Trends in childhood pneumococcal vaccine coverage in Shanghai, China, 2005–2011: a retrospective cohort study

Abstract

BackgroundIn 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.MethodsIn 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.ResultsPPSV23 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.ConclusionsThere 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.

Prevalence and serotype distribution of nasopharyngeal carriage of Streptococcus pneumoniae in China: a meta-analysis

“…According to a survey of children age 1 to 2 years selected from 31 provinces throughout China conducted in 2012, 9.9% of children had received one dose of PCV7 [ 49 ]. Another study from Shanghai reported a similar PCV7 coverage level at 11.4% [ 55 ]. We observed a slightly change of PCV7 coverage level from 43.9% (34.1, 53.6%) to 52.1% (37.3, 66.9%) between pre/post vaccination period because of the limited herd immunity from low vaccine rate of pneumococcal conjugate vaccination.…”

Etiologic spectrum and occurrence of coinfections in children hospitalized with community-acquired pneumonia

“…S. pneumoniae was detected in 3% of the study population, which is similar with a recent study in USA (4%) [ 6 ], but lower than an earlier US pediatric pneumonia etiology study. The 7-valent pneumococcal conjugate vaccine was introduced to China in 2008, it has been covered in around 15% of the children in the last seven years [ 14 ]. While our data, as well as the recent study in USA [ 6 ], partly reflect the substantial reduction of pneumococcal disease due to conjugate vaccines, bacterial culture-based diagnostics have limited sensitivity and bacteremia is detected in a minority of pneumococcal pneumonias [ 6 ].…”

Serotype distribution and antibiotic resistance of Streptococcus pneumoniae isolates from 17 Chinese cities from 2011 to 2016

“…In this study, the average vaccine coverage of PCV7 (37.5%) and PCV13 (58.3%) in the population was similar to the vaccine coverage before they were introduced into China [ 28 ], suggesting that the effects of PCV7 and PCV13 in China were limited. Exclusion from the national immunization program and high prices could be responsible for low vaccination rates and poor herd immunity in the target population [ 29 ]. We also found that in areas with better economic development, vaccine coverage was lower than in less economically developed regions.…”