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.

2014—2020年福建省非免疫规划疫苗使用情况监测分析

目的 对2014—2020年福建省非免疫规划(non-national immunization program,nNIP)疫苗的使用情况进行监测分析,为加强nNIP疫苗接种服务管理提供参考。方法 从“中国免疫规划信息管理系统”提取2014—2020年nNIP疫苗接种数据,采用描述性流行病学方法进行分析。结果 2014—2020年福建省nNIP疫苗共接种28 835 834剂次,人均接种剂次数为1 015剂次/万人,使用的种类从22种增加至28种。nNIP疫苗使用量、占所有疫苗接种总剂次比例、人均接种剂次数基本呈逐年递增趋势。使用量较多的品种主要有水痘减毒活疫苗(varicella attenuated live vaccine,VarV)、乙型肝炎(hepatitis B,HepB)疫苗、人用狂犬病疫苗(rabies vaccine for human use,RabV)、b型流行性感冒(流感)嗜血杆菌(haemophilus influenza type b,Hib)多糖结合疫苗、流感疫苗(influenza vaccine,InfV)、肠道病毒71型(enterovirus 71,EV71)灭活疫苗。替代率最高的3种疫苗为甲肝疫苗、A群流脑疫苗、A群C群流脑疫苗,替代率分别为22.42%、10.32%、9.89%。结论 福建省nNIP疫苗使用的种类、数量越来越多,需进一步加强监测与管理,完善接种服务。

2018-2021年北京市石景山区非免疫规划疫苗接种情况分析

目的 分析北京市石景山区2018-2021年非免疫规划疫苗的使用情况,为加强非免疫规划疫苗的接种管理提供依据。方法 利用中国免疫规划监测信息管理系统及北京市石景山区生物制品报表,收集2018-2021年北京市石景山区非免疫规划疫苗的接种数据,并进行整理和描述性分析。结果 2018-2021年北京市石景山区非免疫规划疫苗共25种,非免疫规划疫苗接种报告完整率为100%。接种量逐年递增,接种剂次前三位的疫苗为狂犬病疫苗、水痘减毒活疫苗、肠道病毒71型灭活疫苗;各街道4年的接种数量呈递增趋势,接种数量前三位的地区为八角街道、苹果园街道、八宝山街道;可替代疫苗替代率从2018年的13.23%上升到2021年的30.11%,呈逐年上升趋势。结论 2018-2021年北京市石景山区非免疫规划疫苗使用量呈增长趋势,但接种剂次仍较少。