Objective:To explore and understand the attitude towards dengue vaccination and its modifiable determinants among inhabitants of Aceh(northern Sumatra Island,Indonesia),the region that was most severely affected by th...Objective:To explore and understand the attitude towards dengue vaccination and its modifiable determinants among inhabitants of Aceh(northern Sumatra Island,Indonesia),the region that was most severely affected by the earthquake and tsunami of 26 December 2004.Methods:A communitybased,cross-sectional study was conducted among 535 healthy inhabitants in nine regencies(Kabupaten or Kotamadya)of Aceh that were selected randomly from November 2014 to March 2015.A set of validated,pre-tested,structured questionnaires was used to guide the interviews.The questionnaires covered a range of explanatory variables and one outcome variable(attitude to dengue vaccination).Multi-step logistic regression analysis and Spearman's rank correlation were used to test the role of explanatory variables for the outcome variable.Results:More than 70%of the participants had a poor attitude towards dengue vaccination.Modifiablc determinants associated with poor attitude to dengue vaccination were low education level,working as farmers and traditional market traders,low socioeconomic status and poor knowledge,attitude and practice regarding dengue fever(P<0.05).The KAP domain scores were correlated strongly with attitude to dengue vaccination,r_s=0.25,r_S=0.67 and r_s=0.20,respectively(P<0.001).Multivariate analysis found that independent predictors associated with attitude towards dengue vaccination among study participants were only sex and attitude towards dengue fever(P<0.001).Conclusions:This study reveals that low KAP regarding dengue fever,low education level and low socioeconomic status are associated with a poor attitude towards dengue vaccination.Therefore,inhabitants of suburbs who are working as larmers or traditional market traders with low socioeconomic status are the most appropriate target group for a dengue vaccine introduction program.展开更多
In order to increase the convenience of application and minimize logistical problems in the recent years, the use of combined vaccines has become a growing trend. The use of combined vaccines offers benefits such as, ...In order to increase the convenience of application and minimize logistical problems in the recent years, the use of combined vaccines has become a growing trend. The use of combined vaccines offers benefits such as, a reduction in the number of patient visits, less complications which are associated with multiple intramuscular drilling and other risks. In 1997 the Department of Epidemiology （DE） of Institute of Public Health initiated and carried out conspicuous quantitative and qualitative modifications of up-to-them statutory notification system thus compiling the new Major Disease-Based Epidemiological Surveillance System. Mandatory reporting system on Measles/Rubella Case-Based Surveillance represents in itself an addendum of the statutory reporting system of infectious diseases. These diseases are enlisted in the Group B of the 14/Sh Form. Diphtheria is enlisted in the Group A containing the infectious diseases of the highest public health importance. They are subject of a mandatory urgent notification from the basic level. The aim of this study is to examine and check up the effectiveness of combined vaccines in our country, through the evaluation of the data from national epidemiologic surveillance verifying the distributions in time and space of these diseases in relation to the history of vaccination policies in Albania.展开更多
Background:Japanese encephalitis(JE)is a leading cause of childhood viral encephalitis both at global level and in China.Vaccination is recommended as a key strategy to control JE.In China most JE cases have been repo...Background:Japanese encephalitis(JE)is a leading cause of childhood viral encephalitis both at global level and in China.Vaccination is recommended as a key strategy to control JE.In China most JE cases have been reported in southwest provinces,which include Yunnan.In this study,we quantify the epidemiological shift of JE in Yunnan Province from 2005 to 2017,covering before and after the introduction of JE vaccination into routine Expanded Program on Immunization(EPI)in 2007.Methods:We used routinely collected data in the case-based JE surveillance system from 2005 through 2017 in Yunnan.Cases were reported from hospital and