Journal Content Recommendation
01
The equity road ahead for financing non-national immunization program vaccines in China: challenges and opportunities from a qualitative study
This study published by Prof Xiaohua Ying and team from Fudan University in BMC Sub-Journal International Journal for Equity in Health, aimed to analyze the current situation of financing the non-NIP vaccines and comprehensively identify challenges and potential opportunities, offering suggestions to enhance vaccine uptake and improve public health.
Between July and December 2023, we conducted a series of semi-structured, in-person interviews with 55 stakeholders from the Health Commissions, Centers for Disease Control and Prevention, Medical Insurance Administrations, and Finance Bureau across five provinces in China. Participants were selected through stratified sampling, and the interviews mainly included their involvement in non-NIP vaccine financing, challenges faced, and strategies for improvement to enhance financing performance. Informed consent was obtained, and thematic analysis was used to analyze the data.
Non-NIP vaccine financing sources include out-of-pocket payments, government fundingl, health insurance and other external funds. These four channels differ in vaccine types covered, costs, and target populations, each with unique challenges and opportunities. High out-of-pocket costs remain a significant barrier to equitable vaccine uptake, while market competition has lowered the vaccine price and improved accessibility. Local fiscal support for free vaccination programs faces challenges related to sustainability and regional disparity, though governmental commitment to vaccination is growing. Nevertheless, centralized procurement organized by the government has lowered the price and reduced the financial burden. Despite legal restrictions on using basic health insurance for vaccinations and limited commercial insurance options, private medical savings accounts and mutual-aid mechanisms present new opportunities. Although the scope and impact of external support are limited, it has successfully increased awareness and social attention to vaccination.
The study indicates that relying on individual payments as the main financing channel for non-NIP vaccines is unsustainable and inadequate for ensuring universal vaccine access. A concerted and synergistic approach is essential to ensure sufficient, sustainable resources and enhance public financial management to improve equity in the non-NIP vaccines.
https://doi.org/10.1186/s12939-024-02282-5
02
Factors associated with timely vaccination of pertussis-containing vaccines in children born from 2019 to 2023, Shanghai
This study was published by Prof Weibing Wang and team from Fudan University in Chinese Journal of Epidemiology. Children born in Shanghai between 2019 and 2023 were selected using a stratified random sampling method, and their vaccination data were obtained from the Shanghai Vaccine Management and Vaccination Service Information System. The vaccination rates, timely vaccination rates, and the proportions of diphtheria-tetanus-acellular pertussis-haemophilus influenzae type b combination vaccine (DTaP-Hib) and diphtheria-tetanus-acellular pertussis-inactivated poliovirus-haemophilus influenzae type b combination vaccine (DTaP-IPV-Hib) for the substitution of diphtheria- tetanus-acellular pertussis vaccine (DTaP) were calculated. Also, the factors associated with timely vaccination rate were analyzed with multivariate logistic regression analysis.
The average vaccination coverage rate of pertussis-containing vaccines in children born in Shanghai from 2019 to 2023 ranged from 94.71% to 99.53%. However, the vaccination timeliness rate gradually decreased with increasing doses, from 94.20% for the first dose to 73.31% for the fourth dose. Non-national immunization program (non-NIP) vaccines were used to substitute DTaP vaccines in some children, with the proportion of DTaP-IPV-Hib vaccine accounting for 50.11%-52.69% and the proportion of DTaP-Hib vaccine accounting for 27.22%-28.43%. The proportions of DTaP-Hib and DTaP-IPV-Hib for the substitution of DTaP had increasing trends over the years. The overall timely vaccination rate of pertussis-containing vaccine vaccination was 84.09%.
The study indicates that the substitution of pertussis- containing vaccines with non-NIP vaccines was common in Shanghai. The coverage and timeliness of pertussis-containing vaccine vaccination were relatively high. There was a certain proportion of delayed and missed vaccinations, and it is necessary to pay attention to children who are not vaccinated timely and conduct high-quality catch-up vaccination to ensure timely and complete vaccination of pertussis-containing vaccines.
https://doi.org/10.3760/cma.j.cn112338-20240506-00238
03
Rotavirus Genotypes in the Postvaccine Era: A Systematic Review and Meta-analysis of Global, Regional, and Temporal Trends by Rotavirus Vaccine Introduction
The study was published in Journal of Infectious Diseases. The study systematically reviewed 361 studies reporting rotavirus genotypes from children <5 years of age globally between 2005 and 2023, and compared rotavirus genotypes between vaccine-introducing and non-introducing settings globally and by World Health Organization (WHO) region, calendar time, and time since vaccine introduction.
The result shows that, within 1-2 yr introducing the vaccine,a non-vaccine genotype G2P[4]prevalence significantly increases in vaccine-introducing settings, both globally and by WHO region. This difference did not emerge when examining genotypes over time in the Americas. Compared with the non-introducing settings, G2P[4] detections were more likely in settings with recent introduction (eg, 1–2 years post-introduction,aOR: 4.39; 95% CI, 2.87–6.72) but were similarly likely in settings with more time elapsed since introduction, (eg, 7 or more years, aOR: 1.62; 95% CI, .49–5.37). Therefore, this phenomenon of increasing genotypes is likely to be a short-term trend and not a long-term vaccine-related selective pressure. In addition, there is no evidence to support concerns about vaccine-related selective pressure resulting from the introduction of Rotarix and RotaTeq into national childhood immunization programmes.
