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Hu Y, Pan X, Chen F, Wang Y, Liang H, Shen L, Chen Y, Lv H. Surveillance of adverse events following immunization of 13-valent pneumococcal conjugate vaccine among infants, in Zhejiang province, China. Hum Vaccin Immunother 2022; 18:2035141. [PMID: 35240930 PMCID: PMC9009923 DOI: 10.1080/21645515.2022.2035141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the safety of 13-valent pneumococcal conjugate vaccine (PCV13) after its licensure. METHODS Review and describe the AEFI reported to national adverse event following immunization surveillance system (NAEFISS) in Zhejiang province from 2017 to 2020. Reporting rates of AEFI were calculated by age, city, severity of AEFI, categories of AEFI, and reaction categories. The data mining algorithm used in this study was reporting odds ratio (ROR). A value of ROR-1.96SE >1 (standard error [SE]) was considered as the positive signal. RESULTS NAEFISS received 3332 AEFI cases following PCV13, with a reporting rate of 17.58/10000 doses. Of the reported AEFI, 652 were serious AEFI cases and the reporting rate was 3.44 for serious AEFI. The reporting rate of fever was the highest among all the clinical diagnosis (7.39/10000 doses). The positive signals were obtained for injection site reaction (ROR-1.96SE: 1.55), hypotonic hyporesponsive episode (HHE) (ROR-1.96SE: 1.62) and febrile seizure (ROR-1.96SE: 1.52). CONCLUSION The present results supported previous observations that the PCV13 administered as the four-dose schedule was generally well tolerated in Chinese infants as we did not identify any new/unexpected safety concern from the NAEFISS during a four-year time period.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Xuejiao Pan
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Fuxing Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Hui Liang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Linzhi Shen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Huakun Lv
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
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Wariri O, Okomo U, Kwarshak YK, Utazi CE, Murray K, Grundy C, Kampmann B. Timeliness of routine childhood vaccination in 103 low-and middle-income countries, 1978-2021: A scoping review to map measurement and methodological gaps. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000325. [PMID: 36962319 PMCID: PMC10021799 DOI: 10.1371/journal.pgph.0000325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Chigozie Edson Utazi
- WorldPop, School of geography and Environmental Science, University of Southampton, Southampton, United Kingdom
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom
| | - Kris Murray
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- MRC Centre for Global Infectious Disease Analysis, Imperial College School of Public Health, Imperial College London, London, United Kingdom
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Hu Y, Pan X, Shen L, Chen F, Wang Y, Liang H, Chen Y, Lv H. Post-licensure safety monitoring of quadrivalent human papillomavirus vaccine using the national adverse event following immunization surveillance system from Zhejiang province, 2018-2020. Hum Vaccin Immunother 2021; 17:5447-5453. [PMID: 34613883 DOI: 10.1080/21645515.2021.1978793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To evaluate the reporting rate of adverse events following immunization (AEFI) of the quadrivalent human papillomavirus vaccine (4vHPV) and to compare the reporting rate of AEFI following 4vHPV with those following other vaccines. METHODS Review and describe the AEFI reported to national adverse event following immunization surveillance system (NAEFISS) in Zhejiang province from 2018 to 2020. Reporting rates of AEFI were calculated by age, city, severity of AEFI, categories of AEFI, and reaction categories. The data mining algorithm used in this study was reporting odds ratio (ROR). A value of ROR‑1.96SE >1 (standard error [SE]) was considered as positive signal. RESULTS NAEFISS received 238 reports after receipt of 4vHPV and 899,282 doses of 4vHPV were administered during the study period, with a crude reporting rate of 2.7/10000 doses. Fever/redness/induration (101 reports) was the most common event reported (1.12/10000 doses). Two cases of anaphylactic shock, three cases of Guillain Barre Syndrome and two cases of acute disseminated encephalomyelitis were reported. ROR showed positive signals for seizure (ROR‑1.96SE: 2.1), syncope (ROR‑1.96SE: 1.3), allergic rash (ROR‑1.96SE: 1.6) and headache (ROR‑1.96SE: 2.1). CONCLUSION The present analysis did not identify new/unexpected safety concerns. Further epidemiological studies are required to systematically validate the data provided by NAEFISS.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Xuejiao Pan
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Linzhi Shen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Fuxing Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Hui Liang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Huakun Lv
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
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Hu Y, Liang H, Chen F, Shen L, Pan X, Wang Y, Chen Y, Lv H. Evaluating the vaccination coverage: validity of household-hold vaccination booklet and caregiver's recall. Hum Vaccin Immunother 2021; 17:3034-3041. [PMID: 33825657 DOI: 10.1080/21645515.2021.1906151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND We compared results from household data sources to medical record sources by using data from a vaccination coverage survey. METHODS Vaccination coverage (VC) was calculated based on parental recall, household vaccination booklet, and Zhejiang provincial immunization information system (ZJIIS). We evaluated the accuracy of VC based on household sources (vaccination booklet and recall) assuming the medical record was accurate. Concordance, sensitivity, specificity, positive predictive value, and negative predictive value were estimated as well as the Kappa statistic was also used to evaluate the agreement between data sources. RESULTS Among the 1,800 children identified in the household survey, all were registered in ZJIIS. VC estimated using the vaccination booklet alone was substantially lower than that based on medical records (net bias 3.4-16.7% in different age groups). VC based on parental recall ranged from 2.5% below (among children aged 1 year) to 16.7% points above (among children aged 6 years) than those based on medical records. Concordance was lowest for card estimates (32.5-45.5%). Sensitivity was <60% for all household sources, except for recall source. Specificity was lowest for recall estimates (14.5-42.6%). Positive predictive value was >75%, while negative predictive value was <50%, for all household sources. Kappa statistics generally indicated poor agreement between household and medical record sources. CONCLUSIONS Household-retained vaccination booklets and parental recall were insufficient sources for evaluating the VC. Our findings emphasized the importance of taking interventions to make the vaccination booklet more consistent with the records from medical resource.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Hu Liang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Fuxing Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Linzhi Shen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Xuejiao Pan
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Huakun Lv
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
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Hu Y, Chen Y, Wang Y, Liang H, Lv H. The association between the density of vaccination workers and immunization coverage in Zhejiang province, East China. Hum Vaccin Immunother 2021; 17:2319-2325. [PMID: 33545020 DOI: 10.1080/21645515.2020.1865045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background: We aimed to evaluate whether the density of vaccination workers was associated with the immunization coverage in Zhejiang province.Methods: The immunization coverage of measles-containing vaccine (MCV), the third dose of diphtheria, tetanus, and pertussis combined vaccine (DTP3), and the third dose of poliomyelitis vaccine (PV3) was selected as the dependent variables. Immunization coverage data of children aged 13-23 months were taken from the Zhejiang immunization information system (ZJIIS). The aggregate density of vaccination workers was an independent variable in one set of regressions, while the full-time and part-time vaccination workers were adopted separately in other sets.Results: The density of total vaccination workers was positively and significantly associated with the immunization coverage (MCV: AOR = 3.36; DTP3: AOR = 2.68; PV3: AOR = 2.37). However, when the effects of full-time vaccination workers and part-time vaccination workers were assessed separately, we only found that the density of full-time vaccination workers was positively and significantly associated with the immunization coverage (MCV: AOR = 5.59; DTP3: AOR = 4.13; PV3: AOR = 3.28). The proportion of migrant children < 7 years and Land area were found as negative and significant factors for immunization coverage.Conclusions: A higher density of vaccination workers could improve the availability of vaccination services and immunization coverage. We recommended that government or other non-government organization should, apart from vaccine-related assistance, focus their efforts on human resources for vaccination.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Hu Liang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Huakun Lv
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
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He Y, Liu Y, Dai B, Zhao L, Lin J, Yang J, Yu H. Assessing vaccination coverage, timeliness, and its temporal variations among children in a rural area in China. Hum Vaccin Immunother 2021; 17:592-600. [PMID: 32643509 PMCID: PMC7899668 DOI: 10.1080/21645515.2020.1772620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/14/2020] [Indexed: 02/03/2023] Open
Abstract
China has achieved high vaccination coverage under the Expanded Program on Immunization (EPI) in children 1-2 years of age. However, a knowledge gap exists regarding vaccination coverage and timeliness for children >2 years of age. As such, this study aimed to estimate coverage and timeliness for all EPI and selected non-EPI vaccines within a rural area of China. Immunization data for 5091 children, born between September 2003 and November 2015, were collected from vaccination cards obtained during sero-surveillance follow-up visits and/or from the Hunan immunization information system. For each dose of both EPI and non-EPI vaccines, vaccination coverage and timeliness were calculated, and temporal variations were examined across birth cohorts. We found coverage for EPI vaccines scheduled for <12 months was 97.1%-99.4%. However, for EPI vaccines scheduled at 6 years coverage was 44.4%-51.7%. The timeliness for EPI vaccines was generally poor, especially for EPI vaccines introduced after 2008 or scheduled for administration at ≥12 months, with a maximum of 35.4% of children vaccinated according to schedule. Despite this, we found increasing trends in vaccination coverage and improvements in timeliness for EPI vaccines. However, for non-EPI vaccines, we found only moderate increases, and in some cases decreases, in vaccination coverage. This study demonstrates the success and improvement of the Chinese immunization program, but also highlights some challenges to be addressed. We recommend that future changes in vaccine practice and policy should primarily focus on improving coverage and timeliness of vaccines introduced after 2008, and/or scheduled for administration ≥12 months.
