Dosage data of combination vaccines in China

1) Pentavalent vaccines (2019-2021)

A study on the usage and coverage of pentavalent vaccines in nine provincial-level administrative divisions (PLAD) of China (Jiangsu, Zhejiang, Shandong, Anhui, Hubei, Hunan, Sichuan, Guizhou, and Gansu) revealed (Table 1) that from 2019 to 2021, a total of 6.79 million doses of pentavalent vaccines were administered. Among them, Zhejiang Province commanded the highest vaccine utilization each year. From 2019 to 2020, pentavalent vaccines per 100 newborns increased significantly by 54.66%. From 2020 to 2021, it grew by 24.13%. Anhui showed the most significant growth, while Gansu’s growth remained slow. Regionally, the dosage rate in the eastern region was consistently the highest, approximately double that of its western counterpart¹.

The number of pentavalent vaccine doses increased gradually from 1.83 million doses in 2019 and 2.35 million doses in 2020 to 2.61 million doses in 2021, with an average annual growth rate of 19.32%. Most of the dosage was concentrated in the eastern regions, with the western regions showing the lowest use. The study also examined the substitution ratio of pentavalent vaccines for DTP vaccines across different provincial administrative regions (Table 2), referred to as the “pentavalent substitution rate.” The overall substitution rate significantly increased from 7.61% in 2019 to 13.83% in 2021. The eastern region reported the highest substitution rate in 2019, while the central region had the lowest; the western region reported the lowest substitution rates in 2020 and 2021¹.

2) Pentavalent vaccine dosage administered by sampling institutions in different PLADs.

In 2020, the total number of pentavalent vaccine doses administered by sampling institutions in different provinces across the country was 446,649. When divided by the eastern, central, and western regions, the eastern region had the highest total with 242,524 doses (54.3%), followed by the central region with 139,019 doses (31.1%), and the western region had the lowest total with 65,106 doses (14.6%).

PLADs	Vaccination volume (doses)	PLADs	Vaccination volume (doses)
Beijing	22476	Shandong	34037
Tianjin	8960	Henan	36660
Anhui	19051	Hubei	41894
Shanxi	4736	Hunan	27169
Inner Mongolia	0	Guangdong	39623
Liaoning	16327	Guangxi	23567
Jilin	491	Hainan	4201
Heilongjiang	1528	Chongqing	6423
Jiangsu	18836	Guizhou	5475
Zhejiang	55553	Yunnan	20459
Anhui	17479	Shaanxi	7451
Fujian	23460	Gansu	194
Jiangxi	9062	Qinghai	1537

3) Pentavalent vaccination dosage in different types of sampled institutions in 2020

In 2020, the dosage of pentavalent vaccines administered by different healthcare facilities varies.  We listed the types of healthcare facilities by the number of pentavalent vaccine dosages in descending order: community health service centers (51.1% of the total), maternity and child healthcare hospitals/institutes/clinics, township hospitals, general hospitals, centers of disease control and prevention, family planning service centers, traditional Chinese medicine hospitals and integrated traditional Chinese and western medicine hospitals, and specialized hospitals (only 0.8% of the total).

Type of organization	Vaccination volume (doses)
General Hospital	38439
Traditional Chinese Medicine Hospitals and Integrated Traditional Chinese and Western Medicine Hospitals	8811
Specialized Hospital	3867
Community Health Service Center	228317
Township Hospitals	59451
Center for Disease Control and Prevention (CDC)	21809
Maternal and Child Health Hospitals/institutes/clinics	72177
Family Planning Service Center	13275

4) Pentavalent vaccination dosage in different types of sampled institutions by profit nature in 2020

China National Health Development Research Center disclosed that the pentavalent vaccination dosage in non-profit medical institutions was much higher than that in for-profit medical institutions, which was about 61 times higher.

Nature of organization	Vaccination volume (doses)
Non-profit	439473
Profit-oriented	7176

Coverage of Pediatric Combination Vaccines in China

We list the coverage rates of combination vaccines in China based on several recent studies. Overall, the coverage of quadrivalent and pentavalent vaccines in China is relatively low.

1)  The national-level vaccination coverage rate for pentavalent vaccines.

