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Hu Y.,Institute of Immunization and Prevention | Chen Y.,Institute of Immunization and Prevention | Wang Y.,Institute of Immunization and Prevention | Song Q.,Institute of Immunization and Prevention | Li Q.,Institute of Immunization and Prevention
Human Vaccines and Immunotherapeutics | Year: 2017

Objectives: To verify the effectiveness of prenatal vaccination education intervention on improving mother's vaccination knowledge and child's vaccination status in Zhejiang province, eastern China. Methods: Pregnant women with ≥ 12 gestational weeks were recruited and randomly assigned into the intervention group and the control group. The intervention group were given a vaccination education session while the control group were not. Two round surveys were performed before and 3 months after the intervention. The vaccination status of child was extracted at 12 months of age from immunization information system. The differences of the vaccination knowledge, the coverage, the completeness and the timeliness of vaccination between 2 groups were evaluated. The effectiveness of vaccination education intervention was assessed, under the control of the other demographic variables. Results: Among the 1252 participants, 851 subjects replied to the post-survey. Significant improvements of vaccination knowledge between the pre- and the post- survey in the intervention group were observed (Mean ± S.D:1.8 ± 1.1 vs. 3.7 ± 1.2 for vaccines score and 2.7 ± 1.5 vs. 4.8 ± 1.0 for vaccine policy score, respectively). The coverage of fully vaccination was significantly higher in the intervention group (90.0% vs. 82.9%, P<0.01). The timeliness of fully vaccination was significantly higher in the intervention group (51.9% vs. 33.0%, P<0.01). In the intervention group, pregnant women were more likely to be with high score of knowledge (OR = 5.2, 95%CI: 2.6–8.8), and children were more likely to complete the full series of vaccination (OR = 3.4, 95%CI: 2.1–4.8), and children were more likely to complete the full series of vaccination in a timely manner (OR = 2.3, 95%CI: 1.6–3.5). Conclusions: Vaccination education in the pregnant women can effectively improve the knowledge regarding immunization and increase the coverage, the completeness and the timeliness of childhood vaccination. Strong partnership needs to be established between the obstetricians and the vaccination staff to improve the performance of NIP. © 2017 Taylor & Francis


Li Q.,Institute of Immunization and Prevention | Hu Y.,Institute of Immunization and Prevention | Zhong Y.,China Institute of Technology | Chen Y.,Institute of Immunization and Prevention | And 3 more authors.
International Journal of Environmental Research and Public Health | Year: 2014

Background: The Zhejiang Immunization Information System (ZJIIS) was established in 2004. This study described the coverage rates of NIP vaccines in Zhejiang Province using the ZJIIS. Methods: Children aged 1-7 years (born from 1 January 2005 to 31 December 2011) registered in ZJIIS were enrolled in this study. All immunization records were obtained from the ZJIIS on 31 December 2012. The cohort method had been used for identifying trends and patterns in vaccine administration. Immunization coverage estimates were analyzed for both individual NIP vaccines and "Fully immunized" by age group, birth cohort, immigration status, and geography area. We also examined the timeliness vaccination for the 2010 birth cohort. Results: A total of 3,579,896 children were registered in ZJIIS. All the vaccines and doses which scheduled to be given at ≤12 months of age exceeded 90%. There was substantial decrease trend in the vaccines scheduled at >12 months of age and most of these vaccines were below 90%. The coverage of migrant children was lower than for resident children and the coverage of WenZhou (WZ), Zhoushan (ZS) and TaiZhou (TZ) was lower than other municipalities for most of vaccines across all the birth cohorts. Nearly 20%-30% of children of 2010 birth cohort delayed for the primary series vaccination scheduled at ≤12 months of age, especially among migrant children. Conclusions: The ZJIIS is useful in tracking vaccine coverage of children aged 1-7 years and the data provided by ZJIIS reflected the fact that NIP delivery was improving in Zhejiang Province, while identifying some areas for improvement. We recommend continuing surveillance to estimate of vaccine coverage through ZJIIS. Immunization strategies such as Assessment, Feedback, Incentives, and Exchange program, reminder/recall activity, home visits, school entry requirements and school-based clinics could be used to reach a higher coverage of the population. © 2014 by the authors; licensee MDPI, Basel, Switzerland.