county-level Centers for Disease Control in line with the National JE Surveillance Guideline.Epidemiological data were extracted,analysed and presented in appropriate ways.Immunization coverage was estimated from actual JE doses administered and new births for each year.Results:A total 4780 JE cases(3077 laboratory-confirmed,1266 clinical and 437 suspected)were reported in the study period.Incidence of JE(per 100000 population)increased from 0.95 in 2005 to 1.69 in 2007.With increase in vaccination coverage,incidence rates decreased steadily from 1.16 in 2009 to 0.17 in 2017.However,seasonality remained similar across the years,peaking in June-September.Banna(bordering Myanmar and Laos),Dehong(bordering Myanmar),and Zhaotong(an inland prefecture)had the highest incidence rates of 2.3,1.9,and 1.6,respectively.97%of all cases were among local residents.As vaccination coverage increased(and incidence decreased),proportion of JE cases among children<10 years old decreased from 70%in 2005 to 32%in 2017,while that among adults>20 years old increased from 12 to 48%.There were a large number of JE cases with unknown treatment outcomes,especially in the earlier years of the surveillance system.Conclusions:The 13-year JE surveillance data in Yunnan Province showed dramatic decrease of total incidence and a shift from children to adults.Improving vaccination coverage,including access to adults at risk,and strengthening the JE surveillance system is needed to further control or eliminate JE in the province.展开更多
Background Migrant and left-behind families are vulnerable in health services utilization,but little is known about their disparities in immunization of non-National Immunization Program(NIP)vaccines.This study aims t...Background Migrant and left-behind families are vulnerable in health services utilization,but little is known about their disparities in immunization of non-National Immunization Program(NIP)vaccines.This study aims to evaluate the immunization coverage,knowledge,satisfaction,and associated factors of non-NIP vaccines among local and migrant families in the urban areas and non-left-behind and left-behind families in the rural areas of China.Methods A cross-sectional survey was conducted in urban areas of Zhejiang and rural areas of Henan in China.A total of 1648 caregivers of children aged 1-6 years were interviewed face-to-face by a pre-designed online questionnaire,and their families were grouped into four types:local urban,migrant,non-left-behind,and left-behind.Non-NIP vaccines includedHemophilus influenza b(Hib)vaccine,varicella vaccine,rotavirus vaccine,enterovirus 71 vaccine(EV71)and 13-valent pneumonia vaccine(PCV13).Log-binomial regression models were used to calculate prevalence ratios(PRs)and 95%confidence intervals(CIs)for the difference on immunization coverage of children,and knowledge and satisfaction of caregivers among families.The network models were conducted to explore the interplay of immunization coverage,knowledge,and satisfaction.Logistic regression models with odds ratios(ORs)and 95%CIs were used to estimate the associated factors of non-NIP vaccination.Results The immunization coverage of all non-NIP vaccines and knowledge of all items of local urban families was the highest,followed by migrant,non-left-behind and left-behind families.Compared with local urban children,thePRs(95%CIs)for getting all vaccinated were 0.65(0.52-0.81),0.29(0.22-0.37)and 0.14(0.09-0.21)among migrant children,non-left-behind children and left-behind children,respectively.The coverage-knowledge-satisfaction network model showed the core node was the satisfaction of vaccination schedule.Non-NIP vaccination was associated with characteristics of both children and caregivers,including age of children(>2 years-OR:1.69,95%CI:1.07-2.68 for local urban children;2.67,1.39-5.13 for migrant children;3.09,1.23-7.76 for non-left-behind children);and below caregivers’characteristics:family role(parents:0.37,0.14-0.99 for non-left-behind children),age(≤35 years:7.27,1.39-37.94 for non-left-behind children),sex(female:0.49,0.30-0.81 for local urban children;0.31,0.15-0.62 for non-left-behind children),physical health(more than average:1.58,1.07-2.35 for local urban children)and non-NIP vaccines knowledge(good:0.45,0.30-0.68 for local urban children;7.54,2.64-21.50 for left-behind children).Conclusions There were immunization disparities in non-NIP vaccines among migrant and left-behind families compared with their local counterparts.Non-NIP vaccination promotion strategies,including education on caregivers,and optimization of the immunization information system,should be delivered particularly among left-behind and migrant families.展开更多
