Background Immunization is a cornerstone of public health.Despite great success,China’s National Immunization Program(NIP)faces challenges,such as the integration of several World Health Organization-recommended vacc...Background Immunization is a cornerstone of public health.Despite great success,China’s National Immunization Program(NIP)faces challenges,such as the integration of several World Health Organization-recommended vaccines and other systemic issues.The Innovation Laboratory for Vaccine Delivery Research(VaxLab),supported by the Bill&Melinda Gates Foundation and established in 2021 at Duke Kunshan University,focuses on enhancing China’s NIP through research and policy advocacy.This editorial aims to summarize the key findings of the manuscripts published in the collection contributed by VaxLab team and set the future research agenda.Key findings The collection contains eleven manuscripts discussing China’s immunization landscape and strategies to improve coverage,particularly for non-NIP vaccines like human papillomavirus vaccine(HPV),pneumococcal conjugate vaccine(PCV),Haemophilus influenzae type b vaccine(Hib),and rotavirus vaccines.Key findings include:(i)The COVID-19 vaccination campaign demonstrated China’s capacity for rapid,large-scale immunization efforts,suggesting potential for broader vaccine coverage improvements;(ii)Efforts in combating cervical cancer through the HPV vaccine indicate progress but also highlight challenges like vaccine supply and equitable access;(iii)The lag in adopting higher-valent paediatric combination vaccines in China needs attention to address regulatory and health system hurdles;(iv)Disparities in access to non-NIP vaccines underscore the need for government initiatives to improve vaccine coverage,especially for remote areas and marginalized populations;(v)Original studies emphasize the influence of caregivers’knowledge,health workers’financial incentives,and concerns about vaccine efficacy on immunization rates;(vi)Case studies from the Weifang City of China and Indonesia to introduce PCV offer insights on successful vaccine introduction strategies and the impact of innovative financing and government support.Conclusion The articles emphasize the need for government leadership,strategic policymaking,and public awareness to enhance vaccine coverage and equity.The VaxLab will continue strengthening China’s NIP by focusing on vaccine financing,emphasizing diversity,equity,and inclusion,and improving maternal vaccination coverage.Research will extend to Southeast Asian and Western Pacific regions,especially in middle-income countries facing challenges in vaccine financing and delivery.The collective efforts outlined in this collection show a commitment to evolving and adapting immunization strategies to meet global health goals and to provide equitable access to vaccines for all.展开更多
Hepatitis A is an infectious liver disease caused by hepatitis A virus(HAV)that results in mild to severe illness.HAV is spread to immunologically naïve persons who ingest food or water contaminated with feces fr...Hepatitis A is an infectious liver disease caused by hepatitis A virus(HAV)that results in mild to severe illness.HAV is spread to immunologically naïve persons who ingest food or water contaminated with feces from HAV-infected individuals(1).Hepatitis A is often seen in sporadic cases,but is also seen in large outbreaks,such as the 1988 outbreak in Shanghai that caused over 300,000 cases and huge economic losses(2).展开更多
China CDC’s National Immunization Program’s Senior Research Scholars Program(NIP-SRSP)is a program created to foster the professional development of early-to-mid-career immunization experts,strengthen knowledge exch...China CDC’s National Immunization Program’s Senior Research Scholars Program(NIP-SRSP)is a program created to foster the professional development of early-to-mid-career immunization experts,strengthen knowledge exchange and cooperation between national and provincial/prefectural-level CDCs,and deepen scientific and programmatic capacity of the National Immunization Program and provincial/prefectural immunization programs.Initiated in September 2019.展开更多
Herpes zoster(HZ)is a painful condition resulting from reactivation of dormant varicella-zoster virus(VZV)in a previously VZV-infected person[1].Typical clinical manifestation of HZ are unilateral radicular pain and a...Herpes zoster(HZ)is a painful condition resulting from reactivation of dormant varicella-zoster virus(VZV)in a previously VZV-infected person[1].Typical clinical manifestation of HZ are unilateral radicular pain and a vesicular rash limited to one side of the body in the distribution of a nerve[2].The most common complication of HZ postherpetic neuralgia(PHN).展开更多
What is already known about this topic?The incidences of vaccine-preventable diseases(VPDs)included in the Expanded Program on Immunization in China have decreased significantly in recent decades.What is added by this...What is already known about this topic?The incidences of vaccine-preventable diseases(VPDs)included in the Expanded Program on Immunization in China have decreased significantly in recent decades.What is added by this report?This study summarizes the national incidences of nine VPDs and the seroprevalence of hepatitis B surface antigen(HBsAg)under different immunization strategies from 1950 through 2021 in China.The sharpest decreases in VPD incidence and under-5-year HBsAg seroprevalence occurred during the latest stage of the National Immunization Program.The decreases in VPD incidence were most prominent among children under five years of age.What are the implications for public health practice?These findings provide valuable insights for vaccine value assessment and emphasize the importance of implementing immunization strategies in targeted populations.展开更多
