Impact of National Immunization Strategies on Vaccine-Preventable Diseases - China, 1950-2021.

What is already known about this topic?: The incidences of vaccine-preventable diseases (VPDs) included in the Expanded Program on Immunization in China have decreased significantly in recent decades. What is added by this report?: This study summarizes the national incidences of nine VPDs and the seroprevalence of hepatitis B surface antigen (HBsAg) under different immunization strategies from 1950 through 2021 in China. The sharpest decreases in VPD incidence and under-5-year HBsAg seroprevalence occurred during the latest stage of the National Immunization Program. The decreases in VPD incidence were most prominent among children under five years of age. What are the implications for public health practice?: These findings provide valuable insights for vaccine value assessment and emphasize the importance of implementing immunization strategies in targeted populations.

Therapeutic angiogenesis based on injectable hydrogel for protein delivery in ischemic heart disease.

Ischemic heart disease (IHD) remains the leading cause of death and disability worldwide and leads to myocardial necrosis and negative myocardial remodeling, ultimately leading to heart failure. Current treatments include drug therapy, interventional therapy, and surgery. However, some patients with severe diffuse coronary artery disease, complex coronary artery anatomy, and other reasons are unsuitable for these treatments. Therapeutic angiogenesis stimulates the growth of the original blood vessels by using exogenous growth factors to generate more new blood vessels, which provides a new treatment for IHD. However, direct injection of these growth factors can cause a short half-life and serious side effects owing to systemic spread. Therefore, to overcome this problem, hydrogels have been developed for temporally and spatially controlled delivery of single or multiple growth factors to mimic the process of angiogenesis in vivo. This paper reviews the mechanism of angiogenesis, some important bioactive molecules, and natural and synthetic hydrogels currently being applied for bioactive molecule delivery to treat IHD. Furthermore, the current challenges of therapeutic angiogenesis in IHD and its potential solutions are discussed to facilitate real translation into clinical applications in the future.

Coverage of 13-Valent Pneumococcal Conjugate Vaccine Among Children 0-15 Months of Age - 9 Provinces, China, 2019-2021.

What is already known on this topic?: Limited data exist regarding the coverage of the 13-valent pneumococcal conjugate vaccine (PCV13) in China. A lack of official statistics, coupled with an insufficient body of published literature, hinders the accurate depiction of the current situation. What is added by this report?: This study investigated the utilization of PCV13 and estimated its coverage in nine provinces across eastern, central, and western China between 2019 and 2021. Despite an annual increase in PCV13 usage during this period, the overall coverage remained suboptimal. What are the implications for public health practice?: Consideration should be given to incorporating vaccines into the Expanded Program of Immunization, reducing vaccine prices, and addressing the vaccination coverage gap between eastern and western regions when there is an adequate supply of PCV13, particularly with domestic vaccines.

Assessing vaccine hesitancy using the WHO scale for caregivers of children under 3 years old in China.

Introduction: Vaccine hesitancy may increase infectious disease burden and impede disease control efforts, while few studies have measured such a phenomenon with a standardized tool in China. This study aimed to test the validation of the Vaccine Hesitancy Scale (VHS) developed by the WHO SAGE Working Group among caregivers and examine demographic characteristics associated with caregiver hesitancy in six provinces of China. Methods: Using a multistage sampling design, this study was conducted in 36 immunization clinics in six provinces from December 2019 to August 2020. Caregivers of children aged 0-3 years were included. The VHS was used to assess vaccine hesitancy. The construct validity and internal consistency of the scale were assessed. Associations between caregivers' characteristics and vaccine hesitancy were examined by simple and multiple linear regression models. Results: Of the 3,359 participants included, a two-factor structure within the scale was identified, consisting of "lack of confidence" (1.89 ± 0.53) and "risks" (3.20 ± 0.75). Caregivers engaged in medical work expressed more confidence and were less concerned about risks compared to those of non-medical staff (p < 0.05). Participants with higher income levels were more confident (p < 0.05), while those surveyed after the COVID-19 pandemic, who were mothers, who had an older child, or who were raising a second or above birth child, had less concern about risks (p < 0.05). Discussion: We found that the VHS had acceptable reliability and construct validity and caregivers' hesitancy was driven more by concerns about risks than by the lack of confidence. Countering these concerns will be particularly important among non-medical staff, lower income, child's fathers, having a younger child, or raising first-birth child groups.