The research team concluded that, when accounting for both regional and temporal trends, there was no substantial evidence of long-term vaccine-related selective pressures on circulating genotypes. Emphasizing the importance of regional rather than global comparisons by vaccine introduction status, it was also called for existing rotavirus surveillance systems to describe the full genetic population of rotaviruses detected in order to investigate issues related to vaccine-related selective pressure.
https://doi.org/10.1093/infdis/jiad403
04
Acceptance of Rubella-Containing Vaccine and Factors Associated with Acceptance among Women of Reproductive Age in China: A Cross-Sectional Study
The study was published in Vaccines. Since RCV was introduced nationwide into China’s Expanded Immunization Program (EPI) in 2008, the incidence of rubella has decreased significantly, maintaining low levels in recent years (less than 1.0 per million population since 2019). However, rubella IgG seroprevalence among women of reproductive age in China is below 85%, often considered a threshold for herd immunity. Most women of reproductive age in China were born before the 2008 nationwide RCV introduction, posing a contemporary risk of congenital rubella syndrome (CRS) .
This study was adapted from the behavioral and social drivers (BeSD) of vaccination survey tool developed by the World Health Organization, to investigate the acceptance and factors influencing acceptance of rubella-containing vaccine (RCV) among women of reproductive age in Guangdong, Henan, Hubei, Liaoning, Shanxi, Sichuan and Zhejiang provinces of China. Using a stratified sampling method,the study selected one urban and one rural community health services center in each of two cities in seven provinces.
From these centers, we recruited women 15–49 years of age to complete a questionnaire that includes four dimensions: rubella vaccination willingness, knowledge level, social process and practical issues.Among 1286 participants, 981 (76.3%) were willing to receive RCV. Awareness of rubella ranged from 12.4% to 70.6%. Willingness to receive RCV differed significantly by region, occupation, vaccination history, and awareness. The BeSD survey tool showed that willingness to be vaccinated was positively associated with Thinking and Feeling, Social Processes, and Practical Issues. Targeted measures are needed to address these key factors to increase RCV acceptance and vaccination among non-pregnant women of reproductive age.
https://doi.org/10.3390/vaccines12101153
*Based on the Theory of Planned Behavior, the Health Belief Model, the “3Cs” model of vaccine hesitancy, and other theoretical frameworks, the BeSD framework has four measurable domains addressing vaccine uptake: Thinking and Feeling, Social Processes, Motivation, and Practical Issues.
Policy Updates
01
First domestic HPV2 vaccine single-dose schedule confirmed by WHO
On 4 October 2024, WHO announced that a fourth WHO-prequalified human papillomavirus (HPV) vaccine product, Cecolin® has been confirmed for use in a single-dose schedule. The decision is made based on new data on the product that fulfilled the criteria set out in the WHO’s 2022 recommendations for alternative, off-label use of HPV vaccines in single-dose schedules. This important milestone will contribute to improving sustainable supply of HPV vaccines—allowing more girls to be reached with the vaccines that prevent cervical cancer.
Despite the effectiveness of HPV vaccines in preventing cervical cancer, HPV vaccine introductions have been hampered by global supply shortages since 2018 and production challenges encountered by one of the manufacturers earlier this year led to further shortfalls, potentially impacting millions of girls in need of HPV vaccines in Africa and Asia. According to WHO reports, the global rollout of single-dose vaccination programs in 2023 will benefit at least 6 million girls, increasing global coverage from 20% in 2022 to 27%. As of 10 September 2024, 57 countries are implementing the single-dose schedule.
https://www.who.int/news/item/04-10-2024-who-adds-an-hpv-vaccine-for-single-dose-use
02
SAGE recommends use of respiratory syncytial virus monoclonal antibody and maternal Vaccine
The World Health Organization’s (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) recommended the global use of monoclonal antibodies and maternal vaccines to prevent serious illnesses caused by respiratory syncytial virus (RSV) in a September meeting document. The recommendation marks an important advance in protecting infants from RSV infection, and is of particular significance to the most vulnerable populations in low- and middle-income countries.
SAGE proposes two main routes of prevention: monoclonal antibodies and a maternal vaccine against RSV. Monoclonal antibodies (e.g., Nirsevimab) provide immediate immune protection to infants after birth, while RSV maternal vaccines provide passive immunity during the first months of life by generating antibodies through vaccination during pregnancy and passing them on to infants through the placenta. These strategies are essential for protecting infants in the first months of life, and SAGE calls on countries to adopt comprehensive immunization strategies and to work with global health organizations to ensure that vaccines and monoclonal antibodies can be made widely available in an affordable manner.
03
Expert consensus on the passive immunization prevention of infant respiratory syncytial virus infection in China
This consensus was published on 9th October in Chinese Journal of Epidemiology. Respiratory syncytial virus（RSV）infection, which has the very heavy disease burdens, is the most common viral pathogen that seriously threatens the health of infants and young children. In order to better guide and standardize the clinical diagnosis, treatment, monitoring and immunization prevention and control of RSV infection in China, the Chinese Preventive Medicine Association jointly organized multidisciplinary experts to form a special working group, drawing on the implementation experience of foreign passive immunization prevention of RSV, integrating the existing evidence and the latest progress as a problem oriented, and putting forward the expert consensus on the passive immunization prevention of infant RSV infection in China in the future. The aim is to answer some professional questions about RSV infection and its immunoprophylaxis, especially passive immunoprophylaxis, in order to provide reference for the practice of immunoprophylaxis for professionals in medical institutions, disease prevention and control institutions and community health service centers at all levels.
https://mp.weixin.qq.com/s/Qs7oaIKghMJJ3Xk0QsC2sQ
Content Editor: Ziqi Liu
Page Editor: Ziqi Liu
