Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
J Glob Health. 2023 Aug 25;13:04080. doi: 10.7189/jogh.13.04080.
The coverage of Haemophilus influenzae type b (Hib) vaccination remains suboptimal in China, and this study aimed to investigate the influencing factors of caregivers' Hib-containing vaccine choices and the association between combination vaccine use and adherence to Hib immunisation schedule among Chinese children.
From August to October 2019, a cross-sectional survey was conducted in 148 community health care centres from ten provinces in China, which collected vaccination records from 5294 children aged 6-59 months. The children were categorised into three groups based on their Hib-containing vaccine receipt: unvaccinated group, monovalent vaccine group, and combination vaccine group. The outcome measures included: (1) receipt and choice of Hib-containing vaccines, and (2) completion of the three-dose schedule. Multinomial logistic regression was used to evaluate the influencing factors of Hib-containing vaccine receipt and choice, and logistic regression was adopted to investigate the associations between vaccine choice and schedule completion.
Of the 5294 children, 19.53% received monovalent vaccines only, 22.59% received at least one dose of combination vaccines, and 57.88% were not vaccinated against Hib. The overall three-dose completion rate was 27.03%. The multinomial logistic (mlogit) regression findings indicated strong associations of socioeconomic status and Hib-containing vaccine supply with vaccination status. Multiple logistic regression among those who received at least one Hib-containing dose demonstrated a 3-fold increase in the likelihood of three-dose schedule completion by children who received any combination dose compared with those received single-antigen vaccines only (adjusted odds ratio (aOR) = 3.97 (95% CI = 3.14-5.03)).
Findings from the current study provide a more comprehensive understanding of the strong relationship between combination vaccine receipt and completion outcomes. Facing the suboptimal Hib vaccination rate in China, the use of combination vaccines could help increase vaccination compliance, and appropriate government actions to reduce out-of-pocket burden of immunisation are encouraged to address inequities in vaccine choices.
在中国，流感嗜血杆菌 b 型（Hib）疫苗的覆盖率仍然不理想，本研究旨在调查影响看护人 Hib 含疫苗选择的因素，以及中国儿童使用联合疫苗与遵守 Hib 免疫接种计划之间的关系。
2019 年 8 月至 10 月，在中国十个省份的 148 个社区卫生服务中心进行了一项横断面调查，从 5294 名 6-59 月龄的儿童中收集了疫苗接种记录。根据 Hib 含疫苗接种情况，将儿童分为三组：未接种组、单价疫苗组和联合疫苗组。结果衡量标准包括：（1）Hib 含疫苗的接种和选择，（2）完成三剂接种计划。采用多项逻辑回归评估 Hib 含疫苗接种和选择的影响因素，采用逻辑回归调查疫苗选择与接种计划完成之间的关系。
在 5294 名儿童中，19.53%仅接种单价疫苗，22.59%至少接种一剂联合疫苗，57.88%未接种 Hib 疫苗。三剂全程接种率为 27.03%。多项逻辑回归（mlogit）结果表明，社会经济地位和 Hib 含疫苗供应与接种状况密切相关。在至少接种一剂 Hib 含疫苗的儿童中，与仅接种单价疫苗的儿童相比，任何联合剂量的儿童完成三剂接种计划的可能性增加 3 倍（调整优势比（aOR）=3.97（95%CI=3.14-5.03））。
本研究结果提供了对联合疫苗接种与接种结果之间密切关系的更全面了解。面对中国 Hib 疫苗接种率不理想的现状，使用联合疫苗可以帮助提高接种依从性，鼓励政府采取适当行动减轻免疫接种的自费负担，以解决疫苗选择方面的不平等问题。