Hu Y.,Institute of Immunization and Prevention | Hu Y.,Zhejiang University
International Journal of Environmental Research and Public Health | Year: 2015

Background: caregivers’ knowledge on vaccination is an important impact factor for their children’s vaccination status. The aims of this study were to evaluate the caregivers’ knowledge of vaccination, and to assess effectiveness of a health education seminar for improving caregivers’ knowledge on immunization. Methods: pre- and post-assessment design was adopted for a single group to evaluate the effectiveness of the health education seminar on vaccination. The seminar consisted of a lecture using simple understandable language. Improvements in total knowledge score before and after the seminar were assessed using a validated questionnaire that included ten questions. Description analysis and non-parametric tests were applied to evaluate and compare the vaccination knowledge level before and after the seminar. Results: 378 caregivers participated in this study. The majority were mothers. Of the ten questions, the correct response rates had significantly increased for nine questions after the education seminar. The mean total score of the assessment before the seminar was 5.2 ± 1.2 while that was 8.4 ± 0.9 for the assessment after the seminar, with a significant increase of 3.18 points. Conclusion: a short education seminar designed for caregivers had a remarkable effect on their vaccination knowledge. Health education on vaccination targeting migrant caregivers, caregivers with lower education level or household income, and employed caregivers are needed in future. © 2015 by the authors; licensee MDPI, Basel, Switzerland.


Sun M.,Institute of Immunization and Prevention | Ma R.,Institute of Immunization and Prevention | Zeng Y.,Institute of Immunization and Prevention | Luo F.,Institute of Immunization and Prevention | And 2 more authors.
Vaccine | Year: 2010

Objective: To properly evaluate the immunization status and determine risk factors of migrant children in 23 densely populated towns and townships in Beijing. Methods: A household cluster sampling survey was implemented and standard face-to-face interviews were conducted with 1820 migrant children aged 12-35 months. Demographic characteristics of the child and primary caregiver, the child's migrant characteristics, the primary caregiver's knowledge and attitude toward immunization, information about immunization services provided by the local clinic, and the child's immunization history were obtained. Weighted up-to-date (UTD) and age-appropriate immunization rates for the following four vaccines were assessed: three doses of diphtheria, tetanus and pertussis combined vaccine (DTP); three doses of oral poliomyelitis vaccine (OPV); three doses of hepatitis B vaccine (HepB); and one dose of Measles-containing vaccine (MCV). Weighted UTD and age-appropriate immunization rates for the overall series of these four vaccines (the 3:3:3:1 immunization series) were also estimated. Risk factors for not being UTD, being invalid and being delayed for the 3:3:3:1 immunization series were explored using both single-level and multi-level multinomial logistic regression models. Results: For each antigen, the weighted UTD immunization rate was above 83%, but the age-appropriate immunization coverages for HepB, OPV, DPT, and MCV were only 45.6%, 49.6%, 50.8% and 54.7%, respectively. The 1st dose was most likely to be invalid or delayed within HepB, OPV and DPT series. For the 3:3:3:1 immunization series, the weighted UTD and age-appropriate immunization rates were 78.1% and 20.5%, respectively. Immunization status of migrant children tended to be homogenous within a village and therefore, multi-level model was more appropriate for assessing risk factors. Besides demographic characteristics, several other factors were significantly associated with age-appropriate immunization coverage. These factors included: the child's migrant characteristics; the primary caregiver's awareness of the importance of vaccination, and outreach services provided by immunization clinics including notification services and supplementary immunization activities (SIAs). The frequency and duration of clinical immunization sessions significantly influenced the UTD immunization rate but not the age-appropriate immunization rate. The degree of the primary caregiver's satisfaction with clinic services and convenience to vaccination clinic had no impact on the child's immunization status. Conclusion: Alarmingly low age-appropriate immunization coverage of migrant children in densely populated areas demanded immediate intervention. Community context was an important factor to a migrant child's vaccination status and should be considered when taking measures. Strategies to strengthen outreach immunization service need to be developed to effectively improve the age-appropriate immunization coverage of migrant children. © 2009 Elsevier Ltd. All rights reserved.


