Key Factors to Consider When Introducing a New Vaccine in Low-Income Settings: Lessons from Malawi Expanded Program on Immunization

Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. This study was conducted to identify key factors that need to be considered when deciding to introduce a new vaccine and current challenges faced by low and middle income countries using Malawi as an example. Methodology: The study employed a desk review approach, examining published literature from various sources such as PubMed, Medline, and Google Scholar. Policy documents from organizations like the World Health Organization, GAVI the Alliance, and the Ministry of Health for Malawi were also included. A total of 99 articles and documents on new vaccine introduction, challenges of immunization, policy documents in immunization and health systems strengthening were included. The review focused on addressing five key areas critical to new vaccine introduction namely: the need for a vaccine, availability of the vaccine, safety and effectiveness of the vaccine, demand for the vaccine, and the prudent use of public or private funds. Results: Malawi considered the burden of cervical cancer and the significance of malaria in the country when introducing the HPV and malaria vaccines. The country opted for vaccines that can be handled by the cold chain capacity and available human resources. Despite that malaria vaccine and Typhoid Conjugate Vaccine trials were done in country, there are limited vaccine safety and efficacy trials conducted in Malawi, leading to a reliance on WHO-prequalified vaccines. Demand for newly introduced vaccines varied, with high demand for Oral Cholera Vaccine during a cholera outbreak, while demand for COVID-19 vaccines decreased over time. Although cost-effectiveness studies were limited in the country, 2 studies indicated that Typhoid Conjugate Vaccine and malaria vaccine would be cost effective. All these have been implemented despite having challenges like lack of accurate surveillance data, inadequate cold chain capacity, limited safety and efficacy vaccine clinical trials, political influence, and limited funding. Conclusion: Despite several challenges Malawi set a good example of the careful considerations required before introducing a new vaccine. The process involves data review, priority setting, precise planning, and consultation with stakeholders. Low-income countries should invest in vaccine safety, efficacy, and cost-effectiveness trials.

Analysis of Epidemiological Characteristics of Varicella Before and After the Implementation of the Two-dose Varicella Vaccine Immunization Program in Banan District of Chongqing City

Objective:To explore the changes in the epidemiological characteristics of varicella before and after implementing the two-dose varicella vaccine(VarV)immunization program in the Banan District of Chongqing and to provide a reference for future epidemic prevention and control.Methods:The data of reported varicella cases in Banan District from 2014 to 2023 were collected and analyzed using the China Disease Prevention and Control Information System.Descriptive epidemiological methods were employed to assess the changes in the reported incidence of varicella before(2014-2018)and after(2019-2023)the implementation of the two-dose VarV immunization program.Results:The average annual reported incidence rate of varicella in Banan District from 2014 to 2023 was 81.53 per 100,000.From 2014 to 2018,the reported incidence rate showed an upward trend year by year(trend x2=223.96,P<0.05).However,the reported incidence rate decreased from 2019 to 2023(trend x?=189.51,P<0.05).Before and after the adjustment of the immunization program,the reported incidence rate for the 5-9 years old group was 774.62 per 100,000 and 476.98 per 100,000,respectively,with a statistically significant difference(x2=161.26,P<0.05).The onset of varicella showed a bimodal distribution,with peak incidence periods in May-June and October-December.From 2014 to 2023,a total of 155,181 doses of VarV were administered in Banan District.The estimated annual vaccination rate for the first varicella vaccine(VarV1)from 2019 to 2023 was 86.28%,and for the second dose(VarV2)was 59.18%.The primary vaccination targets were the 5-9-year-old group,accounting for 64.21%.Conclusion:After implementing the two-dose VarV immunization program in Banan District,the vaccination rate increased yearly,and the reported incidence of varicella showed a downward trend.The incidence rate of varicella in children aged 5-9 years reduced significantly,but the overall downward trend for the entire population was not as pronounced.Therefore,it is necessary to increase the vaccination rate of VarV2.

Fueling the engine and releasing the break: combinational therapy of cancer vaccines and immune checkpoint inhibitors

Immune checkpoint inhibitors are increasingly drawing much attention in the therapeutic development for cancer treatment. However, many cancer patients do not respond to treatments with immune checkpoint inhibitors, partly because of the lack of tumor-infiltrating effector T cells. Cancer vaccines may prime patients for treatments with immune checkpoint inhibitors by inducing effector T-ceU infiltration into the tumors and immune checkpoint signals. The combination of cancer vaccine and an immune checkpoint inhibitor may function synergistically to induce more effective antitumor immune responses, and clinical trials to test the combination are currently ongoing.

