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Huang A, Xu X, Tang L, Huang L, Li J, Zhang X, Liu J, Zhou Y, Zhang B, Wang L, Zhang Q, Zhou Z, Wang Y, Wang X, Liu Q, Liu S, Yin Z, Wang F. Acceptance and willingness to pay for DTaP-HBV-IPV-Hib hexavalent vaccine among parents: A cross-sectional survey in China. Hum Vaccin Immunother 2024; 20:2333098. [PMID: 38619056 PMCID: PMC11020590 DOI: 10.1080/21645515.2024.2333098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/16/2024] [Indexed: 04/16/2024] Open
Abstract
DTaP-HBV-IPV-Hib hexavalent vaccine has been used in high-income countries for many years to prevent diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, and invasive Haemophilus influenzae type b disease. Currently, no hexavalent vaccines have been approved for use in China. Evidence of parental acceptance and interest in hexavalent vaccines can help policy makers and manufacturers make decisions about entering the vaccine market and the immunization program in China. We measured parental acceptance and willingness-to-pay (WTP) for a hexavalent vaccine to provide such evidence. We conducted a cross-sectional survey of children's caregivers in 16 vaccination clinics in seven cities in China and obtained information on socio-demographics, knowledge of disease, confidence in vaccines, previous vaccination experience, and acceptance of and WTP for hexavalent vaccine. Multivariate logistic regression was used to determine factors influencing acceptance, and multivariate tobit regression was used to identify factors impacting WTP. Between April 28 and June 30, 2023, a total of 581 parents of children aged 0-6 years participated in the survey; 435 (74.87%, 95% CI:71.3%-78.4%) parents indicated acceptance of hexavalent vaccine. Residence location, parents' education level, experience paying for vaccination, and disease knowledge scores were key factors affecting parents' choices for vaccination. Mean (SD) and median (IQR) willingness to pay for full 4-dose course vaccination were 2266.66 (1177.1) CNY and 2400 (1600-2800) CNY. Children's age (p < .001), parents' education level (p = .024), and perceived price barriers (p < .001) were significantly associated with WTP. Parents have high acceptance and willingness to pay for hexavalent vaccine. The less money parents have to pay out of pocket, the more willing they can be to accept the vaccine. Therefore, acceptance may increase even further if the vaccine is covered by medical insurance, provided free of charge by the government, or if its price is reduced. Our results provide reference for optimizing and adjusting immunization strategies in China.
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Affiliation(s)
- Aodi Huang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xia Xu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lin Tang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lifang Huang
- Department of National Immunization Programe, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Jun Li
- Department of National Immunization Programe, Henan Provincial Center for Disease Control and Prevention, Zhengzhou, China
| | - Xue Zhang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiajie Liu
- Department of National Immunization Programe, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Yang Zhou
- Department of National Immunization Programe, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Bingling Zhang
- Department of National Immunization Programe, Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Lei Wang
- Department of National Immunization Programe, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Qian Zhang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zemei Zhou
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoqi Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qianqian Liu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Siyu Liu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fuzhen Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
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Gloriani NG, de Paz-Silava SLM, Allison RD, Takashima Y, Avagyan T. The Shifting Epidemiology of Hepatitis A in the World Health Organization Western Pacific Region. Vaccines (Basel) 2024; 12:204. [PMID: 38400187 PMCID: PMC10891653 DOI: 10.3390/vaccines12020204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 02/25/2024] Open
Abstract
Within the past few decades, improvement in sanitation and economic growth has driven a changing epidemiology of hepatitis A in the Western Pacific Region (WPR) of the World Health Organization (WHO). In this review, we gathered available published information on hepatitis A epidemiology of the countries in the WPR and reviewed the trends reported in the literature from the years 2000 to 2021. Many countries have shifted from high endemicity to low endemicity. Moreover, the administration of the hepatitis A vaccine among children in recent years has shifted disease susceptibility to the older population. Seroprevalence among children has decreased in most countries, while nearly 100% seropositivity is seen in mid adulthood. This is contrary to the epidemiology seen in previous decades when most children achieved immunity by age ten. This also presents a paradox in that better living conditions have caused more vulnerability to the older age groups who are at higher risk for severe disease. Given these trends, we recommend vaccination of vulnerable populations such as the older age groups and inclusion of the hepatitis A vaccine in government immunization programs.
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Affiliation(s)
- Nina G. Gloriani
- Institute of Pathology, St. Luke’s Medical Center, Quezon City 1112, Philippines;
| | | | - Robert D. Allison
- Accelerated Disease Control Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;
| | - Yoshihiro Takashima
- Vaccine-Preventable Diseases and Immunization Unit, Division of Programmes for Disease Control, Western Pacific Regional Office, World Health Organization, Manila 1000, Philippines; (Y.T.); (T.A.)
| | - Tigran Avagyan
- Vaccine-Preventable Diseases and Immunization Unit, Division of Programmes for Disease Control, Western Pacific Regional Office, World Health Organization, Manila 1000, Philippines; (Y.T.); (T.A.)
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Fu XL, Ma Y, Li Z, Qi YY, Wang SJ, Fu LJ, Wang SM, von Seidlein L, Wang XY. Cost-of-illness of gastroenteritis caused by rotavirus in Chinese children less than 5 years. Hum Vaccin Immunother 2023; 19:2276619. [PMID: 38013426 PMCID: PMC10760361 DOI: 10.1080/21645515.2023.2276619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023] Open
Abstract
Acute gastroenteritis (AGE) caused by rotavirus (RV) remains a public health issue in China. To accelerate the mass rotavirus vaccination, it is important to inform the policy maker, and the public of the economic burden caused by rotavirus infection. A meta-analysis was conducted applying standardized algorithms. Articles published before January 1, 2023, in English and Chinese were searched through PubMed, CNKI, and WanFang Data. Studies with cost analysis of RV AGE were included. A random-effects model was applied to synthesize the total cost of RV AGE from the societal perspective. A prospective survey aimed to measure the cost of RV AGE was conducted in 2021 and 2022 in Shaoxing city, Zhejiang province, that can represent the developed region. The cost data was applied as deviation indicator, in comparison with the pooled estimate generated from meta-analysis. Totally 286 articles were identified, and eventually 12 studies were included. The pooled total social cost of RV AGE was US$282.1 (95%CI: US$213.4-350.7). The pooled private cost of RV AGE was US$206.4 (95%CI: US$155.2-257.5). RV AGE hospitalized and RV AGE incurred in developed regions caused remarkable higher burden (US$631.2 [95%CI: US$512.6-749.8], and US$333.6 [95%CI: US$234.1-433.2] respectively), compared to RV AGE treated at outpatient, and incurred in less developed regions. Our study demonstrates that RV AGE causes a significant economic burden in China. Given the promising effectiveness and highly cost-effective, introduction of rotavirus vaccines in national immunization programs could substantially reduce the economic burden in China.
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Affiliation(s)
- Xiao-Li Fu
- Key Laboratory of Medical Molecular Virology of MoE & MoH,Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Yan Ma
- Department of Infectious Disease Prevention and Control, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Zheng Li
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Yang-Yang Qi
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Si-Jie Wang
- Key Laboratory of Medical Molecular Virology of MoE & MoH,Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Li-Jun Fu
- Department of Infectious Disease Prevention and Control, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Song-Mei Wang
- Laboratory of Molecular Biology, Training Center of Medical Experiments, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Xuan-Yi Wang
- Key Laboratory of Medical Molecular Virology of MoE & MoH,Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
- Children’s Hospital, Fudan University, Shanghai, China
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Prieto A, Huang R, Eusebi CA, Shostak M. A Brief Overview of Emerging Vaccine Technologies for Pandemic Preparedness. RAND HEALTH QUARTERLY 2023; 11:6. [PMID: 38264321 PMCID: PMC10732239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Over the past two decades, pandemic preparedness has proven to be critical to health, national, and economic security. Now, countries are investing billions of dollars in various pandemic preparedness tools, such as vaccines and broad-spectrum medical countermeasures (MCM), to address the threats arising from outbreaks. These tools not only offer protection against naturally occurring and accidental biological incidents but can also help provide some protection against deliberate biological attacks. Furthermore, pandemic preparedness has substantial economic implications for both the public and private sectors because of its connection with the biotechnology industry, an important component of the worldwide economy. With so many aspects of pandemic preparedness tied to public health, national security, and economic competition, understanding the key technology and policy trends of the major country stakeholders in this space provides valuable insights into pandemic preparedness gaps and ways of addressing them. This study provides a brief characterization of the trends and strategic implications associated with specific aspects of pandemic preparedness in the United States, China, and Russia. The authors discuss both technical and policy aspects of vaccine concepts and technologies, broad-spectrum MCM, and immunization facilitation.
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Xu Y, Chen H, Wang B, Zhu X, Luo L, Wang S, Xiao Y, Wang H, Ma R, Liu S, Yan L, Li X, Chen D, Su Y, Chai Y, Fu J, Mao X, Cao J, Sun P, Tang F, Sun X, Wang Z, Yang X. Immunogenicity and safety of concomitant administration of the sabin-strain-based inactivated poliovirus vaccine, the diphtheria-tetanus-acellular pertussis vaccine, and measles-mumps-rubella vaccine to healthy infants aged 18 months in China. Int J Infect Dis 2023; 137:9-15. [PMID: 37832931 DOI: 10.1016/j.ijid.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVES During the COVID-19 pandemic, there was a decline in vaccine coverage, and the implementation of combined vaccines and co-administration strategies emerged as potential solutions to alleviate this predicament. Our objective is to delve into the concurrent administration of the sabin-strain-based inactivated poliovirus vaccine (sIPV), the diphtheria-tetanus-acellular pertussis vaccine (DTaP), and measles-mumps-rubella vaccine (MMR), with the intention of bridging the evidentiary gap pertaining to vaccine co-administration in Chinese infants, and to ensure a safe and effective vaccination strategy, ultimately leading to an augmentation in immunization coverage. METHODS This study was a follow-up trial of the "Immunogenicity and safety of concomitant administration of the sIPV with the DTaP vaccine in children: a multicenter, randomized, non-inferiority, controlled trial." Blood samples were collected on day 0 and day 30, and serum antibody levels were detected to measure antibody responses to each of the antigens. Local and systemic adverse events were monitored and compared among groups. This study is the first to fill the knowledge gap in China regarding the safe and effective combined vaccination of sIPV, DTaP, and MMR vaccines. RESULTS The geometric mean titer of the poliovirus types I, II, and III neutralizing antibodies were 1060.22 (95% CI: 865.73-1298.39), 1537.06 (95% CI: 1324.27-1784.05), and 1539.10 (95% CI: 1296.37-1827.29) in group I on day 30; geometric mean titer of antibodies against DTaP and MMR in the simultaneous vaccination group was non-inferior to those in the DTaP alone and MMR alone group. Reporting rates of local and systemic adverse reactions were similar between groups and no serious adverse events were reported throughout the clinical study period. CONCLUSION Co-administration of the sIPV, DTaP, and MMR was safe and did not impact immunogenicity, which would help to mitigate administrative costs and enhance vaccine coverage rates.
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Affiliation(s)
- Yan Xu
- Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Haiping Chen
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China
| | - Binbing Wang
- Expanded Program on Immunization, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Xiaoping Zhu
- Vaccine research center, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Linyun Luo
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China
| | - Shengyi Wang
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China
| | - Yanhui Xiao
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China
| | - Hui Wang
- Medical Affairs Department, Beijing Institute of Biological Products Company Limited, Beijing, China
| | - Rui Ma
- Medical Affairs Department, Beijing Institute of Biological Products Company Limited, Beijing, China
| | - Shaoxiang Liu
- Medical Affairs Department, Chengdu Institute of Biological Products Company Limited, Chengdu, China
| | - Long Yan
- Medical Affairs Department, Chengdu Institute of Biological Products Company Limited, Chengdu, China
| | - Xiuling Li
- Medical Affairs Department, Shanghai Institute of Biological Products Company Limited, Shanghai, China
| | - Dandan Chen
- Medical Affairs Department, Shanghai Institute of Biological Products Company Limited, Shanghai, China
| | - Ying Su
- Expanded Program on Immunization, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Yu Chai
- Expanded Program on Immunization, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Jun Fu
- Vaccine research center, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Xiaoying Mao
- Vaccine research center, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Jie Cao
- Expanded Program on Immunization, Jiangyou Center for Disease Control and Prevention, Mianyang, China
| | - Pufei Sun
- Expanded Program on Immunization, Jiangyou Center for Disease Control and Prevention, Mianyang, China
| | - Fenyang Tang
- Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xiang Sun
- Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
| | - Zhiguo Wang
- Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xiaoming Yang
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China
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Wang Q, Jin H, Yang L, Jin H, Lin L. Cost-effectiveness of seasonal influenza vaccination of children in China: a modeling analysis. Infect Dis Poverty 2023; 12:92. [PMID: 37821942 PMCID: PMC10566174 DOI: 10.1186/s40249-023-01144-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND China has a high burden of influenza-associated illness among children. We aimed to evaluate the cost-effectiveness of introducing government-funded influenza vaccination to children in China (fully-funded policy) compared with the status quo (self-paid policy). METHODS A decision tree model was developed to calculate the economic and health outcomes, from a societal perspective, using national- and provincial-level data. The incremental cost-effectiveness ratio (ICER) [incremental costs per quality-adjusted life year (QALY) gained] was used to compare the fully-funded policy with the self-paid policy under the willingness-to-pay threshold equivalent to national and provincial GDP per capita. Sensitivity analyses were performed and various scenarios were explored based on real-world conditions, including incorporating indirect effect into the analysis. RESULTS Compared to the self-paid policy, implementation of a fully-funded policy could prevent 1,444,768 [95% uncertainty range (UR): 1,203,446-1,719,761] symptomatic cases, 92,110 (95% UR: 66,953-122,226) influenza-related hospitalizations, and 6494 (95% UR: 4590-8962) influenza-related death per season. The fully-funded policy was cost-effective nationally (7964 USD per QALY gained) and provincially for 13 of 31 provincial-level administrative divisions (PLADs). The probability of a funded vaccination policy being cost-effective was 56.5% nationally, and the probability in 9 of 31 PLADs was above 75%. The result was most sensitive to the symptomatic influenza rate among children under 5 years [ICER ranging from - 25,612 (cost-saving) to 14,532 USD per QALY gained]. The ICER of the fully-funded policy was substantially lower (becoming cost-saving) if the indirect effects of vaccination were considered. CONCLUSIONS Introducing a government-funded influenza policy for children is cost-effective in China nationally and in many PLADs. PLADs with high symptomatic influenza rate and influenza-associated mortality would benefit the most from a government-funded influenza vaccination program.