Hu Y.,Institute of Immunization and Prevention | Li Q.,Institute of Immunization and Prevention | Luo S.,Institute of Immunization and Prevention | Lou L.,Institute of Immunization and Prevention | And 2 more authors.
PLoS ONE | Year: 2013

Background:The reported coverage rates of first and second doses of measles containing vaccine (MCV) are almost 95% in China, while measles cases are constantly being reported. This study evaluated the vaccine coverage, timeliness, and barriers to immunization of MCV1 and MCV2 in children aged from 8-48 months.Methods:We assessed 718 children aged 8-48 months, of which 499 children aged 18-48 months in September 2011. Face to face interviews were administered with children's mothers to estimate MCV1 and MCV2 coverage rate, its timeliness and barriers to vaccine uptake.Results:The coverage rates were 76.9% for MCV1 and 44.7% for MCV2 in average. Only 47.5% of surveyed children received the MCV1 timely, which postpone vaccination by up to one month beyond the stipulated age of 8 months. Even if coverage thus improves with time, postponed vaccination adds to the pool of unprotected children in the population. Being unaware of the necessity for vaccination and its schedule, misunderstanding of side-effect of vaccine, and child being sick during the recommended vaccination period were significant preventive factors for both MCV1 and MCV2 vaccination. Having multiple children, mother's education level, household income and children with working mothers were significantly associated with delayed or missing MCV1 immunization.Conclusions:To avoid future outbreaks, it is crucial to attain high coverage levels by timely vaccination, thus, accurate information should be delivered and a systematic approach should be targeted to high-risk groups. © 2013 Hu et al.


Hu Y.,Institute of Immunization and Prevention | Shen L.,Institute of Immunization and Prevention | Guo J.,Institute of Immunization and Prevention | Xie S.,Institute of Immunization and Prevention
International Journal of Environmental Research and Public Health | Year: 2014

Background: Vaccine-preventable diseases cause more than one million deaths among children under 5 years of age every year. Public Health Workers (PHWs) are needed to provide immunization services, but the role of human resources for public health as a determinant of vaccination coverage at the population level has not been assessed in China. The objective of this study was to test whether PHW density was positively associated with childhood vaccination coverage in Zhejiang Province, East China. Methods: The vaccination coverage rates of Measles Containing Vaccine (MCV), Diphtheria, Tetanus and Pertussis combined vaccine (DTP), and Poliomyelitis Vaccine (PV) were chosen as the dependent variables. Vaccination coverage data of children aged 13-24 months for each county in Zhejiang Province were taken from the Zhejiang Immunization Information System (ZJIIS). Aggregate PHW density was an independent variable in one set of regressions, and Vaccine Personnel (VP) and other PHW densities were used separately in another set. Data on densities of PHW and VP were taken from a national investigation on EPI launched by Ministry of Health of China in 2013. We controlled other determinants that may influence the vaccination coverage like Gross Domestic Product (GDP) per person, proportion of migrant children aged <7 years, and land area. These data were taken from Zhejiang Provincial Bureau of Statistics and ZJIIS. Results: PHW density was significantly influence the coverage rates of MCV [Adjusted Odds Ratio(AOR) = 4.29], DTP3(AOR = 2.16), and PV3 (AOR = 3.30). However, when the effects of VPs and other PHWs were assessed separately, we found that VP density was significantly associated with coverage of all three vaccinations (MCV AOR = 7.05; DTP3 AOR = 1.82; PV3 AOR = 4.83), while other PHW density was not. Proportion of migrant children < 7 years and Land area were found as negative and significant determinants for vaccination coverage, while GDP per person had no effect on vaccination coverage. Conclusions: A higher density of PHWs (VP) would improve the availability of immunization services over time and space, which may increase the possibility of achieving a higher childhood vaccination coverage rate. It was indicated that the level of GDP per person had no association with the improved vaccination coverage after controlling for other potential factors. Our findings implicated that PHW density was a major constraint on immunization coverage in Zhejiang Province. © 2014 by the authors; licensee MDPI, Basel, Switzerland.