Studies on the coverage rate of the pentavalent vaccine in nine PLADs of China (Jiangsu, Zhejiang, Shandong, Anhui, Hubei, Hunan, Sichuan, Guizhou, and Gansu) showed an increased trend of coverage. However, the overall coverage rate remains low.

In 2019, the coverage rate for ≥1 dose of pentavalent vaccine was 11.25%, which increased to 18.74% in 2021. The coverage rate for completing the primary vaccination series was 7.75% in 2019, expanding to 13.42% in 2021. The coverage rate for booster doses rose from 1.37% in 2019 to 10.13% in 2021. Jiangsu consistently had the highest annual coverage rate for ≥1 dose, while the provinces with the lowest coverage rates were Guizhou (in 2019 and 2020) and Gansu (in 2021). The eastern region had the highest ≥1 dose vaccination rate, completion rate of the primary series, and booster dose coverage rate. In 2021, ≥1 dose vaccination rate in the eastern region was 1.77 times that of the central region. Moreover, coverage rates were consistently higher in urban and rural areas. In urban areas, the coverage rate was 16.33% in 2019, rising to 26.22% in 2021. In contrast, rural areas had significantly lower rates, with 4.91% in 2019 and an increase to 9.45% in 2021.

2）Coverage Rates in Different Provinces and Cities

A study in Wuhan showed that as of December 31, 2022, the cumulative vaccination coverage rates for the pentavalent vaccine in children aged 0-6 years were 22.87%, 21.46%, 20.54%, and 14.28% for the 1st to 4th dose, respectively. As the birth year moved forward, the coverage rates for each dose of the pentavalent vaccine showed an upward trend, while the coverage rates for each birth cohort gradually decreased, possibly due to the complexity of the vaccination schedule, which led to lower parental compliance. The study estimated that the coverage rates for the pentavalent vaccine in Wuhan ranged from 6.94% to 34.67% for the 1st to 4th doses².

A 2022 study analyzed children’s vaccination data from 2015 to 2021 from Jiangsu Province’s Comprehensive Vaccination Service Management Information System. The results showed that the cumulative number of pentavalent vaccine doses administered to children aged 0-6 years in Jiangsu Province was 473,900, 441,900, 402,700, and 217,100 doses for the 1st to 4th dose, respectively. The vaccination rates were 7.65%, 7.14%, 6.50%, and 3.51%, respectively. The vaccination rate in southern Jiangsu was higher than in other regions, and the vaccination rate was higher among children with permanent residential permits than the migrant children group, indicating a distribution imbalance between regions³.

Another study in Beijing involved 480 guardians of children aged 0-3 (born between April 1, 2015, and March 31, 2018), sampled from 30 vaccination units. The results showed that the coverage rate for the pentavalent vaccine was only 12.08%⁴. This finding was similar to an investigation in Fengtai District’s Puhuangyu area in Beijing (11.81%) ⁵ but higher than the coverage rates found in other cities, such as Shapingba District in Chongqing (3.46%)⁶, Beitang District in Wuxi (5.36%)⁷, Cixi City (9.57%)⁶, and Keqiao District in Shaoxing (8.21%)⁹.

Several studies have found that the vaccination rate for the pentavalent vaccine is lower than that for other types of non-NIP vaccines. For example, the coverage rate for the inactivated Japanese encephalitis vaccine in Cixi City was 20%, and the full vaccination rate for the Meningococcal A and C conjugate vaccine in Henan Province had already reached 27.04%¹⁰.

Zhengzhou Children’s Hospital surveyed between June 2018 and June 2019, selecting 600 preschool children aged 0-6 to investigate their vaccination status for non-scheduled vaccines⁸. The results showed that the vaccination rates for the quadrivalent and pentavalent vaccines were not ideal, with local children having higher vaccination rates than migrant children. Of the 343 children eligible for the quadrivalent vaccine, only 2 completed the full vaccination schedule, with a completion rate of 0.58%. Of the 171 children eligible for the pentavalent vaccine, 6 completed the full vaccination schedule, with a higher completion rate of 3.51% compared to the quadrivalent vaccine. The highest vaccination rate for non-NIP vaccines in this survey was for the varicella vaccine, at 76.26%, while the full vaccination rate for the rotavirus vaccine was the lowest, at 0.39%, slightly lower than the coverage rate for the quadrivalent vaccine.

Content Editor：Xiaotong Yang

Page Editor：Ziqi Liu

---

References