Testing for hepatitis B virus alone does not increase vaccine coverage in non-immunized persons

AIM To determine whether hepatitis B virus(HBV)-testing could serve as a gateway to vaccinate non-immunized individuals in a low-prevalent country.METHODS Non-immunized subjects participating in a multi-center, HBV-testing campaign in Paris, France were identified and contacted via telephone 3-9 mo after testing in order to determine vaccination status. Vaccination coverage was evaluated in per-protocol(for all respondents) and intent-to-treat analysis(assuming all non-responders did not vaccinate).RESULTS In total, 1215/4924(24.7%) enrolled subjects with complete HBV serology were identified as nonimmunized and eligible for analysis. There were 99/902 successfully contacted subjects who had initiated HBV vaccination after screening: per-protocol, 11.0%(95%CI: 9.0-13.2); intent-to-treat, 8.2%(95%CI: 6.7-9.8). In multivariable analysis, vaccination was more likely to be initiated in individuals originating from moderate or high HBV-endemic countries(P < 0.001), patients with limited healthcare coverage(P = 0.01) and men who have sex with men(P = 0.02). When asked about the reasons for not initiating HBV vaccination, the most frequent response was "will be vaccinated later"(33.4%), followed by "did not want to vaccinate"(29.8%), and "vaccination was not proposed by the physician"(21.5%). Sub-group analysis indicated a stark contrast in vaccination coverage across centers, ranging from 0%-56%.CONCLUSION HBV-vaccination after HBV screening was very low in this study, which appeared largely attributed to physician-patient motivation towards vaccination. Increased vaccination coverage might be achieved by emphasizing its need at the organizational level.

Advancing the National Immunization Program in an era of achieving universal vaccine coverage in China and beyond

Background Immunization is a cornerstone of public health.Despite great success,China’s National Immunization Program(NIP)faces challenges,such as the integration of several World Health Organization-recommended vaccines and other systemic issues.The Innovation Laboratory for Vaccine Delivery Research(VaxLab),supported by the Bill&Melinda Gates Foundation and established in 2021 at Duke Kunshan University,focuses on enhancing China’s NIP through research and policy advocacy.This editorial aims to summarize the key findings of the manuscripts published in the collection contributed by VaxLab team and set the future research agenda.Key findings The collection contains eleven manuscripts discussing China’s immunization landscape and strategies to improve coverage,particularly for non-NIP vaccines like human papillomavirus vaccine(HPV),pneumococcal conjugate vaccine(PCV),Haemophilus influenzae type b vaccine(Hib),and rotavirus vaccines.Key findings include:(i)The COVID-19 vaccination campaign demonstrated China’s capacity for rapid,large-scale immunization efforts,suggesting potential for broader vaccine coverage improvements;(ii)Efforts in combating cervical cancer through the HPV vaccine indicate progress but also highlight challenges like vaccine supply and equitable access;(iii)The lag in adopting higher-valent paediatric combination vaccines in China needs attention to address regulatory and health system hurdles;(iv)Disparities in access to non-NIP vaccines underscore the need for government initiatives to improve vaccine coverage,especially for remote areas and marginalized populations;(v)Original studies emphasize the influence of caregivers’knowledge,health workers’financial incentives,and concerns about vaccine efficacy on immunization rates;(vi)Case studies from the Weifang City of China and Indonesia to introduce PCV offer insights on successful vaccine introduction strategies and the impact of innovative financing and government support.Conclusion The articles emphasize the need for government leadership,strategic policymaking,and public awareness to enhance vaccine coverage and equity.The VaxLab will continue strengthening China’s NIP by focusing on vaccine financing,emphasizing diversity,equity,and inclusion,and improving maternal vaccination coverage.Research will extend to Southeast Asian and Western Pacific regions,especially in middle-income countries facing challenges in vaccine financing and delivery.The collective efforts outlined in this collection show a commitment to evolving and adapting immunization strategies to meet global health goals and to provide equitable access to vaccines for all.