Objective Allocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention.Using the Centers for Disease Control and Prevention(CDCs)system ...Objective Allocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention.Using the Centers for Disease Control and Prevention(CDCs)system of China as an example,we evaluated inequality in the public health workforce distribution across different regions in China between 2008 and 2017,with the aim of providing information for policymakers to support resource allocation and address growing health inequities.Methods We used three standard public health workforce inequality indices-Gini coefficient,Theil L,and Theil T-and spatial autocorrelation analysis to explore spatial clusters of the workforce in different provinces,visualized with geographical tools.Results The aggregate workforce-to-population ratio decreased from 1.47 to 1.42 per 10,000 population from 2008 to 2017,and was consistently lower than the National Health Commission’s(NHC)recommended critical shortage threshold of 1.75.The workforce distribution inequality indices varied by regional socioeconomic and health system development.Geographic clustering of CDCs workforce distribution was evident,with H–H and L–L clusters in western China and the Guangdong-Fujian region,respectively.Conclusions Our study addressed key issues for government and policymakers in allocation of public health human resources.There is an urgent need for careful identification of analytic questions that will help carry out public health functions in the new era,alongside policy implications for an equitable distribution of the public health workforce focusing on the western region and low–low cluster areas.展开更多
Japanese encephalitis(JE)was first discovered in Japan in 1871;in 1924,a major outbreak occurred,with 6,000 JE cases reported and a mortality rate of approximately 60%[1,2].Later studies showed that JE is caused by th...Japanese encephalitis(JE)was first discovered in Japan in 1871;in 1924,a major outbreak occurred,with 6,000 JE cases reported and a mortality rate of approximately 60%[1,2].Later studies showed that JE is caused by the Japanese encephalitis virus(JEV),which is spread by mosquitoes.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
In 2017,the State Council requested the National Health and Family Planning Commission(NHFPC),known as the Ministry of Health(MoH)before 2013 and as the National Health Commission(NHC)after 2018,to establish China’s ...In 2017,the State Council requested the National Health and Family Planning Commission(NHFPC),known as the Ministry of Health(MoH)before 2013 and as the National Health Commission(NHC)after 2018,to establish China’s National Immunization Advisory Committee(NIAC)(1).The NIAC acts as China’s National Immunization Technical Advisory Group(NITAG)—a deliberative body of national experts who advise national authorities and policy makers with evidence-based recommendations on immunization policy and program(2-3).展开更多
Background:Communication for Development(C4D)is a strategy promoted by the United Nations Children’s Fund to foster positive and measurable changes at the individual,family,community,social,and policy levels of socie...Background:Communication for Development(C4D)is a strategy promoted by the United Nations Children’s Fund to foster positive and measurable changes at the individual,family,community,social,and policy levels of society.In western China,C4D activities have previously been conducted as part of province-level immunization programs.In this study,we evaluated the association of C4D with changes in parental knowledge of immunization services,measles disease,and measles vaccine,and changes in their children’s measles vaccine coverage.Methods:From April 2013 to April 2014,C4D activities were implemented as part of provincial immunization programs in the Inner Mongolia,Guangxi,Chongqing,Guizhou,Tibet,Shaanxi,Gansu,Ningxia,and Qinghai provinces.We used a before-and-after study design and employed face-to-face interviews to assess changes in parental knowledge and vaccination coverage.Results:We surveyed 2107 households at baseline and 2070 households after 1 year of C4D activities.Following C4D,95%of caregivers were aware of the vaccination record check requirement for entry into kindergarten and primary school;80%of caregivers were aware that migrant children were eligible for free vaccination;more than 70%of caregivers knew that measles is a respiratory infectious disease;and 90%of caregivers knew the symptoms of measles.Caregivers’willingness to take their children to the clinic for vaccination increased from 51.3%at baseline to 67.4%in the post-C4D survey.Coverage of one-dose measles-containing vaccine(MCV)increased from 83.8%at baseline to 90.1%after C4D.One-dose MCV coverage was greater than 95%in the Guangxi,Shaanxi,and Gansu provinces.Two-dose MCV coverage increased from 68.5 to 77.6%.House-to-house communication was the most popular C4D activity among caregivers(91.6%favoring),followed by posters and educational talks(64.8 and 49.9%favoring).Conclusions:C4D is associated with increased caregiver knowledge about measles,increased willingness to seek immunization services for their children,and increased measles vaccination coverage.Tailored communication strategies based on insights gained from these analyses may be able to increase vaccination coverage in hard-to-reach areas.C4D should be considered for larger scale implementation in China.展开更多
Aim:Pertussis is a respiratory tract infection,the vaccine for which was introduced in the Expanded Programme on Immunization(EPI)in Guizhou Province of China(hereafter referred as Guizhou)in the 1980s.This vaccine ra...Aim:Pertussis is a respiratory tract infection,the vaccine for which was introduced in the Expanded Programme on Immunization(EPI)in Guizhou Province of China(hereafter referred as Guizhou)in the 1980s.This vaccine rapidly decreased incidence rates of pertussis in the province,however,despite the wide high coverage of the diphtheria,tetanus and acellular pertussis(DTaP)combined vaccine,there has been a resurgence of pertussis since 2014.Even with this recent increase in disease transmission,risk factors for pertussis infection have not been evaluated in Guizhou.We aimed to provide information on pertussis risk factors and insight on designing targeted pertussis control policies and measures through this study.Methods:A 1:2 matched retrospective case-control study was conducted between 2016 and 2017,involving infants and children younger than 6 years old and parents of the participants.The enrolled cases included clinical and laboratory confirmed pertussis cases according to the WHO-recommended pertussis definition.Controls were selected from children in the same neighborhood who were not diagnosed with pertussis prior to our investigation and did not exhibit any clinical manifestations of pertussis.Results:The household size[Matched odds ratio(OR_(m)=1.4,95%confidence interval(Cl):1.1-1.7]and household members with antecedent cough(OR_(m)=3.6,95%CI:1.8-7.2)were significantly associated with their child’s pertussis onset.The parents’occupations were significantly associated with their child’s pertussis onset(ORm=9.4,95%CI:1.6-54.8,for mother side;ORm=4.5,95%CI:1.2-16.5,for father side),when they worked in the business and/or service industry.Having family members with a history of cough was an independent risk factor for pertussis[Adjusted odds ratio(AOR)=43.6,95%CI:2.7-694.0].Besides,the parents’demographic characteristics and DTaP doses were not found to be independent factors.Conclusion:Household exposure is an important risk factor for pertussis infection in infants and young children and should therefore be considered as a major factor during formulation of pertussis control policies and measures.展开更多
