunisation: a cross-sectional study in Fujian, China

OBJECTIVE

The aim of this study was to evaluate the relationship between receipt of the substitutable-for-fee vaccines (SFV) and completion of the expanded programme on immunisation (EPI).

DESIGN AND SETTINGS

A cross-sectional study was conducted in Fujian province, China.

PARTICIPANTS

Children who were born from 1 September 2009 to 31 August 2011, and who had been residing in the township for at least 3 months, were randomly recruited from 34 townships.

MAIN OUTCOMES MEASURES

Outcomes were completion rate of the EPI and coverage rate of the SFV.

RESULTS

The study included 1428 children, of whom 1350 (94.5%) finished the EPI and 282 (19.7%) received at least one dose of the SFV. Administration of the SFV was associated with an increased likelihood of completing the EPI (OR=3.2, 95% CI 1.3 to 7.6 in the total sample and OR=4.0, 95% CI 1.7 to 9.6 in the subsample of children in regions with the SFV accessibility). The impact of the SFV administration on completion of the EPI was larger among children whose parents have junior school education or less (97.8% and 97.9% vs 92.5% and 91.9%, both p<0.001) and among those with a timely hepatitis B vaccine first dose (98.5% vs 94.0%, p<0.001).

CONCLUSIONS

Receipt of SFV is associated with increased likelihood of completion of the EPI in Fujian, China.

Evaluating Childhood Vaccination Coverage of NIP Vaccines: Coverage Survey versus Zhejiang Provincial Immunization Information System

Vaccination coverage in Zhejiang province, east China, is evaluated through repeated coverage surveys. The Zhejiang provincial immunization information system (ZJIIS) was established in 2004 with links to all immunization clinics. ZJIIS has become an alternative to quickly assess the vaccination coverage. To assess the current completeness and accuracy on the vaccination coverage derived from ZJIIS, we compared the estimates from ZJIIS with the estimates from the most recent provincial coverage survey in 2014, which combined interview data with verified data from ZJIIS. Of the enrolled 2772 children in the 2014 provincial survey, the proportions of children with vaccination cards and registered in ZJIIS were 94.0% and 87.4%, respectively. Coverage estimates from ZJIIS were systematically higher than the corresponding estimates obtained through the survey, with a mean difference of 4.5%. Of the vaccination doses registered in ZJIIS, 16.7% differed from the date recorded in the corresponding vaccination cards. Under-registration in ZJIIS significantly influenced the coverage estimates derived from ZJIIS. Therefore, periodic coverage surveys currently provide more complete and reliable results than the estimates based on ZJIIS alone. However, further improvement of completeness and accuracy of ZJIIS will likely allow more reliable and timely estimates in future.