Hepatitis B Vaccination Coverage among University Students in Sub-Saharan Africa: Systematic Review and Meta Analysis

Introduction: Hepatitis B is an infectious disease that remains a real public health problem in Africa. Students represent a group at risk for this disease. The objective of this study was to estimate the hepatitis B vaccination coverage rate among students in sub-Saharan Africa. Methods: A systematic search of databases (PubMed, AJOL) and a manual search of Google Scholar was conducted to retrieve all published studies reporting hepatitis B vaccination coverage among students in sub-Saharan Africa. The pooled coverage rate was estimated with a 95% confidence interval (CI) in a random-effects meta-analysis. Results: A total of 35 studies were included and included 20,520 students. The mean age was 22.1 ± 5.1 years with a predominance of female sex (sex ratio F/M = 1.05). The vaccination coverage rate was 28.8% [95% CI: 22.9% - 34.7%]. Disaggregation allowed to estimate coverage rates of 29.8% [95% CI: 22.9% - 36.7%], 23.4% [95% CI: 9.4% - 37.4%] and 17.0% [95% CI: 14.4% - 19.5%] respectively in West Africa, East Africa and Central Africa. Conclusion: Less than a third of students in sub-Saharan Africa are protected against hepatitis B. However, the majority of this target group is at risk of infection. It would be relevant to screen and, if necessary, vaccinate all new students.

Willingness of Greek general population to get a COVID-19 vaccine

Background:Epidemiological data indicate that a large part of population needs to be vaccinated to achieve herd immunity.Hence,it is of high importance for public health officials to know whether people are going to get vaccinated for COVID-19.The objective of the present study was to examine the willingness of adult residents in Greece to receive a COVID-19 vaccine.Methods:A cross-sectional was survey conducted among the adult general population of Greece between April 28,2020 to May 03,2020(last week of lockdown),using a mixed methodology for data collection:Computer Assisted Telephone Interviewing(CATI)and Computer Assisted web Interviewing(CAWI).Using a sample size calculator,the target sample size was found to be around 1000 respondents.To ensure a nationally representative sample of the urban/rural population according to the Greek census 2011,a proportionate stratified by region systematic sampling procedure was used to recruit particpants.Data collection was guided through a structured questionnaire.Regarding willingness to COVID-19 vaccination,participants were asked to answer the following question:“If there was a vaccine available for the novel coronavirus,would you do it?”Results:Of 1004 respondents only 57.7%stated that they are going to get vaccinated for COVID-19.Respondents aged>65 years old,those who either themselves or a member of their household belonged to a vulnerable group,those believing that the COVID-19 virus was not developed in laboratories by humans,those believing that coronavirus is far more contagious and lethal compared to the H1N1 virus,and those believing that next waves are coming were statistically significantly more likely to be willing to get a COVID-19 vaccine.Higher knowledge score regarding symptoms,transmission routes and prevention and control measures against COVID-19 was significantly associated with higher willingness of respondents to get vaccinated.Conclusion:A significant proportion of individuals in the general population are unwilling to receive a COVID-19 vaccine,stressing the need for public health officials to take immediate awareness-raising measures.

Improving Routine Immunization Coverage Through Optimally Designed Predictive Models

Routine immunization(RI)of children is the most effective and timely public health intervention for decreasing child mortality rates around the globe.Pakistan being a low-and-middle-income-country(LMIC)has one of the highest child mortality rates in the world occurring mainly due to vaccine-preventable diseases(VPDs).For improving RI coverage,a critical need is to establish potential RI defaulters at an early stage,so that appropriate interventions can be targeted towards such populationwho are identified to be at risk of missing on their scheduled vaccine uptakes.In this paper,a machine learning(ML)based predictivemodel has been proposed to predict defaulting and non-defaulting children on upcoming immunization visits and examine the effect of its underlying contributing factors.The predictivemodel uses data obtained from Paigham-e-Sehat study having immunization records of 3,113 children.The design of predictive model is based on obtaining optimal results across accuracy,specificity,and sensitivity,to ensure model outcomes remain practically relevant to the problem addressed.Further optimization of predictive model is obtained through selection of significant features and removing data bias.Nine machine learning algorithms were applied for prediction of defaulting children for the next immunization visit.The results showed that the random forest model achieves the optimal accuracy of 81.9%with 83.6%sensitivity and 80.3%specificity.The main determinants of vaccination coverage were found to be vaccine coverage at birth,parental education,and socioeconomic conditions of the defaulting group.This information can assist relevant policy makers to take proactive and effective measures for developing evidence based targeted and timely interventions for defaulting children.