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Affiliation(s)
- Qiang Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, 210009, China
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7TH, UK
| | - Huajie Jin
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, SE5 8AF, UK
| | - Liuqing Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, 210009, China
- Centre for Digital Public Health in Emergencies, Institute for Risk and Disaster Reduction, University College London, London, WC1E 6BT, UK
| | - Hui Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, 210009, China.
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China.
| | - Leesa Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7TH, UK
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, Hong Kong Special Administrative Region, China
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
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Gao J, Yu X, Cao G, He X, Zhang P, Walline J, Wang Y, Yu X, Xu J, Thach TQ, Liu Y. Assessing the impact of the 2018 tetanus guidelines on knowledge and practices of emergency physicians in trauma patients: a national survey study. PeerJ 2023; 11:e16032. [PMID: 37692124 PMCID: PMC10484204 DOI: 10.7717/peerj.16032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023] Open
Abstract
Background Tetanus remains a significant public health issue in China, with the approach of anti-tetanus prophylaxis in the emergency department resulting in both overuse, particularly of human tetanus immune globulin (TIG), and underuse with the tetanus vaccine. This is largely due to the absence of updated guidelines on tetanus prophylaxis before 2018. Our study aimed to evaluate the effects of the 2018 Chinese tetanus guidelines on the knowledge and practices of emergency physicians about tetanus prevention in trauma patients. Methods From November 2019 to April 2020, we conducted a web-based survey involving 499 emergency physicians. The survey included a questionnaire covering knowledge, attitudes, and practices related to tetanus. We assessed the influence of the 2018 tetanus guidelines on the knowledge and practices of emergency physicians related to tetanus prevention for patients with trauma using multiple regression analysis. Results The survey results showed that only 45.3% of the participants had received formal training on tetanus immunization, despite 53.3% reporting the availability of tetanus vaccines at their institutions. Physicians typically prescribed tetanus antitoxin or human TIG instead of tetanus toxoid (TT) to treat injuries, regardless of the patient's TT vaccination history. Among the respondents, those who were aware of the 2018 tetanus guidelines had higher mean scores on the general knowledge, risk knowledge, and treatment knowledge scales, with increases of 6%, 13%, and 9%, respectively, compared to those who were unaware of the guidelines. Awareness of the 2018 tetanus guidelines was associated with a high level of knowledge, as indicated by the general knowledge score, recommendation knowledge score, and total knowledge score, after adjusting for the effects of all variables on the knowledge, attitudes, and practices of the participants. A high level of education was also associated with a high level of knowledge indicated by the recommendation knowledge score and total knowledge score. Conclusions Our study highlights a substantial gap in the attitudes, knowledge, and practices of emergency physicians in China regarding tetanus immunization. The results suggest an urgent need to promote the Chinese Expert Consensus Guidelines on tetanus to improve emergency physicians' knowledge and competence in tetanus prophylaxis. The findings underscore the importance of enhancing physicians' awareness of the latest guidelines to ensure appropriate and effective treatment for patients with tetanus-prone injuries.
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Affiliation(s)
- Junling Gao
- Buddhist Practices and Counselling Science Lab, Centre of Buddhist Studies, The University of Hong Kong, Hong Kong SAR, China
- Department of Intensive Care Unit, Southern Medical University, Shenzhen, China
| | - Xiaxia Yu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Guanghui Cao
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaoming He
- Department of Neurology, Xiangyang Central Hospital, Hubei University of Arts and Science, Xiangyang, China
| | - Pingde Zhang
- Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - Joseph Walline
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuanxi Wang
- Department of Cardiac and Vascular Interventional Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xingjuan Yu
- Department of Traditional Chinese Medicine, Shandong College of Traditional Chinese Medicine, Yantai, China
| | - Jun Xu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Thuan-Quoc Thach
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Yong Liu
- Department of Intensive Care Unit, Southern Medical University, Shenzhen, China
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Han K, Hou Z, Tu S, Wang Q, Hu S, Xing Y, Du J, Zang S, Chantler T, Larson H. Caregivers' understanding of childhood influenza vaccination during the epidemic in China. A mixed-methods study. Front Public Health 2023; 11:1196019. [PMID: 37637809 PMCID: PMC10447896 DOI: 10.3389/fpubh.2023.1196019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Influenza vaccination uptake among young children has been poor in China, but it is unclear how it changed during the COVID-19. This study aimed to investigate the uptake status and reasons of childhood influenza vaccination during the pandemic in China. Methods A mixed-methods study combining a questionnaire survey and semi-structured interviews was conducted in Anhui, Shaanxi, and Guangdong provinces between September and November 2021. 2081 caregivers completed the valid questionnaire. 38 caregivers participated in interviews, and data were analyzed thematically, using deductive and inductive coding. Results A total of 2081 caregivers completed the valid questionnaire, and 38 caregivers participated in interviews. Among the caregivers, a total of 1796 were in the age group for high-risk groups in the 2019-2020 flu season, and 46.10% reported that their children received influenza vaccination in the 2019-2020 flu season; 43.63% said that they vaccinated their children against influenza in the 2020-2021 flu season. Many caregivers indicated that the adoption of nonpharmacologic interventions (NPIs) during COVID-19 reduced the risk of influenza infection for children. Most caregivers consider the severity of influenza to be low, and some confused the common cold with influenza. Meanwhile, some caregivers lack confidence in the vaccine's effectiveness and importance. They thought that vaccines are not effective in preventing the constantly mutating virus. Despite clear perceptions about the severity of influenza and the effectiveness of the vaccine, we found that most caregivers did not receive any relevant medical information, and the communication about vaccines between caregivers and professional information sources, such as healthcare workers, is inadequate. Hence, caregivers have no scientific evidence to back up their perceptions. In terms of access to vaccination service, caregivers reported conflicts between time of vaccination service and their schedule, and the need for vaccine prices to be reduced. Discussion Targeted interventions are needed to address caregivers' lack of risk perception on influenza during COVID-19 and promote communication between caregivers and professional information sources. Extending vaccination service hours and increasing the number of vaccine clinics close to residential areas and expansion of financing sources for self-paid vaccination could facilitate the access to influenza vaccination service.
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Affiliation(s)
- Kaiyi Han
- School of Public and Health, Fudan University, Shanghai, China
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zhiyuan Hou
- School of Public and Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Shiyi Tu
- School of Public and Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Qian Wang
- School of Public and Health, Fudan University, Shanghai, China
| | - Simeng Hu
- School of Public and Health, Fudan University, Shanghai, China
| | - Yuting Xing
- School of Public and Health, Fudan University, Shanghai, China
| | - Jing Du
- School of Public and Health, Fudan University, Shanghai, China
| | - Shujie Zang
- School of Public and Health, Fudan University, Shanghai, China
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, United States
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Luan M, Qi Q, Shi W, Tao Z, Bao Y, Zhou J. Differential impacts of vaccine scandal by ethnic and socioeconomic factors: Evidence from China. PLoS One 2023; 18:e0288841. [PMID: 37467255 DOI: 10.1371/journal.pone.0288841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 06/22/2023] [Indexed: 07/21/2023] Open
Abstract
Widespread vaccination against important diseases plays a key role for global health security, particularly in the context of the COVID-19 pandemic. However, building and maintaining trust in immunization services remains challenging because of doubts about quality and safety of vaccines. China has periodically faced mounting pressure and even public outrage triggered by incidents of poor-quality vaccines. We aimed to evaluate the impact of the diphtheria, pertussis, and tetanus (DPT) vaccine scandal of 2018 in China and the ensuing misinformation on vaccination, and investigate differential responses to the scandal by ethnic and socioeconomic factors. With data from January 2017 to December 2018 in Sichuan province, China, we used a difference-in-differences (DID) method to compare the changes in the county-level monthly DPT vaccinations against the hepatitis B vaccinations, both before and after the DPT vaccine scandal. We found that the number of DPT vaccinations decreased by 14.0 percent in response to the vaccine scandal and ensuing misinformation. The number of vaccinations in minority regions, under-developed regions, and regions with poor medical resources decreased more than in non-minority regions, developed regions, and regions with good medical resources (24.5 versus 10.1 percent, 17.3 versus 8.3 percent, and 17.0 versus 8.7 percent, respectively). People did more online searching for "Substandard vaccine" and "DPT vaccine" after the scandal, with the socioeconomically advantaged group searching more compared with the socioeconomically disadvantaged group. The results suggest the urgent need to make true information about the vaccine easily accessible over the internet, especially for the socioeconomically disadvantaged groups. Our findings for China can also have implications for immunization service planning for better safeguarding public health in other countries, particularly developing ones.
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Affiliation(s)
- Mengna Luan
- Research Institute of Economics and Management, Southwestern University of Finance and Economics, Chengdu, China
| | - Qi Qi
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Wenjing Shi
- Faculty of Business and Economics, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zhigang Tao
- Cheung Kong Graduate School of Business, Beijing, China
| | - Ying Bao
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Jiushun Zhou
- Sichuan Center for Disease Control and Prevention, Chengdu, China
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10
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Fang H, Chen C, Fang Y, He X, Hou Z, Jiang M, Jiang Y, Li S, Liu Y, Sui B, Sun Q, Wu J, Xu T, Yang J, Yin Z, Ying X, Yuan B, Zheng H, Zheng Y. A guideline for economic evaluations of vaccines and immunization programs in China. Hum Vaccin Immunother 2022; 18:2132802. [PMID: 36287462 PMCID: PMC9746533 DOI: 10.1080/21645515.2022.2132802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
This study aimed to develop a consensus framework for economic evaluations of vaccines as a national guideline in China. Some unique and important aspects were particularly emphasized. Nineteen Chinese experts in the field of health economics and immunization decision-making were nominated to select and discuss relevant aspects of vaccine economic evaluations in China. A workshop attended by external experts was held to summarize unique and important aspects and formulate consensus recommendations. There were ten unique and/or important aspects identified for economic evaluations of vaccines in China, including study perspectives, comparator strategies, analysis types, model choices, costing approaches, utility measures, discounting, uncertainty, equity, and evaluation purposes. Background information and expert recommendations were provided for each aspect. Economic evaluations of vaccines should play an important role in China's immunization policy-making. This guideline can help improve the quality of economic evaluations as a good practice consensus.
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Affiliation(s)
- Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China,Institute for Global Health and Development, Peking University, Beijing, China,CONTACT Hai Fang China Center for Health Development Studies, Peking University, Beijing, China
| | - Chen Chen
- School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Zhiyuan Hou
- School of Public Health, Fudan University, Shanghai, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong Province, China
| | - Shunping Li
- School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Yang Liu
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Binyan Sui
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Qiang Sun
- School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Tingting Xu
- School of Public Health, Capital Medical University, Beijing, China
| | - Juan Yang
- School of Public Health, Fudan University, Shanghai, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaohua Ying
- School of Public Health, Fudan University, Shanghai, China
| | - Beibei Yuan
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Hui Zheng
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yaming Zheng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
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11
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He Q, Fan S, Xue Z, Yuan J, Wang Y, Yang Z, Zhou Z, Zhang Z. Waning of maternal antibody against measles virus in Shufu, China. Hum Vaccin Immunother 2022; 18:2045854. [PMID: 36399713 DOI: 10.1080/21645515.2022.2045854] [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: 11/19/2022] Open
Abstract
BACKGROUND As measles vaccination coverage has increased, measles infection has shifted to the population of infants. We conducted a follow-up seroepidemiological study among mothers and their infants to evaluate measles seroprevalence and the persistence of maternal measles antibody in Shufu, Kashgar from 2018 to 2020. METHODS Maternal venous blood and cord blood was obtained among mothers and their infants at 0, 3, 5, 8, 9, and 12 months of age. An enzyme-linked immunosorbent assay was used for quantitative measurement of measles antibodies. We analyzed the correlation between maternal and neonatal measles antibodies, and antibodies persistence after infants were born. RESULTS The overall neonatal maternal ratio was 2.38 (95%CI: 2.05-2.71). The measles antibodies for mothers and newborns were 438.93 IU/mL (95%CI: 409.47-470.51 IU/mL) and 440.10 IU/mL (95%CI: 410.82-471.48 IU/mL), respectively. Neonatal measles antibodies were dropping after birth and then beginning to increase starting at 8 months of age. CONCLUSIONS Infant measles antibody levels progressively declined after birth regardless of maternal measles antibody levels. Efforts should be carried out to eliminate measles.