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.

Immunization coverage,knowledge,satisfaction,and associated factors of non-National Immunization Program vaccines among migrant and left-behind families in China:evidence from Zhejiang and Henan provinces

Background Migrant and left-behind families are vulnerable in health services utilization,but little is known about their disparities in immunization of non-National Immunization Program(NIP)vaccines.This study aims to evaluate the immunization coverage,knowledge,satisfaction,and associated factors of non-NIP vaccines among local and migrant families in the urban areas and non-left-behind and left-behind families in the rural areas of China.Methods A cross-sectional survey was conducted in urban areas of Zhejiang and rural areas of Henan in China.A total of 1648 caregivers of children aged 1-6 years were interviewed face-to-face by a pre-designed online questionnaire,and their families were grouped into four types:local urban,migrant,non-left-behind,and left-behind.Non-NIP vaccines includedHemophilus influenza b(Hib)vaccine,varicella vaccine,rotavirus vaccine,enterovirus 71 vaccine(EV71)and 13-valent pneumonia vaccine(PCV13).Log-binomial regression models were used to calculate prevalence ratios(PRs)and 95%confidence intervals(CIs)for the difference on immunization coverage of children,and knowledge and satisfaction of caregivers among families.The network models were conducted to explore the interplay of immunization coverage,knowledge,and satisfaction.Logistic regression models with odds ratios(ORs)and 95%CIs were used to estimate the associated factors of non-NIP vaccination.Results The immunization coverage of all non-NIP vaccines and knowledge of all items of local urban families was the highest,followed by migrant,non-left-behind and left-behind families.Compared with local urban children,thePRs(95%CIs)for getting all vaccinated were 0.65(0.52-0.81),0.29(0.22-0.37)and 0.14(0.09-0.21)among migrant children,non-left-behind children and left-behind children,respectively.The coverage-knowledge-satisfaction network model showed the core node was the satisfaction of vaccination schedule.Non-NIP vaccination was associated with characteristics of both children and caregivers,including age of children(>2 years-OR:1.69,95%CI:1.07-2.68 for local urban children;2.67,1.39-5.13 for migrant children;3.09,1.23-7.76 for non-left-behind children);and below caregivers’characteristics:family role(parents:0.37,0.14-0.99 for non-left-behind children),age(≤35 years:7.27,1.39-37.94 for non-left-behind children),sex(female:0.49,0.30-0.81 for local urban children;0.31,0.15-0.62 for non-left-behind children),physical health(more than average:1.58,1.07-2.35 for local urban children)and non-NIP vaccines knowledge(good:0.45,0.30-0.68 for local urban children;7.54,2.64-21.50 for left-behind children).Conclusions There were immunization disparities in non-NIP vaccines among migrant and left-behind families compared with their local counterparts.Non-NIP vaccination promotion strategies,including education on caregivers,and optimization of the immunization information system,should be delivered particularly among left-behind and migrant families.

The coverage and challenges of increasing uptake of non-National Immunization Program vaccines in China:a scoping review

Background Non-National Immunization Program (NIP) vaccines have played an important role in controlling vaccine-preventable diseases (VPDs) in China. However, these vaccines are paid out of pocket and there is room to increase their coverage. We focused on four selected non-NIP vaccines in this study, namely Haemophilus influenzae type b (Hib) vaccine, human papillomavirus (HPV) vaccine, pneumococcal conjugate vaccine (PCV), and rotavirus vaccine. We aimed to conduct a scoping review of their vaccination rates and the major barriers faced by health systems, providers, and caregivers to increase coverage.Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). We searched five English databases (PubMed, Web of Science, EMBASE, Scopus, and WHO IRIS) and four Chinese databases using the search strategy developed by the study team. Two independent reviewers screened, selected studies, and examined their quality. We summarized the non-NIP vaccine coverage data by vaccine and applied the 5A framework (Access, Affordability, Acceptance, Awareness, Activation) to chart and analyze barriers to increasing coverage.Results A total of 28 articles were included in the analysis (nine pertaining to vaccine coverage, and another 19 reporting challenges of increasing uptake). Among the four selected vaccines, coverage for the Hib vaccine was the highest (54.9-55.9% for 1 dose or more from two meta-analyses) in 2016, while the coverage of the other three vaccines was lower than 30%. Eight of the nine included articles mentioned the regional disparity of coverage, which was lower in under-developing regions. For example, the three-dose Hib vaccination rate in eastern provinces was 38.1%, whereas the rate in central and western provinces was 34.3% and 26.2%, respectively in 2017. Within the 5A framework, acceptance, awareness, and affordability stood out as the most prominent themes. Among the 12 identified sub-themes, high prices, low vaccine awareness, concerns about vaccine safety and efficacy were the most cited barriers to increasing the uptake.Conclusions There is an urgent need to increase coverage of non-NIP vaccines and reduce disparities in access to these vaccines across regions. Concerted efforts from the government, the public, and society are required to tackle the barriers and challenges identified in this study, both on the demand and supply side, to ensure everybody has equal access to life-saving vaccines in China. Particularly, the government should take a prudent approach to gradually incorporate non-NIP vaccines into the NIP step by step, and make a prioritizing strategy based on key factors such as disease burden, financial resources, and market readiness, with special attention to high-risk populations and underdeveloped regions.