Hu Y.,Institute of Immunization and Prevention | Chen E.,Institute of Immunization and Prevention | Li Q.,Institute of Immunization and Prevention | Chen Y.,Institute of Immunization and Prevention | Qi X.,Institute of Immunization and Prevention
Asia-Pacific Journal of Public Health | Year: 2015

The study aimed to assess the determinants of immunization coverage in children born in 2008-2009, living in Zhejiang Province. The World Health Organization's cluster sampling technique was applied. Immunization coverage of 5 vaccines was assessed: BCG vaccine, diphtheria and tetanus toxoids and pertussis vaccine, poliomyelitis vaccine, hepatitis B vaccine, and measles-containing vaccine. Determinants for age-appropriate immunization coverage rates were explored using logistic regression models. Immunization coverage of 5 vaccines were all greater than 90%, but the age-appropriate immunization coverage rates for 3 months and for first dose of measles-containing vaccine was 41.3% and 64.5%, respectively. Siblings in household, mother's education level, household registration, socioeconomic level of resident areas, satisfaction with clinical immunization service, and convenient access to local immunization clinic were associated with age-appropriate coverage rates. Age-appropriate immunization coverage rates should be given more attention and should be considered as a benchmark to strive for in the future intervention. © 2011 APJPH.


Hu Y.,Institute of Immunization and Prevention | Chen Y.,Institute of Immunization and Prevention | Guo J.,Institute of Immunization and Prevention | Tang X.,Institute of Immunization and Prevention | Shen L.,Institute of Immunization and Prevention
Human Vaccines and Immunotherapeutics | Year: 2014

Background: We studied completeness and timeliness of vaccination and determinants for low and delayed uptake in children born between 2008 and 2009 in Zhejiang province in eastern China. Methods: We used data from a cross-sectional cluster survey conducted in 2011, which included 1146 children born from 1 Jan 2008 to 31 Dec 2009. Various vaccination history, social-demographic factors, attitude and satisfaction toward immunization from caregivers were collected by a standard questionnaire. We restricted to the third dose of HepB, PV, and DPT (HepB3, PV3, and DPT 3) as outcome variables for completeness of vaccination and restricted to the first dose of HepB, PV, DPT, and MCV(HepB1, PV 1, DPT1, and MCV1) as outcome variables for timeliness of vaccination. The χ2 test and logistic regression analysis were applied to identify the determinants of completeness and timeliness of vaccination. Survival analysis by the Kaplan-Meier method was performed to present the timeliness vaccination. Results: Coverage for HepB1, HepB3, PV1, PV3, DPT1, DPT3, and MCV1 was 93.22%, 90.15%, 96.42%, 91.63%, 95.80%, 90.16%, and 92.70%, respectively. Timely vaccination occurred in 501/1146(43.72%) children for HepB1, 520/1146(45.38%) for PV1, 511/1146(44.59%) for DPT1, and 679/1146(59.25%) for MCV1. Completeness of specific vaccines was associated with mother' age, immigration status, birth place of child, maternal education level, maternal occupation status, socioeconomic development level of surveyed areas, satisfaction toward immunization service and distance of the house to immunization clinic. Timeliness of vaccination for specific vaccines was associated with mother' age, maternal education level, immigration status, siblings, birth place, and distance of the house to immunization clinic. Conclusion: Despite reasonably high vaccination coverage, we observed substantial vaccination delays. We found specific factors associated with low and/or delayed vaccine uptake. These findings can help to improve strategies such as Reaching Every District (RED), out-reach vaccination services and health education to reach children who remain inadequately protected. © 2014 Landes Bioscience.