Background Non-National Immunization Program (NIP) vaccines have played an important role in controlling vaccine-preventable diseases (VPDs) in China. However, these vaccines are paid out of pocket and there is room t...Background Non-National Immunization Program (NIP) vaccines have played an important role in controlling vaccine-preventable diseases (VPDs) in China. However, these vaccines are paid out of pocket and there is room to increase their coverage. We focused on four selected non-NIP vaccines in this study, namely Haemophilus influenzae type b (Hib) vaccine, human papillomavirus (HPV) vaccine, pneumococcal conjugate vaccine (PCV), and rotavirus vaccine. We aimed to conduct a scoping review of their vaccination rates and the major barriers faced by health systems, providers, and caregivers to increase coverage.Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). We searched five English databases (PubMed, Web of Science, EMBASE, Scopus, and WHO IRIS) and four Chinese databases using the search strategy developed by the study team. Two independent reviewers screened, selected studies, and examined their quality. We summarized the non-NIP vaccine coverage data by vaccine and applied the 5A framework (Access, Affordability, Acceptance, Awareness, Activation) to chart and analyze barriers to increasing coverage.Results A total of 28 articles were included in the analysis (nine pertaining to vaccine coverage, and another 19 reporting challenges of increasing uptake). Among the four selected vaccines, coverage for the Hib vaccine was the highest (54.9-55.9% for 1 dose or more from two meta-analyses) in 2016, while the coverage of the other three vaccines was lower than 30%. Eight of the nine included articles mentioned the regional disparity of coverage, which was lower in under-developing regions. For example, the three-dose Hib vaccination rate in eastern provinces was 38.1%, whereas the rate in central and western provinces was 34.3% and 26.2%, respectively in 2017. Within the 5A framework, acceptance, awareness, and affordability stood out as the most prominent themes. Among the 12 identified sub-themes, high prices, low vaccine awareness, concerns about vaccine safety and efficacy were the most cited barriers to increasing the uptake.Conclusions There is an urgent need to increase coverage of non-NIP vaccines and reduce disparities in access to these vaccines across regions. Concerted efforts from the government, the public, and society are required to tackle the barriers and challenges identified in this study, both on the demand and supply side, to ensure everybody has equal access to life-saving vaccines in China. Particularly, the government should take a prudent approach to gradually incorporate non-NIP vaccines into the NIP step by step, and make a prioritizing strategy based on key factors such as disease burden, financial resources, and market readiness, with special attention to high-risk populations and underdeveloped regions.展开更多
With the expansion of vaccination programs,the policy of terminating nonpharmaceutical interventions for preventing the SARS-CoV-2 pandemic should become more flexible.The current study investigated the clinical and e...With the expansion of vaccination programs,the policy of terminating nonpharmaceutical interventions for preventing the SARS-CoV-2 pandemic should become more flexible.The current study investigated the clinical and economic outcomes of intervention policies combining nonpharmaceutical interventions and vaccination programs for dealing with the SARS-CoV-2 pandemic.An agent-based transmission model was adopted that describes how a SARS-CoV-2 virus spreads in the populations of China.The model inputs were derived from the literature and expert opinion.The following intervention policies were simulated:no intervention,strict nonpharmaceutical interventions,and nonpharmaceutical interventions for workplace,community,school and home gradually terminated by combining vaccination programs for specified age groups(vaccination age in years:20-60,20-70,20-80,≥20,≥10 and whole population).Cumulative infections and deaths in one calendar year,costs and quality-adjusted life years(QALYs)were measured.When the vaccination program was taken up in at least the≥20 years age