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Affiliation(s)
- Qing He
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Shujun Fan
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Zhenxiang Xue
- Emergency Management department, Shufu Center for Disease Control and Prevention, Kashgar, China
| | - Jun Yuan
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yuzhong Wang
- Emergency Management department, Shufu Center for Disease Control and Prevention, Kashgar, China
| | - Zhicong Yang
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Ziyan Zhou
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Zhoubin Zhang
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
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12
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Ma J, Li Z, Sun Y, Liu Z, Dang Y, Huang Y. Improving Innovation and Access to Combination Vaccines for Childhood Immunization in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15557. [PMID: 36497631 PMCID: PMC9740052 DOI: 10.3390/ijerph192315557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND combination vaccines can improve timely vaccination coverage and mitigate the social and economic burdens of both caregivers and health systems. Compared to other countries with high immunization performance, China remains behind the curve in promoting the inclusion of new combination vaccines into national vaccination schedules. The domestic research and development pipeline faces many technical obstacles, regulatory pressures, and competitive opposition. In addition to this, health disparities regarding combination vaccines exist in each dimension of access and their determinants, including availability, accessibility, acceptability, and quality. Our study aims to provide a cross-disciplinary analysis of China's combination vaccines (from innovation to access) and identify the main factors that affect the attitudes and behavior choices for combination vaccines. METHOD systematic reviews and secondary data analysis will be conducted to map the landscape of combination vaccines in China and the determinants influencing their innovation and access. A cross-sectional survey will be performed in seven provinces of China based on geo-economic representativeness among caregivers with children that are between 2 and 24 months old and are registered in the national immunization system. Questionnaires will be used to examine the relationship between each dimension of access and their determinants. These questionnaires will cover the caregivers' knowledge, attitude, and willingness to pay for combination vaccines, as well as their perceptions about vaccination services. Semi-structured interviews with the suppliers (public and private) and healthcare providers will help identify research gaps and the key challenges they face when developing and introducing combination vaccines in China. DISCUSSION using a combined approach, with cross-country and multi-disciplinary support from experts, our research is designed to fill the information gaps in China's combination vaccine industry across the innovation-access spectrum. It will lead to evidence-based recommendations which will foster greater access to innovation-enhancing combination vaccines for childhood immunization in China. Moreover, the multi-dimensional approach could also be adapted beyond combination vaccines to assess innovation and other public goods for health among disadvantaged groups in the future.
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Developing an effective and sustainable national immunisation programme in China: issues and challenges. Lancet Public Health 2022; 7:e1064-e1072. [PMID: 36252582 PMCID: PMC9712122 DOI: 10.1016/s2468-2667(22)00171-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 11/06/2022]
Abstract
Since its establishment in 1978, China's National Immunization Program has made remarkable achievements in the control of vaccine-preventable diseases. The National Immunization Program is a vertically integrated programme in the health system, which delivers immunisation services to children. However, achieving the ambitious goals of the Immunization Agenda 2030 and Healthy China 2030 will require overcoming challenges to the National Immunization Program's future expansion and development. Key challenges include inclusion of all WHO-recommended vaccines into the routine programme, improving the function and support of the National Immunization Advisory Committee, increasing and sustaining reliable vaccination financing, ensuring uninterrupted vaccine supplies, overcoming regional disparities in immunisation practices and cold chain processes, strengthening the workforce, and integrating immunisation information systems into all aspects of the programme. It is crucially important to strengthen the National Immunization Program to attain universal coverage of life-saving vaccines in China and meet the 2030 goals.
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14
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Zhao C, Yang S, Zhang F, Wang Z, Zhang Y, Wang X, Li H, Chen H, Wang H. Antimicrobial Resistance Trends of the Most Common Causative Pathogens Associated with Community-acquired Respiratory Infections in China: 2009–2018. Infect Drug Resist 2022; 15:5069-5083. [PMID: 36071818 PMCID: PMC9443291 DOI: 10.2147/idr.s374805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background Emergence of antimicrobial resistance poses new challenges in the management of community acquired respiratory tract infections (CARTIs). Therefore, surveillance on the antimicrobial susceptibilities of common respiratory pathogens is valuable and guides empirical therapeutic choices in management of CARTIs. Objective The objective of the current study is to summarize the antimicrobial resistance trends in common respiratory tract pathogens isolated from patients with CARTIs in China, over a 10-year period (2009–2018). Methods Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis strains were collected from multicenter, and antimicrobial susceptibility testing was performed in the research central laboratory of each study period from 2009–2018. The pathogens that accounted for CARTIs in the adult population was considered and summarized. Results From 2009–2018 a total of 3750 isolates were collected from 22 cities located across different regions of China. Among these the most common bacterial isolates include S. pneumoniae (53.7%) followed by H. influenza (32.4%), M. catarrhalis (13.9%). S. pneumoniae exhibited reduction in susceptibility and increase in resistance to penicillin, cephalosporins (cefaclor, cefuroxime, ceftriaxone) during the surveillance period. Invasive and noninvasive S. pneumoniae showed similar resistance. In the case of H. influenzae susceptibility to β-lactam and β-lactamase inhibitors (ampicillin, amoxicillin and AMC), SXT, clarithromycin and cephalosporins (cefuroxime, cefaclor, ceftazidime) was reduced over the past 10 years with an exception of ceftriaxone. Overall, moxifloxacin and levofloxacin have the highest susceptibility rates against S. pneumoniae (>95%) and H. influenza (>90%). M. catarrhalis exhibited susceptibility to almost all the tested antimicrobials. Conclusion In China the 10-year trends showed a substantial increase in resistance to β-lactam drugs and reduction in sensitivity. However, certain antimicrobial agents namely fluoroquinolones including moxifloxacin and levofloxacin maintained low resistance rates with better susceptibility. Further, with few exceptions decline in susceptibility rates to macrolides and cephalosporins was observed among the tested pathogens.
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Affiliation(s)
- Chunjiang Zhao
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Shuo Yang
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Feifei Zhang
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Zhanwei Wang
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Yawei Zhang
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Xiaojuan Wang
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Henan Li
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Hongbin Chen
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Hui Wang
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, People’s Republic of China
- Correspondence: Hui Wang, Department of Clinical Laboratory, Peking University People’s Hospital, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, People’s Republic of China, Email
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15
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Sun X, Xu Y, Tang F, Xiao Y, Wang Z, Wang B, Zhu X, Yang X, Chen H. Immunogenicity and safety of concomitant administration of the chinese inactivated poliovirus vaccine with the diphtheria-tetanus-acellular pertussis (DTaP) vaccine in children: A multicenter, randomized, non-inferiority, controlled trial. Front Immunol 2022; 13:905634. [PMID: 35958596 PMCID: PMC9361845 DOI: 10.3389/fimmu.2022.905634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Key point Considering that vaccination with the sIPV and DTaP overlap at the ages of 3 and 4 months in China, to reduce the burden of treatment on parents and increase vaccination coverage rates, we designed a postmarket clinical study of co-administration. Background The Sabin-strain-based inactivated poliovirus vaccine (sIPV) and the diphtheria-tetanus-acellular pertussis vaccine (DTaP) have been licensed in China for many years. To conduct a clinical study on the safety and immunogenicity of the sIPV when administered concomitantly with the DTaP. Methods The study population was divided into three groups: group 1 was the sIPV+ DTaP concomitant administration group, group 2 was the sIPV inoculation group, and group 3 was the DTaP inoculation group. Blood samples were collected prevaccination and 30 days postvaccination, and serum antibody levels were detected. Results This study showed that the seropositive and seroconversion rates of type 1, 2 and 3 poliovirus in group 1 were higher than those in group 2, with no statistically significant difference after vaccination (P>0.05). Groups 1 and 3 also showed similar responses for all vaccine antigens except anti-FHA (97.65 (94.09-99.36) vs. 100 (97.89-100)). The geometric mean titers (GMTs) for the DTaP and sIPV among the groups were comparable, and the non-inferiority t test result was P<0.001. The number of local adverse events (AEs) reported in group 1 (29.91%) were larger than those in group 2 (12.39%) and group 3 (21.93%), among which the most common was redness. Similarly, the most common systemic AE was fever. All 5 severe AE (SAE) cases were determined by experts to be unrelated to the vaccines during the study. Conclusions The evidence of similar seroconversion and safety with co-administered DTaP and sIPV supports the co-administration supports the introduction of a strategy of simultaneous administration of both vaccines into routine infant immunization, and it could increase vaccination coverage and protect more infants from morbidity and mortality from these related diseases. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT04054882?term=NCT04054882&cntry=CN&draw=2&rank=1, identifier NCT04054882.
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Affiliation(s)
- Xiang Sun
- Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu, China
- *Correspondence: Xiang Sun, ; Xiaoming Yang,
| | - Yan Xu
- Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu, China
| | - Fenyang Tang
- Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu, China
| | - Yanhui Xiao
- Medical Affairs, China National Biotec Group Company Limited, Beijing, China
| | - Zhiguo Wang
- Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu, China
| | - Binbing Wang
- Expanded Program on Immunization, Anhui Provincial Center for Disease Control and Prevention, Anhui, China
| | - Xiaoping Zhu
- Expanded Program on Immunization, Sichuan Provincial Center for Disease Control and Prevention, Sichuan, China
| | - Xiaoming Yang
- Medical Affairs, China National Biotec Group Company Limited, Beijing, China
- *Correspondence: Xiang Sun, ; Xiaoming Yang,
| | - Haiping Chen
- Medical Affairs, China National Biotec Group Company Limited, Beijing, China
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16
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Jing R, Fang H, Wang H, Wang J. The Role of General Attitudes and Perceptions Towards Vaccination on the Newly-Developed Vaccine: Results From a Survey on COVID-19 Vaccine Acceptance in China. Front Psychol 2022; 13:841189. [PMID: 35712143 PMCID: PMC9194573 DOI: 10.3389/fpsyg.2022.841189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background Vaccination has been considered one of the most effective public health interventions. In the context of the global epidemic of coronavirus disease 2019 (COVID-19), it remains unclear what role general vaccination attitudes and perceptions have on the acceptance of COVID-19 vaccine. Objective This study aims to explore the impact of general attitudes and perceptions toward vaccination on the acceptance of a newly developed vaccine, taking COVID-19 vaccines as an example. Method A cross-sectional survey was conducted among 2,013 Chinese adult participants. Generalized order logistic regression and path analysis models were used to analyze impacts of general attitudes and perceptions toward vaccination on the acceptance of the COVID-19 vaccine. Results The prevalence of hesitancy to vaccination in general is 49.9% among the Chinese adult population. General perceptions of vaccination were associated with corresponding perceptions of the COVID-19 vaccine. A “no hesitancy” attitude toward vaccination is a significant determinant (aOR = 1.77, 95% CI = 1.36–2.31) of future COVID-19 vaccination compared to vaccine refusers, and perceptions of COVID-19 vaccine remain a significant determinant for the acceptance of the COVID-19 vaccine. Path analysis indicates that perceptions of the importance and safety of vaccination have a positive overall effect on the acceptance of the COVID-19 vaccine, and that general perceptions of vaccination as a whole on each measure indirectly influence the acceptance of the COVID-19 vaccine. Conclusion General attitudes and perceptions toward vaccination were associated with those of the COVID-19 vaccine and future vaccination intention. To prepare for possible emergence of diseases in the future, routine health campaigns should be launched by relevant government departments and vaccination authorities to enhance the overall awareness and knowledge of vaccination among the public and to ensure optimal vaccination experience. In addition, targeted knowledge dissemination and mass mobilizations should be urged for newly developed vaccines when some specific infectious diseases emerge, such as COVID-19 at present.
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Affiliation(s)
- Rize Jing
- School of Public Administration and Policy, Renmin University of China, Beijing, China
| | - Hai Fang
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
- Chinese Center for Disease Control and Prevention Joint Center for Vaccine Economics, Peking University Health Science Center, Beijing, China
| | - Hufeng Wang
- School of Public Administration and Policy, Renmin University of China, Beijing, China
- *Correspondence: Hufeng Wang,
| | - Jiahao Wang
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
- Jiahao Wang,
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17
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Immunogenicity of meningococcal polysaccharide conjugate vaccine as a replacement for meningococcal polysaccharide vaccine in children in Guangzhou, China. Vaccine 2022; 40:1370-1375. [DOI: 10.1016/j.vaccine.2021.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/22/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022]
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Wang W, Wang Y, Wang Y, Yan F, Wang N, Fu C. Vaccine bidding, procurement and distribution management practices in mainland China: A nationwide study. Vaccine 2021; 39:7584-7589. [PMID: 34802784 DOI: 10.1016/j.vaccine.2021.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To conduct a nationwide evaluation of vaccine bidding, procurement and distribution management for understanding and improving the current situation well in mainland China. METHODS An institution survey was carried out to collect information on tendering, procurement, distribution and related issues to vaccines by structured questionnaires administered to 31 provinces in mainland China from April to July 2019. RESULTS In 13 (41.9%) of 31 provinces, centralized bidding of National Immunization Program (NIP) vaccines was accomplished, and others conducted independent tendering and purchasing in 2018. For non-NIP vaccines, all provinces implemented unified bidding at the provincial level and over half (18, 58.1%) of them chose provincial public resource trading platforms, but their modes varied over provinces. Then procurement was undertaken by the district-level centers for disease control and prevention (CDC) while they were unable to choose the best option of too many vaccines targeted by the province-level CDC for local populations. The distribution modes of NIP and non-National Immunization Program (non-NIP) vaccines were similar overall in a province but very different over provinces. Main mode was that CDCs at different levels delivered about two thirds (64.5%) of NIP vaccines distribution and more than one third (35.5%) of non-NIP vaccines. Another distribution mode was occupied as fully buying the service from third parties in 3 municipalities. Some provinces mixed both modes, too. The total distribution volume of vaccines was 430.7 million doses in 2018. The top five non-NIP vaccines delivered in 2018 were human rabies vaccine, varicella vaccine, EV71 hand foot mouth disease vaccine, hepatitis B vaccine and influenza vaccine. CONCLUSION The vaccine biding, procurement and distribution management varied over provinces in mainland China in 2018, especially for non-NIP vaccines. Specific policies and measures should be developed for different regions to improve the immunization management better.