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Affiliation(s)
- Yangni He
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Yang Liu
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Bingbing Dai
- Department of Infectious Disease Control, Anhua County Center for Disease Control and Prevention, Yiyang City, Hunan Province, China
| | - Liang Zhao
- Department of Infectious Disease Control, Anhua County Center for Disease Control and Prevention, Yiyang City, Hunan Province, China
| | - Jiqun Lin
- Department of Infectious Disease Control, Anhua County Center for Disease Control and Prevention, Yiyang City, Hunan Province, China
| | - Juan Yang
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Hongjie Yu
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
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Wagner AL, Huang Z, Ren J, Laffoon M, Ji M, Pinckney LC, Sun X, Prosser LA, Boulton ML, Zikmund-Fisher BJ. Vaccine Hesitancy and Concerns About Vaccine Safety and Effectiveness in Shanghai, China. Am J Prev Med 2021; 60:S77-S86. [PMID: 33189502 PMCID: PMC7877188 DOI: 10.1016/j.amepre.2020.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Rapidly urbanizing communities in middle-income countries could be sources of vaccine hesitancy, and may create hot spots of low vaccination coverage. This study characterizes vaccine hesitancy in Shanghai and identifies disparities in vaccine safety and efficacy concerns by residency status-a marker for recent migration into the city. METHODS Parents of children aged ≤18 years from immunization clinics in Shanghai were enrolled in summer 2019, with the data analyzed during winter 2019-2020. The paper questionnaire used the Parental Attitudes towards Childhood Vaccines scale, which included questions about vaccine safety and efficacy concerns. The primary independent variable was residency-whether an individual was a Shanghai local or a recent migrant (i.e., non-local). Linear regression models assessed the relationship between residency and vaccine safety and efficacy concerns. RESULTS Among 1,021 participants, 65.4% had local residency, and the remainder were urban non-locals (13.1%) or rural non-locals (21.5%). A majority of parents expressed concerns about vaccine side effects (73.8%), vaccine safety (63.9%), and vaccine effectiveness (52.4%). Compared with locals, rural non-locals were more concerned about vaccine side effects (β=0.26, 95% CI=0.07, 0.46), vaccine safety (β=0.42, 95% CI=0.19, 0.65), and vaccine effectiveness (β=0.37, 95% CI=0.16, 0.58). CONCLUSIONS Differences in vaccine hesitancy by residency could lead to geographical and sociodemographic disparities in vaccination coverage and outbreaks of vaccine-preventable disease. SUPPLEMENT INFORMATION This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
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Affiliation(s)
- Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Zhuoying Huang
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control and Prevention, Shanghai, China
| | - Jia Ren
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control and Prevention, Shanghai, China
| | - Megan Laffoon
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Mengdi Ji
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Leah C Pinckney
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Xiaodong Sun
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control and Prevention, Shanghai, China
| | - Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Chen Y, Lv H, Liang H, Wang Y, Hu Y. Can vaccination coverage be improved through reducing the missed opportunities for immunization? Results from the evaluation in Zhejiang province, east China. Hum Vaccin Immunother 2020; 17:1483-1489. [PMID: 33180567 DOI: 10.1080/21645515.2020.1829316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND To evaluate the missed opportunities for vaccination (MOV) in Zhejiang province by using the global methodology from World Health Organization (WHO). METHODS Based on the WHO Planning Guide to Reduce Missed Opportunities for Vaccination (MOV) and Methodology for the Assessment of MOV, 33 health facilities from 11 cities in Zhejiang province were selected. For each health facility, exit investigations for 20 caregivers of children aged 0-23 months and knowledge, attitudes, and practices (KAP) surveys for 10 health workers was implemented. A MOV was determined based on the child's age on the date of investigation, eligibility for various vaccines. The prevalence of MOV was calculated and the risk factors of MOV were explored. RESULTS There were 660 completed exit investigations of caregivers of children aged 0-23 months and 330 health worker KAP investigations. Of the 658 children with documented vaccination records, 12.6% were still under-vaccinated. Among these under-vaccinated children, 54.2% still had a MOV. Children's age and their previous vaccination behavior, as well as caregivers' relationship to children and education level had a significant impact on the incidence of MOV. CONCLUSION The high proportions of visits with MOV in Zhejiang province suggested that interventions to reduce MOV in health service settings may be a potential quick win for improving coverage and equity. National immunization programs should explore the tailored efforts to improve health worker practices by making better use of existing health service contacts.
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Affiliation(s)
- Yaping Chen
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Huakun Lv
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Hu Liang
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Ying Wang
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Yu Hu
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
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Li X, Leng SX. Influenza immunization among Chinese seniors: Urgent calling for improving vaccination coverage, education, and research. Aging Med (Milton) 2020; 3:12-15. [PMID: 32232187 PMCID: PMC7099750 DOI: 10.1002/agm2.12103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Xin Li
- Department of Geriatrics The Second Hospital of Tianjin Medical University Tianjin China
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine Baltimore Maryland USA
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Hu Y, Wang Y, Chen Y, Liang H. Analyzing the Urban-Rural Vaccination Coverage Disparity through a Fair Decomposition in Zhejiang Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224575. [PMID: 31752311 PMCID: PMC6887931 DOI: 10.3390/ijerph16224575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/16/2019] [Accepted: 11/17/2019] [Indexed: 12/30/2022]
Abstract
Objectives: Exploring determinants underlying disparities in full vaccination coverage (FVC) can contribute to improved immunization interventions. FVC and its risk factors in Zhejiang province have been studied, yet the determinants explaining the rural-urban disparity in FVC have not been studied. This study aimed to disentangle the factors explaining rural-urban disparities in FVC of vaccine doses scheduled during the first year of life in Zhejiang province. Methods: We used data from a vaccination coverage survey among children aged 24-35 months conducted in 2016. The outcome measure was full vaccination status, and the grouping variable was the area of residence. Descriptive statistics were used to analyze the FVC and rural-urban residence across the exposure variables. The Fairlie decomposition technique was used to decompose factors contributing to explaining the FVC disparity. Results: There were 847 children included in this study, of which 49.6% lived in a rural area. FVC was 94% in rural areas and 85% in urban areas. A disparity of 9% to the advantage of the rural areas and the exposure variables explained 81.1% of the disparity. Maternal factors explained 49.7% of the explained disparity with education, occupation, and ethnicity being the significant contributors to the explained disparity. Children's birth order and immigration status contributed somewhat to the explained inequality. Conclusion: There was a significant disparity in FVC in Zhejiang province, a disadvantage to the urban areas. Policy recommendations or health interventions to reduce the inequality should be focused on eliminating poverty and women's illiteracy, targeted at migrant children or children from minority ethnicities.
