title: Loss of confidence in vaccines following media reports of infant deaths after hepatitis B vaccination in China.
abstract: China reduced hepatitis B virus (HBV) infection by 90% among children under 5 years old with safe and effective hepatitis B vaccines (HepB). In December 2013, this success was threatened by widespread media reports of infant deaths following HepB administration. Seventeen deaths and one case of anaphylactic shock following HBV vaccination had been reported.
  
  
  
  We conducted a telephone survey to measure parental confidence in HepB in eleven provinces at four points in time; reviewed maternal HBV status and use of HepB for newborns in birth hospitals in eight provinces before and after the event; and monitored coverage with hepatitis B vaccine and other programme vaccines in ten provinces.
  
  
  
  HepB from the implicated company was suspended during the investigation, which showed that the deaths were not caused by HepB vaccination. Before the event, 85% respondents regarded domestic vaccines as safe, decreasing to 26.7% during the event. During the height of the crisis, 30% of parents reported being hesitant to vaccinate and 18.4% reported they would refuse HepB. Use of HepB in the monitored provinces decreased by 18.6%, from 53 653 doses the week before the event to 43 688 doses during the week that Biokangtai HepB was suspended. Use of HepB within the first day of life decreased by 10% among infants born to HBsAg-negative mothers, and by 6% among infants born to HBsAg-positive mothers. Vaccine refusal and HepB birth dose rates returned to baseline within 2 months; confidence increased, but remained below baseline.
  
  
  
  The HBV vaccine event resulted in the suspension of a safe vaccine, which was associated with a decline of parental confidence, and refusal of vaccination. Suspension of a vaccine can lead to loss of confidence that is difficult to recover. Timely and credible investigation, accompanied by proactive outreach to stakeholders and the media, may help mitigate negative impact of future coincidental adverse events following immunization.
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and.
authors.forename: Wenzhou
authors.initials: W
authors.lastname: Yu
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and.
authors.forename: Dawei
authors.initials: D
authors.lastname: Liu
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and.
authors.forename: Jingshan
authors.initials: J
authors.lastname: Zheng
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and.
authors.forename: Yanmin
authors.initials: Y
authors.lastname: Liu
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and.
authors.forename: Zhijie
authors.initials: Z
authors.lastname: An
authors.affiliation: World Health Organization Office in China, Beijing, China.
authors.forename: Lance
authors.initials: L
authors.lastname: Rodewald
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Guomin
authors.initials: G
authors.lastname: Zhang
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Qiru
authors.initials: Q
authors.lastname: Su
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Keli
authors.initials: K
authors.lastname: Li
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Disha
authors.initials: D
authors.lastname: Xu
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Fuzhen
authors.initials: F
authors.lastname: Wang
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Ping
authors.initials: P
authors.lastname: Yuan
authors.affiliation: World Health Organization Office in China, Beijing, China hqwang@vip.sina.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Xia
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Guijun
authors.initials: G
authors.lastname: Ning
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Yaozhu
authors.initials: Y
authors.lastname: Chu
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Cui
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Mengjuan
authors.initials: M
authors.lastname: Duan
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Lixin
authors.initials: L
authors.lastname: Hao
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Zhenhua
authors.initials: Z
authors.lastname: Wu
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Xuan
authors.initials: X
authors.lastname: Zhang
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Fuqiang
authors.initials: F
authors.lastname: Cui
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China and hqwang@vip.sina.com.
authors.forename: Huaqing
authors.initials: H
authors.lastname: Wang
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D002423:Cause of Death; D002648:Child; D002681:China / Q000453:epidemiology; D064420:Drug-Related Side Effects and Adverse Reactions / Q000208:ethnology / Q000401:mortality*; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000008:administration & dosage / Q000009:adverse effects; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D066088:Infant Death; D007231:Infant, Newborn; D008297:Male; D008402:Mass Media; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data / Q000639:trends
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines
keywords: Hepatitis B vaccination; coincidental death; communication; vaccine confidence