The World Health Organization(WHO)launched the‘End TB Strategy’,which aims to reduce the mortality and incidence rate of tuberculosis(TB)by 95% and 90% by 2035,respectively,compared with the levels in 2015.To achiev...The World Health Organization(WHO)launched the‘End TB Strategy’,which aims to reduce the mortality and incidence rate of tuberculosis(TB)by 95% and 90% by 2035,respectively,compared with the levels in 2015.To achieve these targets and milestones,the strategy set three pillars and 10 indicators,one of which is systematic screening of contacts and high-risk groups[1].展开更多
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 betwee...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.展开更多
Introduction:The current study aims to assess the performance of data mining techniques in detecting safety signals for adverse events following immunization(AEFI)using routinely obtained data in China.Four different ...Introduction:The current study aims to assess the performance of data mining techniques in detecting safety signals for adverse events following immunization(AEFI)using routinely obtained data in China.Four different methods for detecting vaccine safety signals were evaluated.Methods:The AEFI data from 2011 to 2015 was collected for our study.We analyzed the data using four different methods to detect signals:the proportional reporting ratio(PRR),reporting odds ratio(ROR),Bayesian confidence propagation neural network(BCPNN),and multi-item gamma Poisson shrinker(MGPS).Each method was evaluated at 1–3 thresholds for positivity.To assess the performance of these methods,we used the published signal rates as gold standards to determine the sensitivity and specificity.Results:The number of identified signals varied from 602 for PRR1(with a threshold of 1)to 127 for MGPS1.When considering the common reactions as the reference standard,the sensitivity ranged from 0.9%for MGPS1/2 to 38.2%for PRR1/2,and the specificity ranged from 85.2%for PRR1 and ROR1 to 96.7%for MGPS1.When considering the rare reactions as the reference standard,PRR1,PRR2,ROR1,ROR2,and BCPNN exhibited the highest sensitivity(73.3%),while MGPS1 exhibited the highest specificity(96.9%).Discussion:For common reactions,the sensitivities were modest and the specificities were high.For rare reactions,both the sensitivities and specificities were high.Our study provides valuable insights into the selection of signal detection methods and thresholds for AEFI data in China.展开更多
Context: An unexplained increase in the risk of Guil- lain- Barré syndrome (GBS) occurred among recipients of the swine influenza vaccine in 1976- 1977. Guillain- Barré syndrome remains the most frequent neu...Context: An unexplained increase in the risk of Guil- lain- Barré syndrome (GBS) occurred among recipients of the swine influenza vaccine in 1976- 1977. Guillain- Barré syndrome remains the most frequent neurological condition reported after influenza vaccination to the Vaccine Adverse Events Reporting System (VAERS) since its inception in 1990. Objective: To evaluate trends of reports to VAERS of GBS following influenza vaccination in adults. Design, Setting, and Participants: VAERS is the US national spontaneous reporting system for adverse events following vaccination. Reports of GBS in persons 18 years or older following influenza vaccination were evaluated for each influenza season from July 1, 1990, through June 30, 2003. The number of people vaccinated was estimated from the National Health Interview Survey and US census data. Beginning in 1994, active follow- up was conducted to verify GBS diagnosis and obtain other clinical details. Main Outcome Measure: Reporting rates of GBS following influenza vaccination over time. Results: From July 1990 through June 2003, VAERS received 501 reports of GBS following influenza vaccination in adults. The median onset interval (13 days) was longer than that of non- GBS reports of adverse events after influenza vaccine (1 day) (P<.001). The annual reporting rate decreased 4- fold from a high of 0.17 per 100 000 vaccinees in 1993- 1994 to 0.04 in 2002- 2003 (P < .001). A GBS diagnosis was confirmed in 82% of reports. Preceding illness within 4 weeks of vaccination was identified in 24% of reported cases. Conclusions: From 1990 to 2003, VAERS reporting rates of GBS after influenza vaccination decreased. The long onset interval and low prevalence of other preexisting illnesses are consistent with a possible causal association between GBS and influenza vaccine. These findings require additional research, which can lead to a fuller understanding of the causes of GBS and its possible relationship with influenza vaccine.展开更多
Background WHO recommends that countries considering introduction of rubella vaccine into their immunisation programme assess their burden of congenital rubella syndrome, to determine whether vaccination is warranted....Background WHO recommends that countries considering introduction of rubella vaccine into their immunisation programme assess their burden of congenital rubella syndrome, to determine whether vaccination is warranted. However, few guidelines exist for such assessments in developing countries. We retrospectively estimated the burden of congenital rubella syndrome in Morocco, and assessed our methods of rapid case finding. Methods We undertook case finding in the two cities with Morocco’ s main tertiary care referral centres, using medical records from births between Jan 1, 1990, and May 31, 2002, disability records from 1965 to 1997, and retinal examinations from deaf students born between 1985 and 1994, applying the WHO definition for a clinically confirmed case of congenital rubella syndrome. We also reviewed disability data for evidence of epidemic periodicity and estimated yearly incidence of the syndrome from congenital cataract data for births between 1990 and 2001. Findings We identified 62 clinically confirmed cases of congenital rubella syndrome from medical records, 148 from disability records, and 15 in deaf students. We noted no epidemic periodicity in disability data, and estimated a yearly incidence of the syndrome in Morocco of 8.1- 12.7 cases per 100 000 livebirths. Interpretation We show evidence of congenital rubella syndrome in Morocco and support the addition of rubella vaccination to the national programme. Various data sources can be explored to rapidly assess burden of the syndrome; ophthalmology departments and outpatient cardiology clinics could offer the most potential for such case finding, dependent on documentation practices.展开更多