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.

Seroprotection after hepatitis B vaccination amongst infants aged between 12 and 24 months in Ho Chi Minh City, Vietnam

Objective:To assess levels of HBs Ab amongst infants who received hepatitis B vaccine in the Expanded Program on Immunization in Vietnam.Methods:A cross-sectional study was carried out at 16 community health centers from February 2016 to July 2017.Eligible infants were tested for HBs Ab and HBs Ag.Structured questionnaires were used to collect relevant information about the demographics of the parents/caregivers and their infants after physical examination.Results:A total of 199 eligible infants were selected with a mean age of(17.3±4.5)months.Protective antibody levels with HBs Ab≥10 m IU/m L were detected in 68.3%of infants.Of these,antibody levels from 10 to 99 m IU/m L were 48.5%of those tested and antibody levels≥100 ml U/m L were recorded as 51.5%.No cases were recorded of being infected with hepatitis B virus.The rate of positive HBs Ab level in those who were not wasting and≥18 months old was less than that among those who were<18 months old(OR 0.49,95%CI:0.26-0.92,P<0.05)while the infants with wasting and<18 months were less likely to be positive HBs Ab than those who were not wasting and of the same age group(OR 0.15,95%CI:0.04-0.55,P<0.05).Conclusions:Seroprotection against hepatitis B virus was low in the infants tested(at 68.3%),which suggests that the hepatitis B vaccine should be administered with one additional dose for infants between 12 and 24 months of age,particularly those with wasting.

Viro-immune therapy:A new strategy for treatment ofpancreatic cancer

Pancreatic ductal adenocarcinoma(PDAC) is an almost uniformly lethal disease with less than 5% survival at five years. This is largely due to metastatic disease, which is already present in the majority of patients when diagnosed. Even when the primary cancer can be removed by radical surgery, local recurrence occurs within one year in 50%-80% of cases. Therefore, it is imperative to develop new approaches for the treatment of advanced cancer and the prevention of recurrence after surgery. Tumour-targeted oncolytic viruses(TOVs) have become an attractive therapeutic agent as TOVs can kill cancer cells through multiple mechanisms of action, especially via virus-induced engagement of the immune response specifically against tumour cells. To attack tumour cells effectively, tumour-specific T cells need to overcome negative regulatory signals that suppress their activation or that induce tolerance programmes such as anergy or exhaustion in the tumour microenvironment. In this regard, the recent breakthrough in immunotherapy achieved with immune checkpoint blockade agents, such as anti-cytotoxic T-lymphocyte-associate protein 4, programmed death 1(PD-1) or PD-L1 antibodies, has demonstrated the possibility of relieving immune suppression in PDAC. Therefore, the combination of oncolytic virotherapy and immune checkpoint blockade agents may synergistically function to enhance the antitumour response, lending the opportunity to be the future for treatment of pancreatic cancer.