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Immunogenicity and Safety of the 13-Valent Pneumococcal Conjugate Vaccine Administered in a 3 + 1 versus 2 + 1 Dose Schedule Among Infants in China. Pediatr Infect Dis J 2019; 38:1150-1158. [PMID: 31626050 DOI: 10.1097/inf.0000000000002458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND 13-valent pneumococcal conjugate vaccine (PCV13) was licensed in China based on immunologic noninferiority to 7-valent PCV (PCV7). As part of the noninferiority study, immunogenicity and safety of PCV13 administered as a 3- or 2-dose infant series followed by a toddler dose were examined in healthy Chinese infants. METHODS Infants (42- to 77-days-old) were randomized to a 3-dose PCV13 or PCV7 infant series administered double-blind at 3, 4 and 5 months or PCV13 administered open-label at 2, 4 and 6 months and a 2-dose open-label series at 3 and 5 months; all subjects received a toddler dose (12 months). Serotype-specific immunoglobulin G (IgG) concentrations were measured 1 month after the infant series and before and after the toddler dose. Opsonophagocytic activity (OPA) was measured in a subset of subjects at each time point. Safety was evaluated. RESULTS One month after the infant series, serotype-specific immune responses (IgG ≥ 0.35 µg/mL) were similar for the 2- versus 3-dose schedules, except for serotype 6B, which was significantly lower in the 2-dose group [70.1% in the PCV13 (3, 5 + 12 mo) group vs. 93.2% in the PCV13 (3, 4, 5 + 12 mo) group and 94.7% in the PCV13 (2, 4, 6 + 12 mo) group]. IgG geometric mean concentrations and OPA geometric mean titers trended numerically higher with 3- versus 2-dose schedules. No significant differences in immunogenicity were observed between the 3- versus 2-dose schedules after the toddler dose. PCV13 was well-tolerated across all schedules. CONCLUSIONS PCV13 administered as a 3- or 2-dose infant series followed by a toddler dose was immunogenic and well tolerated in healthy Chinese infants and likely protective against PCV13 serotypes; immune responses with a 2-dose schedule were lower for some serotypes.
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Wu W, Cao L, Zheng J, Cao L, Cui J, Xiao Q. Immunization information system status in China, 2017. Vaccine 2019; 37:6268-6270. [DOI: 10.1016/j.vaccine.2019.08.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 11/28/2022]
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Masters NB, Wagner AL, Boulton ML. Vaccination timeliness and delay in low- and middle-income countries: a systematic review of the literature, 2007-2017. Hum Vaccin Immunother 2019; 15:2790-2805. [PMID: 31070992 PMCID: PMC6930087 DOI: 10.1080/21645515.2019.1616503] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Traditional measurements of vaccine coverage at specific ages can mask poor vaccine timeliness. However, optimal measurement of timing is unclear due to variations in countries’ recommended vaccination schedules and lack of a commonly accepted standard for “timeliness”. We conducted a systematic review of literature on vaccine timeliness and delay in low- and middle-income countries from 2007 to 2017. Methods: A search of articles published between January 1 2007 and December 31 2017, was performed in PubMed, EBSCOhost, and Embase. Results: 67 papers were included, of which 83% used a categorical measure of delay and 41% evaluated continuous delay. The most common age at assessment was 1 month, with earlier age benchmarks typically used with birth doses. Conclusions: Categorical definitions of vaccination timing vary widely, with benchmarks of delay varying from days to weeks to months. Use of a continuous measure of vaccine delay may be more informative and comparable.
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Affiliation(s)
- Nina B Masters
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, MI, USA
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Zeng Y, Luo M, Chen J, He H, Deng X, Xie S, Fang Y. An economic evaluation of the current measles vaccination program: A case study in Zhejiang Province, east China. Vaccine 2019; 37:3071-3077. [PMID: 31040084 DOI: 10.1016/j.vaccine.2019.04.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/21/2019] [Accepted: 04/19/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the economic impact of the current measles vaccination program in Zhejiang Province, east China. METHODS A decision tree-Markov model with parameters from published literatures, government documents and surveys was developed and used to simulate over 40 years of a birth cohort in Zhejiang Province during the year 2014. The expected cost and effectiveness of the current measles vaccination program was compared against no vaccination. Costs were assessed from the payer's perspective. Benefits were defined as savings on the direct cost of measles treatment, and the effectiveness was measured according to the number of measles cases and deaths averted. The net present value (NPV), benefit-cost ratio (BCR) and incremental cost-effectiveness ratio (ICER) were also calculated. A threshold for cost-effectiveness of less than 3 times the Gross Domestic Product (GDP) per capita was used. One-way sensitivity analysis was performed to assess parameter uncertainties. RESULTS The total vaccination cost was estimated to be $2.52 million. The BCR of the current measles program was found to be 6.06 with a NPV of $73.38 million. It was also calculated that a total of 195,165 measles cases and 191 measles-related deaths would be prevented by vaccination. The ICER was approximately $12.91 per case averted and $13,213.43 per death averted, respectively, which was cost-effective. The models were proven to be robust. CONCLUSIONS The current measles vaccination program appeared to be cost-effective and to offer substantial benefits. The results of this analysis sought to contribute to the justification of future investments to achieve the goal of measles elimination.
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Affiliation(s)
- Yanbing Zeng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Mingliang Luo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Junze Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Hanqing He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Xuan Deng
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Shuyun Xie
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen 361102, China.
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15
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Hu Y, Chen Y, Liang H, Wang Y. Reliability and validity of a survey to identify vaccine hesitancy among parents in Changxing county, Zhejiang province. Hum Vaccin Immunother 2019; 15:1092-1099. [PMID: 30676850 DOI: 10.1080/21645515.2019.1572409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND To evaluate the validity and reliability of a survey to identify vaccine hesitancy among parents. METHODS Cross-sectional survey of parents of 19-35 month old children was conducted in Changxing County, Zhejiang Province, through a questionnaire developed for the survey of the vaccine hesitancy. Construct validity was assessed by linking parental responses to their child's immunization record. The association between mean% of days of under-immunization and the parental socio-demographics and the individual item response was explored via the univariate and multivariate analyses. Factor analysis was applied to confirm survey sub-domains and Cronbach's α to determine the internal consistency reliability of sub-domain scales. RESULTS We approached 336 households while 285 of them agreed to participate in this study. Education level and the parental 'score of vaccination hesitancy' were significantly associated with the mean% of days of under-immunization. Cronbach's coefficients for the 3 sub-domain scales created by re-grouping the questionnaire's items were 0.71, 0.83, and 0.72, respectively. CONCLUSIONS The survey represented a valid and reliable instrument to identify VHPs and it could help to screen parents to receive an intervention aimed at increasing acceptance of vaccinations.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention , Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Yaping Chen
- a Institute of Immunization and Prevention , Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Hui Liang
- a Institute of Immunization and Prevention , Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Ying Wang
- a Institute of Immunization and Prevention , Zhejiang Center for Disease Control and Prevention , Hangzhou , China
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Hu Y, Chen Y, Wang Y, Liang H. Validity of Maternal Recall to Assess Vaccination Coverage: Evidence from Six Districts in Zhejiang Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060957. [PMID: 30889780 PMCID: PMC6466224 DOI: 10.3390/ijerph16060957] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 01/30/2023]
Abstract
Background: Although recall-based data are collected by survey when the vaccination records are not available, the preferred estimates remain the record-based ones due to the limited validity of recall-based data. However, the evidence on validity of maternal recalls is limited and varied across vaccine types. To close the gaps, we validated the maternal recall on vaccination against record-based data in six districts in Zhejiang Province, China. Methods: We used a cross-sectional survey of about 648 households with mothers who delivered in the last 12 months prior to the survey in October 2017, from six districts in Zhejiang Province. Vaccination status on five vaccine types scheduled before 12 months of age were collected through maternal recall and vaccination records. The level of agreement and recall bias between the two resources, the sensitivity and specificity of maternal recall were evaluated. Risk factors for maternal recall bias were also identified through logistic regression model for each type of vaccine. Results: The level of agreement between recall and record was above 90% across vaccine types, with the recall bias ranged from 2.2% to 9.7%. Recall bias due to over-reporting was slightly higher than that due to under-reporting. Recall bias was positively associated with high parity, home delivery, younger mothers, mothers with low education, and migrant mothers. Conclusions: This study indicated most of the vaccination status across vaccine types was accurately identified through maternal recall and supported the use of maternal recall to estimate the vaccination coverage as an alternative in the absence of record-based data.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310000, China.
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310000, China.
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310000, China.
| | - Hui Liang
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310000, China.
