title: Trends in childhood pneumococcal vaccine coverage in Shanghai, China, 2005-2011: a retrospective cohort study.
abstract: BACKGROUND
  In China, the pneumococcal conjugate vaccine (PCV7) and the pneumococcal polysaccharide vaccine (PPSV23) are not offered under the government's Expanded Program on Immunization and are instead administered for a fee. PCV7 is more effective and covers more serotypes associated with invasive disease in children, but is also more expensive, than PPSV23. Because of their expense, there is concern that these vaccines, especially PCV7, have low uptake particularly among non-locals, migrants from outside of Shanghai. This paper characterizes the differential coverage of PCV7 and PPSV23 between locals and non-locals in Shanghai, and illustrates coverage trends over time.
  
  
  METHODS
  In this retrospective cohort study, children born between 2005 and 2011 were sampled from the Shanghai Immunization Program Information System. Bivariate and multivariable analyses examined the relationships between demographic characteristics, residency status (non-locals vs locals), and vaccination coverage.
  
  
  RESULTS
  PPSV23 coverage (29.8 %) among children over 2 years of age was higher than PCV7 coverage (10.1 %) for locals and non-locals. Uptake of PCV7 increased substantially after children were 2 years of age. Overall, non-local populations had higher PPSV23 coverage (OR: 1.34; 98 % CI: 1.22, 1.46) but lower PCV7 coverage (OR: 0.617, 98 % CI: 0.547, 0.695) than locals.
  
  
  CONCLUSIONS
  There is a need for increasing overall pneumococcal coverage in Shanghai children, particularly with the more effective PCV7 vaccine. Morbidity and mortality due to invasive pneumococcal disease for children <1 year of age are unlikely to be mitigated if the current age-related vaccination patterns are not improved.
authors.affiliation: University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, 48109, MI, USA. mboulton@umich.edu.|University of Michigan Medical School, Ann Arbor, MI, 48109, USA. mboulton@umich.edu.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Boulton
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, 48109, USA.
authors.forename: Nithin S
authors.initials: NS
authors.lastname: Ravi
authors.affiliation: Centers for Disease Control and Prevention, Shanghai, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Sun
authors.affiliation: Centers for Disease Control and Prevention, Shanghai, China.
authors.forename: Zhuoying
authors.initials: Z
authors.lastname: Huang
authors.affiliation: University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, 48109, MI, USA.
authors.forename: Abram L
authors.initials: AL
authors.lastname: Wagner
mesh_terms: D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000191:economics; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data*; D018074:Vaccines, Conjugate
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
references.citation: Clin Infect Dis. 2010 Mar 1;50(5):741-4
references.pmid: 20113175
references.citation: BMC Health Serv Res. 2014 Feb 07;14:56
references.pmid: 24507480
references.citation: MMWR Morb Mortal Wkly Rep. 2013 Jun 28;62(25):521-4
references.pmid: 23803961
references.citation: Vaccine. 2014 Jul 31;32(35):4471-4477
references.pmid: 24968160
references.citation: Pediatr Infect Dis J. 2015 Mar;34(3):289-95
references.pmid: 25259932
references.citation: PLoS One. 2014 May 14;9(5):e97800
references.pmid: 24828814
references.citation: J Infect Dis. 2010 Jan 1;201(1):32-41
references.pmid: 19947881
references.citation: PLoS One. 2011;6(11):e27333
references.pmid: 22110628
references.citation: Clin Microbiol Infect. 2012 Oct;18 Suppl 5:15-24
references.pmid: 22882735
references.citation: Popul Dev Rev. 2010;36(2):357-64
references.pmid: 20734556
references.citation: Health Aff (Millwood). 2012 Nov;31(11):2545-53
references.pmid: 23129686
references.citation: Vaccine. 2010 Feb 3;28(5):1264-74
references.pmid: 19941996
references.citation: Lancet. 2009 Sep 12;374(9693):893-902
references.pmid: 19748398
references.citation: Lancet. 2012 Mar 3;379(9818):843-52
references.pmid: 22386037