Yang Zhou

Objectives: This study aimed to investigate the levels of varicella antibodies in Zhejiang, China, after a decade of implementing the two-dose varicella vaccine (VarV) strategy. Methods: Healthy participants aged 1 to 69 years from Zhejiang, China, were recruited from January to April 2024 using multistage stratified random sampling, and varicella zoster virus (VZV) IgG antibodies were detected by ELISA. We assessed the seroprevalence and geometric mean concentration (GMC) of VZV IgG and analyzed related factors using Logistic and linear regression models. Results: A total of 807 participants were included in the study. The overall seropositivity rate for VZV IgG in the healthy population was 73.08% (95%CI: 69.87–76.11), with a corresponding GMC of 200.97 mIU/mL (95%CI: 182.75 mIU/mL–221.01 mIU/mL). Multivariate analysis identified age group, VarV immunization history, and history of varicella disease as factors significantly associated with both VZV IgG seropositivity and GMC levels (p < 0.05). The seropositivity rate for VZV IgG in children aged 1–14 years was 42.67% (95%CI: 36.22–49.31), with a corresponding GMC of 82.10 mIU/mL (95%CI: 69.14 mIU/mL–97.48 mIU/mL). Furthermore, a significant decline in both seropositivity and GMC was observed over time following vaccination among vaccinated children aged 1–14 years (p < 0.05). Conclusions: Two-dose VarV vaccination may be considered for inclusion in the national immunization program.

Chronic hepatitis B (CHB) remains a significant public health burden in China. Sustained adherence to long-term nucleos(t)ide analogues (NAs) therapy is cr

Despite increasing pertussis breakthroughs and waning immunity, this study evaluates the cost-effectiveness of replacing the DT booster with DTaP in 6-year-olds in Zhejiang, China. While implemented in high-income regions, this strategy's cost-effectiveness remains unassessed in diverse Chinese settings. We address this gap using local data.Using surveillance data from the Zhejiang Provincial Center for Disease Control and Prevention, literature reviews, and a 10-year simulation timeframe, a decision tree-Markov model was constructed from a societal perspective. The study cohort was 6-year-old children in Zhejiang Province in 2022. Comprehensive evaluation indicators, including Incremental Cost Effectiveness Ratio (ICER) and Incremental Cost-Utility Ratio (ICUR), were used. Robustness was assessed via Deterministic Sensitivity Analysis (DSA) and Probabilistic Sensitivity Analysis (PSA). Simulating 10 years after implementing the DTaP strategy for 628,619 children in 2022, under lower background incidence, DTaP could prevent 1,886 pertussis cases, reduce costs by 1.7 billion CNY, and gain 0.09 QALYs (ICUR = 3,096.15 CNY/QALY). Under higher incidence, it could prevent 8,743 cases, reduce costs by 1.6 billion CNY, and gain 0.084 QALYs (ICUR = 3,081.86 CNY/QALY). Both ICUR values are significantly lower than Zhejiang's per capita GDP (118,496 CNY). Our findings indicate that administering a second booster dose of DTaP to 6-year-old children is cost-effective, particularly with high incidence of pertussis.

Objectives: To investigate the acceptance and factors influencing acceptance of rubella-containing vaccine (RCV) among women of reproductive age in Guangdong, Henan, Hubei, Liaoning, Shanxi, Sichuan and Zhejiang provinces of China. Methods: Using a stratified sampling method, we selected one urban and one rural community health services center in each of two cities in seven provinces. From these centers, we recruited women 15–49 years of age to complete a questionnaire on their willingness to receive RCV and factors influencing willingness. The survey instrument was adapted from the behavioral and social drivers (BeSD) of vaccination survey tool developed by the World Health Organization. Results: Among 1286 participants, 981 (76.3%) were willing to receive RCV. Awareness of rubella ranged from 12.4% to 70.6%. Willingness to receive RCV differed significantly by region, occupation, vaccination history, and awareness. All latent variables of the structural equation model (SEM) were positively correlated with willingness, and all standardized paths were statistically significant (p < 0.001). Thinking and Feeling had direct positive effects on Social Processes (β = 0.789) and Practical Issues (β = 0.542), thereby indirectly affecting motivation. Conclusions: Women of reproductive age had high willingness to receive the rubella vaccination, but their general awareness of rubella was relatively low. It is necessary to strengthen the health education of women of reproductive age regarding rubella to improve RCV coverage.