中美免疫规划疫苗需求量预测方法及管理模式比较

疫苗接种是预防和控制相关传染病最经济、最有效、最方便的手段。随着我国免疫规划的进展,疫苗种类与需求量日益增加,疫苗分配不均、疫苗短缺或过剩的情况也时有发生。对疫苗需求量进行合理预测,能够确保疫苗的合理供应,是保障人民健康、树立人群免疫屏障的基础。我国早期主要根据历史经验对疫苗需求进行大致估算,后期套用公式进行测算,但由于招采主体分散、季节性变动、疾病暴发等情况,有时并不能满足真实使用的需求。美国疾病控制与预防中心主要根据美国免疫实施咨询委员会的建议对不同人群需求进行预测,受益于较早开展的信息化管理,人口数据和疫苗数据较为翔实完善,使得需求预测便于开展,也易于做得精准。作为世界上较早开展相关探索与实践的国家,美国采用管理模式的迭代以平衡需求量预测的不稳定性,是目前世界范围内较为成熟的体系,值得我国借鉴。该研究对中美两国疫苗需求量预测方法和管理模式进行比较,参考相关经验,为我国后续发展提供参考。

某市预防接种人员对非免疫规划疫苗推荐意愿及影响因素分析

目的探讨某市预防接种医务人员对非免疫规划(expanded program on immunization,EPI)疫苗推荐意愿及影响因素。方法选取2021年8月—2022年12月聊城市疾病预防控制中心免疫规划管理所500名预防接种医务人员为研究对象。调查医务人员非EPI疫苗推荐意愿,并采用多因素logistic回归分析影响医务人员非EPI疫苗推荐意愿的危险因素。结果纳入的500名调查对象中,非EPI疫苗的推荐意愿率为65.20%(326/500),其中流感疫苗(flu vaccine,FLU)、水痘减毒活疫苗(live attenuated varicella vaccine,VarV)、b型流感嗜血杆菌疫苗(Haemophilusinfluenzae type b vaccine,Hib)、乙型肝炎疫苗(hepatitis B vaccine,HepB)的推荐意愿率分别为88.60%(443/500)、84.00%(420/500)、79.00%(395/500)和77.20%(386/500),其他5种非EPI疫苗的推荐意愿率为36.60%~58.00%。单因素分析显示,工作年限、收入是否与非EPI疫苗接种量有关、是否经历疫苗负性事件、是否认为预防接种工作有风险、疫苗接种流程、接种工作量及被推荐者态度不同者非EPI疫苗推荐意愿率比较差异有统计学意义(P<0.05);不同性别、年龄、文化程度、职称、工作岗位、非EPI疫苗知识是否知晓者非EPI疫苗推荐意愿率比较差异无统计学意义(P>0.05)。多因素logistic回归分析显示,工作年限(OR=4.008,95%CI1.528~10.934)、经历疫苗负性事件(OR=4.870,95%CI 1.328~17.859)、疫苗接种流程(OR=5.275,95%CI1.541~18.063)、接种工作量(OR=4.773,95%CI1.413~16.122)及被推荐者态度(OR=5.778,95%CI1.772~18.838)是预防接种医务人员非EPI疫苗推荐意愿的影响因素(P<0.05)。结论某市预防接种医务人员非EPI疫苗推荐意愿总体处于较低水平,且工作年限、经历疫苗负性事件、疫苗接种流程、接种工作量及被推荐者态度均是其主要影响因素,建议完善非EPI疫苗预防接种保障措施,以提高预防接种医务人员非EPI疫苗推荐意愿。

2017-2022年北京市怀柔区免疫规划疫苗接种报告情况分析

目的回顾性分析2017-2022年北京市怀柔区免疫规划疫苗接种报告数据,为进一步做好接种率监测报告工作提供参考。方法利用北京市免疫规划监测信息管理系统获取2017-2022年北京市怀柔区免疫规划疫苗接种率监测数据,对接种报告的及时性、完整性、可靠性进行分析评价。结果2017年1月1日至2022年12月31日,北京市怀柔区各预防接种单位免疫规划疫苗接种报告及时性、完整性均为100%;5种免疫规划疫苗PV1-3、DTaP1-3、MMR/MR1、JE-L1、MPSV1-2基础免疫报告接种率均在96%以上,估算接种率为90.53%~127.42%;D值评价指标:可信占36.67%,可疑占50.00%,不可信占13.33%;R值评价指标:可信占66.67%,可疑占29.17%,不可信占4.17%。结论2017-2022年北京市怀柔区常规免疫接种率监测系统运行良好,大部分常规免疫疫苗维持在较高接种水平,但可能存在流动儿童摸底不够清晰、报告接种率偏高的问题,需要更精准掌握应种儿童人数,优化免疫规划监测信息管理系统接种率判定功能,做好漏种儿童补种等,进一步强化常规免疫接种率监测工作。