Context.Each year 2.1 million children 19 to 35 months of age are undervaccinated.Among these are children who have received no vaccinations.Unvaccinated children are at increased risk of acquiring and transmitting va...Context.Each year 2.1 million children 19 to 35 months of age are undervaccinated.Among these are children who have received no vaccinations.Unvaccinated children are at increased risk of acquiring and transmitting vaccine-preventable diseases.Objectives.To assess whether the characteristics of children with no vaccinations differ from those of undervaccinated children, tomonitor trends in the numbers of unvaccinated children, and to identify states with high rates and counties with large numbers of unvaccinated children.Design.A nationally representative probability sample of children 19 to 35 months of age was collected annually between 1995 and 2001.Vaccination histories were ascertained from children’s medical providers.Undervaccinated children had received ≥1 dose of diphtheriatetanus-pertussis, polio, measles, Haemophilus influenzae type b, hepatitis B, or varicella vaccine butwere not fully vaccinated.Unvaccinated children were children who were reported as having no medical providers and having received no vaccinations or children whose medical providers reported administering no vaccinations.Participants.A total of 151 720 children sampled between 1995 and 2001, 795 of whom were unvaccinated.Results.Undervaccinated children tended to be black, to have a younger mother who was not married and did not have a college degree, to live in a household near the poverty level, and to live in a central city.Unvaccinated children tended to be white, to have a mother who was married and had a college degree, to live in a household with an annual income exceeding ＄75 000, and to have parents who expressed concerns regarding the safety of vaccines and indicated that medical doctors have little influence over vaccination decisions for their children.Unvaccinated children were more likely to be male than female.Annually, ～17 000 children were unvaccinated.The largest numbers of unvaccinated children lived in counties in California, Illinois, New York, Washington, Pennsylvania, Texas, Oklahoma, Colorado, Utah, and Michigan.States that allowed philosophical exemptions to laws mandating vaccinations for children as they entered school had significantly higher estimated rates of unvaccinated children.Conclusions.Unvaccinated children have characteristics that are distinctly different from those of undervaccinated children.Unvaccinated children are clustered geographically, increasing the risk of transmitting vaccine-preventable diseases to both unvaccinated and undervaccinated children.展开更多
In 2021,China’s domestically produced coronavirus disease 2019(COVID-19)vaccines received approval from regulatory bodies and were administered worldwide.Due to a low number of infections within China during that per...In 2021,China’s domestically produced coronavirus disease 2019(COVID-19)vaccines received approval from regulatory bodies and were administered worldwide.Due to a low number of infections within China during that period,it became imperative to evaluate the vaccines’real-world effectiveness through international studies.To facilitate this,China CDC launched the COVID-19 Vaccines Evaluation Program(COVEP).This program formed research collaboration agreements with health institutes across five World Health Organization regions,addressing key questions about vaccine performance through ten cooperative agreements.The findings from COVEP projects reinforced confidence,both domestically and globally,in the effectiveness of the vaccines produced in China.Moreover,the outcomes observed internationally were frequently mirrored by later studies conducted within China.COVEP thus pioneered a novel approach for fostering cross-national research collaborations,addressing significant public health issues and exemplifying a framework for international cooperation.This approach is in line with the strategic objectives and other development efforts of China CDC’s national disease control and prevention initiatives.展开更多
Introduction:Infants born to HBsAg-positive mothers are exposed to hepatitis B virus(HBV)during childbirth and require timely hepatitis B vaccination(HepB)and hepatitis B immunoglobulin(HBIG)to prevent vertical transm...Introduction:Infants born to HBsAg-positive mothers are exposed to hepatitis B virus(HBV)during childbirth and require timely hepatitis B vaccination(HepB)and hepatitis B immunoglobulin(HBIG)to prevent vertical transmission.Post-vaccination serological testing(PVST)determines whether HBVexposed infants are protected,infected,or need revaccination.This study evaluated PVST implementation among HBV-exposed infants and the effectiveness of the recommended strategy to prevent mother-to-child transmission(MTCT)of HBV.Methods:This observational study of infants born to HBsAg-positive mothers evaluated implementation of the MTCT prevention strategy and PVST follow-up across five provinces in China.Chi-square tests assessed timely HepB1 and HBIG administration and HepB series completion.PVST was used to evaluate MTCT prevention effectiveness.Bivariate analyses explored factors influencing infection and protection rates among HBV-exposed infants.Results:Among 7,425 infants born to HBsAgpositive mothers,94.8%received timely HepB1 and HBIG,and 99.5%completed the full HepB vaccination series.PVST was conducted in 3,243(43.7%)infants;the median interval between HepB3 and PVST was 66 days(interquartile range:47–114).26(0.8%)infants tested HBsAg-positive;3,147(97.0%)developed protective antibody levels;and 72(2.2%)were neither infected nor protected,requiring revaccination.Maternal HBeAg positivity was a significant risk factor for MTCT prevention failure[adjusted odds ratio(aOR)=12.7,95%confidence interval(CI):4.7,34.1].Conclusions:The MTCT prevention strategy was highly effective.PVST for infants born to HBsAgpositive mothers enables evaluation of MTCT prevention strategies and improvement of strategy their effectiveness.PVST utilization should be expanded to test all HBV-exposed infants to ensure their protection and to further enhance the MTCT prevention.展开更多