Oxygen removal and silicon recovery from polycrystalline silicon kerf loss by combining vacuum magnesium thermal reduction and hydrochloric acid leaching.

With the strengthened awareness of environmental protection and the growing interests of wastes recycling, silicon recovery from polycrystalline silicon kerf loss (PSKL) has drawn extensive attentions all over the world. In this paper, an efficient and environmental friendly approach for oxygen removal and silicon recovery from PSKL by combining vacuum magnesium thermal reduction (VMTR) and hydrochloric acid leaching was proposed. The effects of temperature, duration and particle size on the reduction of PSKL were investigated thoroughly. It is proved that the amorphous SiO2 in PSKL can be reduced by magnesium vapor at 923 K to generate MgO, and then the produced MgO can be dissolved by hydrochloric acid to eliminate the impurity oxygen. The oxygen removal fraction and the silicon recovery efficiency attained 98.43% and 94.46%, respectively, under the optimal conditions, indicating that a high efficiency recovery of silicon from PSKL was achieved. Compared to the existing PSKL deoxidation technologies, e.g., the high temperature process and the hydrofluoric acid leaching method, this method requires a relatively lower temperature and the waste acid can be easily recovered. Additionally, by taking into accounts the fact that the MgCl2 in leaching liquor can be recycled for cyclic utilization with a molten salt electrolysis method, it should be suggested that an efficient and environmental friendly process for PSKL recycling was obtained, which shows good prospects for commercial application.

Willingness of parents of 9-to-18-year-old females in China to vaccinate their daughters with HPV vaccine.

OBJECTIVE: To assess knowledge about HPV and HPV vaccine, willingness to have their daughters receive HPV vaccine, and factors associated with knowledge and willingness among parents of females 9 to 18 years of age in China. METHODS: We conducted a cross-sectional survey of parents with daughters 9 to 18 years of age in four provinces of China using a self-administered questionnaire. We used multivariable regression analyses to determine factors associated with willingness vaccinate. RESULTS: We received completed surveys from 5,215 parents. Among respondents, 846 (16.24 %) had a high level of knowledge about HPV (total score ≥ 5). High level of HPV knowledge was associated with having daughters who were <15 years old; having experience paying out-of-pocket for other vaccines; being a mother; having higher educational achievement; being a medical staff member; being in a higher-income category; and residing in an urban area. There were 2,419 (46.39 %) parents who were willing to vaccinate their daughter against HPV and 2,757 (52.87 %) who were willing to receive vaccine themselves (for female respondents) or indicated willingness of their spouse to be vaccinated (for male respondents). Willingness of mothers to be vaccinated was associated with daughters' age being greater than 14 years; having previously purchased self-paid vaccines; having higher educational achievement; being in a higher-income category; having a higher level of knowledge; and residing in an urban area. Parental willingness to vaccinate daughters was associated with daughters' age being greater than 14 years, age of parents younger 40, a history of purchasing self-paid vaccines; higher educational achievement; having a higher level of knowledge; being willing to receive HPV vaccine (themselves or their spouse); and residing in an urban area. CONCLUSIONS: Level of knowledge and willingness to have daughters vaccinated with HPV vaccine are low among Chinese parents. For universal HPV vaccination of females 9-18 years of age, it is necessary to educate parents about HPV and HPV vaccine, and to reduce the price of HPV vaccine.

Health and Economic Evaluation of Vaccination Against Pertussis in China: A 40-Year Analysis.

OBJECTIVES: This study aimed to evaluate the health and economic impact of diphtheria, tetanus, whole-cell pertussis vaccine (DTwP) and diphtheria-tetanus-acellular pertussis vaccine (DTaP) vaccination on pertussis prevention and control in China during the 40 years from 1978 to 2017. METHODS: We conducted cost-benefit analyses with a decision tree model populated with historical vaccination coverage levels and pertussis incidence and mortality data from before 1978 and during 1978 to 2017. We modeled 40 birth cohorts from birth until death. Costs and benefits were estimated from direct cost and societal perspectives (direct and indirect costs). Costs and benefits were adjusted to 2017 US dollars (USD), and future values were discounted at a 3% annual rate. We calculated net benefit values (net savings) and benefit-cost ratios of pertussis vaccination of children younger than 5 years. We conducted sensitivity analyses by varying key parameters within plausible ranges. RESULTS: Without DTwP and DTaP vaccination, there would be an estimated 115.76 million pertussis cases and 426 650 pertussis deaths in the 40 cohorts. With DTwP/DTaP vaccination, pertussis cases and deaths were decreased by an estimated 92.57% and 97.43%, saving 46 987.81 million USD in direct costs and 82 013.37 million USD from societal perspective. Pertussis vaccination program costs were 2168.76 million USD and 3961.28 million USD from direct cost and societal perspectives. Benefit-cost ratios were 21.67:1 from the direct cost perspective and 20.70:1 from the societal perspective. Sensitivity analyses showed the results to be robust. CONCLUSIONS: Over the lifetime of 40 birth cohorts, China's immunization program is preventing 93% of pertussis cases and 97% of pertussis deaths, resulting in substantial savings to the healthcare system and society.