流动儿童免疫规划管理在儿童疫苗接种中的应用效果分析

目的:分析流动儿童免疫规划管理在儿童疫苗接种中的应用效果。方法:选取2021年3月—2022年3月滨州市疾病预防控制中心登记的流动儿童1 000例作为研究对象,随机分为研究组和对照组,各500例。对照组实施常规管理,研究组在对照组基础上实施流动儿童免疫规划管理。比较两组家长疫苗接种知识掌握情况、儿童按时接种情况、接种依从性、接种满意度。结果:研究组家长疫苗接种知识总掌握率高于对照组,差异有统计学意义(P<0.001)。研究组按时接种率高于对照组,差异有统计学意义(P<0.001)。研究组接种依从性高于对照组,差异有统计学意义(P<0.001)。研究组家长接种总满意度高于对照组,差异有统计学意义(P<0.001)。结论:流动儿童免疫规划管理在儿童疫苗接种中的应用价值较高,能够提高家长疫苗接种知识掌握率、接种依从性及接种满意度。

猪圆环病毒2型、猪肺炎支原体和猪瘟疫苗不同免疫程序的免疫效果比较分析

为了评估不同免疫策略对猪场免疫效果和经济效益的影响,以确定最佳的疫苗免疫程序,本试验将处于产前1个月的四胎次健康三元母猪随机分为2个组,A组(联合免疫组)母猪于产前27 d联合免疫猪圆环病毒2型基因工程疫苗、猪肺炎支原体灭活疫苗和猪瘟活疫苗(圆柯欣+柯喘宁+稳柯健),其所产仔猪于21日龄联合免疫圆柯欣、柯喘宁和稳柯健;B组(对照组)母猪于产前34和27 d分别免疫稳柯健、猪圆环病毒疫苗和猪肺炎支原体疫苗二联疫苗(圆-支二联疫苗),其所产仔猪于14日龄免疫圆-支二联疫苗,28日龄免疫稳柯健。统计和分析免疫各组临床指标、生产性能和持续性抗体水平。结果显示,免疫疫苗后,2个组的母猪采食情况均正常;2个组的仔猪整体精神状态良好,哺乳情况正常,均未出现咳嗽和喘气等呼吸道疾病。在试验期间内,2个组的母猪的窝产健仔数和仔猪出生健仔均重并无差别。A组和B组的出生至23日龄死淘率、出生至50日龄死淘率分别为3.77%、5.11%和4.07%、5.43%,A组略优于B组。抗体监测结果显示,A组母猪的CSFV和PCV2抗体水平较B组无显著差异(P>0.05);A组仔猪的CSFV抗体阳性率与B组无明显差异(P>0.05),而PCV2抗体水平在免疫早期阶段(21日龄)明显高于B组(P<0.05)。结果表明,猪圆环病毒2型、猪肺炎支原体和猪瘟疫苗可以联合免疫,且免疫后相互之间不干扰。该联合免疫策略在确保免疫效果的同时,简化了疫苗免疫程序,为确定最佳的疫苗免疫程序提供了有价值的临床应用参考。

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.

山西省438名孕妇对未来子女非免疫规划疫苗的接种意愿及其影响因素

目的了解孕妇对未来子女非免疫规划疫苗(expanded program on immunization,EPI)的接种意愿及其影响因素,为提高儿童非EPI接种率提供参考。方法采用便利抽样的方法,选取山西省妇幼保健院438名产检孕妇为研究对象进行问卷调查。利用独立样本t检验、方差分析和多重线性回归模型分析个人社会经济因素、疫苗倾向和疫苗信息获取渠道对孕妇为未来子女接种非EPI意愿的影响,并基于计划行为理论构建结构方程模型分析孕妇对子女非EPI接种的态度、主观规范、知觉行为控制对接种意愿的影响。结果98.4%调查对象愿意为子女接种非EPI。与倾向于接种进口疫苗的群体相比,有接种国产疫苗倾向的群体(β=0.119)为子女接种非EPI的意愿更强,有接触媒体宣传较没有接触的群体子女非EPI接种意愿更强(β=0.099),有接触社区医院和疾病预防控制中心的宣传册和活动讲座的群体较没有接触的群体子女非EPI接种意愿更强(β=0.119)。结构方程模型结果显示影响接种意愿强度的因素从大到小依次为知觉行为控制、行为态度、主观规范(路径系数分别为0.73,0.13,0.12)。结论孕妇对未来子女非EPI的接种意愿水平较高。加强非EPI接种宣传教育,改变孕妇对非EPI的知觉行为控制和态度,能够帮助提高儿童非EPI接种率。

