Impact of the free‐vaccine policy on timely initiation and completion of hepatitis B vaccination in Fujian, China

Abstract

The extent to which the free-vaccine policy impacts the initiation and completion of a hepatitis B vaccine series is poorly understood. The aim of this study was to evaluate the impact of the free-vaccine policy on hepatitis B vaccination. A provincial survey was conducted in 2006 in Fujian Province, south-east of China, where the free-vaccine policy for hepatitis B was announced in 2002 and implemented in 2003. A total of 1628 children were investigated, and 1443 (88.6%) were included in this analysis. Among the children studied, 55.2% were vaccinated within 24 h of birth, and 76.1% completed the hepatitis B vaccine series on time. The rate of hepatitis B surface antibody positivity increased from 29.9% among children born in 1992 to 90.5% among children born in 2005, while the corresponding HBV infection rate decreased from 30.4% to 1.72%. Logistic regression indicated that, compared to children born between 1996 and 2001, the odds ratios (ORs) for timely initiation were 2.57 (95% confidence interval [CI], 1.71-3.84), 5.24 (95% CI, 3.26-8.43) and 9.06 (95% CI, 4.48-18.34) among children born in 2003, 2004 and 2005, respectively; the corresponding ORs for completing the vaccine series were 4.23 (95% CI, 1.97-9.10), 3.76 (95% CI, 1.81-7.82) and 4.94 (95% CI, 1.74-14.00) among children born in 2003, 2004 and 2005, respectively. Children with delayed vaccine initiation (>24 h after birth) were less likely to complete the vaccine series than those who received a timely first dose (OR = 0.02, 95% CI, 0.005-0.09). The impact of the free-vaccine policy on vaccine initiation and vaccine series completion did not differ by children's residence area (rural vs urban). As hypothesized, the odds of completing the vaccine series increased after the free-vaccine policy was announced in 2002 among children with delayed initiation (>24 h after birth) but not among those with timely initiation (≤ 24 h after birth). In conclusion, the free-vaccine policy significantly improved the timely initiation and completion of the vaccine series. The impact of this policy on completion of the vaccine series was larger among children with delayed vaccine initiation.

Hepatitis B Vaccination among 1999–2017 Birth Cohorts in Zhejiang Province: The Determinants Associated with Infant Coverage

“…Although there had been a great improvement in infant Hep B coverage, this study showed that certain groups remained at high risk of not receiving a timely birth dose or full immunization. This was consistent with previous reports from other provinces of China [4,14,15,16,17], and was attributed to risk factors such as uneven economic development, rural areas, and ethnic minorities. Other reports from some developing countries attributed the delayed or incomplete Hep B vaccination to the poor practice of the vaccination service [18,19,20].…”

“…The recommended schedule involves the administration of Hep B1 within 24 h after birth and the administration of two subsequent doses at 1 and 6 months of age. This scheme can not only effectively prevent mother-to-child transmission, but also provide lifelong protection [4].…”

Relationship between receipt of substitutable for-fee vaccines and completion of the expanded programme on immunisation: a cross-sectional study in Fujian, China

“…Minority children were less likely to complete the EPI, which may be related to poor economic conditions of their families 34 and the lack of vaccination awareness of their parents. 35 Similar to previous studies, 36 37 we confirmed that timely HepB first dose initiation improved the EPI completion in children, possibly because receiving a timely HepB first dose might help emphasise the importance of vaccination to the parents and promote their children’ completion of the EPI. 1 …”

Association between timely initiation of hepatitis B vaccine and completion of the hepatitis B vaccine and national immunization program vaccine series

“…The prevalence of positivity for hepatitis B surface antigen was estimated to be 10.2% in the population aged 1 to 59 years in 2006. 1 To control HBV infection, hepatitis B vaccine (HB vaccine) has been recommended for newborns and infants since 1992, and was included in the national immunization program vaccine (NIPV) series in 2002. 2 It is recommended that infants receive three doses of HB vaccine, to be given within 24 h after birth and at 1 month and 6 months of age.…”