Vaccination coverage in children with juvenile idiopathic arthritis,inflammatory bowel diseases,and healthy peers:Cross-sectional electronic survey data

BACKGROUND Patients with immune-mediated diseases,such as juvenile idiopathic arthritis(JIA)and inflammatory bowel disease(IBD)are at increased risk of developing infections,due to disease-related immune dysfunction and applying of immunosuppressive drugs.AIM To evaluate vaccine coverage in patients with IBD and JIA,and compare it with healthy children.METHODS In the cross-sectional study we included the data from a questionnaire survey of 190 Legal representatives of children with JIA(n=81),IBD(n=51),and healthy children(HC,n=58).An electronic online questionnaire was created for the survey.RESULTS There were female predominance in JIA patients and younger onset age.Parents of JIA had higher education levels.Employment level and family status were similar in the three studied groups.Patients with JIA and IBD had lower vaccine coverage,without parental rejection of vaccinations in IBD,compare to JIA and healthy controls.The main reason for incomplete vaccination was medical conditions in IBD and JIA.IBD patients had a lower rate of normal vaccine-associated reactions compared to JIA and HC.The encouraging role of physicians for vaccinations was the lowest in JIA patients.IBD patients had more possibilities to check antibodies before immune-suppressive therapy and had more supplementary vaccinations compared to JIA and HC.CONCLUSION JIA and IBD patients had lower vaccine coverage compared to HC.Physicians'encouragement of vaccination and the impossibility of discus about future vaccinations and their outcomes seemed the main factors for patients with immune-mediated diseases,influencing vaccine coverage.Further investigations are required to understand the reasons for incomplete vaccinations and improve vaccine coverage in both groups,especially in rheumatic disease patients.The approaches that stimulate vaccination in healthy children are not always optimal in children with immunemediated diseases.It is necessary to provide personalized vaccine-encouraging strategies for parents of chronically ill children with the following validation of these technics.

Inequity in the global distribution of monkeypox vaccines

Monkeypox(mpox)has been a public health emergency of international concern that emerged in mid-2022 and has spread to 110 countries.The clinical findings of the disease vary according to the seriousness of the cases.Although its case fatality risk has not been high,a significant percentage of patients require hospitalization.In this context,local initiatives were taken to extend the limited supply of vaccines against the disease;however,such measures have not been sufficient to contain the spread of cases and ensure an equitable distribution of health resources.As a result,endemic regions of low-income countries continue to have insufficient access to mpox vaccination.Despite this and considering the global scope of the disease,there is still little discussion in the literature about the difficulties in achieving adequate vaccination coverage rates for the target population of interest.In this article,we briefly discussed general aspects of the disease,including its surveillance,the current global context of challenges for mpox vaccination,and issues on global allocation of health resources as well as proposed related recommendations.

Thinking Out-of-Box in Addressing Communication and Service Delivery Challenges: Use of a Traditional Communication Method for Improving Immunization Coverage in Remote Rural Hard-to-Reach Areas of India

Sirmaur district in the state of Himachal Pradesh in India is a hard-to-reach area situated in the western Himalayas having an extreme landscape with snow-laden mountains and extensive river systems that makes the delivery of immunization services extremely challenging. Vaccinators needed a long walk through the hilly terrain to reach outreach sites. Community mobilizers were unable to go house to house to inform the caregivers to bring children to the site for vaccination. Caregivers were unaware when the vaccinators arrive at the site. As a result, many children missed vaccination or were not vaccinated timely. Age-appropriate vaccination coverage (according to national immunization schedule) in the Sirmaur district was the lowest in the state. Thinking out-of-box to address the communication barriers with the caregivers, the traditional drum beating was used, for the first time in India, in two blocks of the Sirmaur district (Rajpura and Shillai). The initiative was planned and implemented by the district health system with the support of the local community leaders. An exit interview was conducted to know the reach of the drum beating to caregivers, and a baseline and end line household survey was conducted to know the outcome of the initiative on age-appropriate vaccination coverage. Analysis of exit interviews data indicated a very high reach of a drum beating to the caregivers;more than 97% of caregivers in Rajpura and 100% in Shillai heard drum beating, and almost 95% of caregivers in Rajpura and 98% in Shillai knew the purpose of drum beating. Analysis of immunization data from baseline and end line surveys showed improvement in age-appropriate vaccination coverage for all vaccines in Rajpura (by 2.2% for BCG, 15.3% for Pentavalent 1, 14.9% for Pentavalent 2, 14.1% for Pentavalent 3, and 6.5% for Measles/MR). In Shillai, age-appropriate vaccination coverage improved for Pentavalent 1 (by 3.4%), Pentavalent 2 (by 5%) and Measles/MR (by 1.7%). In addition, dropout rates were reduced in both the blocks, particularly in Rajpura Pentavalent 1 to Measles dropout rate was reduced by 13.5%. Both health workers and community leaders had positive perceptions of the drum beating initiative. However, another important lesson learned from the initiative was that both the access and demand-side barriers need to be addressed for the desired improvement of age-appropriate immunization coverage. In Shillai, there was lower coverage improvement and a reduction in dropout rates attributed to vacant positions of vaccinators that caused an issue with access to immunization services to people.

