Control of Measles and Pneumococcal Disease in China.

measles;pneumococcal disease;immunization coverage;China;Public Health;Health Sciences;Epidemiological Science

Wagner, AbramZikmund-Fisher, Brian J. ;

University of Michigan

关键词: measles;    pneumococcal disease;    immunization coverage;    China;    Public Health;    Health Sciences;    Epidemiological Science;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/113295/awag_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

China has made great strides in controlling most common vaccine-preventable diseases by increasing access to childhood vaccines through the government-funded Expanded Program for Immunization. Despite this success, China was unable to meet the national and WHO goal of measles elimination by 2012, and has chosen to not publicly fund newer vaccines, like the pneumococcal vaccine. Non-locals, migrants from rural to urban areas, are generally thought to be a significant contributor to the difficulty in controlling vaccine preventable diseases in China because of their higher mobility and lower socioeconomic status. Using registry and survey data, we quantified differences in disease incidence between locals and non-locals. In the first study, we characterized differences in the measles incidence rate between locals and non-locals in a Poisson regression of time series data from Tianjin. We found that non-locals had a higher rate of measles before the 2008 supplementary immunization activity (SIA), but this disparity attenuated in the two years after the first SIA and was completely eliminated after the 2010 SIA. In the second study, we used logistic regression models to examine patterns of measles and pneumococcal vaccination among children in the Shanghai immunization registry, in particular focusing on differences between locals and non-locals and on role of township-level factors. Non-locals had less timely measles vaccines and lower uptake of pneumococcal vaccines, except for the pneumococcal polysaccharide vaccine. Children residing in non-local-majority townships also had less timely administration of measles vaccines than those living in local-majority townships. For the third study, we surveyed parents in Shanghai, and compared parental perceptions of measles, pneumonia, and meningitis using a logistic regression model. Parents believed that measles and meningitis needed a vaccine more than pneumonia. Perceived prevalence of disease was not associated with vaccine necessity, and more non-locals believed the pneumonia vaccine to be necessary than locals. The findings from this dissertation help to identify the contribution of non-locals towards difficulties in controlling vaccine-preventable diseases in China, and this dissertation provides a framework for discussing what township-level variables and individual-level attitudes are associated with vaccination behaviors.