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Hu Y, Wang Y, Chen Y, Liang H, Chen Z. Measles vaccination coverage, determinants of delayed vaccination and reasons for non-vaccination among children aged 24-35 months in Zhejiang province, China. BMC Public Health 2018; 18:1298. [PMID: 30482185 PMCID: PMC6258446 DOI: 10.1186/s12889-018-6226-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 11/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background This study was aimed to assess the coverage of two doses of measles vaccine and identify the determinants of the delayed vaccination. Methods A cluster survey among 1386 children aged 24–35 months was conducted. Characteristics on demographic and socio-economic and vaccination records was collected. The overall coverage was defined as the proportion of children receiving the first dose of measles vaccination and the second dose of measles vaccination by 24 months of age. The age-appropriate coverage was defined as the proportion of children receiving the measles vaccine doses within one month after its relevant due date. Timeliness was evaluated with the Kaplan-Meier analysis. Cox proportional hazard regression was adopted to identify determinants of the delayed vaccination. Results The overall coverage was 96.9% for the first dose of measles vaccine and 93.9% for the second dose of measles vaccine. The age-appropriate coverage of the first and the second dose of measles vaccine was 76.6 and 68.2%, respectively. Household having more than one child, non-local children were associated with the delayed vaccination for the first and the second dose of measles vaccine. Children delivered at home, younger mothers, low maternal education background, mothers with a fixed job, and low household income were associated with the delayed vaccination for the second dose of measles vaccine. Conclusions The coverage of measles vaccine had been improved for both the first and the second dose, while the timeliness still needed improvement. We suggested the policy-makers pay more attention to the reasons for non-vaccination and determinants of delayed vaccination when planning efforts to ensure the high age-appropriate coverage of measles vaccination.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, People's Republic of China
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, People's Republic of China
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, People's Republic of China
| | - Hui Liang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, People's Republic of China
| | - Zhiping Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, People's Republic of China.
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18
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Hu Y, Liang H, Wang Y, Chen Y. Inequities in Childhood Vaccination Coverage in Zhejiang, Province: Evidence from a Decomposition Analysis on Two-Round Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092000. [PMID: 30217080 PMCID: PMC6164817 DOI: 10.3390/ijerph15092000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 11/20/2022]
Abstract
Objective: The objectives of this study were to determine the degree and risk factors of the inequity in the childhood coverage of full primary immunization (FPI) in Zhejiang province. Method: We used data from two rounds of vaccination coverage surveys among children aged 24–35 months conducted in 2014 and 2017, respectively. The household income per month was used as an index of socioeconomic status for the inequality analysis. The concentration index (CI) was used to quantify the degree of inequality, and the decomposition approach was applied to quantify the contributions from demographic factors to inequality in the coverage of FPI. Results: The coverage rates of FPI were 80.6%, with a CI value of 0.12028 for the 2014 survey, while the coverage rates of FPI were 85.2%, with a CI value of 0.10129 for the 2017 survey. The results of decomposition analysis suggested that 68.2% and 67.1% of the socioeconomic inequality in the coverage of FPI could be explained by the mother’s education level for the 2014 and 2017 survey, respectively. Other risk factors including birth order, ethnic group, mother’s age, maternal employment status, residence, immigration status, GDP per-capita, and the percentage of the total health spending allocated to public health could also explain this inequality. Conclusion: The socioeconomic inequity in the coverage of FPI still remained, although this gap was reduced between 2014 and 2017. Policy recommendations for health interventions on reducing the inequality in the coverage of FPI should be focused on eliminating poverty and women’s illiteracy.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou 310000, China.
| | - Hui Liang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou 310000, China.
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou 310000, China.
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou 310000, China.
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Hu Y, Chen Y, Liang H, Wang Y. Routine vaccination coverage of children aged 1-7 years in Zhejiang province, China. Hum Vaccin Immunother 2018; 14:2876-2883. [PMID: 30047821 DOI: 10.1080/21645515.2018.1504523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND This study was to evaluate the coverage, completeness and timeliness of routine vaccination among children aged 1-7 years in Zhejiang province. METHODS Demographic information and immunization records of 4613160 children born from Jan 1, 2010 to Dec 31, 2016 were extracted from Zhejiang provincial immunization information system (ZJIIS) on Dec 31, 2017. Vaccination coverage for each vaccine dose and completeness of different vaccine series were calculated by birth cohort, immigration status, and geographic area. The timeliness of vaccine doses scheduled before 12 months of age for the 2016 birth cohort was also examined Results: Coverage of all the vaccine doses scheduled before 12 months of age and its completeness reached the target goal of 90%. The coverage and completeness decreased substantially in vaccinations scheduled after 12 months old, and most of them were below 90%. The coverage and timeliness estimates of migrant children was lower than those of resident children and the coverage of WenZhou (WZ), Zhoushan (ZS) and Lishui (LS) was lower than other cities across all the birth cohorts. Despite high coverage rates for all antigens by age 12 months, there was a very large range of percent of vaccination delay when comparing different antigens scheduled in the first year of life for the 2016 birth cohort. CONCLUSIONS This study demonstrated the success and improvement of immunization program in Zhejiang province, and identified some challenges. Strategies such as assessment, feedback, incentives, and exchange program, reminder/recall activity, home visits, immunization requirement for school's enrollment could be used to reach a higher coverage of the population.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention , Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Yaping Chen
- a Institute of Immunization and Prevention , Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Hui Liang
- a Institute of Immunization and Prevention , Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Ying Wang
- a Institute of Immunization and Prevention , Zhejiang Center for Disease Control and Prevention , Hangzhou , China
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An Overview of Coverage of BCG Vaccination and Its Determinants Based on Data from the Coverage Survey in Zhejiang Province. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061155. [PMID: 29865207 PMCID: PMC6025410 DOI: 10.3390/ijerph15061155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/17/2022]
Abstract
To assess the Bacille Calmette-Guérin (BCG) vaccination coverage in Zhejiang province and to investigate predictors of the BCG vaccination, we used data from the 2017 Zhejiang provincial coverage survey. Demographic and immunization data on the selected children, their mothers, and their families were also collected by using a pre-tested questionnaire. BCG scars were verified among children who were available at the moment of survey. Coverage of BCG and other expanded program on immunization (EPI) vaccines scheduled before the first year of life was calculated. BCG coverage through the scar assessment and timeliness of BCG were also presented. Multivariate analyses of the predictors associated with the BCG vaccination and its timeliness were conducted separately. In total, 1393 children agreed to participate in the survey and presented the immunization cards. Of them, the coverage of BCG was 92.0% and 88.3% received the BCG within the first 28 days after birth. Besides this, 1282 out of the 1393 children were screened for the BCG scars and 97.1% of them had developed the scars. The multivariable logistic regression analyses indicated that hospital delivery, higher maternal education, a mother with no job, and a resident child were positively associated with the higher BCG vaccination coverage and its timely administrations. BCG coverage was optimal and it was administered in a timely manner. The majority of children vaccinated with BCG developed scars. Tailored interventions should be more greatly focused on and targeted to children with the risk factors identified in this study.