Introduction:Eliminating hepatitis B virus(HBV)as a major public health threat is a global health priority that requires cost-effective screening strategies.This study evaluated the cost-effectiveness of sequential bi...Introduction:Eliminating hepatitis B virus(HBV)as a major public health threat is a global health priority that requires cost-effective screening strategies.This study evaluated the cost-effectiveness of sequential birth cohort HBV screening strategies in China.Methods:Using a Markov model,we compared five screening strategies with current practice,calculating HBV-related deaths averted,qualityadjusted life years(QALYs)gained,and incremental cost-effectiveness ratios(ICER).One-way deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the results.Results:The sequential birth cohort screening strategy(Sequential Screening 1:screening the 1991–2000 cohort in 2025–2026,the 1971–1990 cohort in 2027–2028,and the 1951–1970 cohort in 2029–2030)was the most cost-effective,with an ICER of 58,523 Chinese Yuan(CNY)per QALY at a willingness-to-pay threshold of three times the percapita Gross Domestic Product(GDP).An alternative strategy that prioritized the 1951–1970 cohort in 2025–2026 averted the most HBV-related deaths(approximately 3.44 million)and gained 24.9 million QALYs,with an ICER of 60,113 CNY per QALY,also showing cost-effectiveness.Discussion:Our findings support sequential birth cohort screening as an optimal and innovative approach to achieving the WHO HBV elimination targets,offering evidence-informed guidance for policymakers to optimize screening programs and resource allocation.展开更多
文摘Background Immunization is a cornerstone of public health.Despite great success,China’s National Immunization Program(NIP)faces challenges,such as the integration of several World Health Organization-recommended vaccines and other systemic issues.The Innovation Laboratory for Vaccine Delivery Research(VaxLab),supported by the Bill&Melinda Gates Foundation and established in 2021 at Duke Kunshan University,focuses on enhancing China’s NIP through research and policy advocacy.This editorial aims to summarize the key findings of the manuscripts published in the collection contributed by VaxLab team and set the future research agenda.Key findings The collection contains eleven manuscripts discussing China’s immunization landscape and strategies to improve coverage,particularly for non-NIP vaccines like human papillomavirus vaccine(HPV),pneumococcal conjugate vaccine(PCV),Haemophilus influenzae type b vaccine(Hib),and rotavirus vaccines.Key findings include:(i)The COVID-19 vaccination campaign demonstrated China’s capacity for rapid,large-scale immunization efforts,suggesting potential for broader vaccine coverage improvements;(ii)Efforts in combating cervical cancer through the HPV vaccine indicate progress but also highlight challenges like vaccine supply and equitable access;(iii)The lag in adopting higher-valent paediatric combination vaccines in China needs attention to address regulatory and health system hurdles;(iv)Disparities in access to non-NIP vaccines underscore the need for government initiatives to improve vaccine coverage,especially for remote areas and marginalized populations;(v)Original studies emphasize the influence of caregivers’knowledge,health workers’financial incentives,and concerns about vaccine efficacy on immunization rates;(vi)Case studies from the Weifang City of China and Indonesia to introduce PCV offer insights on successful vaccine introduction strategies and the impact of innovative financing and government support.Conclusion The articles emphasize the need for government leadership,strategic policymaking,and public awareness to enhance vaccine coverage and equity.The VaxLab will continue strengthening China’s NIP by focusing on vaccine financing,emphasizing diversity,equity,and inclusion,and improving maternal vaccination coverage.Research will extend to Southeast Asian and Western Pacific regions,especially in middle-income countries facing challenges in vaccine financing and delivery.The collective efforts outlined in this collection show a commitment to evolving and adapting immunization strategies to meet global health goals and to provide equitable access to vaccines for all.
基金funded by the Project of Strengthening National Laboratories,Surveillance&Program Monitoring Systems,and Service Delivery Models for Viral Hepatitis in China.
文摘Hepatitis A is an infectious liver disease caused by hepatitis A virus(HAV)that results in mild to severe illness.HAV is spread to immunologically naïve persons who ingest food or water contaminated with feces from HAV-infected individuals(1).Hepatitis A is often seen in sporadic cases,but is also seen in large outbreaks,such as the 1988 outbreak in Shanghai that caused over 300,000 cases and huge economic losses(2).
文摘China CDC’s National Immunization Program’s Senior Research Scholars Program(NIP-SRSP)is a program created to foster the professional development of early-to-mid-career immunization experts,strengthen knowledge exchange and cooperation between national and provincial/prefectural-level CDCs,and deepen scientific and programmatic capacity of the National Immunization Program and provincial/prefectural immunization programs.Initiated in September 2019.
基金supported by the Operation of Public Health Emergency Response Mechanism of the Chinese Center for Disease Control and Prevention(10239322002001,0000017)Research on Vaccine Evaluation Strategy and capacity Building Project(09207).
文摘Herpes zoster(HZ)is a painful condition resulting from reactivation of dormant varicella-zoster virus(VZV)in a previously VZV-infected person[1].Typical clinical manifestation of HZ are unilateral radicular pain and a vesicular rash limited to one side of the body in the distribution of a nerve[2].The most common complication of HZ postherpetic neuralgia(PHN).
基金Supported by Operation of the CDC Public Health Emergency Response Mechanism in China(131031001000150001).
文摘What is already known about this topic?The incidences of vaccine-preventable diseases(VPDs)included in the Expanded Program on Immunization in China have decreased significantly in recent decades.What is added by this report?This study summarizes the national incidences of nine VPDs and the seroprevalence of hepatitis B surface antigen(HBsAg)under different immunization strategies from 1950 through 2021 in China.The sharpest decreases in VPD incidence and under-5-year HBsAg seroprevalence occurred during the latest stage of the National Immunization Program.The decreases in VPD incidence were most prominent among children under five years of age.What are the implications for public health practice?These findings provide valuable insights for vaccine value assessment and emphasize the importance of implementing immunization strategies in targeted populations.