[Trust in vaccination and its influencing factors among parents of children aged 0-6 years].

Objective: To analyze the trust in vaccination and its influencing factors in parents of children aged 0-6 years. Methods: In June 2021, a cross-sectional survey was conducted to collect the basic information of parents of children aged 0-6 years, including their trust in vaccination and their attitudes towards vaccination. The χ2 test was used to compare the difference between different groups, and logistic regression was used to analyze the influencing factors. Results: A total of 10 916 parents of children aged 0-6 years were investigated in this study, and their trust in vaccine was 67.20%, of which safety (55.80%) was the key factor limiting the trust in vaccination. 37.94% (4 142/10 916) of the parents were willing to vaccinate more than two kinds of vaccines at the same time, and 85.07% (9 286/10 916) of the parents feared that abnormal reactions would occur after vaccination. The parents' age, education level and annual family income were the promoting factors of their trust in vaccination (P<0.05). Obtaining vaccine knowledge through vaccination APP or official account (OR=1.330, 95%CI: 1.188-1.489) and popular science leaflets distributed by vaccination clinics (OR=1.120, 95%CI: 1.020-1.228) were the promoting factors of parents' trust in vaccination. Young children and parents, high family income and education level were the promoting factors for parents to be willing to vaccinate at the same time (P<0.05), and young children and parents, low family income and education level were the inducing factors for fear of abnormal reaction after vaccination (P<0.05). Parents of children in the central region had a high acceptance of simultaneous vaccination for children, while parents of children in the western region had a low degree of concern about abnormal reactions after vaccination (P<0.05). Parents of children who read books and got vaccine knowledge online (OR=1.257, 95%CI: 1.153-1.371), urban residents (OR=1.173, 95%CI: 1.062-1.295) and with jobs (OR=1.109, 95%CI: 1.015-1.212) were more willing to vaccinate at the same time. The choice of imported vaccine was a promoting factor for parents to worry about abnormal reactions after vaccination (P<0.05). Conclusion: There is room for parents of children aged 0-6 years to further improve their trust in vaccination. At this stage, it is necessary to innovate the way of health education and health promotion, and pay attention to the publicity of vaccine safety knowledge, so as to improve parents' trust in vaccination.

Use of Hydrogen-Rich Gas in Blast Furnace Ironmaking of V-bearing Titanomagnetite: Mass and Energy Balance Calculations.

The iron and steel industry is a major CO2 emitter and an important subject for the implementation of carbon emission reduction goals and tasks. Due to the complex ore composition and low iron grade, vanadium-bearing titanomagnetite smelting in a blast furnace consumes more coke and emits more carbon than in an ordinary blast furnace. Injecting hydrogen-rich gas into blast furnace can not only partially replace coke, but also reduce the carbon emission. Based on the whole furnace and zonal energy and mass balance of blast furnace, the operation window of the blast furnace smelting vanadium-bearing titanomagnetite is established in this study on the premise that the thermal state of the blast furnace is basically unchanged (raceway adiabatic flame temperature and top gas temperature). The effects of different injection amounts of hydrogen-rich gases (shale gas, coke oven gas, and hydrogen) on raceway adiabatic flame temperature and top gas temperature, and the influence of blast temperature and preheating temperature of hydrogen-rich gases on operation window are calculated and analyzed. This study provides a certain theoretical reference for the follow-up practice of hydrogen-rich smelting of vanadium-bearing titanomagnetite in blast furnace.