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Hu Y, Chen Y, Liang H, Wang Y. Analysis of the effects of individual- and community- level predictors on migrant children's primary immunization in Yiwu city, east China. Hum Vaccin Immunother 2018; 14:2239-2247. [PMID: 29792549 DOI: 10.1080/21645515.2018.1467684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND To evaluate the effects of a wide range of individual- and community-level factors on migrant children's primary immunization. METHODS Migrant children aged 13-24 months (born from 1 June 2013 to 31 May 2014) were surveyed in Yiwu city, in June 2015. Social-demographic factors and vaccination records were collected. Five factors at community-level including community wealth, distance to the nearest immunization clinic, maternal education, antenatal clinic (ANC) visits, and hospital delivery were constructed. The relationship between individual- and community-level factors and a child's vaccination status for Chinese primary immunization were evaluated by logistic regression model and the adjusted odds ratio (AOR) with the p-values and 95% confidence interval (CI) were calculated. RESULTS The community wealth (aOR:1.4; 95% CI:1.1-2.7), the community maternal education (aOR:1.8; 95% CI:1.4-4.5), the community ANC visits (aOR:1.8; 95% CI:1.3-2.8), and the community hospital delivery (aOR:2.2; 95% CI:1.6-4.8) were positively associated with the completeness of primary immunization, while community distance to the nearest immunization clinic was negatively associated with the completeness of primary immunization (aOR:0.7; 95% CI:0.5-0.9). The coverage of completeness of primary immunization was higher among children living in rural areas than those living in urban areas (aOR:1.7; 95% CI: 1.3-3.1). CONCLUSIONS In order to achieve better vaccination coverage among migrant children in Yiwu, as well as to close the gaps and disparities of acceptability and accessibility in childhood vaccination in urban areas, policy makers should design interventions based on the factors addressed in this study.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Yaping Chen
- a Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Hui Liang
- a Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Ying Wang
- a Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention , Hangzhou , China
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Hu Y, Chen Y, Hui L, Wang Y. Initiation and completion rates of inactivated hepatitis A vaccination among children born between 2005 and 2014 in Zhejiang province, east China. Hum Vaccin Immunother 2018; 14:1013-1017. [PMID: 29173014 DOI: 10.1080/21645515.2017.1407481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To evaluate the initiation and completion and timeliness of inactivated hepatitis A vaccine (HAV-I) series, to identify the missed opportunities for HAV-I series, and to examine determinants associated with the completion of HAV-I. METHODS Children born from 1 January 2005 to 31 December 2014 and registered in Zhejiang provincial immunization information system (ZJIIS), were enrolled in this study. Descriptive statistics were used to describe the initiation and completion, the timeliness and the missed opportunities for HAV-I. Logistic regression analysis was applied to explore the determinants of the completeness of HAV-I. RESULTS The initiation rate of HAV-I increased from 8.1% for the 2005 birth cohort to 13.2% for the 2014 birth cohort. The completion rate of HAV-I increased from 4.2% for the 2005 birth cohort to 7.8% for the 2014 birth cohort. The timeliness rate of the 1st dose of HAV-I increased from 38.2% for the 2005 birth cohort to 57.9% for the 2014 birth cohort. The timeliness rate the 2nd dose of HAV-I increased from 17.3% for the 2005 birth cohort to 35.3% for the 2014 birth cohort. 78.3% of the children who did not initiated any hepatitis A vaccine, had at least one immunization clinic visit after their 18th month of age. 36.0% of the children who received the 1st dose of HAV-I but did not receive the 2nd dose, had at least one immunization clinic visit after 6 months from the date of receiving the 1st dose of HAV-I. The determinants including year of birth, socio-economic development level of municipals, place of delivery, receipt of MMR/VarV were associated with the completion of HAV-I series. CONCLUSION Although the initiation and completion of HAV-I series had improved in recent years, these indicators were still lower than those for other vaccines scheduled at the similar age. It is important for providers to identify every opportunity for HAV-I vaccination and to assure that children get protection from this vaccine-preventable disease.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Yaping Chen
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Liang Hui
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Ying Wang
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
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Hu Y, Chen Y, Wang Y, Liang H. Evaluation of potentially achievable vaccination coverage of the second dose of measles containing vaccine with simultaneous administration and risk factors for missed opportunities among children in Zhejiang province, east China. Hum Vaccin Immunother 2018; 14:875-880. [PMID: 29252094 DOI: 10.1080/21645515.2017.1419111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the potential achievable coverage of the second dose of measles containing vaccine (MCV2) when the protocol of simultaneous administration of childhood vaccines was fully implemented. Risk factors for missed opportunity (MO) for simultaneous administration of MCV2 were also investigated. METHODS Children born from 1 January 2005 to 31 December 2014 and registered in Zhejiang provincial immunization information system were enrolled in this study. The MO of simultaneous administration of MCV2, the actual age-appropriate coverage (AAC) of MCV2 and the potentially achievable coverage (PAC) of MCV2 were evaluated and compared across different birth cohorts, by different socio-demographic variables. For the 2014 birth cohort, logistic regression model was used to detect the risk factors of MOs, from both socio-demographic and vaccination service providing aspects. RESULTS Compared to the AAC, the PAC of MCV2 increased significantly from 2005 birth cohort to 2014 birth cohort (p<0.001), with a median of 12.7 percentage points. Higher birth order of children, resident children, higher maternal education background, higher socio-economic development level of resident areas, less frequent vaccination service, and shorter vaccination service time were significant risk factors of MO for simultaneous administration of MCV2, with all p-value < 0.05. CONCLUSION The findings in this study suggest that fully utilization of all opportunities for simultaneous administration of all age-eligible vaccine doses at the same vaccination visit is critical for achieving the coverage target of 95% for MCV2. Future interventions focusing on the group with risk factors observed could substantially eliminate MOs for simultaneous administration of MCV2, further to improve the coverage of fully immunization of MCV, and finally achieve the goal of eliminating measles.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Yaping Chen
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Ying Wang
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Hui Liang
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
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Hu Y, Li Q, Chen Y. Evaluation of two health education interventions to improve the varicella vaccination: a randomized controlled trial from a province in the east China. BMC Public Health 2018; 18:144. [PMID: 29338782 PMCID: PMC5771153 DOI: 10.1186/s12889-018-5070-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/11/2018] [Indexed: 11/13/2022] Open
Abstract
Background We evaluated the effect of two Elaboration Likelihood Model (ELM)-based health educational interventions on varicella vaccine (VarV) vaccination among pregnant women in a province in the east China. Methods A prospective randomized controlled trial was conducted among 200 pregnant women with ≥12 gestation weeks to test two interventions, including a messaging video and a messaging booklet. The participants were randomly assigned into the control group, the video group or the booklet group. The VarV coverage at 12 and 24 months old was compared among the children of the three groups and relative risks (RRs) were calculated, by using the coverage of the control group as reference. The timeliness of VarV was also assessed. Furthermore, differences in the effects on the knowledge and attitude of VarV vaccination between the two interventions was evaluated. Results The VarV coverage of their children by 24 months of age was 86.4%, 76.1% and 56.7% for the video group, the booklet group and the control group, respectively. The relative risks (RRs) for the coverage of VarV at 24 months of age were 4.8 (95% CI: 2.06–11.3) for the video group and 2.4 (95% CI: 1.2–5.1) for the booklet group. The means of delays were 57.3 days in the video group, 76.9 days in the booklet group, and 100.6 days in the control group. The proportion of women who intended to vaccinate their children with VarV was higher in the video group than the booklet group (93.9% vs. 82.1%, p < 0.05). Conclusions Our findings indicated that perinatal health education through booklet or video could improve the coverage and schedule adherence for children’s VarV vaccination.
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Affiliation(s)
- Yu Hu
- Department of Expanded Program on Immunization, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, People's Republic of China
| | - Qian Li
- Department of Expanded Program on Immunization, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, People's Republic of China
| | - Yaping Chen
- Department of Expanded Program on Immunization, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, People's Republic of China.
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Hu Y, Chen Y, Wang Y, Liang H. Knowledge, Attitude and Practice of Pregnant Women towards Varicella and Their Children's Varicella Vaccination: Evidence from Three Distrcits in Zhejiang Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101110. [PMID: 28946647 PMCID: PMC5664611 DOI: 10.3390/ijerph14101110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 11/16/2022]
Abstract
Background: The objectives of this study were to examine the knowledge, attitudes and practice (KAP) towards varicella and varicella vaccine (VarV) vaccination among pregnant women in three distrcits in Zhejiang Province, China. Methods: From 1 January to 31 March 2014, pregnant women with ≥12 gestational weeks were recruited and received a self-administrated questionnaire. The first dose of VarV (VarV1) vaccination status of children from present pregnancy was extracted at 24 months of age from Zhejiang provincial immunization information system (ZJIIS). Three variables was defined as the main outcomes, which included: (1) knowing about both the availability of VarV and the number of doses required; (2) positive attitude towards the utility of varicella vaccination; (3) the vaccination coverage of VarV1, which meant the proportion of children having received the VarV1. Counts and proportions were used to describe the socio-demographic characteristics of study participants, and their relationship with study outcomes were tested using chi-square tests in univariate analysis and logistic regression in multivariable analysis. Results: A total of 629 pregnant women participated in this study. The majority of the participants (68.0%) answered correctly about the transmission route of varicella. The proportion of participants who heard about varicella vaccination was 76.5% and 66.8% knew that VarV was currently available. Only 13.5% of the participants answered correctly that the complete VarV series needed two doses. Age, immigration status, education level, household income, and number of children of the pregnant women were significant predictors of the KAP regarding the VarV vaccination. Conclusions: The current survey indicated that optimal KAP levels and coverage on VarV vaccination were observed in three districts of Zhejiang Province. Health education programs on varicella and VarV vaccination directed towards both pre-natal and post-natal women are needed, which will result in a better attitude on vaccination of VarV and in a high coverage of VarV.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China.
