Lei Wang

Background/Objectives: Real-world evidence on influenza vaccine effectiveness (VE) against severe outcomes among older adults in China remains limited. We evaluated influenza vaccination against medically attended influenza, influenza hospitalization, and influenza-related intensive care unit (ICU) admission among adults aged ≥60 years in Yichang, China. Methods: We conducted a multi-season population-based retrospective cohort study using linked immunization and healthcare records. Season-specific propensity scores and overlap weighting were used to improve comparability between vaccinated and unvaccinated participants. Weighted Cox regression with individual-level clustered robust variance was used to estimate VE; proportional-hazards assumptions were formally assessed, with extended Cox models fitted when treatment-specific non-proportionality was detected. Results: The cohort comprised 1,106,886 person-seasons, including 31,540 vaccinated and 1,075,346 unvaccinated person-seasons. Vaccination was associated with lower hazards of medically attended influenza (VE, 55.7%; 95% CI, 43.4–65.3%), influenza hospitalization (54.4%; 39.4–65.7%), and influenza-related ICU admission (52.7%; 14.2–73.9%). Protective associations were observed in both winter seasons and persisted when the vaccination window was restricted to 14–180 days before the index date, with VE estimates of 78.4% for medically attended influenza and 83.1% for influenza hospitalization; findings were also robust across other sensitivity analyses. VE point estimates were numerically higher during higher antigenic-concordance periods, although the interaction was not statistically significant. Conclusions: Influenza vaccination within the prespecified pre-index exposure window was associated with lower risks of medically attended influenza and severe influenza-related outcomes among older adults in Yichang. Residual confounding and outcome misclassification cannot be excluded, and the estimates primarily apply to the overlap population rather than all older adults in Yichang.

Objective: To systematically analyze the practical application and differences in vaccination compliance of two rabies post-exposure prophylaxis regimens based on real-world data, and to explore the associated influencing factors of vaccination compliance, aiming to provide evidence for optimizing vaccination strategies. Methods: Vaccination records of exposed individuals who received the freeze-dried human rabies vaccine (Vero cell) documented in the Hubei Provincial Immunization Information Management System from 1 January to 31 December 2024 were retrospectively collected to evaluate compliance with the five-dose (Essen) and four-dose (Zagreb) vaccination schedules. Good compliance was defined as completing the vaccination according to the schedule within the prescribed time frame. The evaluation included the vaccination compliance rate and the full-course vaccination rate. Factors associated with compliance were explored using univariate and multivariable analyses. Results: A total of 51,066 subjects were enrolled. The four-dose (Zagreb) schedule was associated with significantly higher vaccination compliance (77.1% vs. 72.0%, χ² = 94.913, p < 0.05) and full-course completion rates (85.2% vs. 82.4%, χ² = 38.251, p < 0.05), whereas the five-dose (Essen) regimen was associated with a higher rate of timely initial vaccination (81.7% vs. 78.1%, χ² = 61.602, p < 0.05). In the multivariable analysis, the four-dose (Zagreb) regimen was also associated with increased full-course completion (aOR = 1.49, 95% CI = 1.39–1.60) and better compliance (aOR = 1.52, 95% CI = 1.43–1.61), whereas in a pre-specified, descriptive exploratory model, it was associated with delayed first doses (exploratory aOR = 0.84, 95% CI = 0.79–0.89); this adjusted association should not be interpreted as a causal effect of regimen on timely initiation. Younger age, lower-limb wounds, high-security occupations, farming, passive immunization and non-winter exposure were associated with better full-course vaccination; adults aged ≥18 years, males, Han/Miao ethnicity, Grade III exposure and cat bites were associated with lower compliance (p < 0.05). Severe exposure, farmer/student/resident identity, passive immunization and spring exposure were associated with more timely initiation, whereas male sex, neck-and-above exposure and flexible work were associated with less timely initiation (p < 0.05). Conclusions: In this retrospective, non-randomized study, receipt of the four-dose (Zagreb) regimen was associated with modestly higher full-course completion (absolute difference: 2.8 percentage points) and better compliance (5.1 percentage points) than the five-dose (Essen) regimen. Conversely, it was associated with a lower rate of timely first-dose vaccination. As an observational study, these findings do not establish causal relationships. Therefore, immediate wound care, prompt vaccination, and appropriate administration of rabies immunoglobulin remain the principal clinical priorities.

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.