Factors associated with recommendation behaviors of four non-National Immunization Program vaccines:a cross-sectional survey among public health workers in China

Background Immunization is a crucial preventive measure to safeguard children under five years old against a range of diseases.In China,the coverage rate of non-National Immunization Program(non-NIP)vaccines can be improved by leveraging the recommendation from public health workers.Hence,understanding the influencing factors of recommendation behaviors assume paramount importance.This study aims to investigate influencing factors of public health workers’recommendation behaviors towards non-NIP vaccines,with a particular emphasis on financial incentives.Methods A cross-sectional survey was conducted using a multi-stage sampling method in 2019 from August to October.627 public health workers were recruited from 148 community healthcare centers in ten provincial-level administrative divisions in China.An anonymous questionnaire was used to collect demographic information,attitudes towards vaccination,and recommendation behaviors towards non-NIP vaccines,includingHaemophilus influenzae type b(Hib)vaccine,pneumococcal conjugate vaccine,varicella vaccine,and rotavirus vaccine.Descriptive analysis and multivariate logistic regression analysis were adopted in this study.Results Of the 610 public health workers with complete survey data,53.8%,57.4%,84.1%,and 54.1%often recommended Hib vaccine,pneumococcal pneumonia vaccine(PCV),varicella vaccine,and rotavirus vaccine,respectively.Logistic regression revealed that gender(Hib vaccine:OR=0.4,95%CI:0.2-0.8;PCV:OR=0.4,95%CI:0.2-0.8;rotavirus vaccine:OR=0.3,95%CI:0.2-0.6),financial incentives for non-NIP vaccination(Hib vaccine:OR=1.9,95%CI:1.1-3.6;PCV:OR=2.1,95%CI:1.1-3.9;rotavirus vaccine:OR=2.0,95%CI:1.1-3.8)and perception of vaccine safety(Hib vaccine:OR=2.7,95%CI:1.1-7.0;PCV:OR=3.2,95%CI:1.2-8.0;rotavirus vaccine:OR=3.0,95%CI:1.2-7.7)were associated with public health workers’recommendation towards Hib vaccine,PCV and rotavirus vaccine.Conclusions The findings highlighted public health workers’recommendation behaviors of non-NIP vaccines in China and revealed strong association between vaccine recommendation and financial incentives.This highlights the importance of financial incentives in public health workers’recommendation toward non-NIP vaccines in China.Proper incentives are recommended for public health workers to encourage effective health promotion in immunization practices.

Impact of the national hepatitis B immunization program in China:a modeling study

Background:Elimination of hepatitis B virus(HBV)is a striking challenge for countries with high or moderate disease burden.Therefore,using China as a practical case to share experiences for similar countries may accelerate the achievement of the WHO 2030 target of 90%reduction in HBV-related incidence.We aim to evaluate the impact of national HBV immunization strategies in China;and the feasibility to achieve WHO 2030 targets under diferent scenarios.Methods:We constructed an expanded Susceptible-Exposed-Infectious-Recovered(SEIR)model and decision treeMarkov model to estimate the epidemic of HBV in China,assess the feasibility of 2030 Elimination Goals through the projections and conduct the economic analysis.Least square method was used to calibrate the expanded SEIR model by yearly data of laboratory-confrmed HBV cases from 1990 to 2018.Two models were separately used to evaluate the impact and cost-efectiveness of HBV vaccine by comparing prevalence of chronic HBV infections,qualityadjusted life-years(QALYs),incremental cost efectiveness ratio and beneft–cost ratio(BCR)under various intervention options,providing a basis for exploring new containment strategies.Results:Between 1990 and 2020,the number of chronic HBV infections decreased by 33.9%.The current status quo would lead to 55.73 million infections(3.95%prevalence)in 2030,compared to 90.63 million(6.42%prevalence)of the“Without the NIP”scenario(NIP:National Immunization Program),114.78 million(8.13%prevalence)without any interventions.The prevention of mother to child transmission(PMTCT)strategy showed a net beneft as 12,283.50 dollars per person,with BCR as 12.66,which is higher than that of universal vaccination at 9.49.Compared with no screening and no vaccination,the PMTCT strategy could save 7726.03 dollars for each QALY increase.Conclusions:Our fndings proved the HBV vaccination has demonstrated a substantial positive impact on controlling the epidemic of HBV in terms of efectiveness and economy after about 30 years of implementation of the national hepatitis B immunization program which also provided containment experience for high or medium burden countries.As for China,the next step should focus on exploring strategies to improve diagnosis and treatment coverage to reduce the burden of HBV-related deaths and ultimately eliminate HBV.

Promoting higher-valent pediatric combination vaccines in China: challenges and recommendations for action

Many countries have adopted higher-valent pediatric combination vaccines to simplify vaccination schedules and minimize health expenditures and social costs.However,China is conservative in the use of pediatric combina-tion vaccines.By reviewing and synthesizing quantitative and qualitative data,in this commentary we identify gaps and challenges to combination vaccine use and make recommendations for promoting use of higher-valent pediatric combination vaccines in China.Challenges are in four dimensions:(1)legislation and regulation,(2)immunization schedule design,(3)vaccine awareness and price,and(4)research and development capacity.To optimize the use of combination vaccines to reduce vaccine-preventable disease burden,we make recommendations that address key challenges:(1)develop policies and regulations to strengthen enforcement of the Vaccine Administration Law and remove regulatory hurdles that hinder combination vaccine research and development,(2)establish an evi-dence-informed policy-making mechanism for combination vaccines,(3)resolve immunization schedule conflicts between monovalent and combination vaccines,and(4)implement effective interventions to increase vaccine awareness and reduce price.