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Affiliation(s)
- Wei Wang
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yanhuan Wang
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Ying Wang
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Fei Yan
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Na Wang
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Chaowei Fu
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
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19
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Lin Y, Hu Z, Zhao Q, Alias H, Danaee M, Wong LP. Chinese parents' intentions to vaccinate their children against SARS-CoV-2 infection and vaccine preferences. Hum Vaccin Immunother 2021; 17:4806-4815. [PMID: 34892992 DOI: 10.1080/21645515.2021.1999143] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This study aims to determine the intention of Chinese parents to vaccinate their children against SARS-CoV-2. Secondly, preferences for foreign- or domestically made COVID-19 vaccines were also explored. A nationwide, cross-sectional, self-administered online survey based on the Health Belief Model (HBM) and new vaccine concerns was used. Participants were eligible if they were residents of China with children aged 12 years old or younger. A total of 2,026 parents responded to the survey. Half reported a probable intent (50.7%) and 26.9% reported a definite intent. The results of the data analysis of partial least squares structural equation modeling (PLS-SEM) found that perceived cost barriers (B = -0.210, p < .001) and new vaccine concerns (B = -0.201, p < .001) had major effects in vaccination intent. Important constructs of vaccine concerns that predict vaccination intent were efficacy (B = 0.898, p < .001), followed by safety (B = 0.861, p < .001), side-effect (B = 0.806, p < .001) and faulty/fake vaccine (B = 0.579, p < .001). Perceived benefits (B = 1.81, p < .001), self-efficacy (B = 0.159, p < .001) and severity (B = 0.083, p < .01) were also significant predictors in vaccination intent. Almost two-thirds (62.0%; 95%CI 59.8 to 64.1) reported a preference for domestically made and 19.1% (95%CI 17.2 to 20.7) preferred foreign-made COVID-19 vaccines. Multivariable logistic regression analysis revealed that higher incomes and concern of side-effects of the new COVID-19 vaccine were two of the most important influencing factors of preference for a foreign-made vaccine. This study sheds light on the importance of addressing concerns of new vaccines and the helpfulness of HBM in understanding parental decisions toward their children being vaccinated against SARS-CoV-2.
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Affiliation(s)
- Yulan Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Qinjian Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian Province, China
| | - Haridah Alias
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Li Ping Wong
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China.,Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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What Influences Health Professionals' Recommendations for Non-Scheduled Childhood Vaccinations? A Qualitative Study of Health Professionals' Perspectives in Three Provinces of China. Vaccines (Basel) 2021; 9:vaccines9121433. [PMID: 34960179 PMCID: PMC8708869 DOI: 10.3390/vaccines9121433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022] Open
Abstract
Recommendations by health professionals are important for vaccines that are not included in national schedules. This study explored health professionals’ perspectives on recommending non-scheduled (user-fee) childhood vaccinations in China, identifying key influences on professionals’ interactions with caregivers. We conducted individual semi-structured interviews with 20 health professionals from three provinces in China and analyzed data thematically using deductive and inductive coding. Health professionals from all three provinces were uncomfortable about being perceived to encourage parents to accept vaccines that incurred a fee. They provided information about non-scheduled vaccines but emphasized parental autonomy in decision-making. Rural parents were less aware of unscheduled vaccines and health professionals were more likely to encourage parents living in more affluent areas to consider these vaccines; varicella vaccine was preferred by parents as a way of preventing school absence. Economic incentives for unscheduled vaccines were given to staff at most study sites, although the amount given varied widely. These variations meant that staff receiving lower incentives were not motivated to promote non-scheduled vaccines if their workload was high; on the contrary, those receiving higher incentives were more likely to promote these vaccines. Health professionals need more guidance on how to recommend unscheduled vaccines in an informative, positive and appropriate manner. It is evident that parents’ awareness of these vaccines, and their economic circumstances, influence vaccinators recommendation practice. Economic incentives prompted health professionals to recommend non-scheduled vaccines; however, the application of such staff incentives varied widely in China. To adopt appropriate economic incentives, professional organizations should develop protocols for the use of incentives that account for their influence on recommendation practices. Suitable recommendation policy needs to balance basic salaries with performance-based incentives, consider overall workload, and include monitoring and evaluation of economic incentives.
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Xu L, Li N, Zhang L, Ma R, Fang T, Liu Z, Zhan S. Febrile Seizures and Measles-Containing Vaccines in China: A Self-Controlled Case Series Study. Vaccines (Basel) 2021; 9:vaccines9101073. [PMID: 34696181 PMCID: PMC8541362 DOI: 10.3390/vaccines9101073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 01/25/2023] Open
Abstract
Little is known about the risk of febrile seizures (FS) after vaccination with measles-containing vaccines (MCVs) in middle- and low-income countries. This self-controlled case series study aimed to evaluate the risk of FSs in Chinese children using data from the Ningbo Regional Health Information Platform. The observation period was 0-12 and 13-24 months of age for the MR and MMR vaccines, respectively. The relative incidences (RIs) within 0-6 days, 7-13 days, 14-27 days, and 28-42 days after vaccination with MCVs were estimated. The remaining observation period was the control period. The RIs within 0-6 days, 7-13 days, 14-27 days, and 28-42 days after MR vaccination were 1.11 [95% confidence interval (CI) 0.33 to 3.70], 0.80 (95% CI 0.23 to 2.86), 1.67 (95% CI 0.81 to 3.42), and 1.02 (95% CI 0.49 to 2.14), respectively. The corresponding RIs after MMR vaccination were 0.99 (95% CI 0.56 to 1.75), 1.17 (95% CI 0.68 to 2.01), 0.87 (95% CI 0.54 to 1.39), and 0.85 (95% CI 0.54 to 1.34), respectively. This study suggests that China's vaccination schedule for MCVs, as suggested by the World Health Organization (WHO) for countries with a high risk of measles mortality and ongoing transmission, does not increase the risk of FSs.
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Affiliation(s)
- Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (L.X.); (Z.L.)
| | - Ning Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China; (N.L.); (L.Z.); (R.M.); (T.F.)
| | - Liang Zhang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China; (N.L.); (L.Z.); (R.M.); (T.F.)
| | - Rui Ma
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China; (N.L.); (L.Z.); (R.M.); (T.F.)
| | - Ting Fang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China; (N.L.); (L.Z.); (R.M.); (T.F.)
| | - Zhike Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (L.X.); (Z.L.)
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (L.X.); (Z.L.)
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
- Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing 100191, China
- Correspondence:
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22
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Zhang H, Garcia C, Yu W, Knoll MD, Lai X, Xu T, Jing R, Qin Y, Yin Z, Wahl B, Fang H. National and provincial impact and cost-effectiveness of Haemophilus influenzae type b conjugate vaccine in China: a modeling analysis. BMC Med 2021; 19:181. [PMID: 34376214 PMCID: PMC8356460 DOI: 10.1186/s12916-021-02049-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, Haemophilus influenzae type b (Hib) vaccine has substantially reduced the burden of Hib invasive disease. However, China remains the only country not to include Hib vaccine into its national immunization program (NIP), although it accounts for 11% of global Hib deaths. We aimed to assess the cost-effectiveness of including Hib vaccine in China's NIP at the national and provincial levels. METHODS Using a decision-tree Markov state transition model, we estimated the cost-effectiveness of Hib vaccine in the NIP compared to the status quo of Hib vaccine in the private market for the 2017 birth cohort. Treatment costs and vaccine program costs were calculated from Chinese Center for Disease Control and Prevention (CDC) and national insurance databases. Epidemiological data and other model parameters were obtained from published literature. Cases and deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICER) were predicted by province. Deterministic and probabilistic sensitivity analyses were performed to explore model uncertainty. RESULTS Including Hib vaccine in the NIP was projected to prevent approximately 2700 deaths (93% reduction) and 235,700 cases of Hib disease (92% reduction) for the 2017 birth cohort at the national level. Hib vaccine was cost-effective nationally (US$ 8001 per QALY gained) compared to the GDP per capita and cost-effective in 15 of 31 provinces. One-way and scenario sensitivity analyses indicated results were robust when varying model parameters, and in probabilistic sensitivity analysis, Hib vaccine had a 64% probability of being cost-effective nationally. CONCLUSION Introducing Hib vaccine in China's NIP is cost-effective nationally and in many provinces. Less socioeconomically developed provinces with high Hib disease burden and low access to Hib vaccine in the current private market, such as those in the west region, would benefit the most from adding Hib vaccine to the NIP. In the absence of a national policy decision on Hib vaccine, this analysis provides evidence for provincial governments to include Hib vaccine into local immunization programs to substantially reduce disease burden and treatment costs.
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Affiliation(s)
- Haijun Zhang
- China Center for Health Development Studies, Peking University, Beijing, China
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Cristina Garcia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Wenzhou Yu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maria Deloria Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Xiaozhen Lai
- China Center for Health Development Studies, Peking University, Beijing, China
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Tingting Xu
- Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China
| | - Rize Jing
- China Center for Health Development Studies, Peking University, Beijing, China
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Ying Qin
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Brian Wahl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China.
- Peking University Health Science Center, Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics, Beijing, China.
- Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China.
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Lin S, Jing Z, Howard N, Chantler T, Cheng J, Zhang S, Zhou C, Sun M. Associations of Elements of Parental Social Integration with Migrant Children's Vaccination: An Epidemiological Analysis of National Survey Data in China. Vaccines (Basel) 2021; 9:vaccines9080884. [PMID: 34452009 PMCID: PMC8402568 DOI: 10.3390/vaccines9080884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
Our study explored the effects of parental social integration on migrant children's vaccination status in China. Using data obtained from the 2014 China Migrants Dynamic Survey, a total of 4915 participants were included in this study. Social integration was measured by economic, social, cultural, and internal identity. Univariate chi-square testing was used to calculate associations between all variables and migrant children's vaccination status. Binary logistic regression was employed to calculate the impacts of social integration on migrant children's vaccination status. In total, 94.7% of migrant children had complete vaccinations for their age. Migrants who had medical insurance, spoke the native language when communicating with locals, lived mainly with locals, and did not perceive discrimination were more likely to have their children completely vaccinated. Social integration was positively associated with migrant children's vaccination status. Our study indicated that to improve vaccination coverage of migrant children, more policy support for migrant employment and housing, promotion of health services for migrants, and language support in health institutions is needed.
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Affiliation(s)
- Shiyu Lin
- Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai 200032, China; (S.L.); (J.C.); (S.Z.)
- NHC Key Laboratory of Health Technology Assessment, Fudan University, 130 Dong’an Road, Shanghai 200032, China
| | - Zhengyue Jing
- School of Health Policy and Management, Nanjing Medical University, Nanjing 211166, China;
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK; (N.H.); (T.C.)
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK; (N.H.); (T.C.)
| | - Jiejie Cheng
- Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai 200032, China; (S.L.); (J.C.); (S.Z.)
- NHC Key Laboratory of Health Technology Assessment, Fudan University, 130 Dong’an Road, Shanghai 200032, China
| | - Shiya Zhang
- Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai 200032, China; (S.L.); (J.C.); (S.Z.)
- NHC Key Laboratory of Health Technology Assessment, Fudan University, 130 Dong’an Road, Shanghai 200032, China
| | - Chengchao Zhou
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, 44 Wen-hua-xi Road, Jinan 250012, China
- Correspondence: (C.Z.); (M.S.); Tel.: +86-0531-8838-1567 (C.Z.); +86-21-3356-3956 (M.S.)
| | - Mei Sun
- Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai 200032, China; (S.L.); (J.C.); (S.Z.)
- NHC Key Laboratory of Health Technology Assessment, Fudan University, 130 Dong’an Road, Shanghai 200032, China
- Correspondence: (C.Z.); (M.S.); Tel.: +86-0531-8838-1567 (C.Z.); +86-21-3356-3956 (M.S.)