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China.
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China.
| | - Hui Liang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China.
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Evaluating Childhood Vaccination Coverage of NIP Vaccines: Coverage Survey versus Zhejiang Provincial Immunization Information System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070758. [PMID: 28696387 PMCID: PMC5551196 DOI: 10.3390/ijerph14070758] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/07/2017] [Accepted: 07/09/2017] [Indexed: 12/16/2022]
Abstract
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.
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Zhou Y, He H, Deng X, Yan R, Tang X, Xie S, Yao J. Significant reduction in notification and seroprevalence rates of hepatitis B virus infection among the population of Zhejiang Province, China, aged between 1 and 29years from 2006 to 2014. Vaccine 2017; 35:4355-4361. [PMID: 28687404 DOI: 10.1016/j.vaccine.2017.06.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/17/2017] [Accepted: 06/23/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVE The Chinese government integrated hepatitis B vaccination into the national immunization program in 1992, when the hepatitis B birth dose was introduced in China. Zhejiang province is a relatively developed area in eastern China and was an area with high endemicity for hepatitis B virus (HBV) infection via mother-to-child transmission. The hepatitis B vaccine vaccination rates for the birth dose and 3- dose schedule in Zhejiang Province since 1992 have both remained above 90% [1]. The results of two hepatitis B seroepidemiological surveys conducted in 2006 and 2014, respectively, to evaluate the rates of notification and seroprevalence of HBV infection among the population of Zhejiang Province, China, aged between 1 and 29years. METHODS Data on the notification rates of HBV infection in Zhejiang province from 2006 to 2014 were obtained from the National Notifiable Disease Reporting System (NNDRS). The prevalence rate of HBV serological markers and the rate of immunization coverage were compared between surveys. RESULTS The reported notification rates in people aged between 1 and 29years according to the NNDRS decreased approximately 4.88 times from 2006 to 2014. The prevalence of HBsAg decreased from 2.16% in 2006 to 1.05% in 2014, while the prevalence of anti-HBc decreased from 7.13% to 5.49%. The anti-HBc seroprevalence in the 15-29-year-old age group was significantly higher than that in all the other age groups both in the 2006 and 2014 serosurveys. The rate of anti-HBs seroprevalence in those aged between 1 and 14years was maintained at a high level between 2006 and 2014. CONCLUSIONS The rate of hepatitis B reported and the rate of HBsAg positivity decreased significantly in Zhejiang province by maintaining the high-level coverage rate of the hepatitis B timely birth dose and three-dose schedule. While additional efforts are needed to achieve the goal of elimination.
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Affiliation(s)
- Yang Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, PR China.
| | - Hanqing He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, PR China.
| | - Xuan Deng
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, PR China.
| | - Rui Yan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, PR China.
| | - Xuewen Tang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, PR China.
| | - Shuyun Xie
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, PR China.
| | - Jun Yao
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, PR China.
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Wagner AL, Boulton ML, Sun X, Mukherjee B, Huang Z, Harmsen IA, Ren J, Zikmund-Fisher BJ. Perceptions of measles, pneumonia, and meningitis vaccines among caregivers in Shanghai, China, and the health belief model: a cross-sectional study. BMC Pediatr 2017; 17:143. [PMID: 28606106 PMCID: PMC5468991 DOI: 10.1186/s12887-017-0900-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 06/05/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In China, the measles vaccine is offered for free whereas the pneumococcal vaccine is a for-fee vaccine. This difference has the potential to influence how caregivers evaluate whether a vaccine is important or necessary for their child, but it is unclear if models of health behavior, such as the Health Belief Model, reveal the same associations for different diseases. This study compares caregiver perceptions of different diseases (measles, pneumonia and meningitis); and characterizes associations between Health Belief Model constructs and both pneumococcal vaccine uptake and perceived vaccine necessity for pneumonia, measles, and meningitis. METHODS Caregivers of infants and young children between 8 months and 7 years of age from Shanghai (n = 619) completed a written survey on their perceptions of measles, pneumonia, and meningitis. We used logistic regression models to assess predictors of pneumococcal vaccine uptake and vaccine necessity. RESULTS Only 25.2% of children had received a pneumococcal vaccine, although most caregivers believed that pneumonia (80.8%) and meningitis (92.4%), as well as measles (93.2%), vaccines were serious enough to warrant a vaccine. Perceived safety was strongly associated with both pneumococcal vaccine uptake and perceived vaccine necessity, and non-locals had 1.70 times higher odds of pneumonia vaccine necessity than non-locals (95% CI: 1.01, 2.88). CONCLUSIONS Most factors had a similar relationship with vaccine necessity, regardless of disease, indicating a common mechanism for how Chinese caregivers decided which vaccines are necessary. Because more caregivers believed meningitis needed a vaccine than pneumonia, health care workers should emphasize pneumococcal vaccination's ability to protect against meningitis.
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Affiliation(s)
- Abram L. Wagner
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Matthew L. Boulton
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Xiaodong Sun
- Department of Immunization Programs, Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336 China
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Zhuoying Huang
- Department of Immunization Programs, Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336 China
| | - Irene A. Harmsen
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Jia Ren
- Department of Immunization Programs, Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336 China
| | - Brian J. Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, 1415 Washington Heights, Ann Arbor, MI 48109 USA
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Hu Y, Wang Y, Chen Y, Li Q. Determinants of inequality in the up-to-date fully immunization coverage among children aged 24-35 months: Evidence from Zhejiang province, East China. Hum Vaccin Immunother 2017; 13:1902-1907. [PMID: 28604178 DOI: 10.1080/21645515.2017.1327108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This study aimed to determine the degree and determinants of inequality in up-to-date fully immunization (UTDFI) coverage among children of Zhejiang province, east China. METHOD We used data from the Zhejiang provincial vaccination coverage survey of 2014 and the health outcome was the UTDFI status among children aged 24-35 months. The household income per month was used as an index of socio-economic status for the inequality analysis. The concentration index (CI) was used to quantify the degree of inequality and the decomposition approach was applied to quantify the contributions from demographic factors to inequality in UTDFI coverage. RESULTS The UTDFI coverage was 80.63% and the CI for UTDFI coverage was 0.12028 (95% CI: 0.10852-0.13175), indicating that immunization practice significantly favored children with relatively higher socio-economic status. The results of decomposition analysis suggested that 68.2% of the socio-economic inequality in UTDFI coverage should be explained by the mother's education level. Furthermore, factors such as birth order, ethnic group, maternal employment status, residence, immigration status, GDP per-capital and percentage of public health spending of the total health spending also could explain the disparity in UTDFI coverage. CONCLUSION There exists inequality in UTDFI coverage among the socio-economic disadvantage children. Health interventions of narrowing the socio-economic inequality in UTDFI coverage will benefit from being supplemented with strategies aimed at poverty and illiteracy reduction.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention , Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Ying Wang
- a Institute of Immunization and Prevention , Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Yaping Chen
- a Institute of Immunization and Prevention , Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Qian Li
- a Institute of Immunization and Prevention , Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
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Hu Y, Chen Y, Wang Y, Song Q, Li Q. Prenatal vaccination education intervention improves both the mothers' knowledge and children's vaccination coverage: Evidence from randomized controlled trial from eastern China. Hum Vaccin Immunother 2017; 13:1-8. [PMID: 28319453 DOI: 10.1080/21645515.2017.1285476] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To verify the effectiveness of prenatal vaccination education intervention on improving mother's vaccination knowledge and child's vaccination status in Zhejiang province, eastern China. METHODS Pregnant women with ≥ 12 gestational weeks were recruited and randomly assigned into the intervention group and the control group. The intervention group were given a vaccination education session while the control group were not. Two round surveys were performed before and 3 months after the intervention. The vaccination status of child was extracted at 12 months of age from immunization information system. The differences of the vaccination knowledge, the coverage, the completeness and the timeliness of vaccination between 2 groups were evaluated. The effectiveness of vaccination education intervention was assessed, under the control of the other demographic variables. RESULTS Among the 1252 participants, 851 subjects replied to the post-survey. Significant improvements of vaccination knowledge between the pre- and the post- survey in the intervention group were observed (Mean ± S.D:1.8 ± 1.1 vs. 3.7 ± 1.2 for vaccines score and 2.7 ± 1.5 vs. 4.8 ± 1.0 for vaccine policy score, respectively). The coverage of fully vaccination was significantly higher in the intervention group (90.0% vs. 82.9%, P<0.01). The timeliness of fully vaccination was significantly higher in the intervention group (51.9% vs. 33.0%, P<0.01). In the intervention group, pregnant women were more likely to be with high score of knowledge (OR = 5.2, 95%CI: 2.6-8.8), and children were more likely to complete the full series of vaccination (OR = 3.4, 95%CI: 2.1-4.8), and children were more likely to complete the full series of vaccination in a timely manner (OR = 2.3, 95%CI: 1.6-3.5). CONCLUSIONS Vaccination education in the pregnant women can effectively improve the knowledge regarding immunization and increase the coverage, the completeness and the timeliness of childhood vaccination. Strong partnership needs to be established between the obstetricians and the vaccination staff to improve the performance of NIP.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