Hu Y.,Institute of Immunization and Prevention | Li Q.,Institute of Immunization and Prevention | Chen E.,Institute of Immunization and Prevention | Chen Y.,Institute of Immunization and Prevention | Qi X.,Institute of Immunization and Prevention
International Journal of Environmental Research and Public Health | Year: 2013

Objective: To determine the coverage of childhood immunization appropriate for age among socio-economically disadvantaged recent migrants living in East China and to identify the determinants of full immunization uptake among these migrant children. Methods: This is a cross-sectional survey of 1,426 migrant mothers with a child aged ≤24 months, who were interviewed with a pretested questionnaire. Various vaccines, migration history and some other social-demographic and income details were collected. Single-level logistic regression analyses were applied to identify the determinants of full immunization status. Results: Immunization coverage rates are lower among migrants and even lower among recent migrants. The likelihood of a child receiving full immunization rise with parents' educational level and the frequency of mother's utilization of health care. Higher household income also significantly increase the likelihood of full immunization, as dose post-natal visits by a health worker. Conclusions: Recent migrant status favours low immunization uptake, particularly in the vulnerability context of alienation and livelihood insecurity. Services must be delivered with a focus on recent migrants. Investments are needed in education, socio-economic development and secure livelihoods to improve and sustain equitable health care services. © 2013 by the authors; licensee MDPI, Basel, Switzerland.


PubMed | Institute of Immunization and Prevention
Type: Journal Article | Journal: International journal of environmental research and public health | Year: 2016

In 2014 a 2-doses varicella vaccine (VarV) schedule was recommended by the Zhejiang Provincial Center for Disease Control and Prevention. We aimed to assess the coverage of the 1st dose of VarV (VarV) and the 2nd dose of VarV (VarV) among children aged 2-6 years through the Zhejiang Provincial Immunization Information System (ZJIIS) and to explore the determinants associated with the VarV coverage.Children aged 2-6 years (born from 1 January 2009 to 31 December 2013) registered in ZJIIS were enrolled. Anonymized individual records of target children were extracted from the ZJIIS database on 1 January 2016, including their VarV and (measles-containing vaccine) MCV vaccination information. The VarV and VarV coverage rates were evaluated for each birth cohorts. The coverage of VarV also was estimated among strata defined by cities, gender and immigration status. We also evaluated the difference in coverage between VarV and MCV.A total of 3,028,222 children aged 2-6 years were enrolled. The coverage of VarV ranged from 84.8% to 87.9% in the 2009-2013 birth cohorts, while the coverage of VarV increased from 31.8% for the 2009 birth cohort to 48.7% for the 2011 birth cohort. Higher coverage rates for both VarV and VarV were observed among resident children in relevant birth cohorts. The coverage rates of VarV and VarV were lower than those for the 1st and 2nd dose of MCV, which were above 95%. The proportion of children who were vaccinated with VarV at the recommended age increased from 34.6% for the 2009 birth cohort to 75.2% for the 2013 birth cohort, while the proportion of children who were vaccinated with VarV at the recommended age increased from 19.7% for the 2009 birth cohort to 48.7% for the 2011 birth cohort.Our study showed a rapid increasing VarV coverage of children, indicating a growing acceptance of the 2-doses VarV schedule among childrens caregivers and physicians after the new recommendation released. We highlighted the necessity for a 2-doses VarV vaccination school-entry requirement to achieve the high coverage of >90% and to eliminate disparities in coverage among sub-populations. We also recommended continuous monitoring of the VarV coverage via ZJIIS over time.

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