Background Herpes zoster (HZ) and postherpetic neuralgia (PHN) cause substantial clinical and economic burdens, especially in older adults, yet real-world data from China are limited.Methods Using the Jinan Regional Health Information Platform, we conducted a population-based retrospective cohort study (2018-2023) to estimate HZ and PHN incidence (per 1,000 person-years [PY]), recurrence rates, and direct medical costs and factors associated with costs.Results The study included 166,869 patients with HZ. The coverage-adjusted incidence of HZ was 6.80 per 1,000 person-years (PY) overall and ranged from 9.68 per 1,000 PY in the 50-59-year age group to a peak of 16.48 per 1,000 PY in the 70-79-year age group. PHN occurred in 14.2% of HZ patients. The overall coverage-adjusted incidence of PHN was 0.94 per 1,000 PY. HZ recurrence occurred in 0.87% of patients, corresponding to an incidence of 4.26 per 1,000 PY. A total of 72.9% of patients were included in the cost analyses. Median annual costs per patient were CNY 155.2 (interquartile range [IQR]: 50.3-533.1) overall, CNY 126.7 (IQR: 44.4-365.6) for outpatients and CNY 6,290.2 (IQR: 4,038.4-9,093.6) for inpatients. Higher costs were associated with older age, PHN, healthcare facility type, more frequent visits, and length of stay.Conclusions HZ and PHN impose substantial epidemiological and economic burdens in Jinan, with incidence increasing with age, a persistent risk of recurrence, and costs influenced by demographic and healthcare-related factors.

What is already known about this topic?:Rotavirus causes severe acute gastroenteritis and diarrhea-related mortality in children aged <5 years. Vaccination is an effective preventive strategy; however, no nationwide data on rotavirus vaccine coverage are available. What is added by this report?:Based on data from the National Immunization Program Information System, despite the upward trend, rotavirus vaccine coverage among children born between 2019 and 2023 in China remained low, with suboptimal series completion. Disparities by socioeconomic region and clinic density were observed for non-National Immunization Program (non-program) childhood vaccines. What are the implications for public health practice?:Improving follow-up for children with missed rotavirus vaccine doses, optimizing the distribution and accessibility of vaccination clinics, and exploring non-program-funded financing mechanisms for vaccination may improve rotavirus vaccine uptake.

OBJECTIVE:To assess adverse events following immunization (AEFI) for Enterovirus type 71 (EV71) vaccines in the mainland of China during a post-market-authorization period. METHODS:We obtained AEFI reports for EV71 vaccine during 2016-2023 from the Chinese National Immunization Information System (CNIIS). We obtained EV71 vaccine doses administered data for 2016-2018 and 2019-2023 from provincial immunization information systems or vaccination doctors' reports and from CNIIS, respectively. We analyzed all EV71 vaccine AEFI reports. RESULTS:During the study period, there were 100.95 million doses of EV71 vaccine administered and 41,025 AEFI reports following EV71 vaccination. Incidences of EV71 AEFI reports for any reason, serious AEFI, common vaccine reactions (usually minor), and rare vaccine reactions (possibly serious) were 40.64, 0.30, 36.55, and 2.78 reports per 100,000 doses administered. The most frequently reported common vaccine reaction was fever; allergic rash was the main reported rare vaccine reaction; respective incidences were 30.28 and 2.43 per 100,000 doses. CONCLUSIONS:A favorable safety profile of EV71 vaccine was confirmed. EV71 vaccine can be used safely to prevent EV71-related diseases in children under 5 years old.

BACKGROUND:Although the hepatitis A vaccine has been introduced into in China's National Immunization Program for many years, an immunity gap persists among young adults, posing a continued risk of hepatitis A outbreaks. This study aimed to evaluate the cost-effectiveness of hepatitis A vaccination in adults (≥20 years). METHODS:We developed a decision tree Markov model to evaluate various hepatitis A vaccination strategies from a societal perspective, incorporating parameters derived from previously published data. The strategies included serological screening followed by vaccination of susceptible individuals, as well as vaccination without prior screening. Both live attenuated and inactivated vaccines were considered. The incremental cost-effectiveness ratio (ICER) of each strategy was calculated relative to the status quo (no vaccination). The robustness of the findings was assessed through one-way deterministic sensitivity analysis and probabilistic sensitivity analysis. RESULTS:In a cohort of 100,000 individuals aged 20-78 years, the four vaccination strategies prevented 4024-4180 hepatitis A cases. Compared to no vaccination, all strategies were cost-saving at a willingness-to-pay threshold of one time China's per capita GDP, with incremental savings of $1584-$2733 per QALY gained. However, when applying standard incremental analysis to compare active strategies, screening followed by single-dose live attenuated hepatitis A vaccine (HepA-L) was the most cost-effective option compared to the previous non-dominated option. The two non-screening strategies were dominated by screening-based strategies. Results remained robust across sensitivity analyses. CONCLUSION:Compared to the status quo (no vaccination), hepatitis A vaccination in Chinese adults is cost-saving, while pre-vaccination serological screening yields additional cost savings. Screening followed by administration of a single-dose of live attenuated hepatitis A vaccine (HepA-L) for the population aged 20-78 years was the most cost-saving strategy. Our findings offer evidence-based support for the future adjustment and optimization of immunization strategies for policymakers.