group in all populations,nonpharmaceutical interventions for workplace and community settings could be gradually terminated because the cumulative number of infections was<100 per 100,000 persons.Further ending nonpharmaceutical interventions in school and home settings could not meet the target even when the vaccination program had been taken up in all populations.When cumulative deaths were used as the endpoint,nonpharmaceutical interventions in workplace,community and school settings could be gradually terminated.Vaccine efficacy and coverage have substantial impacts.Terminating nonpharmaceutical interventions in workplace settings could produce the lowest cost when vaccination programs are taken up at least in the≥10 years age group;this method dominates most intervention strategies due to its lower costs and higher QALYs.According to our findings,nonpharmaceutical interventions might be gradually terminated in Chinese settings.展开更多
文摘Objective:To explore and understand the attitude towards dengue vaccination and its modifiable determinants among inhabitants of Aceh(northern Sumatra Island,Indonesia),the region that was most severely affected by the earthquake and tsunami of 26 December 2004.Methods:A communitybased,cross-sectional study was conducted among 535 healthy inhabitants in nine regencies(Kabupaten or Kotamadya)of Aceh that were selected randomly from November 2014 to March 2015.A set of validated,pre-tested,structured questionnaires was used to guide the interviews.The questionnaires covered a range of explanatory variables and one outcome variable(attitude to dengue vaccination).Multi-step logistic regression analysis and Spearman's rank correlation were used to test the role of explanatory variables for the outcome variable.Results:More than 70%of the participants had a poor attitude towards dengue vaccination.Modifiablc determinants associated with poor attitude to dengue vaccination were low education level,working as farmers and traditional market traders,low socioeconomic status and poor knowledge,attitude and practice regarding dengue fever(P<0.05).The KAP domain scores were correlated strongly with attitude to dengue vaccination,r_s=0.25,r_S=0.67 and r_s=0.20,respectively(P<0.001).Multivariate analysis found that independent predictors associated with attitude towards dengue vaccination among study participants were only sex and attitude towards dengue fever(P<0.001).Conclusions:This study reveals that low KAP regarding dengue fever,low education level and low socioeconomic status are associated with a poor attitude towards dengue vaccination.Therefore,inhabitants of suburbs who are working as larmers or traditional market traders with low socioeconomic status are the most appropriate target group for a dengue vaccine introduction program.
文摘In order to increase the convenience of application and minimize logistical problems in the recent years, the use of combined vaccines has become a growing trend. The use of combined vaccines offers benefits such as, a reduction in the number of patient visits, less complications which are associated with multiple intramuscular drilling and other risks. In 1997 the Department of Epidemiology （DE） of Institute of Public Health initiated and carried out conspicuous quantitative and qualitative modifications of up-to-them statutory notification system thus compiling the new Major Disease-Based Epidemiological Surveillance System. Mandatory reporting system on Measles/Rubella Case-Based Surveillance represents in itself an addendum of the statutory reporting system of infectious diseases. These diseases are enlisted in the Group B of the 14/Sh Form. Diphtheria is enlisted in the Group A containing the infectious diseases of the highest public health importance. They are subject of a mandatory urgent notification from the basic level. The aim of this study is to examine and check up the effectiveness of combined vaccines in our country, through the evaluation of the data from national epidemiologic surveillance verifying the distributions in time and space of these diseases in relation to the history of vaccination policies in Albania.
基金This study was conducted as part of the routine duties of the principal author at the Yunnan Provincial Centre for Disease Control and Prevention and required no additional funding resourcesFunding for the costs of publication in an open-access,peer-reviewed journal was supported by Yunnan Provincial Centre for Disease Control and Prevention.