Assessment of the Vaccination Status of Children Aged 6 to 30 Months in a Tertiary Level Health Care Center in Côte d’Ivoire

Introduction: Vaccination coverage in Côte d’Ivoire over the period 2011 to 2015 was below the target of 95% for all antigens. The objective of this study was to analyze the vaccination status of children aged 6 to 30 months with a view to improving vaccination coverage. Patients and Methods: This was a descriptive cross-sectional study which took place from June to September 2018 in a tertiary health center, focusing on children aged 6 to 30 months with a correctly completed health record. The parameters studied were sex, age, educational level of mothers, dates of vaccine administration and reason for missed vaccination opportunities. Results: We retained 212 children. The sex ratio was 1.21 and 93% had received the BCG vaccine before the age of 1 month. The average ages of combined and co-administered vaccines for the 1st and 2nd doses were 7.66 ± 3.81 and 12.88 ± 3.95 weeks, respectively. The median was 16.57 weeks for the 3rd dose. The proportion of vaccinated subjects was greater than 90% for the BCG vaccine and the 3 doses of combined vaccines, and 77% for the yellow fever and measles vaccines. The reasons for non-vaccination were attributable to the children’s parents and health facilities. Conclusion: Improving vaccination coverage requires regular supply of vaccines to centers, and the involvement of all health professionals, community and religious leaders in the vaccination awareness process.

Impact of Hepatits B Vaccination as an Important Indicator for Immunization Program in Albania

Albania has been a country with a high prevalence of hepatitis B virus. Hepatitis B vaccine has been introduced nationwide in Albanian Immunization Program in 1994. Hepatitis B is given at birth, as a separate antigen, followed by three doses at 2, 4 and 6 months, where Hepatitis B, starting from 2009, is part of pentavalent vaccine of DTP-HepB-Hib. The aim of this study was to evaluate Immunization Program with Hepatitis B vaccination in order to prove program efficacy, increase public confidence in immunizations and advocate for sustainable immunization programs. Methodology was based on three components such as Immunization coverage surveys, serologic surveys and surveillance for acute cases of Hepatitis B. Results of this study showed that vaccination coverage is really high, more than 95% all over the country and with drop-out rates less than 10%. Anti-HBs levels in immunized children were very high in comparison with unimmunized ones. Incidence of HBV in children 0-14 years old is almost zero. Such results tell us that Hepatitis B vaccination is one of the most fruitful strategies for long term control of Hepatitis B disease.

Factors Influencing Routine Vaccination of Children of Mothers Live-Stock Retailers in the Markets of Yaoundé

Background: The job of mothers though having a positive impact on the family could be detrimental to children’s health due to her unavailability. Methodology: A cross-sectional study was carried out from March to August 2014. Mothers of children aged 11 - 48 months were interviewed to determine factors which could influence the vaccination of their children. Results: A total of 265 mothers were interviewed. Despite their occupations, they completely vaccinated all of their children. The vaccination coverage of tracer antigens (third dose of DPT/HiB/HepB) was high 97.7% as well as the proportion of children completely vaccinated (91.7%). A mastery of the vaccination calendar of the site, and resumption of activities when the children were more than 4 months old, significantly influenced the completion of vaccination. Only 6 children (2.3%) were not correctly or incompletely vaccinated. The reason given by their mothers were: the lack of time (45.0%), the adverse effects of vaccines (27.0%), forgetfulness (18%), and shortage of vaccines supplies (5.0%). Conclusions: Occupation was not a hindrance to the vaccination of children of live-stock retailers. The problem of absent or incomplete vaccination could be overcome by improving the strategies of social mobilisation, permitting the sensitisation of mothers hesitant to vaccinate their children. A regular supply of vaccines will reduce the missed opportunities, thus maintaining high vaccination coverage in this social group.