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24
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China and the global search for health security: history, vaccines, and governance. CHINA INTERNATIONAL STRATEGY REVIEW 2021. [PMCID: PMC7988248 DOI: 10.1007/s42533-021-00066-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AbstractChina is a key player, not just an actor, in the global search for health security. Reiteration of this point is useful for International Relations studies, which often portray China as a factor to contend with, especially given the background of the country as the first to report the outbreak of the COVID-19 pandemic. This paper adopts an analytical framework developed through a summary of routines in Chinese engagement in global health from a practitioner’s perspective: aid, interdependence, governance and knowledge. These are the core elements in a country’s pursuit of engagement with the rest of the world. After the introduction, the second section of the paper reviews contributions from China in the history of global plague control over the past century. The third section discusses structural issues affecting access to vaccines, which are essential for bringing COVID-19 under effective control. The fourth section identifies a number of challenges China is facing in global health governance. The final section offers a few concluding thoughts, reiterating the nature of interdependence in the global search for enhancement of health security.
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Pan J, Wang Y, Cao L, Wang Y, Zhao Q, Tang S, Gong W, Guo L, Liu Z, Wen Z, Zheng B, Wang W. Impact of immunization programs on 11 childhood vaccine-preventable diseases in China: 1950-2018. Innovation (N Y) 2021; 2:100113. [PMID: 34557762 PMCID: PMC8454656 DOI: 10.1016/j.xinn.2021.100113] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/27/2021] [Indexed: 11/07/2022] Open
Abstract
To evaluate the achievements of China's immunization program between 1950 and 2018, we chose 11 vaccine-preventable diseases (VPDs) as representative notifiable diseases and used annual surveillance data obtained between 1950 and 2018 to derive disease incidence and mortality trends. Quasi-Poisson and polynomial regression models were used to estimate the impacts of specific vaccine programs, and life-table methods were used to calculate the loss of life expectancy, years of life lost, and loss of working years. The total notification number for the 11 VPDs was 211,866,000 from 1950 to 2018. The greatest number occurred in 1959, with a total incidence of 1,723 per million persons. From 1978 to 2018, a substantial decline was observed in the incidence of major infectious diseases. The incidence of pertussis fell 98% from 126.35 to 1.58 per million, and the incidences of measles, meningococcal meningitis, and Japanese encephalitis fell 99%, 99%, and 98%, respectively. The regression models showed that most of the 11 diseases exhibited dramatic declines in morbidity after their integration into the Expanded Program on Immunization (EPI), while varicella and paratyphoid fever, which were not integrated into the EPI, showed increased morbidity. From 1978 to 2018, the total life expectancy for the 11 VPDs increased by 0.79 years, and similar results were obtained for different age groups. China has had great success in controlling VPDs in recent decades, and improving vaccination coverage is a key aspect of controlling VPDs in China. 11 vaccine-preventable diseases (VPDs) were examined to measure the impact of the national immunization program Most of the 11 VPDs exhibited dramatic declines in morbidity rate after their integration into the Expanded Program on Immunization (EPI) From 1978 to 2018, the total life expectancy for the 11 VPDs increased by 0.79 years, and similar results were obtained for different age groups Improving vaccination coverage is a key aspect of controlling VPDs in China
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Affiliation(s)
- Jinhua Pan
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Yesheng Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Lingsheng Cao
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Ying Wang
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai 200032, China
| | - Qi Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China.,School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA
| | - Wenfeng Gong
- Bill and Melinda Gates Foundation, Seattle, WA 98109, USA
| | - Lei Guo
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA
| | - Zhixi Liu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Zexuan Wen
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Bo Zheng
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Weibing Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China.,School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
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Qin W, Wang E, Ni Z. Chinese consumers' willingness to get a COVID-19 vaccine and willingness to pay for it. PLoS One 2021; 16:e0250112. [PMID: 33945544 PMCID: PMC8096001 DOI: 10.1371/journal.pone.0250112] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/30/2021] [Indexed: 01/12/2023] Open
Abstract
A COVID-19 vaccine is the key to beating the virus, and effective vaccines are going to be available in the near future. It is urgent to estimate the acceptability of COVID-19 vaccines and their value to individuals, in order to develop an effective public vaccination strategy. Based on a survey of 1,188 randomly selected respondents in China, we analyzed Chinese consumers’ willingness to get a COVID-19 vaccine and their willingness to pay for it. We find that 79.41% of the respondents are willing to get vaccinated in China, and the average amount that they’re willing to pay for a COVID-19 vaccine shot is 130.45 yuan. However, though the elderly are at higher risk of infection and the disease could be fatal for them, they are less willing to get the vaccine and not willing to pay as much for the shot. Subsidies and health communication concerning COVID-19 vaccines should be provided in order to expand vaccination coverage.
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Affiliation(s)
- Wen Qin
- School of Economics and Management, Nanjing Tech University, Nanjing, China
| | - Erpeng Wang
- School of Economics and Management, Nanjing Tech University, Nanjing, China
- * E-mail:
| | - Zhengyu Ni
- School of Economics and Management, Nanjing Tech University, Nanjing, China
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Wang X, Lin L, Xu J, Wang W, Zhou X. Expectant parents' vaccine decisions influenced by the 2018 Chinese vaccine crisis: A cross-sectional study. Prev Med 2021; 145:106423. [PMID: 33440190 DOI: 10.1016/j.ypmed.2021.106423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
Immunization programs have been challenged by vaccine crises. Between 2013 and 2018, China has experienced three major vaccine scandals and crises, which has partly impaired Chinese public trust in domestically produced vaccines. This study aims to explore the associations between parental trust toward CDC-released crisis communication information, parents' critical understanding of crisis information, parental confidence in vaccine efficacy, and parental vaccine decisions. A cross-sectional survey was conducted among 1065 expectant parents two weeks after the 2018 vaccine crisis was revealed. The proportion of parental hesitancy toward domestically produced vaccines and overall vaccination increased from 30.6% to 82.7% and 8.3% to 52.1%, respectively, after the crisis. Parents with higher levels of trust toward crisis communication information were less likely to report vaccine hesitancy toward both domestically produced vaccines and vaccines overall after the crisis. Parents with better critical understanding of crisis information were less likely to report a vaccine hesitancy toward overall vaccine and more likely to maintain a vaccine intention. Additionally, parents with lower levels of confidence in vaccine efficacy were more likely to became vaccine hesitant but were also more likely to maintain their vaccine intentions after the crisis. It is crucial to guarantee the safety of vaccines, maintain parental confidence in vaccine efficacy, and eliminate the potential risks that result in parental vaccine hesitancy. Future crisis communication strategies are encouraged to ensure timely responses to sustain public confidence.
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Affiliation(s)
- Xiaomin Wang
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China.
| | - Leesa Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7TH, UK.
| | - Jiayao Xu
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China.
| | - Weiyi Wang
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China.
| | - Xudong Zhou
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China.
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28
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Lu EY, Chen HH, Zhao H, Ozawa S. Health and economic impact of the pneumococcal conjugate vaccine in hindering antimicrobial resistance in China. Proc Natl Acad Sci U S A 2021; 118:e2004933118. [PMID: 33758096 PMCID: PMC8020802 DOI: 10.1073/pnas.2004933118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Antimicrobial resistance (AMR) poses a serious threat to global public health. However, vaccinations have been largely undervalued as a method to hinder AMR progression. This study examined the AMR impact of increasing pneumococcal conjugate vaccine (PCV) coverage in China. China has one of the world's highest rates of antibiotic use and low PCV coverage. We developed an agent-based DREAMR (Dynamic Representation of the Economics of AMR) model to examine the health and economic benefits of slowing AMR against commonly used antibiotics. We simulated PCV coverage, pneumococcal infections, antibiotic use, and AMR accumulation. Four antibiotics to treat pneumococcal diseases (penicillin, amoxicillin, third-generation cephalosporins, and meropenem) were modeled with antibiotic utilization, pharmacokinetics, and pharmacodynamics factored into predicting AMR accumulation. Three PCV coverage scenarios were simulated over 5 y: 1) status quo with no change in coverage, 2) scaled coverage increase to 99% in 5 y, and 3) accelerated coverage increase to 85% over 2 y followed by 3 y to reach 99% coverage. Compared to the status quo, we found that AMR against penicillin, amoxicillin, and third-generation cephalosporins was significantly reduced by 6.6%, 10.9%, and 9.8% in the scaled scenario and by 10.5%, 17.0%, and 15.4% in the accelerated scenario. Cumulative costs due to AMR, including direct and indirect costs to patients and caretakers, were reduced by $371 million in the scaled and $586 million in the accelerated scenarios compared to the status quo. AMR-reducing benefits of vaccines are essential to quantify in order to drive appropriate investment.
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Affiliation(s)
- Ember Yiwei Lu
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Hui-Han Chen
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Hongqing Zhao
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599;
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
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Ou L, Chen ACC, Reifsnider E. Review of Chinese young adults' human papillomavirus knowledge, attitudes, and vaccine acceptability. Public Health Nurs 2021; 38:701-714. [PMID: 33715199 DOI: 10.1111/phn.12893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/18/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The human papillomavirus (HPV) vaccine is effective in reducing HPV-related disease. The 2-, 4-, and 9-valent HPV vaccines have been approved by the Chinese FDA since 2016; however, factors associated with HPV vaccine acceptability and use in Chinese young adults remain unclear. DESIGN AND SAMPLE We conducted a systematic review to analyze factors affecting HPV vaccine acceptability and use in Chinese young adults. A comprehensive search of databases (e.g., PubMed, CINAHL, and PsycINFO) was conducted, and articles between 2011 and 2020 were included. RESULTS Seventeen studies were included in the final review, and eleven were conducted in mainland China and six in Hong Kong. All studies reported low level of HPV-related knowledge. Better knowledge, more concerns about HPV-associated diseases, and being female were found associated with higher vaccine acceptability. The vaccine cost and safety were the major concerns for vaccination. CONCLUSIONS Findings suggested a low level of HPV-related knowledge and suboptimal vaccination rate in Chinese young adults. Theory-based interventions addressing knowledge and other influencing factors and involving both males and females are urgently needed to increase vaccine acceptability and use in Chinese young adults.
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Affiliation(s)
- Lihong Ou
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Angela Chia-Chen Chen
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Elizabeth Reifsnider
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
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30
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Wang J, Lyu Y, Zhang H, Jing R, Lai X, Feng H, Knoll MD, Fang H. Willingness to pay and financing preferences for COVID-19 vaccination in China. Vaccine 2021; 39:1968-1976. [PMID: 33714653 PMCID: PMC7914003 DOI: 10.1016/j.vaccine.2021.02.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 01/19/2023]
Abstract
Background The COVID-19 pandemic has caused significant diseases and economic burdens in the world. Vaccines are often considered as a cost-effective way to prevent and control infectious diseases, and the research and development of COVID-19 vaccines have been progressing unprecedently. It is needed to understand individuals’ willingness to pay (WTP) among general population, which provides information about social demand, access and financing for future COVID-19 vaccination. Objective To investigate individuals’ WTP and financing mechanism preference for COVID-19 vaccination during the pandemic period in China. Methods During March 1–18, 2020, we conducted a network stratified random sampling survey with 2058 respondents in China. The survey questionnaires included out-of-pocket WTP, financing mechanism preference as well as basic characteristics of the respondents; risk perception and impact of the COVID-19 pandemic; attitude for future COVID-19 vaccination. Multivariable Tobit regression was used to determine impact factors for respondents’ out-of-pocket WTP. Results The individuals’ mean WTP for full COVID-19 vaccination was CNY 254 (USD 36.8) with median of CNY 100 (USD 14.5). Most respondents believed that governments (90.9%) and health insurance (78.0%) needed to pay for some or full portions of COVID-19 vaccination, although 84.3% stated that individuals needed to pay. Annual family income, employee size in the workplace, and whether considering the COVID-19 pandemic in China in a declining trend affected respondents’ WTP significantly. Conclusion The findings demonstrated the individuals’ WTP for COVID-19 vaccination in China and their preferences for financing sources from individuals, governments and health insurance. And to suggest an effective and optimal financing strategy, the public health perspective with equal access to COVID-19 vaccination should be prioritized to ensure a high vaccination rate.
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Affiliation(s)
- Jiahao Wang
- School of Public Health, Peking University, Beijing 100083, China; China Center for Health Development Studies, Peking University, Beijing 100083, China.
| | - Yun Lyu
- School of Public Health, Peking University, Beijing 100083, China; China Center for Health Development Studies, Peking University, Beijing 100083, China.
| | - Haijun Zhang
- School of Public Health, Peking University, Beijing 100083, China; China Center for Health Development Studies, Peking University, Beijing 100083, China.
| | - Rize Jing
- School of Public Health, Peking University, Beijing 100083, China; China Center for Health Development Studies, Peking University, Beijing 100083, China.
| | - Xiaozhen Lai
- School of Public Health, Peking University, Beijing 100083, China; China Center for Health Development Studies, Peking University, Beijing 100083, China.
| | - Huangyufei Feng
- School of Public Health, Peking University, Beijing 100083, China; China Center for Health Development Studies, Peking University, Beijing 100083, China.
| | - Maria Deloria Knoll
- International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing 100083, China; Peking University Health Science Center-Chinese Center for Disease Control and Prevention Joint Center for Vaccine Economics, Beijing 100083, China; Key Laboratory of Reproductive Health National Health Commission of the People's Republic of China, Beijing 100083, China.