文摘Background:Japanese encephalitis(JE)is a leading cause of childhood viral encephalitis both at global level and in China.Vaccination is recommended as a key strategy to control JE.In China most JE cases have been reported in southwest provinces,which include Yunnan.In this study,we quantify the epidemiological shift of JE in Yunnan Province from 2005 to 2017,covering before and after the introduction of JE vaccination into routine Expanded Program on Immunization(EPI)in 2007.Methods:We used routinely collected data in the case-based JE surveillance system from 2005 through 2017 in Yunnan.Cases were reported from hospital and county-level Centers for Disease Control in line with the National JE Surveillance Guideline.Epidemiological data were extracted,analysed and presented in appropriate ways.Immunization coverage was estimated from actual JE doses administered and new births for each year.Results:A total 4780 JE cases(3077 laboratory-confirmed,1266 clinical and 437 suspected)were reported in the study period.Incidence of JE(per 100000 population)increased from 0.95 in 2005 to 1.69 in 2007.With increase in vaccination coverage,incidence rates decreased steadily from 1.16 in 2009 to 0.17 in 2017.However,seasonality remained similar across the years,peaking in June-September.Banna(bordering Myanmar and Laos),Dehong(bordering Myanmar),and Zhaotong(an inland prefecture)had the highest incidence rates of 2.3,1.9,and 1.6,respectively.97%of all cases were among local residents.As vaccination coverage increased(and incidence decreased),proportion of JE cases among children<10 years old decreased from 70%in 2005 to 32%in 2017,while that among adults>20 years old increased from 12 to 48%.There were a large number of JE cases with unknown treatment outcomes,especially in the earlier years of the surveillance system.Conclusions:The 13-year JE surveillance data in Yunnan Province showed dramatic decrease of total incidence and a shift from children to adults.Improving vaccination coverage,including access to adults at risk,and strengthening the JE surveillance system is needed to further control or eliminate JE in the province.
基金This study was funded by the Bill&Melinda Gates Foundation(INV-034554)。
文摘Background Migrant and left-behind families are vulnerable in health services utilization,but little is known about their disparities in immunization of non-National Immunization Program(NIP)vaccines.This study aims to evaluate the immunization coverage,knowledge,satisfaction,and associated factors of non-NIP vaccines among local and migrant families in the urban areas and non-left-behind and left-behind families in the rural areas of China.Methods A cross-sectional survey was conducted in urban areas of Zhejiang and rural areas of Henan in China.A total of 1648 caregivers of children aged 1-6 years were interviewed face-to-face by a pre-designed online questionnaire,and their families were grouped into four types:local urban,migrant,non-left-behind,and left-behind.Non-NIP vaccines includedHemophilus influenza b(Hib)vaccine,varicella vaccine,rotavirus vaccine,enterovirus 71 vaccine(EV71)and 13-valent pneumonia vaccine(PCV13).Log-binomial regression models were used to calculate prevalence ratios(PRs)and 95%confidence intervals(CIs)for the difference on immunization coverage of children,and knowledge and satisfaction of caregivers among families.The network models were conducted to explore the interplay of immunization coverage,knowledge,and satisfaction.Logistic regression models with odds ratios(ORs)and 95%CIs were used to estimate the associated factors of non-NIP vaccination.Results The immunization coverage of all non-NIP vaccines and knowledge of all items of local urban families was the highest,followed by migrant,non-left-behind and left-behind families.Compared with local urban children,thePRs(95%CIs)for getting all vaccinated were 0.65(0.52-0.81),0.29(0.22-0.37)and 0.14(0.09-0.21)among migrant children,non-left-behind children and left-behind children,respectively.The coverage-knowledge-satisfaction network model showed the core node was the satisfaction of vaccination schedule.Non-NIP vaccination was associated with characteristics of both children and caregivers,including age of children(>2 years-OR:1.69,95%CI:1.07-2.68 for local urban children;2.67,1.39-5.13 for migrant children;3.09,1.23-7.76 for non-left-behind children);and below caregivers’characteristics:family role(parents:0.37,0.14-0.99 for non-left-behind children),age(≤35 years:7.27,1.39-37.94 for non-left-behind children),sex(female:0.49,0.30-0.81 for local urban children;0.31,0.15-0.62 for non-left-behind children),physical health(more than average:1.58,1.07-2.35 for local urban children)and non-NIP vaccines knowledge(good:0.45,0.30-0.68 for local urban children;7.54,2.64-21.50 for left-behind children).Conclusions There were immunization disparities in non-NIP vaccines among migrant and left-behind families compared with their local counterparts.Non-NIP vaccination promotion strategies,including education on caregivers,and optimization of the immunization information system,should be delivered particularly among left-behind and migrant families.