基金funded by China CDC’s Public Health and Emergency Response Mechanism Programme[131031001000150001]。
文摘Objective Allocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention.Using the Centers for Disease Control and Prevention(CDCs)system of China as an example,we evaluated inequality in the public health workforce distribution across different regions in China between 2008 and 2017,with the aim of providing information for policymakers to support resource allocation and address growing health inequities.Methods We used three standard public health workforce inequality indices-Gini coefficient,Theil L,and Theil T-and spatial autocorrelation analysis to explore spatial clusters of the workforce in different provinces,visualized with geographical tools.Results The aggregate workforce-to-population ratio decreased from 1.47 to 1.42 per 10,000 population from 2008 to 2017,and was consistently lower than the National Health Commission’s(NHC)recommended critical shortage threshold of 1.75.The workforce distribution inequality indices varied by regional socioeconomic and health system development.Geographic clustering of CDCs workforce distribution was evident,with H–H and L–L clusters in western China and the Guangdong-Fujian region,respectively.Conclusions Our study addressed key issues for government and policymakers in allocation of public health human resources.There is an urgent need for careful identification of analytic questions that will help carry out public health functions in the new era,alongside policy implications for an equitable distribution of the public health workforce focusing on the western region and low–low cluster areas.
基金supported by grants from the National Key Research and Development Program[2016YFD0500401](WH)the Development Grant of State Key Laboratory of Infectious Disease Prevention and Control[2014SKLID103](LG)and[2015SKLID505](WH)。
文摘Japanese encephalitis(JE)was first discovered in Japan in 1871;in 1924,a major outbreak occurred,with 6,000 JE cases reported and a mortality rate of approximately 60%[1,2].Later studies showed that JE is caused by the Japanese encephalitis virus(JEV),which is spread by mosquitoes.
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.
文摘In 2017,the State Council requested the National Health and Family Planning Commission(NHFPC),known as the Ministry of Health(MoH)before 2013 and as the National Health Commission(NHC)after 2018,to establish China’s National Immunization Advisory Committee(NIAC)(1).The NIAC acts as China’s National Immunization Technical Advisory Group(NITAG)—a deliberative body of national experts who advise national authorities and policy makers with evidence-based recommendations on immunization policy and program(2-3).
基金The UNICEF China Office and the Fourth Round of Three-Year Public Health Action Plan of Shanghai,China(15GWZK0101)supported the C4D intervention activities,the baseline investigation,and the evaluation investigation。
文摘Background:Communication for Development(C4D)is a strategy promoted by the United Nations Children’s Fund to foster positive and measurable changes at the individual,family,community,social,and policy levels of society.In western China,C4D activities have previously been conducted as part of province-level immunization programs.In this study,we evaluated the association of C4D with changes in parental knowledge of immunization services,measles disease,and measles vaccine,and changes in their children’s measles vaccine coverage.Methods:From April 2013 to April 2014,C4D activities were implemented as part of provincial immunization programs in the Inner Mongolia,Guangxi,Chongqing,Guizhou,Tibet,Shaanxi,Gansu,Ningxia,and Qinghai provinces.We used a before-and-after study design and employed face-to-face interviews to assess changes in parental knowledge and vaccination coverage.Results:We surveyed 2107 households at baseline and 2070 households after 1 year of C4D activities.Following C4D,95%of caregivers were aware of the vaccination record check requirement for entry into kindergarten and primary school;80%of caregivers were aware that migrant children were eligible for free vaccination;more than 70%of caregivers knew that measles is a respiratory infectious disease;and 90%of caregivers knew the symptoms of measles.Caregivers’willingness to take their children to the clinic for vaccination increased from 51.3%at baseline to 67.4%in the post-C4D survey.Coverage of one-dose measles-containing vaccine(MCV)increased from 83.8%at baseline to 90.1%after C4D.One-dose MCV coverage was greater than 95%in the Guangxi,Shaanxi,and Gansu provinces.Two-dose MCV coverage increased from 68.5 to 77.6%.House-to-house communication was the most popular C4D activity among caregivers(91.6%favoring),followed by posters and educational talks(64.8 and 49.9%favoring).Conclusions:C4D is associated with increased caregiver knowledge about measles,increased willingness to seek immunization services for their children,and increased measles vaccination coverage.Tailored communication strategies based on insights gained from these analyses may be able to increase vaccination coverage in hard-to-reach areas.C4D should be considered for larger scale implementation in China.
基金supported by grants from the Science and Technology Foundation of Guizhou Province of China(Grant No.[2019]1185).
文摘Aim:Pertussis is a respiratory tract infection,the vaccine for which was introduced in the Expanded Programme on Immunization(EPI)in Guizhou Province of China(hereafter referred as Guizhou)in the 1980s.This vaccine rapidly decreased incidence rates of pertussis in the province,however,despite the wide high coverage of the diphtheria,tetanus and acellular pertussis(DTaP)combined vaccine,there has been a resurgence of pertussis since 2014.Even with this recent increase in disease transmission,risk factors for pertussis infection have not been evaluated in Guizhou.We aimed to provide information on pertussis risk factors and insight on designing targeted pertussis control policies and measures through this study.Methods:A 1:2 matched retrospective case-control study was conducted between 2016 and 2017,involving infants and children younger than 6 years old and parents of the participants.The enrolled cases included clinical and laboratory confirmed pertussis cases according to the WHO-recommended pertussis definition.Controls were selected from children in the same neighborhood who were not diagnosed with pertussis prior to our investigation and did not exhibit any clinical manifestations of pertussis.Results:The household size[Matched odds ratio(OR_(m)=1.4,95%confidence interval(Cl):1.1-1.7]and household members with antecedent cough(OR_(m)=3.6,95%CI:1.8-7.2)were significantly associated with their child’s pertussis onset.The parents’occupations were significantly associated with their child’s pertussis onset(ORm=9.4,95%CI:1.6-54.8,for mother side;ORm=4.5,95%CI:1.2-16.5,for father side),when they worked in the business and/or service industry.Having family members with a history of cough was an independent risk factor for pertussis[Adjusted odds ratio(AOR)=43.6,95%CI:2.7-694.0].Besides,the parents’demographic characteristics and DTaP doses were not found to be independent factors.Conclusion:Household exposure is an important risk factor for pertussis infection in infants and young children and should therefore be considered as a major factor during formulation of pertussis control policies and measures.
