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 DPT3) as outcome variables for completeness of vaccination and restricted to the first dose of HepB, PV, DPT, and MCV(HepB1, PV1, 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 HepB...

Background: Reasons for acceptance of seasonal influenza vaccine (SIV) vaccination among pregnant women in China are poorly understood. We assessed the intention to accept SIV among pregnant women in Zhejiang province, by using a self-administrated structured questionnaire developed on the basis of health belief model (HBM). Methods: From 1 January to 31 March 2014, pregnant women with ≥12 gestational weeks who attended antenatal clinics (ANCs) at public hospitals in 6 out of 90 districts were surveyed using a self-administered questionnaire that covered knowledge, attitudes, and beliefs related to SIV vaccination and influenza infection. We examined the associations between the acceptance of SIV vaccination and the demographic factors and HBM constructs using the logistic regression model, calculating the adjusted odds ratio (AOR). Results: Of the 1252 participants, 76.28% were willing to receive the SIV vaccination during their current pregnancy. High levels of perceived susceptibility of influenza (AOR = 1.75 (95%CI: 1.36–2.08)), high levels of perceived severity of influenza (AOR = 1.62 (95%CI: 1.25–1.95)), high level of perceived benefits of vaccination (AOR = 1.97 (95%CI: 1.76–2.21)), and high levels of cues to action were positively associated with the acceptance of SIV vaccination among pregnant women (AOR = 2.03 (95%CI: 1.70–2.69)), while high level of perceived barriers of vaccination was a negative determinant (AOR = 0.76 (95%CI: 0.62–0.94)). Conclusions: Poor knowledge and negative attitude towards SIV were associated with the poor acceptance of SIV. Health providers’ recommendations were important to pregnant women’s acceptance of SIV. Health education and direct communication strategies on SIV vaccination and influenza infection are necessary to improve the acceptance of SIV vaccination among pregnant women.

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.

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. 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. 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. 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.

This study aimed to describe the disparities in immunization coverage between National Immunization Program (NIP) vaccines and non-NIP vaccines in Yiwu and to identify potential determinants. A face-to-face interview-based questionnaire survey among 423 migrant children born from 1 June 2010 to 31 May 2013 was conducted. Immunization coverage was estimated according to the vaccines scheduled at different age, the birth cohorts, and socio- demographic characteristics. Single-level logistic regression analysis was applied to identify the determinants of coverage of non-NIP vaccines. We found that NIP vaccines recorded higher immunization coverage compared with non-NIP vaccines (87.9100%– vs 0%-74.8%). Among the non-NIP vaccines, varicella vaccine (VarV) recorded the highest coverage of 85.4%, which was introduced in 1998; while 7-valent pneumococcal conjugate vaccine(PCV7) recorded the lowest coverage of 0% for primary series, which was introduced recently. Lower coverage rate of non-NIP vaccines was significantly associated with more siblings in household, shorter duration of living in the surveyed areas, lower family income, mother with a job, mother with poor awareness of vaccination, and mother with lower education level. We found the immunization coverage rate of non-NIP vaccines was significant lower than that of NIP vaccines. Expansion of NIP to include non-NIP vaccines can provide better protection against the vaccine preventable diseases through increased immunization coverage.

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.