基金supported by the Bill&Melinda Gates Foundation(INV-034554).
文摘Background Non-National Immunization Program (NIP) vaccines have played an important role in controlling vaccine-preventable diseases (VPDs) in China. However, these vaccines are paid out of pocket and there is room to increase their coverage. We focused on four selected non-NIP vaccines in this study, namely Haemophilus influenzae type b (Hib) vaccine, human papillomavirus (HPV) vaccine, pneumococcal conjugate vaccine (PCV), and rotavirus vaccine. We aimed to conduct a scoping review of their vaccination rates and the major barriers faced by health systems, providers, and caregivers to increase coverage.Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). We searched five English databases (PubMed, Web of Science, EMBASE, Scopus, and WHO IRIS) and four Chinese databases using the search strategy developed by the study team. Two independent reviewers screened, selected studies, and examined their quality. We summarized the non-NIP vaccine coverage data by vaccine and applied the 5A framework (Access, Affordability, Acceptance, Awareness, Activation) to chart and analyze barriers to increasing coverage.Results A total of 28 articles were included in the analysis (nine pertaining to vaccine coverage, and another 19 reporting challenges of increasing uptake). Among the four selected vaccines, coverage for the Hib vaccine was the highest (54.9-55.9% for 1 dose or more from two meta-analyses) in 2016, while the coverage of the other three vaccines was lower than 30%. Eight of the nine included articles mentioned the regional disparity of coverage, which was lower in under-developing regions. For example, the three-dose Hib vaccination rate in eastern provinces was 38.1%, whereas the rate in central and western provinces was 34.3% and 26.2%, respectively in 2017. Within the 5A framework, acceptance, awareness, and affordability stood out as the most prominent themes. Among the 12 identified sub-themes, high prices, low vaccine awareness, concerns about vaccine safety and efficacy were the most cited barriers to increasing the uptake.Conclusions There is an urgent need to increase coverage of non-NIP vaccines and reduce disparities in access to these vaccines across regions. Concerted efforts from the government, the public, and society are required to tackle the barriers and challenges identified in this study, both on the demand and supply side, to ensure everybody has equal access to life-saving vaccines in China. Particularly, the government should take a prudent approach to gradually incorporate non-NIP vaccines into the NIP step by step, and make a prioritizing strategy based on key factors such as disease burden, financial resources, and market readiness, with special attention to high-risk populations and underdeveloped regions.
文摘With the expansion of vaccination programs,the policy of terminating nonpharmaceutical interventions for preventing the SARS-CoV-2 pandemic should become more flexible.The current study investigated the clinical and economic outcomes of intervention policies combining nonpharmaceutical interventions and vaccination programs for dealing with the SARS-CoV-2 pandemic.An agent-based transmission model was adopted that describes how a SARS-CoV-2 virus spreads in the populations of China.The model inputs were derived from the literature and expert opinion.The following intervention policies were simulated:no intervention,strict nonpharmaceutical interventions,and nonpharmaceutical interventions for workplace,community,school and home gradually terminated by combining vaccination programs for specified age groups(vaccination age in years:20-60,20-70,20-80,≥20,≥10 and whole population).Cumulative infections and deaths in one calendar year,costs and quality-adjusted life years(QALYs)were measured.When the vaccination program was taken up in at least the≥20 years age group in all populations,nonpharmaceutical interventions for workplace and community settings could be gradually terminated because the cumulative number of infections was<100 per 100,000 persons.Further ending nonpharmaceutical interventions in school and home settings could not meet the target even when the vaccination program had been taken up in all populations.When cumulative deaths were used as the endpoint,nonpharmaceutical interventions in workplace,community and school settings could be gradually terminated.Vaccine efficacy and coverage have substantial impacts.Terminating nonpharmaceutical interventions in workplace settings could produce the lowest cost when vaccination programs are taken up at least in the≥10 years age group;this method dominates most intervention strategies due to its lower costs and higher QALYs.According to our findings,nonpharmaceutical interventions might be gradually terminated in Chinese settings.