A new strategy for de-oxidation of diamond-wire sawing silicon waste via the synergistic effect of magnesium thermal reduction and hydrochloric acid leaching.

With the rapid development of photovoltaic industry, the amount of diamond-wire sawing silicon waste (DWSSW) increased dramatically. Recently, how to achieve cost-effective deoxygenation of DWSSW should be the most critical issue in silicon waste recycling. Herein, a new strategy for de-oxidation from DWSSW, employing Mg vapor as de-oxidation agent and hydrochloric acid (HCl) as leaching agent, under low temperature was suggested. The de-oxidation mechanism and the mineralogical evolution of different phases during the magnesium thermal reduction and acid leaching were clarified. Results showed that the impurity oxygen in DWSSW exists as amorphous SiO2 on the surface of Si particles, which can be eliminated by transforming it into crystalline MgO using magnesium thermal reduction and followed by acid leaching. As the reduction condition was controlled at 1333 K for 2 h, the residual oxygen content in DWSSW was 0.9643% and the de-oxidation fraction attained 93%. Additionally, the removal rate of impurities Al and Fe were 99.06% and 92.20%, respectively, and the Si recovery rate achieved 88%. Taking into consideration the recoverability of Mg, the cost of the process will be reduced significantly, making this process more viable in industry.

National, regional, and provincial disease burden attributed to Streptococcus pneumoniae and Haemophilus influenzae type b in children in China: Modelled estimates for 2010-17.

Background: Vaccination against Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib) is not included in China's national immunization programme. To inform China's immunization polices, we estimated annual national, regional, and provincial childhood mortality and morbidity attributable to pneumococcus and Hib in 2010-17. Methods: We estimated proportions of pneumonia and meningitis deaths and cases attributable to pneumococcus and Hib using evidence from vaccine clinical trials and surveillance studies of bacterial meningitis and pathogen-specific case fatality ratios (CFR). Then we applied the proportions to model provincial-level pneumonia cases and deaths, meningitis deaths and meningitis CFR in children aged 1-59 months, accounting for vaccine coverage. Non-pneumonia, non-meningitis (NPNM) invasive disease cases were derived by applying NPNM meningitis ratios to meningitis estimates. Findings: In 2010-17, annual pneumococcal deaths fell by 49% from 15 600 (uncertainty range: 10 800-17 300) to 8 000 (5 500-8 900), and Hib deaths fell by 56% from 6 500 (4 500-8 800) to 2 900 (2 000-3 900). Severe pneumococcal and Hib cases decreased by 16% to 218 200 (161 500-252 200) in 2017 and 29% to 49 900 (29 000-99 100). Estimated 2017 national three-dose coverage in private market was 1·3% for PCV and 33·4% for Hib vaccine among children aged 1-59 months. Provinces in the west region had the highest disease burden. Interpretation: Childhood mortality and morbidity attributable to pneumococcal and Hib has decreased in China, but still substantially varied by region and province. Higher vaccine coverage could further reduce disease burden. Funding: Bill & Melinda Gates Foundation.

Vaccine events raising public concern and associated immunization program policy and practice changes, China, 2005-2021.

INTRODUCTION: Several vaccine events causing public concern have occurred in China that were investigated and responded to by the central government. We describe causes, influences, and policy or practice changes associated with vaccine events that occurred between 2005 and 2021. We make recommendations to foster resilience in China's Expanded Program of Immunization (EPI) system and vaccination enterprises and to sustain vaccine and program confidence. METHODS: Our study included all vaccine events since 2005 that were investigated and responded to by the central government of China. We verified mainstream and social media visibility of the events through Internet search. We extracted event times, causes, investigation processes, results, actions, and policy or practice regulation changes from official reports of government meetings and from official websites with media briefings. RESULTS: Seven vaccine events were identified, each of which caused more than 100,000 mainstream or social media reports nationally or nationally and internationally. The events ranged in magnitude from 145 children receiving out-of-date oral poliovirus vaccine to a measles supplementary immunization activity involving 103 million children. Few, if any, children were directly harmed by vaccines in the events. Government responded to each event with program or policy changes, and in one case, with legislation. Responses affected the conduct of campaigns and supplementary immunization activities, use of schools as vaccination venues, financial incentives for vaccinating with non-program vaccines, vaccine procurement and distribution, and program policy making. The most fundamental response was enacting the country's first vaccine law, the 2019 Vaccine Administration Law, which guides virtually all aspects of vaccination work, from vaccine development through regulation, program implementation, and safety and impact monitoring. CONCLUSIONS: All seven events generated substantial national and international mainstream and social media criticism and discussion, most commonly expressed through concerns of vaccine safety or vaccine effectiveness. Most had temporally associated temporary declines in vaccine confidence and coverage, jeopardizing decades of vaccination effort. The central government responded to each event by attempting to address root causes. Faithful implementation of the Vaccine Administration Law is fundamental to program strengthening and sustaining confidence of families, stakeholders, and government in vaccines and immunization in China.