基金sponsored by Beijing Natural Science Foundation[7174323]the Young Scholar Scientific Research Foundation of China CDC[2018A104]。
文摘The World Health Organization(WHO)launched the‘End TB Strategy’,which aims to reduce the mortality and incidence rate of tuberculosis(TB)by 95% and 90% by 2035,respectively,compared with the levels in 2015.To achieve these targets and milestones,the strategy set three pillars and 10 indicators,one of which is systematic screening of contacts and high-risk groups[1].
文摘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.
基金Supported by the Beijing Natural Science Foundation(L212058).
文摘Introduction:The current study aims to assess the performance of data mining techniques in detecting safety signals for adverse events following immunization(AEFI)using routinely obtained data in China.Four different methods for detecting vaccine safety signals were evaluated.Methods:The AEFI data from 2011 to 2015 was collected for our study.We analyzed the data using four different methods to detect signals:the proportional reporting ratio(PRR),reporting odds ratio(ROR),Bayesian confidence propagation neural network(BCPNN),and multi-item gamma Poisson shrinker(MGPS).Each method was evaluated at 1–3 thresholds for positivity.To assess the performance of these methods,we used the published signal rates as gold standards to determine the sensitivity and specificity.Results:The number of identified signals varied from 602 for PRR1(with a threshold of 1)to 127 for MGPS1.When considering the common reactions as the reference standard,the sensitivity ranged from 0.9%for MGPS1/2 to 38.2%for PRR1/2,and the specificity ranged from 85.2%for PRR1 and ROR1 to 96.7%for MGPS1.When considering the rare reactions as the reference standard,PRR1,PRR2,ROR1,ROR2,and BCPNN exhibited the highest sensitivity(73.3%),while MGPS1 exhibited the highest specificity(96.9%).Discussion:For common reactions,the sensitivities were modest and the specificities were high.For rare reactions,both the sensitivities and specificities were high.Our study provides valuable insights into the selection of signal detection methods and thresholds for AEFI data in China.
文摘Context: An unexplained increase in the risk of Guil- lain- Barré syndrome (GBS) occurred among recipients of the swine influenza vaccine in 1976- 1977. Guillain- Barré syndrome remains the most frequent neurological condition reported after influenza vaccination to the Vaccine Adverse Events Reporting System (VAERS) since its inception in 1990. Objective: To evaluate trends of reports to VAERS of GBS following influenza vaccination in adults. Design, Setting, and Participants: VAERS is the US national spontaneous reporting system for adverse events following vaccination. Reports of GBS in persons 18 years or older following influenza vaccination were evaluated for each influenza season from July 1, 1990, through June 30, 2003. The number of people vaccinated was estimated from the National Health Interview Survey and US census data. Beginning in 1994, active follow- up was conducted to verify GBS diagnosis and obtain other clinical details. Main Outcome Measure: Reporting rates of GBS following influenza vaccination over time. Results: From July 1990 through June 2003, VAERS received 501 reports of GBS following influenza vaccination in adults. The median onset interval (13 days) was longer than that of non- GBS reports of adverse events after influenza vaccine (1 day) (P<.001). The annual reporting rate decreased 4- fold from a high of 0.17 per 100 000 vaccinees in 1993- 1994 to 0.04 in 2002- 2003 (P < .001). A GBS diagnosis was confirmed in 82% of reports. Preceding illness within 4 weeks of vaccination was identified in 24% of reported cases. Conclusions: From 1990 to 2003, VAERS reporting rates of GBS after influenza vaccination decreased. The long onset interval and low prevalence of other preexisting illnesses are consistent with a possible causal association between GBS and influenza vaccine. These findings require additional research, which can lead to a fuller understanding of the causes of GBS and its possible relationship with influenza vaccine.
文摘Background WHO recommends that countries considering introduction of rubella vaccine into their immunisation programme assess their burden of congenital rubella syndrome, to determine whether vaccination is warranted. However, few guidelines exist for such assessments in developing countries. We retrospectively estimated the burden of congenital rubella syndrome in Morocco, and assessed our methods of rapid case finding. Methods We undertook case finding in the two cities with Morocco’ s main tertiary care referral centres, using medical records from births between Jan 1, 1990, and May 31, 2002, disability records from 1965 to 1997, and retinal examinations from deaf students born between 1985 and 1994, applying the WHO definition for a clinically confirmed case of congenital rubella syndrome. We also reviewed disability data for evidence of epidemic periodicity and estimated yearly incidence of the syndrome from congenital cataract data for births between 1990 and 2001. Findings We identified 62 clinically confirmed cases of congenital rubella syndrome from medical records, 148 from disability records, and 15 in deaf students. We noted no epidemic periodicity in disability data, and estimated a yearly incidence of the syndrome in Morocco of 8.1- 12.7 cases per 100 000 livebirths. Interpretation We show evidence of congenital rubella syndrome in Morocco and support the addition of rubella vaccination to the national programme. Various data sources can be explored to rapidly assess burden of the syndrome; ophthalmology departments and outpatient cardiology clinics could offer the most potential for such case finding, dependent on documentation practices.
