Background: A life-course immunization approach would enhance the quality of life across all age groups and improve societal well-being. The herpes zoster (HZ) vaccine is highly recommended for older adults to prevent HZ infection and related complications. The proportions of willingness to receive the HZ vaccine varies across countries, and various kinds of factors, including sociodemographics and individual perceptions, influence the willingness to vaccinate. Objective: We aim to estimate the HZ vaccination willingness rate and identify factors associated with vaccine uptake willingness across all World Health Organization (WHO) regions. Methods: A global systematic search was performed on PubMed, Web of Science, and the Cochrane Library for all papers related to the HZ vaccine published until June 20, 2022. Study characteristics were extracted for each included study. Using double arcsine transformation, vaccination willingness rates with 95% CIs were pooled and reported. The willingness rate and associated factors were analyzed by geographical context. Associated factors were also summarized based on Health Belief Model (HBM) constructs. Results: Of the 26,942 identified records, 13 (0.05%) papers were included, covering 14,066 individuals from 8 countries in 4 WHO regions (Eastern Mediterranean Region, European Region, Region of the Americas, and Western Pacific Region). The pooled vaccination willingness rate was 55.74% (95% CI 40.85%-70.13%). Of adults aged ≥50 years, 56.06% were willing to receive the HZ vaccine. After receiving health care workers’ (HCWs) recommendations, 75.19% of individuals were willing to get the HZ vaccine; without HCWs’ recommendations, the willingness rate was only 49.39%. The willingness rate was more than 70% in the Eastern Mediterranean Region and approximately 55% in the Western Pacific Region. The willingness rate was the highest in the United Arab Emirates and the lowest in China and the United Kingdom. The perception of HZ severity and susceptibility was positively associated with vaccination willingness. The perceived barriers to vaccination willingness (main reasons for unwillingness) included low trust in the effectiveness of the HZ vaccine, concerns about safety, financial concerns, and being unaware of the HZ vaccine’s availability. Older individuals, those having lower education, or those having lower income levels were less likely to willing to be vaccinated. Conclusions: Only 1 in 2 individuals showed a willingness to be vaccinated against HZ. The willingness rate was the highest in the Eastern Mediterranean Region. Our findings show the critical role HCWs play in promoting HZ vaccination. Monitoring HZ vaccination willingness is necessary to inform public health decision-making. These findings provide critical insights for designing future life-course immunization programs.

Background: Promoting vaccination and eliminating vaccine hesitancy are key measures for controlling vaccine-preventable diseases. Objective: We aimed to understand the beliefs surrounding and drivers of vaccination behavior, and their relationships with and influence on vaccination intention and practices. Methods: We conducted a web-based survey in 31 provinces in mainland China from May 24, 2021 to June 15, 2021, with questions pertaining to vaccination in 5 dimensions: attitude, subjective norms, perceived behavioral control, intention, and behavior. We performed hierarchical regression analysis and structural equation modeling based on the theory of planned behavior—in which, the variables attitude, subjective norms, and intention each affect the variable intention; the variable intention mediates the relationships of attitude and subjective norms with behavior, and the variable perceived behavioral control moderates the strength of this mediation—to test the validity of the theoretical framework. Results: A total of 9924 participants, aged 18 to 59 years, were included in this study. Vaccination intention mediated the relationships of attitude and subjective norms with vaccination behavior. The indirect effect of attitude on vaccination behavior was 0.164 and that of subjective norms was 0.255, and the difference was statistically significant (P<.001). The moderated mediation analysis further indicated that perceived behavioral control would affect the mediation when used as moderator, and the interaction terms for attitude (β=–0.052, P<.001) and subjective norms (β=–0.028, P=.006) with perceived behavioral control were significant. Conclusions: Subjective norms have stronger positive influences on vaccination practices than attitudes. Perceived behavioral control, as a moderator, has a substitution relationship with attitudes and subjective norms and weakens their positive effects on vaccination behavior.