Background: Measles and rubella are vaccine-preventable diseases targeted for elimination in most World Health Organization regions, and China is considered to have momentum towards measles elimination. Therefore, this study aimed to assess the population immunity levels against measles and rubella in Zhejiang Province in China in order to provide valuable insights for informing future public health measures and contributing to the ongoing global campaign against these diseases. Materials and methods: A cross-sectional serological survey was conducted in 2022. A total of 2740 blood samples were collected from healthy individuals spanning the age range of 0–59 years, representing diverse demographic strata across 11 prefectures in Zhejiang Province in China. The sera were tested for measles and rubella IgG antibodies to determine positivity rates and geometric mean concentrations (GMCs). Results: The overall positivity rate for the measles IgG antibody was 85.3%, with a GMC of 588.30 mIU/mL. The positivity rate for the rubella IgG antibody was 70.9%, and the GMC was 35.30 IU/mL. Measles IgG antibody positivity rates across the 0–11 months, 12–23 months, 24–35 months, 3–5 years, 6–9 years, 10–14 years, 15–19 years, 20–29 years, and 30–59 years age groups were 63.1%, 92.5%, 97.0%, 94.0%, 85.8%, 77.3%, 86.9%, 84.9%, and 88.7%, respectively (trend χ² = 118.34, p < 0.001). Correspondingly, rubella antibody positivity rates for these same age brackets were 55.9%, 87.9%, 94.7%, 88.2%, 69.9%, 54.2%, 72.6%, 67.5%, and 74.3% (trend χ² = 199.18, p < 0.001). Both univariate and multivariate analyses consistently demonstrated that age, immunization history, and differing economic levels were significant factors contributing to variations in antibody levels. Conclusions: The seroprevalence of measles and rubella was lower than that required for herd immunity. Periodic vaccination campaigns should be launched to increase immunity.

Following the rollout of a booster campaign to promote immunity against COVID-19 in China, this study aimed to assess booster hesitancy among adults who were fully vaccinated with primary doses across Zhejiang Province. Firstly, the modified 5C scale developed by a German research team was assessed for reliability and validity via a pre-survey in Zhejiang Province. Then, a 30-item questionnaire was established to conduct online and offline surveys during 10 November to 15 December 2021. Demographic characteristics and information on previous vaccination experience, vaccine type of primary doses, attitudes towards booster doses and awareness of SARS-CoV-2 infection were collected. Chi-square tests, pairwise comparison and multivariate logistic regression were performed in data analysis. In total, 4039 valid questionnaires were analyzed, with booster hesitancy of 14.81%. Dissatisfaction with previous vaccination experience of primary doses (ORs = 1.771~8.025), less confidence in COVID-19 vaccines (OR = 3.511, 95%CI: 2.874~4.310), younger age compared to the elderly aged 51–60 years old (2.382, 1.274~4.545), lower education level (ORs = 1.707~2.100), weaker awareness of social responsibility of prevention and control of COVID-19 (1.587, 1.353~1.859), inconvenience of booster vaccination (1.539, 1.302~1.821), complacency regarding vaccine efficacy as well as self-health status (1.224, 1.056~1.415) and excessive trade-offs before vaccination (1.184, 1.005~1.398) were positively associated with booster hesitancy. Therefore, intelligent means should be strengthened to optimize vaccination services. More influential experts and other significant figures should be supported to promote timely evidence-based information via various media platforms to reduce public hesitancy and increase booster uptake.

In order to control the spread of rubella and reduce the risk for congenital rubella syndrome, an additional rubella vaccination program was set up for all secondary school students since 2008 in Zhejiang, China. We conducted a descriptive analysis of rubella incidence among different age groups from 2005 to 2015 and a serosurvey of female subjects aged 15–39 years to understand the possible effects of this immunization program. The average annual rubella incidence rate had decreased from 15.86 per 100,000 population (2005–2007) to 0.75 per 100,000 population (2013–2015) in Zhejiang. The decrease in the rate of rubella incidence in girls aged 15–19 years was more accelerated (from 138.30 to 0.34 per 100,000) than in the total population during 2008–2015 (from 32.20 to 0.46 per 100,000). Of 1225 female subjects in the serosurvey, 256 (20.9%) were not immune to rubella. The proportion of subjects immune to rubella was significantly different among different age groups (Wald χ2 = 22.19, p = 0.000), and subjects aged 15–19 years old had the highest immunity (88.0%). Rubella antibody levels were significantly lower in women aged 25–30 years with 26.7% of them not immune, followed by the group aged 20–24 years (25.0%) and 30–35 years (24.5%). Rubella vaccine included in the Expanded Program on Immunization together with vaccination activities for secondary school students can help in rubella control, particularly in targeted age groups in the program. Seroprevalence of antibodies to the rubella virus amongst the female population within childbearing age in Zhejiang, China, is still too low to provide immunity. In addition to vaccination programs in the secondary schools, rubella vaccination should also be encouraged in women of childbearing age, which can be done effectively combined with pre-marital examination in China.