Effectiveness of Inactivated COVID-19 Vaccines Against Symptomatic, Pneumonia, and Severe Disease Caused by the Delta Variant: Real World Study and Evidence - China, 2021.

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Effectiveness of China's 2 inactivated vaccines (BBIBP-CorV and CoronaVac) against pre-Delta severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants ranged from 47% to over 90%, depending on the clinical endpoint, and with greater effectiveness against more severe coronavirus disease 2019 (COVID-19). During an outbreak in Guangdong, inactivated vaccine effectiveness (VE) against the Delta variant was 70% for symptomatic infection and 100% for severe COVID-19. However, separate or combined VE estimates for the two inactivated vaccines against Delta are not available. WHAT IS ADDED BY THIS REPORT?: In an outbreak that started in a hospital, VEs of completed primary vaccination with inactivated COVID-19 vaccines against symptomatic COVID-19, COVID-19 pneumonia, and severe COVID-19 caused by the Delta variant were 51%, 61%, and 82%. Completed primary vaccination reduced the risk of progressing from mild to moderate or severe COVID-19 by 74%. VE estimates for BBIBP-CorV and CoronaVac or combined vaccination were similar, and partial vaccination was ineffective. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: Completed primary vaccination with either of the 2 inactivated COVID-19 vaccines reduces risk of symptomatic COVID-19, COVID-19 pneumonia, and severe COVID-19 caused by the Delta variant. Completion of the completed primary vaccination with two doses is necessary for protection from Delta.

Willingness to accept COVID-19 vaccine among the elderly and the chronic disease population in China.

A cross-sectional field survey was conducted from November 2020 to January 2021 among 7259 participants to investigate the public perception, willingness, and information sources for COVID-19 vaccination, with the focus on the elderly and non-communicable chronic disease (NCD) population. Multiple logistic regressions were performed to identify associated factors of the vaccination willingness. The willingness rate of the elderly to accept the future COVID-19 vaccine (79.08%) was lower than that of the adults aged 18-59 (84.75%). The multiple analysis didn't identify significant relationship between NCD status and the vaccination intention. The main reasons for vaccine hesitancy by the public were: concern for vaccine safety, low infection risk, waiting and seeing others getting vaccinated, concern of vaccine effectiveness and price. Their relative importance differed between adults aged 18-59 and the elderly, and between adults aged 18-59 with or without NCD. Perception for vaccination importance, vaccine confidence, and trust in health workers were significant predictors of the vaccination intention in both age groups. The elderly who perceived high infection risk or had trust in governments were more likely to accept the vaccine. Compared with the adults aged 18-59, the elderly used fewer sources for COVID-19 vaccination information and more trusted in traditional media and family, relatives, and friends for getting vaccination recommendations. To promote vaccine uptake, the vaccination campaigns require comprehensive interventions to improve vaccination attitude, vaccine accessibility and affordability, and tailor strategies to address specific concerns among different population groups and conducted via their trusted sources, especially for the elderly.

Vaccination Vehicles for COVID-19 Immunization - China, 2021.

BACKGROUND: Recently, developed vaccination vehicles were repurposed and deployed for coronavirus disease 2019 (COVID-19) vaccination in China. We described the vehicles and reported an evaluation of vaccination throughput of these vehicles for COVID-19 vaccination in China. METHODS: We obtained daily reports of COVID-19 vaccine doses administered in vehicles in Hubei Province between March 16 and 29 of 2021. We determined the rate of COVID-19 vaccines given and evaluated the applicability of vaccination vehicles for COVID-19 vaccination. RESULTS: Vehicles with 2 vaccination stations are suitable for several real-world scenarios. Vehicles administered an average of 72 COVID-19 vaccine doses per hour, with an upper limit of 145 doses per hour. CONCLUSION: Vaccination vehicles can save human and financial resources and provide high quality, effective, convenient, and rapid on-site vaccination services; they can increase the pace of COVID-19 vaccination.