| | - Yaping Chen
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
| | - Ying Wang
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
| | - Quanwei Song
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
| | - Qian Li
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
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On-time Measles and Pneumococcal Vaccination of Shanghai Children: The Impact of Individual-level and Neighborhood-level Factors. Pediatr Infect Dis J 2016; 35:e311-7. [PMID: 27294307 DOI: 10.1097/inf.0000000000001267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Measles-containing vaccines (MCVs) and pneumococcal conjugate vaccines (PCVs) can prevent a large proportion of infant deaths and are recommended by international organizations for inclusion in pediatric immunization schedules. In China, MCV but not PCV is publically funded and access to vaccination may be limited among nonlocals, who are rural migrants to cities. In this study, we estimate the proportion of Shanghai children with on-time MCV and PCV administration, compare vaccination in nonlocals versus locals and assess the impact of township-level characteristics on vaccination outcomes. METHODS Data from children in the Shanghai Immunization Program Information System were linked to township-level data from the 2010 China Census. We used generalized estimating equations with logistic regression models to assess the impact of residency and township-level predictors on on-time MCV and PCV administration. RESULTS Nonlocals had lower vaccination levels than locals. Compared with locals, nonlocals had 0.50 times the odds of MCV dose 1 by 9 months [95% confidence interval (CI): 0.47, 0.53], 0.42 times the odds of MCV dose 2 by 24 months (95% CI: 0.39, 0.45), 0.37 times the odds of PCV by 9 months of age (95% CI: 0.33, 0.42) and 0.41 times the odds of PCV by 24 months of age (95% CI: 0.37, 0.45). Overall, children had less on-time MCV and PCV administration in nonlocal-majority than local-majority townships. CONCLUSIONS Late vaccination negatively impacts disease control efforts in Shanghai. Nonlocals, particularly those living in nonlocal-majority townships, should especially be targeted for vaccination in order to improve disease control efforts in Shanghai.
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Hu Y, Chen Y, Zhang B. 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. Hum Vaccin Immunother 2016; 13:75-80. [PMID: 27624854 DOI: 10.1080/21645515.2016.1225640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the coverage and timeliness of seasonal influenza vaccine vaccination (SIV) among children aged 6 months to 3 years from the 2010-11 through the 2014-15 seasons. METHODS Children registered in Zhejiang Provincial Immunization Information System (ZJIIS) and needed 2 seasonal influenza vaccine doses in a given season from 2010-11 to 2014-15 were enrolled. Socio-economic information and SIV records of target children were extracted from ZJIIS on 1 January 2016. Any (≥1 dose) and full (2 doses) vaccination coverage by December 1 and March 31 as well as interval between 2 doses were calculated. Trends of coverage over time and determinants on fully vaccination coverage and interval between 2 doses were assessed. RESULTS Full SIV overage by Mar 31 increased from the 2010-11 to the 2014-15 seasons (2.60% vs 2.92%). Less than 1% of children received 2 doses by December 1. The interval between 2 doses among fully vaccinated children decreased over time (2010-11: 68.32 days; 2014-15: 49.51 days; p < 0.05). Age, socio-economic development level of resident areas were inversely associated with full vaccination coverage and resident children had a significantly higher full vaccination coverage. Younger age, resident children, receiving vaccination from higher service frequency clinics and clinics with morning and afternoon sessions were positive determinants of a shorter interval between 2 doses. CONCLUSION Majority of children aged 6 months to 3 years remained at risk of incomplete and delayed SIV. The importance of the 2-dose SIV recommendation needs to be emphasized and effective interventions needs to be implemented to improve the completeness and the timeliness of SIV.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Yaping Chen
- b Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Bing Zhang
- c Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
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Hu Y, Chen Y, Zhang B, Li Q. An Evaluation of Voluntary Varicella Vaccination Coverage in Zhejiang Province, East China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060560. [PMID: 27271649 PMCID: PMC4924017 DOI: 10.3390/ijerph13060560] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 11/17/2022]
Abstract
Background: In 2014 a 2-doses varicella vaccine (VarV) schedule was recommended by the Zhejiang Provincial Center for Disease Control and Prevention. We aimed to assess the coverage of the 1st dose of VarV (VarV1) and the 2nd dose of VarV (VarV2) among children aged 2–6 years through the Zhejiang Provincial Immunization Information System (ZJIIS) and to explore the determinants associated with the VarV coverage. Methods: Children aged 2–6 years (born from 1 January 2009 to 31 December 2013) registered in ZJIIS were enrolled. Anonymized individual records of target children were extracted from the ZJIIS database on 1 January 2016, including their VarV and (measles-containing vaccine) MCV vaccination information. The VarV1 and VarV2 coverage rates were evaluated for each birth cohorts. The coverage of VarV also was estimated among strata defined by cities, gender and immigration status. We also evaluated the difference in coverage between VarV and MCV. Results: A total of 3,028,222 children aged 2–6 years were enrolled. The coverage of VarV1 ranged from 84.8% to 87.9% in the 2009–2013 birth cohorts, while the coverage of VarV2 increased from 31.8% for the 2009 birth cohort to 48.7% for the 2011 birth cohort. Higher coverage rates for both VarV1 and VarV2 were observed among resident children in relevant birth cohorts. The coverage rates of VarV1 and VarV2 were lower than those for the 1st and 2nd dose of MCV, which were above 95%. The proportion of children who were vaccinated with VarV1 at the recommended age increased from 34.6% for the 2009 birth cohort to 75.2% for the 2013 birth cohort, while the proportion of children who were vaccinated with VarV2 at the recommended age increased from 19.7% for the 2009 birth cohort to 48.7% for the 2011 birth cohort. Conclusions: Our study showed a rapid increasing VarV2 coverage of children, indicating a growing acceptance of the 2-doses VarV schedule among children’s caregivers and physicians after the new recommendation released. We highlighted the necessity for a 2-doses VarV vaccination school-entry requirement to achieve the high coverage of >90% and to eliminate disparities in coverage among sub-populations. We also recommended continuous monitoring of the VarV coverage via ZJIIS over time.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
| | - Bing Zhang
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
| | - Qian Li
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
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Awoh AB, Plugge E. Immunisation coverage in rural-urban migrant children in low and middle-income countries (LMICs): a systematic review and meta-analysis. J Epidemiol Community Health 2016; 70:305-11. [PMID: 26347277 PMCID: PMC4789817 DOI: 10.1136/jech-2015-205652] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/06/2015] [Accepted: 08/04/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The majority of children who die from vaccine-preventable diseases (VPDs) live in low-income and-middle-income countries (LMICs). With the rapid urbanisation and rural-urban migration ongoing in LMICs, available research suggests that migration status might be a determinant of immunisation coverage in LMICs, with rural-urban migrant (RUM) children being less likely to be immunised. OBJECTIVES To examine and synthesise the data on immunisation coverage in RUM children in LMICs and to compare coverage in these children with non-migrant children. METHODS A multiple database search of published and unpublished literature on immunisation coverage for the routine Expanded Programme on Immunisation (EPI) vaccines in RUM children aged 5 years and below was conducted. Following a staged exclusion process, studies that met the inclusion criteria were assessed for quality and data extracted for meta-analysis. RESULTS Eleven studies from three countries (China, India and Nigeria) were included in the review. There was substantial statistical heterogeneity between the studies, thus no summary estimate was reported for the meta-analysis. Data synthesis from the studies showed that the proportion of fully immunised RUM children was lower than the WHO bench-mark of 90% at the national level. RUMs were also less likely to be fully immunised than the urban-non-migrants and general population. For the individual EPI vaccines, all but two studies showed lower immunisation coverage in RUMs compared with the general population using national coverage estimates. CONCLUSIONS This review indicates that there is an association between rural-urban migration and immunisation coverage in LMICs with RUMs being less likely to be fully immunised than the urban non-migrants and the general population. Specific efforts to improve immunisation coverage in this subpopulation of urban residents will not only reduce morbidity and mortality from VPDs in migrants but will also reduce health inequity and the risk of infectious disease outbreaks in wider society.