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Yang J, Zheng W, Shi H, Yan X, Dong K, You Q, Zhong G, Gong H, Chen Z, Jit M, Viboud C, Ajelli M, Yu H. Who should be prioritized for COVID-19 vaccination in China? A descriptive study. BMC Med 2021; 19:45. [PMID: 33563270 PMCID: PMC7872877 DOI: 10.1186/s12916-021-01923-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/20/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND All countries are facing decisions about which population groups to prioritize for access to COVID-19 vaccination after the first vaccine products have been licensed, at which time supply shortages are inevitable. Our objective is to define the key target populations, their size, and priority for a COVID-19 vaccination program in the context of China. METHODS On the basis of utilitarian and egalitarian principles, we define and estimate the size of tiered target population groups for a phased introduction of COVID-19 vaccination, considering evolving goals as vaccine supplies increase, detailed information on the risk of illness and transmission, and past experience with vaccination during the 2009 influenza pandemic. Using publicly available data, we estimated the size of target population groups, and the number of days needed to vaccinate 70% of the target population. Sensitivity analyses considered higher vaccine coverages and scaled up vaccine delivery relative to the 2009 pandemic. RESULTS Essential workers, including staff in the healthcare, law enforcement, security, nursing homes, social welfare institutes, community services, energy, food and transportation sectors, and overseas workers/students (49.7 million) could be prioritized for vaccination to maintain essential services in the early phase of a vaccination program. Subsequently, older adults, individuals with underlying health conditions and pregnant women (563.6 million) could be targeted for vaccination to reduce the number of individuals with severe COVID-19 outcomes, including hospitalizations, critical care admissions, and deaths. In later stages, the vaccination program could be further extended to target adults without underlying health conditions and children (784.8 million), in order to reduce symptomatic infections and/or to stop virus transmission. Given 10 million doses administered per day, and a two-dose vaccination schedule, it would take 1 week to vaccinate essential workers but likely up to 7 months to vaccinate 70% of the overall population. CONCLUSIONS The proposed framework is general but could assist Chinese policy-makers in the design of a vaccination program. Additionally, this exercise could be generalized to inform other national and regional strategies for use of COVID-19 vaccines, especially in low- and middle-income countries.
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Affiliation(s)
- Juan Yang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Wen Zheng
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Huilin Shi
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Xuemei Yan
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Kaige Dong
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Qian You
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Guangjie Zhong
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Hui Gong
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Zhiyuan Chen
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Mark Jit
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Special Administrative Region, Hong Kong, China
| | - Cecile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Marco Ajelli
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA, USA
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China.
- Department of infectious diseases, Huashan Hospital, Fudan University, Shanghai, China.
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Wang Y, Chen L, Cheng F, Biggerstaff M, Situ S, Zhou S, Gao J, Liu C, Zhang J, Millman AJ, Zhang T, Tian J, Zhao G. Economic burden of influenza illness among children under 5 years in Suzhou, China: Report from the cost surveys during 2011/12 to 2016/17 influenza seasons. Vaccine 2021; 39:1303-1309. [PMID: 33494968 DOI: 10.1016/j.vaccine.2020.12.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/02/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data are limited on the economic burden of seasonal influenza in China. We estimated the cost due to influenza illness among children < 5-year-old in Suzhou, China. METHODS This study adopted a societal perspective to estimate direct medical cost, direct non-medical cost, and indirect cost related to lost productivity. Data to calculate costs and rates of three influenza illness outcomes (non-medically attended, outpatient and hospitalization) were collected from prospective community-based cohort studies and hospital-based enhanced laboratory-confirmed influenza surveillance in Suzhou during the 2011/12 to 2016/17 influenza seasons. We used mean cost-per-episode, annual incidence rates of episodes of each outcome, and annual population size to estimate the total annual economic burden of influenza illnesses among children < 5-year-old for Suzhou. All costs were reported in 2017 U.S. dollars. RESULTS The mean cost-per-episode (standard deviation) was $9.92 (13.26) for non-medically attended influenza, $161.05 (176.98) for influenza outpatient illnesses, and $1425.95 (603.59) for influenza hospitalizations. By applying the annual incidence rates to the population size, we estimated an annual total of 4,919 episodes of non-medically attended influenza, 21,994 influenza outpatient, and 2,633 influenza hospitalization. Total annual economic burden of influenza to society among children < 5-year-old in Suzhou was $7.37 (95% confidence interval, 6.9-7.8) million, with estimated costs for non-medically attended influenza of $49,000 (46,000-52,000), influenza outpatients $3.5 (3.3-3.8) million, and influenza hospitalizations $3.8 (3.6-3.9) million. Among outpatients, the indirect cost was 36.3% ($1.3 million) of total economic burden, accounting for 21,994 days of lost productivity annually. Among inpatients, the indirect cost was 22.1% ($829,000), accounting for 18,431 days of lost productivity annually. CONCLUSIONS Our findings show that influenza in children < 5-year-oldcauses substantial societal economic burden in Suzhou, China. Assessing the potential economic benefit of increasing influenza vaccination coverage in this population is warranted.
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Affiliation(s)
- Yin Wang
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China; Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Liling Chen
- Suzhou Center for Disease Prevention and Control, Suzhou, China
| | - Fangfang Cheng
- Children's Hospital of Soochow University, Suzhou, China
| | - Matthew Biggerstaff
- Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, USA
| | - Sujian Situ
- Centers for Disease Control and Prevention, Center of Global Health, Atlanta, GA, USA
| | - Suizan Zhou
- Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, USA
| | - Junmei Gao
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Changpeng Liu
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jun Zhang
- Suzhou Center for Disease Prevention and Control, Suzhou, China
| | - Alexander J Millman
- Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, USA
| | - Tao Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jianmei Tian
- Children's Hospital of Soochow University, Suzhou, China.
| | - Genming Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China; Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
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Wu Q, Zaid M, Xuan Z, Wang C, Gu H, Shi M, Zhu J, Hu Y, Liu J. Changes in epidemiological features of vaccine preventable infectious diseases among three eras of national vaccination strategies from 1953 to 2018 in Shanghai, China. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 7:100092. [PMID: 34327419 PMCID: PMC8315356 DOI: 10.1016/j.lanwpc.2021.100092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/08/2020] [Accepted: 01/04/2021] [Indexed: 12/04/2022]
Abstract
Background Recurring outbreaks of infectious diseases highlight the importance of population vaccination strategies. We aimed to assess the impact of national vaccination strategies on vaccine-preventable infectious diseases (VPDs) in Shanghai, China and to identify vulnerable groups that may benefit from future vaccination policies. Methods Infectious disease data from 1953 to 2018 was obtained from Xuhui District Center for Disease Control and Prevention, Shanghai China. We used joinpoint regression to show incidence, mortality and fatality trends and to determine annual percent change in incidence of 12 VPDs among three eras of national immunization strategies: (1)1953–1977, (2)1978–2007, and(3)2008–2018. Findings Incidence, mortality, and fatality from VPDs have decreased drastically over the three eras, despite the inclusion of more diseases over time. Strikingly, the overall yearly incidence of VPDs shows an increasing trend from 2000 to 2018 in Shanghai (annual percentage changes, APC:7.7, p = 0.025). In the third era (2008–2018), the three VPDs with the highest incidence were varicella (80.2 cases/100,000), hand, foot, and mouth disease (HFMD) (73.6 cases/100,000), and hepatitis (43.5 cases/100,000). A significant upward trend was also observed in hepatitis (APC:24.9, p<0.001), varicella (APC:5.9, p = 0.006), and HFMD (APC:11.8, p = 0.003) from 2008–2018. Hepatitis and tuberculosis are the only VPDs with fatality cases in this period. Interpretation Focus is needed in controlling adult hepatitis and tuberculosis, either by introducing adult booster vaccines or by research into more effective vaccines. Varicella and HFMD are on the rise, but vaccines for these are not included in national programs. Strategies funded by government agencies or encouraged by research incentives are needed for varicella and HFMD, such as two-dose and novel multi-valent vaccines, respectively. Funding Chinese Ministry of Education, Shanghai Municipal Government.
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Affiliation(s)
- Qiangsong Wu
- Xuhui District Center for Disease Control and Prevention, Shanghai 200237, China
| | - Maryam Zaid
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, Shanghai, China
| | - Zeliang Xuan
- Xuhui District Center for Disease Control and Prevention, Shanghai 200237, China
| | - Chenxi Wang
- Xuhui District Center for Disease Control and Prevention, Shanghai 200237, China
| | - Haiyan Gu
- Xuhui District Center for Disease Control and Prevention, Shanghai 200237, China
| | - Min Shi
- Xuhui District Center for Disease Control and Prevention, Shanghai 200237, China
| | - Jiahui Zhu
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, Shanghai, China
| | - Yi Hu
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, Shanghai, China
| | - Jingyi Liu
- Xuhui District Center for Disease Control and Prevention, Shanghai 200237, China
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Lin Y, Hu Z, Zhao Q, Alias H, Danaee M, Wong LP. Understanding COVID-19 vaccine demand and hesitancy: A nationwide online survey in China. PLoS Negl Trop Dis 2020; 14:e0008961. [PMID: 33332359 PMCID: PMC7775119 DOI: 10.1371/journal.pntd.0008961] [Citation(s) in RCA: 374] [Impact Index Per Article: 93.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/31/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022] Open
Abstract
Background This study attempts to understand coronavirus disease 2019 (COVID-19) vaccine demand and hesitancy by assessing the public’s vaccination intention and willingness-to-pay (WTP). Confidence in COVID-19 vaccines produced in China and preference for domestically-made or foreign-made vaccines was also investigated. Methods A nationwide cross-sectional, self-administered online survey was conducted on 1–19 May 2020. The health belief model (HBM) was used as a theoretical framework for understanding COVID-19 vaccination intent and WTP. Results A total of 3,541 complete responses were received. The majority reported a probably yes intent (54.6%), followed by a definite yes intent (28.7%). The perception that vaccination decreases the chances of getting COVID-19 under the perceived benefit construct (OR = 3.14, 95% CI 2.05–4.83) and not being concerned about the efficacy of new COVID-19 vaccines under the perceived barriers construct (OR = 1.65, 95% CI 1.31–2.09) were found to have the highest significant odds of a definite intention to take the COVID-19 vaccine. The median (interquartile range [IQR]) of WTP for COVID-19 vaccine was CNY¥200/US$28 (IQR CNY¥100–500/USD$14–72). The highest marginal WTP for the vaccine was influenced by socio-economic factors. The majority were confident (48.7%) and completely confident (46.1%) in domestically-made COVID-19 vaccine. 64.2% reported a preference for a domestically-made over foreign-made COVID-19 vaccine. Conclusions The findings demonstrate the utility of HBM constructs in understanding COVID-19 vaccination intent and WTP. It is important to improve health promotion and reduce the barriers to COVID-19 vaccination. This study investigated vaccine demand and hesitancy by assessing the intention to vaccinate against COVID-19 and willingness-to-pay. We found that a considerable proportion of the public in China has a definite intention to receive the COVID-19 vaccine; a higher proportion expressed a probable intention. Perceived benefits and barriers to vaccination (namely vaccine efficacy and adverse event concerns) of the health belief model constructs were significant predictors of COVID-19 vaccination intent. A substantial proportion was concerned about fake or faulty COVID-19 vaccines; however, this was not a significant predictor of vaccination intention. The willingness-to-pay for the COVID-19 was determined and was found to be positively associated with income. Higher confidence in domestically-made COVID-19 vaccines was also found in this study. The preference for domestically-made over foreign-made COVID-19 vaccines indicates that a future COVID-19 vaccine developed by domestic companies will receive a favourable response from the public in China.The findings of this study provide useful guidance for tailored interventions to enhance the acceptance of a new COVID-19 vaccine once it is available. Promotional messages framing the benefit of vaccination and concerns about new vaccine safety to enhance vaccine uptake is warranted.
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Affiliation(s)
- Yulan Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
- * E-mail: (YL); (ZH); (LPW)
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
- * E-mail: (YL); (ZH); (LPW)
| | - Qinjian Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Haridah Alias
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Li Ping Wong
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail: (YL); (ZH); (LPW)
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Zhang W, Gao J, Chen L, Tian J, Biggerstaff M, Zhou S, Situ S, Wang Y, Zhang J, Millman AJ, Greene CM, Zhang T, Zhao G. Estimated influenza illnesses and hospitalizations averted by influenza vaccination among children aged 6-59 months in Suzhou, China, 2011/12 to 2015/16 influenza seasons. Vaccine 2020; 38:8200-8205. [PMID: 33176936 PMCID: PMC7728434 DOI: 10.1016/j.vaccine.2020.10.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/17/2020] [Accepted: 10/21/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND There are few estimates of vaccination-averted influenza-associated illnesses in China. METHODS We used a mathematical model and Monte Carlo algorithm to estimate numbers and 95% confidence intervals (CI) of influenza-associated outcomes (hospitalization, illness, and medically-attended (MA) illness) averted by vaccination among children aged 6-59 months in Suzhou from October 2011-September 2016. Influenza illnesses included non-hospitalized MA influenza illnesses and non-MA influenza illnesses. The numbers of influenza-associated outcomes averted by vaccination were the difference between the expected burden if there were no vaccination given and the observed burden with vaccination. The model incorporated the disease burden estimated based on surveillance data from Suzhou University Affiliated Children's Hospital (SCH) and data from health utilization surveys conducted in the catchment area of SCH, age-specific estimates of influenza vaccination coverage in Suzhou from the Expanded Program on Immunization database, and influenza vaccine effectiveness estimates from previous publications. Averted influenza estimations were presented as absolute numbers and in terms of the prevented fraction (PF). A hypothetical scenario with 50% coverage (but identical vaccine effectiveness) over the study period was also modeled. RESULTS In ~250,000 children, influenza vaccination prevented an estimated 731 (CI: 549-960) influenza hospitalizations (PF: 6.2% of expected, CI: 5.8-6.6%) and 10,024 (7593-12,937) influenza illnesses (PF: 6.5%, 6.4-6.7%), of which 8342 (6338-10,768) were MA (PF: 6.6%, 6.4-6.7%) from 2011 to 2016. The PFs declined each year along with decreasing influenza vaccination coverage. If 50% of the study population had been vaccinated over time, the estimated numbers of averted cases during the study period would have been 4059 (3120-5762) influenza hospitalizations (PF: 27.2%, 26.4-27.9%) and 56,215 (42,925-78,849) influenza illnesses (PF: 28.5%, 28.3-28.7%), of which 46,596 (35,662-65,234) would be MA (PF: 28.5%, 28.3-28.7%). CONCLUSION Influenza vaccination is estimated to have averted influenza-associated illness outcomes even with low coverage in children aged 6-59 months in Suzhou. Increasing influenza vaccination coverage in this population could further reduce illnesses and hospitalizations.