National and provincial impact and cost-effectiveness of Haemophilus influenzae type b conjugate vaccine in China: a modeling analysis.

BACKGROUND: Globally, Haemophilus influenzae type b (Hib) vaccine has substantially reduced the burden of Hib invasive disease. However, China remains the only country not to include Hib vaccine into its national immunization program (NIP), although it accounts for 11% of global Hib deaths. We aimed to assess the cost-effectiveness of including Hib vaccine in China's NIP at the national and provincial levels. METHODS: Using a decision-tree Markov state transition model, we estimated the cost-effectiveness of Hib vaccine in the NIP compared to the status quo of Hib vaccine in the private market for the 2017 birth cohort. Treatment costs and vaccine program costs were calculated from Chinese Center for Disease Control and Prevention (CDC) and national insurance databases. Epidemiological data and other model parameters were obtained from published literature. Cases and deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICER) were predicted by province. Deterministic and probabilistic sensitivity analyses were performed to explore model uncertainty. RESULTS: Including Hib vaccine in the NIP was projected to prevent approximately 2700 deaths (93% reduction) and 235,700 cases of Hib disease (92% reduction) for the 2017 birth cohort at the national level. Hib vaccine was cost-effective nationally (US$ 8001 per QALY gained) compared to the GDP per capita and cost-effective in 15 of 31 provinces. One-way and scenario sensitivity analyses indicated results were robust when varying model parameters, and in probabilistic sensitivity analysis, Hib vaccine had a 64% probability of being cost-effective nationally. CONCLUSION: Introducing Hib vaccine in China's NIP is cost-effective nationally and in many provinces. Less socioeconomically developed provinces with high Hib disease burden and low access to Hib vaccine in the current private market, such as those in the west region, would benefit the most from adding Hib vaccine to the NIP. In the absence of a national policy decision on Hib vaccine, this analysis provides evidence for provincial governments to include Hib vaccine into local immunization programs to substantially reduce disease burden and treatment costs.

The associations of geographic location and perceived risk of infection with the intentions to get vaccinated against COVID-19 in China.

BACKGROUND: Vaccines are a critical tool against coronavirus disease 2019 (COVID-19) pandemic, yet little is known regarding the associations of geographic location and perceived risk with the intentions to get vaccinated against COVID-19 in China. METHODS: An on-site survey of adults aged 18 or older (n = 7261) was conducted from November to December, 2020 in China, and this survey selected six provinces based on the geographic location. RESULTS: In the total sample, 82.5% reported that they would intend to get vaccinated against COVID-19. Compared with Hubei province, respondents' intentions to get vaccinated decreased by 70% in Zhejiang, 61% in Guangdong, 87% in Gansu, and 71% in Jilin, respectively. However, within Hubei province, compared with Wuhan city, respondents' intentions to get vaccinated in other cities were not significantly different. Respondents with higher perceived risk of infection were associated with increased odds of intentions to get vaccinated against COVID-19. CONCLUSION: Our study identified priority geographic regions that need to pay attention on the vaccination campaign and help design effective immunization strategies to increase the vaccine uptake against COVID-19. More attention should be paid to adults residing farther from the epicenter of the outbreak and having lower perceived risk of infection.

The Changing Acceptance of COVID-19 Vaccination in Different Epidemic Phases in China: A Longitudinal Study.

COVID-19 vaccines have been conditionally used in a few countries, including China since December 2020. The present study aimed to examine whether the acceptance of COVID-19 vaccination changed in different COVID-19 epidemic phases in China. Two consecutive surveys were conducted among Chinese adults in March (n = 2058) (severe epidemic phase) and November-December (n = 2013) (well-contained phase, right before the COVID-19 vaccine was conditionally approved) 2020, and 791 respondents were longitudinally followed-up. The attitude, acceptance, and preferences for future COVID-19 vaccination were compared between two epidemic phases. Multivariate logistic regression was used to identify influencing factors of acceptance. Among the 791 respondents longitudinally followed, 91.9% in March and 88.6% of them in November-December 2020 would like to get COVID-19 vaccination in China. In March 58.3% wished to get vaccinated immediately, but the proportion declined to 23.0% in November-December 2020, because more respondents wanted to delay vaccination until the vaccine's safety was confirmed. Similar results were found by comparing all respondents from the two cross-sectional surveys in different epidemic phases. The risk perception, attitude for the importance of vaccination against COVID-19, vaccination history, valuing doctor's recommendations, vaccination convenience, or vaccine price in decision-making had impacts on respondents' intention for immediate vaccination. The public acceptance for COVID-19 vaccination in China sustained at a high level in different COVID-19 epidemic phases. However, the intention of immediate vaccination declined substantially due to concerns about the vaccine's safety. Information about vaccination safety from authoritative sources, doctor's recommendations, and vaccination convenience were important in addressing vaccine hesitancy and promoting successful herd immunity for the general population in China.

