The impact of residency and urbanicity on Haemophilus influenzae Type b and pneumococcal immunization in Shanghai Children: a Retrospective Cohort Study.
BACKGROUND
Haemophilus influenzae type b (Hib) vaccine and pneumococcal conjugate vaccine (PCV) are relatively expensive, newly introduced vaccines in China. This study evaluates the impact of residency and urbanicity on Hib vaccine and PCV coverage for children aged 2 to 7 years living in Shanghai, China, in August 2012.


METHODS
In this exploratory cohort study, a sample of children aged 2 to 7 years, all of whom were eligible to have received the complete series of Hib vaccine and PCV, was obtained from the Shanghai Immunization Program Information System. Three measures of vaccination coverage for Hib vaccine and PCV were examined: dose 1 coverage, series completion, and timeliness of dose 1 vaccination. Multivariable binomial regression was used to estimate the difference in vaccination coverage between locals and the floating population.


RESULTS
Dose 1 coverage was 50.9% for Hib vaccine and 11.4% for PCV for the 28,141 abstracted pediatric records. For both vaccines, dose 1 coverage was higher in locals than in the floating population. The disparity in coverage between locals and the floating population was greater in suburban areas than urban areas. Of all children who received dose 1, 79.7% completed the Hib vaccine series, and 91.3% completed the PCV series. Timely dose 1 coverage was 8.2% for Hib vaccine and 0.5% for PCV.


CONCLUSIONS
Low vaccination coverage and extremely low levels of timely dose 1 vaccination indicate that current vaccination efforts are inadequate to reduce the burden of Hib and pneumococcal disease among Chinese children, especially infants. Government funding of the Hib vaccine and PCV through the Expanded Program on Immunization would increase uptake and could also ensure that improvement in the timeliness of administration and series completion is targeted for all demographic groups.
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America.
Abram L
AL
Wagner
Department of Immunization Program, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
Xiaodong
X
Sun
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America.
JoLynn P
JP
Montgomery
Department of Immunization Program, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
Zhuoying
Z
Huang
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America; Division of Infectious Diseases, School of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.
Matthew L
ML
Boulton
D016667:Bacterial Capsules / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D002681:China; D005260:Female; D006192:Haemophilus Infections / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D018073:Haemophilus Vaccines / Q000008:administration & dosage / Q000191:economics / Q000276:immunology*; D019741:Haemophilus influenzae type b / Q000276:immunology*; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007115:Immunization Schedule; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014505:Urban Population; D014611:Vaccination; D018074:Vaccines, Conjugate
D018073:Haemophilus Vaccines; C044237:Haemophilus influenzae type b polysaccharide vaccine; D018074:Vaccines, Conjugate