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Affiliation(s)
- Abiyemi Benita Awoh
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Emma Plugge
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
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Frøen JF, Myhre SL, Frost MJ, Chou D, Mehl G, Say L, Cheng S, Fjeldheim I, Friberg IK, French S, Jani JV, Kaye J, Lewis J, Lunde A, Mørkrid K, Nankabirwa V, Nyanchoka L, Stone H, Venkateswaran M, Wojcieszek AM, Temmerman M, Flenady VJ. eRegistries: Electronic registries for maternal and child health. BMC Pregnancy Childbirth 2016; 16:11. [PMID: 26791790 PMCID: PMC4721069 DOI: 10.1186/s12884-016-0801-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/07/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Global Roadmap for Health Measurement and Accountability sees integrated systems for health information as key to obtaining seamless, sustainable, and secure information exchanges at all levels of health systems. The Global Strategy for Women's, Children's and Adolescent's Health aims to achieve a continuum of quality of care with effective coverage of interventions. The WHO and World Bank recommend that countries focus on intervention coverage to monitor programs and progress for universal health coverage. Electronic health registries - eRegistries - represent integrated systems that secure a triple return on investments: First, effective single data collection for health workers to seamlessly follow individuals along the continuum of care and across disconnected cadres of care providers. Second, real-time public health surveillance and monitoring of intervention coverage, and third, feedback of information to individuals, care providers and the public for transparent accountability. This series on eRegistries presents frameworks and tools to facilitate the development and secure operation of eRegistries for maternal and child health. METHODS In this first paper of the eRegistries Series we have used WHO frameworks and taxonomy to map how eRegistries can support commonly used electronic and mobile applications to alleviate health systems constraints in maternal and child health. A web-based survey of public health officials in 64 low- and middle-income countries, and a systematic search of literature from 2005-2015, aimed to assess country capacities by the current status, quality and use of data in reproductive health registries. RESULTS eRegistries can offer support for the 12 most commonly used electronic and mobile applications for health. Countries are implementing health registries in various forms, the majority in transition from paper-based data collection to electronic systems, but very few have eRegistries that can act as an integrating backbone for health information. More mature country capacity reflected by published health registry based research is emerging in settings reaching regional or national scale, increasingly with electronic solutions. 66 scientific publications were identified based on 32 registry systems in 23 countries over a period of 10 years; this reflects a challenging experience and capacity gap for delivering sustainable high quality registries. CONCLUSIONS Registries are being developed and used in many high burden countries, but their potential benefits are far from realized as few countries have fully transitioned from paper-based health information to integrated electronic backbone systems. Free tools and frameworks exist to facilitate progress in health information for women and children.
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Affiliation(s)
- J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
| | - Sonja L Myhre
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Michael J Frost
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- John Snow, Inc., Boston, MA, USA.
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Garrett Mehl
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Lale Say
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Socheat Cheng
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Ingvild Fjeldheim
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Ingrid K Friberg
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Steve French
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Jagrati V Jani
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
| | - Jane Kaye
- HeLEX - Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - John Lewis
- Health Information System Programme (HISP) Vietnam, Ho Chí Minh, Vietnam.
- Department of Informatics, University of Oslo, Oslo, Norway.
| | - Ane Lunde
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Kjersti Mørkrid
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Victoria Nankabirwa
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Department of Epidemiology and Biostatics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Linda Nyanchoka
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Hollie Stone
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Mahima Venkateswaran
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
| | - Aleena M Wojcieszek
- Mater Research Institute, The University of Queensland, Brisbane, Australia.
- International Stillbirth Alliance, Millburn, NJ, USA.
| | | | - Vicki J Flenady
- Mater Research Institute, The University of Queensland, Brisbane, Australia.
- International Stillbirth Alliance, Millburn, NJ, USA.
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Hu Y, Luo S, Tang X, Lou L, Chen Y, Guo J. Comparative assessment of immunization coverage of migrant children between national immunization program vaccines and non-national immunization program vaccines in East China. Hum Vaccin Immunother 2015; 11:761-8. [PMID: 25760670 DOI: 10.1080/21645515.2015.1012015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
This study aimed to describe the disparities in immunization coverage between National Immunization Program (NIP) vaccines and non-NIP vaccines in Yiwu and to identify potential determinants. A face-to-face interview-based questionnaire survey among 423 migrant children born from 1 June 2010 to 31 May 2013 was conducted. Immunization coverage was estimated according to the vaccines scheduled at different age, the birth cohorts, and socio- demographic characteristics. Single-level logistic regression analysis was applied to identify the determinants of coverage of non-NIP vaccines. We found that NIP vaccines recorded higher immunization coverage compared with non-NIP vaccines (87.9100%- vs 0%-74.8%). Among the non-NIP vaccines, varicella vaccine (VarV) recorded the highest coverage of 85.4%, which was introduced in 1998; while 7-valent pneumococcal conjugate vaccine(PCV7) recorded the lowest coverage of 0% for primary series, which was introduced recently. Lower coverage rate of non-NIP vaccines was significantly associated with more siblings in household, shorter duration of living in the surveyed areas, lower family income, mother with a job, mother with poor awareness of vaccination, and mother with lower education level. We found the immunization coverage rate of non-NIP vaccines was significant lower than that of NIP vaccines. Expansion of NIP to include non-NIP vaccines can provide better protection against the vaccine preventable diseases through increased immunization coverage.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention; Zhejiang Center for Disease Control and Prevention ; Hangzhou , China
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37
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Public health workers and vaccination coverage in Eastern China: a health economic analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:5555-66. [PMID: 24859680 PMCID: PMC4053906 DOI: 10.3390/ijerph110505555] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 05/16/2014] [Accepted: 05/16/2014] [Indexed: 11/17/2022]
Abstract
Background: Vaccine-preventable diseases cause more than one million deaths among children under 5 years of age every year. Public Health Workers (PHWs) are needed to provide immunization services, but the role of human resources for public health as a determinant of vaccination coverage at the population level has not been assessed in China. The objective of this study was to test whether PHW density was positively associated with childhood vaccination coverage in Zhejiang Province, East China. Methods: The vaccination coverage rates of Measles Containing Vaccine (MCV), Diphtheria, Tetanus and Pertussis combined vaccine (DTP), and Poliomyelitis Vaccine (PV) were chosen as the dependent variables. Vaccination coverage data of children aged 13–24 months for each county in Zhejiang Province were taken from the Zhejiang Immunization Information System (ZJIIS). Aggregate PHW density was an independent variable in one set of regressions, and Vaccine Personnel (VP) and other PHW densities were used separately in another set. Data on densities of PHW and VP were taken from a national investigation on EPI launched by Ministry of Health of China in 2013. We controlled other determinants that may influence the vaccination coverage like Gross Domestic Product (GDP) per person, proportion of migrant children aged <7 years, and land area. These data were taken from Zhejiang Provincial Bureau of Statistics and ZJIIS. Results: PHW density was significantly influence the coverage rates of MCV [Adjusted Odds Ratio(AOR) = 4.29], DTP3(AOR = 2.16), and PV3 (AOR = 3.30). However, when the effects of VPs and other PHWs were assessed separately, we found that VP density was significantly associated with coverage of all three vaccinations (MCV AOR = 7.05; DTP3 AOR = 1.82; PV3 AOR = 4.83), while other PHW density was not. Proportion of migrant children < 7 years and Land area were found as negative and significant determinants for vaccination coverage, while GDP per person had no effect on vaccination coverage. Conclusions: A higher density of PHWs (VP) would improve the availability of immunization services over time and space, which may increase the possibility of achieving a higher childhood vaccination coverage rate. It was indicated that the level of GDP per person had no association with the improved vaccination coverage after controlling for other potential factors. Our findings implicated that PHW density was a major constraint on immunization coverage in Zhejiang Province.
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