三阴性乳腺癌在免疫治疗中的研究进展

三阴性乳腺癌(TNBC)是指病理染色报告中,雌激素受体(ER)和孕酮受体(PR)及人表皮生长因子受体2(HER-2)均为阴性的乳腺癌亚型,是目前乳腺癌治疗中最棘手、进展最快、死亡率及复发率最高的亚型。TNBC区别于其他亚型乳腺癌的主要特征在于其无明确靶点,无法选择靶点治疗。目前国际指南对于TNBC主要以化学治疗为主,但随着医疗技术进步,越来越多的免疫治疗被证实在TNBC的直接和间接治疗中起到关键作用。本文就近年来免疫治疗TNBC的研究进展进行综合论述。

2022年邵阳市免疫规划人力资源现况调查

目的了解邵阳市免疫规划人力资源配置现状,为相关部门科学制定免疫规划人力资源配置策略提供参考依据。方法于2023年2月对邵阳市13个疾病预防控制中心、216个乡镇(街道)预防接种单位从事免疫规划人员的相关情况进行横断面调查并进行描述性分析。结果2022年邵阳市从事免疫规划工作人员共772名,其中市疾控9名、县市区疾控52名、乡镇(街道)预防接种单位711名;县市区疾控机构、乡镇预防接种单位免疫规划人员每万人分别配置0.08名、1.10名;≤7岁儿童每万人分别配置1.11名、15.24名;每km2分别配置2.50名、34.14名;县市区疾控机构免疫规划人员以年龄>29~39岁、女性、<5年免疫规划工作、在编、中级职称、本科、预防医学为主,分别为36.54%、55.77%、34.62%、86.54%、51.92%、55.77%、38.46%;乡镇(街道)预防接种单位以年龄>29~39岁、女性、<5年免疫规划工作、在编、初级职称、大专、护理学为主,分别为34.60%、83.54%、50.63%、72.15%、60.90%、46.69%、60.06%。结论邵阳市免疫规划人力资源配置低且区域间不均衡、人员流动性大,需要进一步合理配置及完善相关服务能力。

Accelerating into Immunization Agenda 2030 with momentum from China’s successful COVID-19 vaccination campaign during dynamic COVID Zero

China’s immunization programs conducted a unified,tightly coordinated COVID-19 vaccination campaign during the dynamic COVID Zero period that reached well over 90%of the population with vaccines having>90%effectiveness against serious-to-fatal COVID-19.The campaign was eight times the size of the annual routine national immunization program,administering 3.4 billion doses of vaccines while monitoring vaccine coverage,acceptability,safety,and effectiveness.Every asset of the routine immunization program had to be strengthened and expanded to attain high coverage and reach hundreds of millions of adults who had not been vaccinated since childhood.Program strengthening and expansion were in directions aligned with the World Health Organization’s Immunization Agenda 2030,which has a vision that"everyone,everywhere,at every age fully benefits from vaccines for good health and well-being"and requires reaching all children,adolescents,and adults with lifesaving vaccines.Momentum from this campaign should not be lost but should be invested into achieving what is possible with a properly resourced national immunization program that is now proven to be capable of reaching everyone in the world’s largest country throughout the life course,and to do so with all vaccines recommended by the World Health Organization.

预防接种证查验对适龄儿童国家免疫规划疫苗接种率的影响

目的探讨适龄儿童入学前进行预防接种证查验对疫苗接种率的影响。方法选取我国西部、中部、东部地区7所幼儿园及小学中2022年秋季入学的儿童1400名,统计儿童预防接种证查验前后的疫苗接种情况、接种证持证率及不同年龄的疫苗接种情况、漏种情况、补种情况。结果1400名儿童中,有1378名持证,总持证率高达98.43%;其中,幼儿园儿童的持证率达100%,未持证儿童均为小学学生。预防接种证查验后,小学儿童除MPV-AC2及DT疫苗外,其余疫苗接种率均大于95%。140名2岁儿童的接种率由接种证查验前的70.00%升至接种后的98.57%;335名3岁儿童由89.85%升至99.70%;110名4岁儿童由83.64%升至99.09%;343名5岁儿童由90.38%升至100%;472名不低于6岁儿童由97.46%升至99.79%。接种证查验后,疫苗补种率有所改善。结论对适龄儿童实施预防接种证查验可提升国家免疫规划接种率,能有效预防传染性疾病的侵袭,促进儿童的健康成长。