The Impact of Residency and Urbanicity on Haemophilus influenzae Type b and Pneumococcal Immunization in Shanghai Children: A Retrospective Cohort Study

Abstract

Background Haemophilus influenzae type b (Hib) vaccine and pneumococcal conjugate vaccine (PCV) are relatively expensive, newly introduced vaccines in China. This study evaluates the impact of residency and urbanicity on Hib vaccine and PCV coverage for children aged 2 to 7 years living in Shanghai, China, in August 2012.MethodsIn this exploratory cohort study, a sample of children aged 2 to 7 years, all of whom were eligible to have received the complete series of Hib vaccine and PCV, was obtained from the Shanghai Immunization Program Information System. Three measures of vaccination coverage for Hib vaccine and PCV were examined: dose 1 coverage, series completion, and timeliness of dose 1 vaccination. Multivariable binomial regression was used to estimate the difference in vaccination coverage between locals and the floating population.ResultsDose 1 coverage was 50.9% for Hib vaccine and 11.4% for PCV for the 28,141 abstracted pediatric records. For both vaccines, dose 1 coverage was higher in locals than in the floating population. The disparity in coverage between locals and the floating population was greater in suburban areas than urban areas. Of all children who received dose 1, 79.7% completed the Hib vaccine series, and 91.3% completed the PCV series. Timely dose 1 coverage was 8.2% for Hib vaccine and 0.5% for PCV.ConclusionLow vaccination coverage and extremely low levels of timely dose 1 vaccination indicate that current vaccination efforts are inadequate to reduce the burden of Hib and pneumococcal disease among Chinese children, especially infants. Government funding of the Hib vaccine and PCV through the Expanded Program on Immunization would increase uptake and could also ensure that improvement in the timeliness of administration and series completion is targeted for all demographic groups.

Clinical and pathogenic analysis of 507 children with bacterial meningitis in Beijing, 2010–2014

“…One study performed in 2014 in Shanghai showed a PCV vaccine coverage of 11.4% from 28 141 abstracted pediatric records. 22 In the present study, a total of five serotypes were identified among 12 S. pneumoniae isolates. There were four isolates of serotype 19F, three isolates of 23F, two isolates each of 19A and 14, and one isolate of 6A.…”

“…One key contributing factor is that a meningococcal vaccine has been part of the National Immunization Program (NIP) since the 1980s; the coverage of group A meningococcal polysaccharide reported in 2012 was 91.22%. 21 The Hib vaccine has been in use since the 1990s with a coverage of 50.9%, 22 even though it has not been included in the NIP. The other key factor is the high rate of antimicrobial drug use in clinical practice in China.…”

Trends in childhood pneumococcal vaccine coverage in Shanghai, China, 2005–2011: a retrospective cohort study

“…Moreover, we have found that disparities between non-locals and locals are greater in regards to non-EPI vaccines than EPI vaccines. In a previous analysis of children <8 years of age living in Shanghai, we found that the coverage of DTP, an EPI vaccine, was similar in locals and non-locals, but there was substantially lower coverage of two non-EPI vaccines (PCV7 and a Haemophilus influenzae type b vaccine) among non-locals compared to locals [ 17 ].…”

Countering vaccine hesitancy through immunization information systems, a narrative review

“…56 Another example comes from the study by MacDonald et al where they assess, through a postal questionnaire, the reasons for no vaccination, or partial immunization, in children 2 y old during the period May 2008-April 2009 in Edmonton, Canada. 48 The obtained results show that concerns about vaccine safety, lack of awareness about disease severity and susceptibility and lack of trust in Underimmunized cluster were in low publicfunded areas Wagner 131…”

“…In this review, we synthetized results from 13 studies. [119][120][121][122][123][124][125][126][127][128][129][130][131] Eccles et al, using a geographical visualization method and IIS, assessed how geographical distribution of those who refuse vaccine had changed during a certain period and over time, identifying specific areas of non-vaccinated. 125 This geographical distribution has high public health impact, both to identify areas with health systems or ethnic-religious barriers and to identify areas with sanitary issues.…”