Measles vaccination among children in border areas of Yunnan Province, Southwest China.

BACKGROUND: Border areas are at high risk of measles epidemics. This study aimed to evaluate the effectiveness of the implementation of the routine two-dose measles containing vaccine (MCV) program in border counties of Southwest China. METHODS: Data used in the study were derived from a cross-sectional survey among 1,467 children aged 8 to 84 months from five border counties of Yunnan Province, Southwest China in 2016. The participants were recruited using a multistage sampling method. Primary guardians of the children were interviewed to collect information on vaccination history, socio-economic status, and knowledge about immunization. Both coverage and timely coverage for the first (MCV1) and the second (MCV2) dose of MCV were calculated. The Kaplan-Meier method was performed to estimate the cumulative coverage of MCV, and Log-rank tests were adopted to compare the differences across counties and birth cohorts. Univariate and multivariate logistic regression models were used to investigate the predictors of delayed MCV1 vaccination. RESULTS: The coverage for MCV1 and MCV2 were 97.5% and 93.4%, respectively. However, only 63.8% and 84.0% of the children received MCV1 or MCV2 on time. Significant differences in the cumulative coverage were detected across counties and birth cohorts. Results of the multivariate logistic regression analysis indicated that children whose primary guardian knew the schedule of MCV were less likely to receive MCV1 late (OR = 0.63, P<0.01). For the guardians, doctors at vaccination units were the primary and also the most desired source of vaccination information. CONCLUSIONS: Although the coverage for MCV is high in border areas of Southwest China, the timeliness of MCV vaccination seems suboptimal. Tailored information from local health professionals may help to reduce untimely vaccination.

Psychological resilience and positive coping styles among Chinese undergraduate students: a cross-sectional study.

BACKGROUND: Psychological resilience and coping strategies have been found to be related to various psychological and mental health problems. Evaluations of the relationship between resilience and coping style among university students are important for developing effective health promotion strategies focused on resilience intervention to benefit students' health and well-being. The relationship between psychological resilience and coping styles has usually been examined among adults and patients. Very few studies have investigated the relationship between resilience and coping style in university students. The present study aimed to investigate the associations between psychological resilience, students' characteristics (gender, major and grade) and coping styles among undergraduate students. METHODS: A cross-sectional survey was conducted among undergraduate students in Shandong Province, China. Undergraduate students were randomly selected from 6 universities in 3 cities of the province using a stratified random sampling method. The questionnaire included questions on the participants' demographic information, including gender, grade and major, measures of psychological resilience and coping style. Coping style was measured by the Simplified Coping Style Questionnaire (SCSQ). The Asian Resilience Scale (ARS) was applied to evaluate undergraduates' psychological resilience. Multivariable regression analysis was used to examine the relationships between resilience, students' characteristics and positive coping styles. RESULTS: A sample of 1743 undergraduates was analysed. The mean psychological resilience score was 70.41. The mean score for positive coping style was 24.72. Multiple regression analysis showed that three factors of psychological resilience, mood control, self-plasticity and coping flexibility, were all significant factors for positive coping styles (regression coefficient = 0.34, 0.35, 0.14, p < 0.01 for the three factors, respectively). Medical students and females had higher scores for positive coping styles than non-medical students and males (p < 0.01). CONCLUSIONS: The research revealed that females and medical students are more likely than males and non-medical students to adopt positive coping styles. Higher psychological resilience is associated with a better positive coping style. The findings suggest that psychological education and health promotion programmes that target strengthening psychological resilience among undergraduate students may help foster positive coping styles to benefit their mental health and psychological well-being.