Factors Associated with Full Vaccination of Children Aged 12 to 23 Months in the Commune of Thiomby (Kaolack/Senegal)

Introduction: Data on the complete vaccination of children in rural areas and the factors associated with it are poorly known. Knowledge of these factors is necessary for the adoption of effective vaccination strategies. The aim of our study was to determine the proportion of children aged 12 to 23 months fully vaccinated before the age of 12 months in the commune of Thiomby and to identify associated factors. Methods: A descriptive and analytical cross-sectional study was conducted from 15 January to 15 February 2020 in Thiomby among of children aged 12 to 23 months and their mothers/caregivers. The sampling was carried out in two-step clusters. Bivariate analysis was done with Epi-Info version 7.2.2.16. Results: The sample included 380 mothers/caregivers with children aged on average 24.7 years. Among them, 93.2% were housewives, 29.4% had attended school and 12.8% had a monthly income of more than 100,000 CFA francs. In total, 296 children were fully inoculated i.e. 77.9% of children aged 12 - 23 months had received all the appropriate vaccines by the age of 12 months. In addition, 42% of mothers and babysitters had a good level of knowledge about vaccination (benefits, side effects, etc.). The primary source of information for mothers about vaccination was the midwife, with 88 percent of women being informed through this channel. The age of mothers less than or equal to 30 years would significantly reduce (p Conclusion: Factors such as a good level of knowledge of mothers and access to information through midwives during prenatal and postnatal consultations contribute to an improvement in complete vaccination coverage among children aged 12 to 23 months.

Implementing the communication for development strategy to improve knowledge and coverage of measles vaccination in western Chinese immunization programs:a before-and-after evaluation

Background:Communication for Development(C4D)is a strategy promoted by the United Nations Children’s Fund to foster positive and measurable changes at the individual,family,community,social,and policy levels of society.In western China,C4D activities have previously been conducted as part of province-level immunization programs.In this study,we evaluated the association of C4D with changes in parental knowledge of immunization services,measles disease,and measles vaccine,and changes in their children’s measles vaccine coverage.Methods:From April 2013 to April 2014,C4D activities were implemented as part of provincial immunization programs in the Inner Mongolia,Guangxi,Chongqing,Guizhou,Tibet,Shaanxi,Gansu,Ningxia,and Qinghai provinces.We used a before-and-after study design and employed face-to-face interviews to assess changes in parental knowledge and vaccination coverage.Results:We surveyed 2107 households at baseline and 2070 households after 1 year of C4D activities.Following C4D,95%of caregivers were aware of the vaccination record check requirement for entry into kindergarten and primary school;80%of caregivers were aware that migrant children were eligible for free vaccination;more than 70%of caregivers knew that measles is a respiratory infectious disease;and 90%of caregivers knew the symptoms of measles.Caregivers’willingness to take their children to the clinic for vaccination increased from 51.3%at baseline to 67.4%in the post-C4D survey.Coverage of one-dose measles-containing vaccine(MCV)increased from 83.8%at baseline to 90.1%after C4D.One-dose MCV coverage was greater than 95%in the Guangxi,Shaanxi,and Gansu provinces.Two-dose MCV coverage increased from 68.5 to 77.6%.House-to-house communication was the most popular C4D activity among caregivers(91.6%favoring),followed by posters and educational talks(64.8 and 49.9%favoring).Conclusions:C4D is associated with increased caregiver knowledge about measles,increased willingness to seek immunization services for their children,and increased measles vaccination coverage.Tailored communication strategies based on insights gained from these analyses may be able to increase vaccination coverage in hard-to-reach areas.C4D should be considered for larger scale implementation in China.

Measuring COVID-19 vaccination coverage: an enhanced age-adjusted two-step foating catchment area model

Background:There are only limited studies on access to COVID-19 vaccines and identifying the most appropriate health centres for performing vaccination in metropolitan areas.This study aimed to measure potential spatial access to COVID-19 vaccination centres in Mashhad,the second-most populous city in Iran.Methods:The 2021 age structure of the urban census tracts was integrated into the enhanced two-step foating catchment area model to improve accuracy.The model was developed based on three diferent access scenarios:only public hospitals,only public healthcare centres and both(either hospitals or healthcare centres)as potential vaccination facilities.The weighted decision-matrix and analytic hierarchy process,based on four criteria(i.e.service area,accessibility index,capacity of vaccination centres and distance to main roads),were used to choose potential vaccination centres looking for the highest suitability for residents.Global Moran’s index(GMI)was used to measure the spatial autocorrelation of the accessibility index in diferent scenarios and the proposed model.Results:There were 26 public hospitals and 271 public healthcare centres in the study area.Although the exclusive use of public healthcare centres for vaccination can provide the highest accessibility in the eastern and north-eastern parts of the study area,our fndings indicate that including both public hospitals and public healthcare centres provide high accessibility to vaccination in central urban part.Therefore,a combination of public hospitals and public healthcare centres is recommended for efcient vaccination coverage.The value of GMI for the proposed model(accessibility to selected vaccination centres)was calculated as 0.53(Z=162.42,P<0.01).Both GMI and Z-score values decreased in the proposed model,suggesting an enhancement in accessibility to COVID-19 vaccination services.Conclusions:The periphery and poor areas of the city had the least access to COVID-19 vaccination centres.Measuring spatial access to COVID-19 vaccination centres can provide valuable insights for urban public health decisionmakers.Our model,coupled with geographical information systems,provides more efcient vaccination coverage by identifying the most suitable healthcare centres,which is of special importance when only few centres are available.