Background: It was reported that one in four parents were hesitant about vaccinating their children in China. Previous studies have revealed a declining trend in the vaccine willingness rate in China. There is a need to monitor the level of parental vaccine hesitancy toward routine childhood vaccination and hesitancy toward the COVID-19 vaccine during the ongoing COVID-19 pandemic. Objective: This study aims to assess changes in trends of parental attitudes toward routine childhood vaccines and COVID-19 vaccinations across different time periods in China. Methods: Three waves of cross-sectional surveys were conducted on parents residing in Wuxi City in Jiangsu Province, China from September to October 2020, February to March 2021, and May to June 2021. Participants were recruited from immunization clinics. Chi-square tests were used to compare the results of the three surveys, controlling for sociodemographic factors. Binary and multivariable logistic regression analysis was used to examine factors related to parental vaccine hesitancy and COVID-19 vaccine willingness. Results: Overall, 2881, 1038, and 1183 participants were included in the survey’s three waves. Using the Vaccine Hesitancy Scale, 7.8% (225/2881), 15.1% (157/1038), and 5.5% (65/1183) of parents showed hesitancy to childhood vaccination (P<.001), and 59.3% (1709/2881), 64.6% (671/1038), and 92% (1088/1183) of parents agreed to receive a COVID-19 vaccine themselves in the first, second, and third surveys, respectively (P<.001). In all three surveys, “concerns about vaccine safety and side effects” was the most common reason for refusal. Conclusions: There has been an increasing acceptance of COVID-19 vaccination in Wuxi City, China. Effective interventions are needed to mitigate public concerns about vaccine safety.

Background. The performance of risk prediction models for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) was uncertain. The aim of the study was to critically evaluate the reports of transparent and external validation performances of these prediction models based on system review and meta‐analysis. Methods. A systematic search of the Web of Science and PubMed was performed for studies published until October 17, 2020. The transparent reporting of a multivariable prediction model for the individual prognosis or diagnosis (TRIPOD) tool was used to critically evaluate the quality of external validation reports for six models (CU‐HCC, GAG‐HCC, PAGE‐B, mPAGE‐B, REACH‐B, and mREACH‐B). The area under the receiver operator characteristic curve (AUC) values was to estimate the pooled external validating performance based on meta‐analysis. Subgroup analysis and metaregression were also performed to explore heterogeneity. Results. Our meta‐analysis included 22 studies published between 2011 and 2020. The compliance of the included studies to TRIPOD ranged from 59% to 90% (median, 74%; interquartile range (IQR), 70%, 79%). The AUC values of the six models ranged from 0.715 to 0.778. In the antiviral therapy subgroups, the AUC values of mREACH‐B, GAG‐HCC, and mPAGE‐B were 0.785, 0.760, and 0.778, respectively. In the cirrhosis subgroup, all models had poor discrimination performance (AUC < 0.7). Conclusions. A full report of calibration and handling of missing values would contribute to a greater improvement in the quality of external validation reports for CHB‐related HCC risk prediction. It was necessary to develop a specific HCC risk prediction model for patients with cirrhosis.

Background: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was first reported in China, which caused a respiratory disease known as Coronavirus Disease 2019 (COVID-19). Since its discovery, the virus has spread to over 160 countries and claimed more than 9800 deaths. This study aimed to assess the effectiveness and cost-effectiveness of various response public health measures. Methods: The stochastic agent-based model was used to simulate the process of COVID-19 outbreak in scenario I (imported one case) and II (imported four cases) with a series of public health measures, involving the personal protection, isolation-and-quarantine, gathering restriction, and community containment. The virtual community was constructed following the susceptible-latent-infectious-recovered framework. The epidemiological and economic parameters derived from the previous literature and field investigation. The main outcomes included avoided infectors, cost-effectiveness ratios (CERs), and incremental cost-effectiveness ratios (ICERs). The sensitivity analyses were undertaken to assess uncertainty. Results: In scenario I and II, the isolation-and-quarantine averted 1696 and 1990 humans infected respectively at the cost of US$12 428 and US$58 555, both with negative value of ICERs. The joint strategy of personal protection and isolation-and-quarantine could avert one more case than single isolation-and-quarantine with additional cost of US$166 871 and US$180 140 respectively. The effectiveness of isolation-and-quarantine decreased as lowering quarantine probability and increasing delay-time. Especially in scenario II, when the quarantine probability was less than 25%, the number of infections raised sharply; when the quarantine delay-time reached six days, more than a quarter of individuals would be infected in the community. The strategy including community containment could protect more lives and was cost-effective, when the number of imported cases was no less than 65, or the delay-time of quarantine was more than five days, or the quarantine probability was below 25%, based on current assumptions. Conclusions: The isolation-and-quarantine was the most cost-effective intervention. However, personal protection and isolation-and-quarantine was the optimal strategy averting more infectors than single isolation-and-quarantine. Certain restrictions should be considered, such as more initial imported cases, longer quarantine delay-time and lower quarantine probability.

Vaccine hesitancy is one of the top ten health threats. We aimed to (1) assess parental Category B vaccines hesitancy and associated sociodemographic factors in China, and (2) explore the associati...