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Affiliation(s)
- Wanqing Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Junmei Gao
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Liling Chen
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Jianmei Tian
- Suzhou University Affiliated Children's Hospital, Suzhou, China
| | - Matthew Biggerstaff
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suizan Zhou
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sujian Situ
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yin Wang
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jun Zhang
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Alexander J Millman
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carolyn M Greene
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tao Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
| | - Genming Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
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Hussain R, Bukhari NI, ur Rehman A, Hassali MA, Babar ZUD. Vaccine Prices: A Systematic Review of Literature. Vaccines (Basel) 2020; 8:vaccines8040629. [PMID: 33137948 PMCID: PMC7712864 DOI: 10.3390/vaccines8040629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 01/15/2023] Open
Abstract
Vaccines are among the most vital interventions to control and reduce the morbidity and mortality worldwide. In accessing vaccines, pricing is usually the single most important deciding element. However, there is a scarcity of the literature on the vaccines pricing. The current study aims to review vaccine prices from the published literature and to evaluate factors that impact the pricing of vaccines. The literature (from 2015–2020) was reviewed to identify the original research articles. Systematic searches were conducted across the five databases including, Google Scholar, PubMed, Science Direct, Scopus and Springer Link. Literature search yielded 23,626 articles, of which 7351 were screened and 7310 articles were excluded based on title and abstracts relevance. The 41 studies were selected for full text review and 4 studies were found to meet the inclusion criteria. The included studies discussed vaccine prices for childhood vaccines, for Human Papilloma Virus (HPV) in US, China and in Europe. One study detailed the various scenarios of the HPV vaccines pricing. It was found that recently introduced vaccines have higher prices owing to the involvement of technology and research for their manufacture. However, prices tended to decrease over some maturation in price and by the involvement of Global Alliance for Vaccine Initiative (GAVI) and other allies. The prices of vaccines in China were much lower than the other high-income countries and the prices offered through United Nations Children’s Fund (UNICEF), mainly due to the large scale of demand in China. The affordable prices of vaccines were related to delicate procedures involving multiple stakeholders and a shorter duration of contract. This review systematically evaluated the literature and identified key factors that could impact vaccines pricing. The prices were higher for the newly introduced vaccines into the market. However, with the price maturation, there was a decline in the pricing and affordable prices could be achieved through tender pricing and involvement of GAVI and other allies.
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Affiliation(s)
- Rabia Hussain
- Commonwealth Pharmacists Association, London E1W 1AW, UK;
- Faculty of Pharmacy, The University of Lahore, Lahore 54590, Pakistan
| | - Nadeem Irfan Bukhari
- Punjab University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore 54000, Pakistan;
| | - Anees ur Rehman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia; (A.u.R.); (M.A.H.)
| | - Mohamed Azmi Hassali
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia; (A.u.R.); (M.A.H.)
- Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield, Queensgate HD1 3DH, UK
- Correspondence:
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Lai X, Hosyanto FF, Xu L. Risk of Clostridium tetani infection in an elderly patient following hemorrhoid ligation. J Int Med Res 2020; 48:300060520963983. [PMID: 33107774 PMCID: PMC7604989 DOI: 10.1177/0300060520963983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tetanus after gastrointestinal surgery is an extremely rare but very dangerous
disease caused by infection with Clostridium tetani. Tetanus
can occur due to bacterial infection during surgery or dressing change, or the
bacteria may exist in the patient’s intestines and be discharged with feces.
This report describes a 71-year-old woman who developed tetanus 3 days after a
hemorrhoidal ligation. Clinicians need to be aware of symptoms of C.
tetani infection that might present in patients who have undergone
gastrointestinal procedures.
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Affiliation(s)
- Xiaofei Lai
- Department of Laboratory Medicine, The First Affiliated Hospital
of Chongqing Medical University, Chongqing, China
| | | | - Lei Xu
- Department of Pathogenic Biology, Chongqing Medical University,
Chongqing, China
- Lei Xu, Department of Pathogenic Biology,
Chongqing Medical University, No. 1 YiXueYuan Road, Yuzhong District, Chongqing
400016, China.
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Changes in parents’ decisions pertaining to vaccination of their children after the Changchun Changsheng vaccine scandal in Guangzhou, China. Vaccine 2020; 38:6751-6756. [DOI: 10.1016/j.vaccine.2020.08.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/24/2020] [Accepted: 08/16/2020] [Indexed: 11/19/2022]
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Li X, Lu H, Wu H, Chen Q, Wu P, Pan Q. Factors impacting self-pay pediatric vaccine utilization in China: a large-scale maternal survey. J Int Med Res 2020; 48:300060520948752. [PMID: 32847451 PMCID: PMC7457670 DOI: 10.1177/0300060520948752] [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: 11/16/2022] Open
Abstract
OBJECTIVES Utilization of self-pay vaccines worldwide is very low, especially in China; the reasons for this are unclear. We aimed to identify factors that impact the decision among Chinese mothers to utilize self-pay vaccines for their children. METHODS Mothers who were hospitalized at two hospitals in Zhanjiang City and who agreed to participate by completing the required questionnaire were eligible for this study. RESULTS In total, 7518 respondents (n = 7592) completed the questionnaire and were included in this survey. The self-pay option was largely elected by mothers with one child, compared with those who had two or more children. Similarly, utilization by workers at government agencies and organizations was higher than that among factory workers or unemployed respondents. Mothers with a college degree or above had higher utilization than those with a high school level education or lower. The main issues affecting maternal decisions to utilize self-pay pediatric vaccines were safety, the protective effect, and the high cost. CONCLUSION Mothers with higher socioeconomic status were more inclined to self-pay for pediatric vaccines. Steps taken to enhance public awareness about the safety and protective benefits of self-pay vaccines, as well as lowering their cost will likely encourage broader utilization of these vaccines.
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Affiliation(s)
- Xinxin Li
- Clinical Research Center, Institute of Nephrology, Division of Rheumatology, Affiliated Hospital of Guangdong Medical University, Guangdong, China
| | - Haiyan Lu
- Department of Vaccination, Xiashan Maternal and Child Healthy Hospital, Guangdong, China
| | - Han Wu
- Clinical Research Center, Institute of Nephrology, Division of Rheumatology, Affiliated Hospital of Guangdong Medical University, Guangdong, China
| | - Qiuhua Chen
- Clinical Research Center, Institute of Nephrology, Division of Rheumatology, Affiliated Hospital of Guangdong Medical University, Guangdong, China
| | - Ping Wu
- Clinical Research Center, Institute of Nephrology, Division of Rheumatology, Affiliated Hospital of Guangdong Medical University, Guangdong, China
| | - Qingjun Pan
- Clinical Research Center, Institute of Nephrology, Division of Rheumatology, Affiliated Hospital of Guangdong Medical University, Guangdong, China
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Yan S, Chen H, Zhang Z, Chang S, Xiao Y, Luo L, Zhang Z, Sun L, Chen X, Yang Y, Shi X, Guo Y, Sun Y, Li H, Li N, Han S, Ma M, Yang X. Immunogenicity and safety of different sequential schedules of Sabin strain-based inactivated poliovirus vaccination: A randomized, controlled, open-label, phase IV clinical trial in China. Vaccine 2020; 38:6274-6279. [PMID: 32747216 DOI: 10.1016/j.vaccine.2020.07.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The immunogenicity and safety of the sequential schedule of Sabin strain-based inactivated poliovirus vaccine (sIPV) and bivalent oral poliovirus vaccine (bOPV) remains poorly understood in Chinese population. METHODS A multi-center, open-label, randomized controlled trial was performed involving 648 healthy infants aged 2 months from Inner Mongolia, Shanxi, and Hebei provinces. These participants were divided into three groups: sIPV-bOPV-bOPV, sIPV-sIPV-bOPV, and sIPV-sIPV-sIPV. Doses were administered sequentially at age 2, 3, and 4 months. Neutralisation assays were tested using sera collected at 2 months and 5 months. RESULTS A total of 569 were included in the per-protocol analysis. The seroconversion rates of poliovirus type 1 and 3 were 100% in all three groups, the seroconversion rate of poliovirus type 2 was 91.53% (173/189) (95% CI: 86.62-95.08) in the sIPV-bOPV-bOPV group, 98.38% (182/185) (95% CI: 95.33-99.66) in the sIPV-sIPV-bOPV group, and 99.49% (194/195) (95% CI: 97.18-99.99) in the sIPV-sIPV-sIPV group. For the seroconversion rate of poliovirus types 1 and 3, the sIPV-bOPV-bOPV and sIPV-sIPV-bOPV groups were non-inferior to the sIPV-sIPV-sIPV group. For the seroconversion rate of poliovirus type 2, the sIPV-sIPV-bOPV group was non-inferior to the sIPV-sIPV-sIPV group, and the sIPV-bOPV-bOPV group was inferior to the sIPV-sIPV-sIPV group. All three groups exhibited good safety, with two serious adverse events reported, that were unrelated to vaccine. CONCLUSIONS In china, a new vaccination schedule that including 2 doses of IPV in the national immunization programs is essential. Trial registration ClinicalTrials.govNCT04054492.
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Affiliation(s)
- Shaohong Yan
- Inner Mongolia Autonomous Region Disease Prevention and Control Center, Huhhot, China
| | - Haiping Chen
- China National Biotec Group Company Limited, Beijing, China
| | - Zhenguo Zhang
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Shaoying Chang
- Shanxi Provincial Center for Disease Control and Prevention, Taiyuan, China
| | - Yanhui Xiao
- China National Biotec Group Company Limited, Beijing, China
| | - Linyun Luo
- China National Biotec Group Company Limited, Beijing, China
| | - Zhaoyong Zhang
- Inner Mongolia Autonomous Region Disease Prevention and Control Center, Huhhot, China
| | - Li Sun
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Xiao Chen
- Shanxi Provincial Center for Disease Control and Prevention, Taiyuan, China
| | - Yunkai Yang
- Beijing Institute of Biological Products Company Limited, Beijing, China
| | - Xuanwen Shi
- China National Biotec Group Company Limited, Beijing, China
| | - Yu Guo
- Inner Mongolia Autonomous Region Disease Prevention and Control Center, Huhhot, China
| | - Yunlong Sun
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Hong Li
- Shanxi Provincial Center for Disease Control and Prevention, Taiyuan, China
| | - Na Li
- Beijing Institute of Biological Products Company Limited, Beijing, China
| | - Shasha Han
- China National Biotec Group Company Limited, Beijing, China
| | - Meng Ma
- Beijing Institute of Biological Products Company Limited, Beijing, China
| | - Xiaoming Yang
- China National Biotec Group Company Limited, Beijing, China.
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Morales KF, Menning L, Lambach P. The faces of influenza vaccine recommendation: A Literature review of the determinants and barriers to health providers' recommendation of influenza vaccine in pregnancy. Vaccine 2020; 38:4805-4815. [PMID: 32499068 PMCID: PMC7306152 DOI: 10.1016/j.vaccine.2020.04.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/09/2020] [Accepted: 04/12/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION WHO recommends influenza vaccination for pregnant women and health providers (HPs), yet global uptake for both is persistently low. Research suggests that HPs greatly influence uptake of influenza vaccine in pregnant women. Our review studies HPs' recommendation of influenza vaccine to pregnant women, determinants and barriers to recommendation, and the role that HPs may play in global influenza vaccine coverage. METHODS We undertook a comprehensive global review of literature relating to HPs' recommendation of seasonal influenza vaccines to pregnant women and the determinants and barriers to recommendation and how this may vary by country and context. We evaluated data from each study including frequency of HP recommendation, vaccine coverage, determinants and barriers to recommendation, and the odds of recommending. We tracked the frequency of determinants and barriers to recommendation in heat maps and organized data by world regions and income classifications. RESULTS From 32 studies in 15 countries, we identified 68 determinants or barriers to HPs' recommendation. Recommendation rates were highest (77%) in the Americas and lowest in South East Asia (18%). A HP's own influenza vaccine status was a main determinant of recommendation in multiple country contexts and from different provider types. Financial barriers to recommendation were present in higher-income countries and policy-related barriers were highlighted in lower-income countries. HP perceptions of safety, efficacy, and the utility of vaccine were the most frequently cited barriers, relevant in almost every context. CONCLUSIONS HP recommendation is important to influenza vaccine implementation in pregnant women. A HP's own status is an important recommendation determinant in multiple contexts. Vaccine program implementation plans should consider the impact of HPs' knowledge, awareness and vaccine confidence on their own uptake and recommendation practices, as well as on the uptake among pregnant women. Addressing safety and efficacy concerns is relevant in all contexts for HPs and pregnant women.