Coverage rates for diphtheria,tetanus,poliomyelitis,and pertussis age-specific booster recommendations in France:2018 update of the real-world cohort analysis

The French National Immunization Program was updated in 2013 for vaccination against diphtheria,tetanus,per-tussis,and poliomyelitis.Our previous findings on the evolution of age-specific booster vaccination coverage rates(VCRs)up to 2017 suggested suboptimal vaccination coverages due to the pre-2013 recommendation-residual vaccination practices.In the current analysis,we evaluated all age-specific booster VCR and distribution of age at vaccination visits in 2018.In this retrospective observational cohort study,the cumulative booster VCRs were updated at all vaccination visits up to 2018 among the people who were eligible for a booster vaccination,using a 1/97th random sample of French national healthcare reimbursement databases.The cumulative booster VCR for individuals from all age groups increased from 2017 to 2018,except for 85-years-old vaccination visit.Majority of the individuals from all age groups were vaccinated(boosted)with a vaccine containing the pertussis valence.In 2018,sharp peaks corresponding to the recommended ages for booster vaccination visits were observed for individuals aged 6,11 to 13,25,45,and 65 years.Our study reiterates suboptimal coverages in France and implies the need for booster vaccination throughout life for the protection of the population.

Prevalence and factors associated with pentavalent vaccination:a cross-sectional study in Southern China

Background Immunization is one of the most far-reaching and cost-effective strategies for promoting good health and saving lives.A complex immunization schedule,however,may be burdensome to parents and lead to reduced vaccine compliance and completion.Thus,it is critical to develop combination vaccines to reduce the number of injections and simplify the immunization schedule.This study aimed to investigate the current status of the pentavalent diphtheria-tetanus-acellular pertussis inactivated poliomyelitis andHaemophilus influenzae type B conjugate(DTaP-IPV/Hib)vaccination in Southern China as well as explore the factors in the general population associated with uptake and the differences between urban and rural populations.Methods A cross-sectional study was conducted with recently enrolled kindergarten students in Hainan Province between December 2022 and January 2023.The study employed a stratified multistage cluster random sampling method.Information regarding the demographic characteristics and factors that influence decisions were collected from the caregivers of children via an online questionnaire.Multivariate logistic regression was used to determine the factors associated with the status of DTap-IPV/Hib vaccinations.Results Of the 4818 valid responses,95.3%of children were aged 3-4 years,and 2856(59.3%)held ruralhukou.Coverage rates of the DTaP-IPV/Hib vaccine,from 1 to 4 doses,were 24.4%,20.7%,18.5%,and 16.0%,respectively.Caregivers who are concerned about vaccine efficacy[adjusted odds ratio(aOR)=1.53,95%confidence interval(CI):1.30-1.79],the manufacturer(aOR=2.05,95%CI:1.69-2.49),and a simple immunization schedule(aOR=1.26,95%CI:1.04-1.54)are factors associated with a higher likelihood of vaccinating children against DTaP-IPV/Hib.In addition,caregivers in urban areas showed more concern about the vaccine price(P=0.010)and immunization schedule(P=0.022)in regard to vaccinating children.Conclusions The DTaP-IPV/Hib vaccine coverage rate in Hainan Province remains low.Factors such as lower socioeconomic status,cultural beliefs,concerns about vaccine safety,and cost may hinder caregivers from vaccinating their children.Further measures,such as health education campaigns to raise knowledge and awareness,and encouragement of domestic vaccine innovation,which would reduce out-of-pocket costs,could be implemented to improve the coverage of DTap-IPV/Hib vaccination.