文摘Context.Each year 2.1 million children 19 to 35 months of age are undervaccinated.Among these are children who have received no vaccinations.Unvaccinated children are at increased risk of acquiring and transmitting vaccine-preventable diseases.Objectives.To assess whether the characteristics of children with no vaccinations differ from those of undervaccinated children, tomonitor trends in the numbers of unvaccinated children, and to identify states with high rates and counties with large numbers of unvaccinated children.Design.A nationally representative probability sample of children 19 to 35 months of age was collected annually between 1995 and 2001.Vaccination histories were ascertained from children’s medical providers.Undervaccinated children had received ≥1 dose of diphtheriatetanus-pertussis, polio, measles, Haemophilus influenzae type b, hepatitis B, or varicella vaccine butwere not fully vaccinated.Unvaccinated children were children who were reported as having no medical providers and having received no vaccinations or children whose medical providers reported administering no vaccinations.Participants.A total of 151 720 children sampled between 1995 and 2001, 795 of whom were unvaccinated.Results.Undervaccinated children tended to be black, to have a younger mother who was not married and did not have a college degree, to live in a household near the poverty level, and to live in a central city.Unvaccinated children tended to be white, to have a mother who was married and had a college degree, to live in a household with an annual income exceeding ＄75 000, and to have parents who expressed concerns regarding the safety of vaccines and indicated that medical doctors have little influence over vaccination decisions for their children.Unvaccinated children were more likely to be male than female.Annually, ～17 000 children were unvaccinated.The largest numbers of unvaccinated children lived in counties in California, Illinois, New York, Washington, Pennsylvania, Texas, Oklahoma, Colorado, Utah, and Michigan.States that allowed philosophical exemptions to laws mandating vaccinations for children as they entered school had significantly higher estimated rates of unvaccinated children.Conclusions.Unvaccinated children have characteristics that are distinctly different from those of undervaccinated children.Unvaccinated children are clustered geographically, increasing the risk of transmitting vaccine-preventable diseases to both unvaccinated and undervaccinated children.
基金supported by the Chinese Center for Disease Control and Prevention through the COVID-19 Vaccines Evaluation Program(COVEP).
文摘In 2021,China’s domestically produced coronavirus disease 2019(COVID-19)vaccines received approval from regulatory bodies and were administered worldwide.Due to a low number of infections within China during that period,it became imperative to evaluate the vaccines’real-world effectiveness through international studies.To facilitate this,China CDC launched the COVID-19 Vaccines Evaluation Program(COVEP).This program formed research collaboration agreements with health institutes across five World Health Organization regions,addressing key questions about vaccine performance through ten cooperative agreements.The findings from COVEP projects reinforced confidence,both domestically and globally,in the effectiveness of the vaccines produced in China.Moreover,the outcomes observed internationally were frequently mirrored by later studies conducted within China.COVEP thus pioneered a novel approach for fostering cross-national research collaborations,addressing significant public health issues and exemplifying a framework for international cooperation.This approach is in line with the strategic objectives and other development efforts of China CDC’s national disease control and prevention initiatives.
基金funded by the Major Science and Technology Special Project of China’s 13th 5-Year Plan(grant no.2017ZX10105015).
文摘Introduction:Infants born to HBsAg-positive mothers are exposed to hepatitis B virus(HBV)during childbirth and require timely hepatitis B vaccination(HepB)and hepatitis B immunoglobulin(HBIG)to prevent vertical transmission.Post-vaccination serological testing(PVST)determines whether HBVexposed infants are protected,infected,or need revaccination.This study evaluated PVST implementation among HBV-exposed infants and the effectiveness of the recommended strategy to prevent mother-to-child transmission(MTCT)of HBV.Methods:This observational study of infants born to HBsAg-positive mothers evaluated implementation of the MTCT prevention strategy and PVST follow-up across five provinces in China.Chi-square tests assessed timely HepB1 and HBIG administration and HepB series completion.PVST was used to evaluate MTCT prevention effectiveness.Bivariate analyses explored factors influencing infection and protection rates among HBV-exposed infants.Results:Among 7,425 infants born to HBsAgpositive mothers,94.8%received timely HepB1 and HBIG,and 99.5%completed the full HepB vaccination series.PVST was conducted in 3,243(43.7%)infants;the median interval between HepB3 and PVST was 66 days(interquartile range:47–114).26(0.8%)infants tested HBsAg-positive;3,147(97.0%)developed protective antibody levels;and 72(2.2%)were neither infected nor protected,requiring revaccination.Maternal HBeAg positivity was a significant risk factor for MTCT prevention failure[adjusted odds ratio(aOR)=12.7,95%confidence interval(CI):4.7,34.1].Conclusions:The MTCT prevention strategy was highly effective.PVST for infants born to HBsAgpositive mothers enables evaluation of MTCT prevention strategies and improvement of strategy their effectiveness.PVST utilization should be expanded to test all HBV-exposed infants to ensure their protection and to further enhance the MTCT prevention.
文摘Introduction:Eliminating hepatitis B virus(HBV)as a major public health threat is a global health priority that requires cost-effective screening strategies.This study evaluated the cost-effectiveness of sequential birth cohort HBV screening strategies in China.Methods:Using a Markov model,we compared five screening strategies with current practice,calculating HBV-related deaths averted,qualityadjusted life years(QALYs)gained,and incremental cost-effectiveness ratios(ICER).One-way deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the results.Results:The sequential birth cohort screening strategy(Sequential Screening 1:screening the 1991–2000 cohort in 2025–2026,the 1971–1990 cohort in 2027–2028,and the 1951–1970 cohort in 2029–2030)was the most cost-effective,with an ICER of 58,523 Chinese Yuan(CNY)per QALY at a willingness-to-pay threshold of three times the percapita Gross Domestic Product(GDP).An alternative strategy that prioritized the 1951–1970 cohort in 2025–2026 averted the most HBV-related deaths(approximately 3.44 million)and gained 24.9 million QALYs,with an ICER of 60,113 CNY per QALY,also showing cost-effectiveness.Discussion:Our findings support sequential birth cohort screening as an optimal and innovative approach to achieving the WHO HBV elimination targets,offering evidence-informed guidance for policymakers to optimize screening programs and resource allocation.