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Malagón T. Reasons for optimism about eliminating cervical cancer in China. LANCET PUBLIC HEALTH 2020; 4:e434-e435. [PMID: 31493833 DOI: 10.1016/s2468-2667(19)30157-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Talía Malagón
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada.
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Sidiq KR, Sabir DK, Ali SM, Kodzius R. Does Early Childhood Vaccination Protect Against COVID-19? Front Mol Biosci 2020; 7:120. [PMID: 32582766 PMCID: PMC7292051 DOI: 10.3389/fmolb.2020.00120] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/25/2020] [Indexed: 01/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) is an on-going pandemic caused by the SARS-coronavirus-2 (SARS-CoV-2) which targets the respiratory system of humans. The published data show that children, unlike adults, are less susceptible to contracting the disease. This article aims at understanding why children constitute a minor group among hospitalized COVID-19 patients. Here, we hypothesize that the measles, mumps, and rubella (MMR) vaccine could provide a broad neutralizing antibody against numbers of diseases, including COVID-19. Our hypothesis is based on the 30 amino acid sequence homology between the SARS-CoV-2 Spike (S) glycoprotein (PDB: 6VSB) of both the measles virus fusion (F1) glycoprotein (PDB: 5YXW_B) and the rubella virus envelope (E1) glycoprotein (PDB: 4ADG_A). Computational analysis of the homologous region detected the sequence as antigenic epitopes in both measles and rubella. Therefore, we believe that humoral immunity, created through the MMR vaccination, provides children with advantageous protection against COVID-19 as well, however, an experimental analysis is required.
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Affiliation(s)
- Karzan R Sidiq
- Charmo Centre for Research, Training and Consultancy, Charmo University, Chamchamal, Iraq.,Department of Medical Laboratory Sciences, Charmo University, Chamchamal, Iraq
| | - Dana Khdr Sabir
- Department of Medical Laboratory Sciences, Charmo University, Chamchamal, Iraq
| | - Shakhawan M Ali
- Department of Oral and Maxillofacial Surgery, University of Sulaimani, Sulaimani, Iraq
| | - Rimantas Kodzius
- Panevezys Faculty of Technology and Business, Kaunas Technology University (KTU), Panevezys, Lithuania.,Faculty of Medicine, Ludwig Maximilian University of Munich (LMU), Munich, Germany
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Measles vaccination of young infants in China: A cost-effectiveness analysis. Vaccine 2020; 38:4616-4624. [PMID: 32451210 DOI: 10.1016/j.vaccine.2020.04.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although global progress in measles control has been realized, achieving elimination has proven difficult in many regions of the world. China has adopted a goal of measles elimination but recent outbreaks predominantly affecting children <8 months who are ineligible for vaccination and incompletely protected by maternal antibodies has impeded progress. We assess the cost-effectiveness of adding an initial measles vaccine dose in China to earlier than the currently recommended 8 months of age. METHODS We conducted a cost-utility analysis comparing the costs and health benefits associated with adding a measles vaccine dose to the routine schedule at 4, 5, 6 or 7 months compared to the current recommendation for the first dose at age 8 months. A decision analytic model was developed in Microsoft Excel, including five non-severe and two fatal health outcomes associated with measles infection. Model parameters were informed by the literature and surveillance data. Future costs and health benefits were discounted at 3%. Primary outcomes included costs, Quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) over a lifetime time horizon. RESULTS Lowering the recommended age for initiating the measles vaccination series to address susceptibility in children <8 months provided incremental health gains compared to minimal costs at the individual-level. The ICER was most favorable ($232.70 per QALY gain) for administering an initial dose at 4 months of age due to fewer incremental program costs when shifting measles administration to an immunization visit already established under the Chinese vaccination program. CONCLUSION We found potential beneficial health gains at a minimum cost associated with adding an earlier measles dose <8 months of age in China. Further investigation about disease transmission dynamics is required to more fully assess the tradeoffs of administering measles at a younger age to infants in China.
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Yang J, Atkins KE, Feng L, Baguelin M, Wu P, Yan H, Lau EHY, Wu JT, Liu Y, Cowling BJ, Jit M, Yu H. Cost-effectiveness of introducing national seasonal influenza vaccination for adults aged 60 years and above in mainland China: a modelling analysis. BMC Med 2020; 18:90. [PMID: 32284056 PMCID: PMC7155276 DOI: 10.1186/s12916-020-01545-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China has an aging population with an increasing number of adults aged ≥ 60 years. Influenza causes a heavy disease burden in older adults, but can be alleviated by vaccination. We assessed the cost-effectiveness of a potential government-funded seasonal influenza vaccination program in older adults in China. METHODS We characterized the health and economic impact of a fully funded influenza vaccination program for older adults using China-specific influenza disease burden, and related cost data, etc. Using a decision tree model, we calculated the incremental costs per quality-adjusted life year (QALY) gained of vaccination from the societal perspective, at a willingness-to-pay threshold equivalent to GDP per capita (US$8840). Moreover, we estimated the threshold vaccination costs, under which the fully funded vaccination program is cost-effective using GDP per capita as the willingness-to-pay threshold. RESULTS Compared to current self-paid vaccination, a fully funded vaccination program is expected to prevent 19,812 (95% uncertainty interval, 7150-35,783) influenza-like-illness outpatient consultations per year, 9418 (3386-17,068) severe acute respiratory infection hospitalizations per year, and 8800 (5300-11,667) respiratory excess deaths due to influenza per year, and gain 70,212 (42,106-93,635) QALYs per year. Nationally, the incremental costs per QALY gained of the vaccination program is US$4832 (3460-8307), with a 98% probability of being cost-effective. The threshold vaccination cost is US$10.19 (6.08-13.65). However, variations exist between geographical regions, with Northeast and Central China having lower probabilities of cost-effectiveness. CONCLUSIONS Our results support the implementation of a government fully funded older adult vaccination program in China. The regional analysis provides results across settings that may be relevant to other countries with similar disease burden and economic status, especially for low- and middle-income countries where such analysis is limited.
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Affiliation(s)
- Juan Yang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Katherine E Atkins
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Luzhao Feng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Marc Baguelin
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Han Yan
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Eric H Y Lau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Joseph T Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yang Liu
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Mark Jit
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Modelling and Economics Unit, Public Health England, London, UK
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
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Huang K, Tao S, Zhou X, Mo J, Zhu B, Shen P, Lin H, Arena PJ, He N. Incidence rates of health outcomes of interest among Chinese children exposed to selected vaccines in Yinzhou Electronic Health Records: A population-based retrospective cohort study. Vaccine 2020; 38:3422-3428. [PMID: 32178909 DOI: 10.1016/j.vaccine.2020.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Oral poliovirus vaccine (OPV) and diphtheria-tetanus-acellular pertussis vaccine (DTaP) are widely used in China while Haemophilus influenzae type b vaccines (Hib) and a DTaP, inactivated poliovirus (IPV) andHib polysaccharide conjugated to tetanus protein (PRP ~ T) combined vaccine (DTaP-IPV//PRP ~ T) have lower coverage. There are limited safety data on these vaccines in Chinese pediatric populations. METHODS To estimate incidence rates (IRs) of health outcomes of interest (HOIs) among children exposed to OPV, DTaP, Hib, and DTaP-IPV//PRP ~ T, we conducted a retrospective cohort study using a population-based electronic health record (EHR) database in Yinzhou district, Ningbo City. Children 0-2 years of age receiving at least one dose of these vaccines between January 1, 2012 and March 31, 2017 were included in the study. Yinzhou EHR database consisted of immunization records and healthcare data of children from hospitals and community health centers in the district. Eight HOIs (i.e., anaphylaxis, febrile seizures, all seizures, asthma, apnea, Kawasaki disease [KD], urticaria/angioedema, Guillain-Barré syndrome [GBS]) were identified using ICD-10 codes. RESULTS A total of 220,422 eligible children was identified. No cases of apnea, KD, and GBS were observed within 7 days post-vaccination. During 0-7 days post-vaccination for OPV, DTaP, Hib, and DTaP-IPV//PRP ~ T, the IRs of anaphylaxis, febrile seizures, all seizures, urticaria/angioedema and asthma ranged from 0.0 to 50.0, 0.0 to 99.9, 29.1 to 249.8, 297.8 to 949.1, and 992.7 to 2298.2 per 100,000 person-years, respectively, and 0.0 to 0.9, 0.0 to 1.9, 0.6 to 4.6, 5.6 to 17.5, and 18.7 to 42.3 per 100,000 doses, respectively. CONCLUSION IRs of some HOIs in our study were comparable with those in the literature while IRs of other HOIs were not due to differences in study design, post-vaccination risk periods assessed, and vaccine types. Future studies should consider medical chart review for validating HOIs obtained in the EHR.
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Affiliation(s)
- Kui Huang
- Pfizer Inc., 235 East 42nd Street, New York, NY 10017, United States
| | - Sha Tao
- School of Public Health, Fudan University 138 Yi Xue Yuan Road, Shanghai 200032, China
| | - Xiaofeng Zhou
- Pfizer Inc., 235 East 42nd Street, New York, NY 10017, United States
| | - Jingping Mo
- Pfizer Inc., 235 East 42nd Street, New York, NY 10017, United States
| | - Bowen Zhu
- School of Public Health, Fudan University 138 Yi Xue Yuan Road, Shanghai 200032, China
| | - Peng Shen
- Yinzhou Center for Disease Control and Prevention, 221 Xueshi Road, Ningbo, Zhejiang 315100, China
| | - Hongbo Lin
- Yinzhou Center for Disease Control and Prevention, 221 Xueshi Road, Ningbo, Zhejiang 315100, China
| | - Patrick J Arena
- Pfizer Inc., 235 East 42nd Street, New York, NY 10017, United States
| | - Na He
- School of Public Health, Fudan University 138 Yi Xue Yuan Road, Shanghai 200032, China.
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Zhou S, Greene CM, Song Y, Zhang R, Rodewald LE, Feng L, Millman AJ. Review of the status and challenges associated with increasing influenza vaccination coverage among pregnant women in China. Hum Vaccin Immunother 2020; 16:602-611. [PMID: 31589548 DOI: 10.1080/21645515.2019.1664230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Influenza vaccination coverage in pregnant women in China remains low. In this review, we first provide an overview of the evidence for the use of influenza vaccination during pregnancy. Second, we discuss influenza vaccination policy and barriers to increased seasonal influenza vaccination coverage in pregnant women in China. Third, we provide case studies of successes and challenges of programs for increasing seasonal influenza vaccination in pregnant women from other parts of Asia with lessons learned for China. Finally, we assess opportunities and challenges for increasing influenza vaccination coverage among pregnant women in China.
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Affiliation(s)
- Suizan Zhou
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carolyn M Greene
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ying Song
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ran Zhang
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lance E Rodewald
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Luzhao Feng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Alexander J Millman
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Special issues raised by evolving areas of clinical research. ETHICAL CONSIDERATIONS WHEN PREPARING A CLINICAL RESEARCH PROTOCOL 2020. [PMCID: PMC7329119 DOI: 10.1016/b978-0-12-386935-7.00014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Each study presents its own set of ethical considerations. Certain kinds of ethical issues are inherent in particular areas of clinical research, regardless of specific ethical questions associated with a specific study. In this chapter, some of the most common special areas of clinical research are presented, highlighting the ethical issues most frequently associated with each.
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50
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Zhuang J, Lu Y, Wagner AL, Jiang Q. Profit considerations in vaccine safety-related events in China. Expert Rev Vaccines 2019; 18:1187-1199. [PMID: 31674844 DOI: 10.1080/14760584.2019.1688150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives: China has made remarkable achievements in the field of immunization. However, several widespread vaccine safety-related events have recently received worldwide attention and reflect flaws in vaccine management. This study aimed to summarize vaccine safety-related events between 1985 and 2018 in China and analyze the profit motives of these events.Methods. Literature and media reviews were conducted to discover vaccine safety-related events. We developed a conceptual model with profit-related variables, and using information available from each event, we identified which profit-related variable was implicated, and how it related to the pursuit of higher profits.Results: A total of 39 vaccine safety-related events were found in vaccine production, procurement, transportation, and daily management, along with adverse events following immunization (AEFIs). Overall, 90% (35/39) of the events could be classified as profit-driven. The motives of most events could be tied to one or more reasons, including decreasing costs among vaccine producers (67%, 26/39), reducing actual procurement price (67%, 26/39), and reducing costs of transportation and/or cold chain (24/39, 62%).Conclusions: In order to deal with vaccine-related challenges, a more restrictive supervision system on vaccine production and more emergency preparedness, including health and risk communication strategies, for vaccine safety should be implemented.
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Affiliation(s)
- Jianlin Zhuang
- School of Public Health, Fudan University, Shanghai, China.,Department of General Affairs and Emergency Response, Changing District Centers for Disease Control and Prevention, Shanghai, China
| | - Yihan Lu
- School of Public Health, Fudan University, Shanghai, China
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Qingwu Jiang
- School of Public Health, Fudan University, Shanghai, China
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