BACKGROUND:Influenza vaccination rates remain low among primary school students and vary by school, even under the free School-Located Influenza Vaccination (SLIV) in Beijing, China. To improve influenza vaccination coverage, we developed multifaceted, enhanced SLIV (E-SLIV) strategies in response to factors that influenced the SLIV implementation. The E-SLIV strategies were proved with modest effectiveness in improving influenza vaccination uptake via a cluster randomized trial in the 2022-2023 influenza season. This paper reports the implementation outcomes and identifies influencing factors for the implementation of the E-SLIV strategies, which was conducted in the same settings. METHOD:The E-SLIV intervention study involved 20 primary schools in Beijing, China, which were randomly allocated in a 1:1 ratio to the intervention (i.e., E-SLIV) or control (i.e., usual SLIV practice) groups in the 2022-2023 influenza season. This study applied a convergent mixed methods design to evaluate implementation outcomes specifically for 10 schools in the E-SLIV group. Quantitative data were collected from 39 implementers via a close-ended questionnaire and a project-specific implementation checklist, and from 915 parents via a close-ended questionnaire. Qualitative data were gathered from 18 implementers and 8 parents via semi-structured interviews. Quantitative descriptive and qualitative thematic analysis were applied, with findings integrated via joint display for meta-inference based on an evaluation framework that combines the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework with Normalization Process Theory (NPT). RESULTS:E-SLIV reached 1,172 of the 1,541 targeted students in 10 intervention schools, representing an intervention coverage rate of 76.1% (95% CI [74.0%, 78.2%]). Qualitative findings indicated that the E-SLIV strategies may have limited success in reaching those with social media information overload and those who were hesitant about influenza vaccination. All 10 schools adopted the overarching E-SLIV strategies, but insufficient priority and endorsement from school administrators may have hindered the consistent adoption of specific program components. Both quantitative and qualitative findings suggested the E-SLIV strategies were flexible with adequate resources, enabling good implementation of most intervention components. However, relationships, skills, contexts, and content integration needed strengthening, and implementation was limited by COVID-19 related workload and vaccination uncertainty, and vaccine shortage, as the qualitative findings indicated. Around 83.3% (95% CI [73.4%, 93.2%]) of school implementers and 70.4% (95% CI [67.4%, 73.4%]) of parents favored maintaining E-SLIV. CONCLUSION:The multifaceted E-SLIV strategies reached most target populations and were well-implemented with high fidelity by most schools. The E-SLIV strategies strengthened collaboration, enhanced capacity, and provided tailored education, yet faced challenges including entrenched parental views, social media information overload, inadequate school leadership, low proactivity among school doctors in coordinating vaccinations, the COVID-19 pandemic, and temporary vaccine shortages. Findings inform future optimization of school-based vaccination programs and present a compelling case for measuring implementation outcomes using mixed methods.

BACKGROUND:Human papillomavirus (HPV) vaccine has been authorized by the National Medical Products Administration for marketing in China since 2016. This study analyzed the adverse events following immunization (AEFI) with all HPV vaccines available in China during 2021-2024: three imported and two domestic HPV vaccines, which were all non-program vaccines approved for females only during the study period. METHODS:We obtained all AEFI reports and numbers of HPV vaccine doses administered during 2021-2024 from the Chinese National Immunization Information System (CNIIS). We used descriptive epidemiological methods to analyze characteristics and reporting incidence (RI) of HPV vaccine AEFI reports. RESULTS:During the study period, 163.57 million doses of HPV vaccine were administered and 23,890 HPV vaccine AEFI were reported, for an overall RI of 14.61 AEFI reports per 100,000 doses. Respective AEFI RIs for 9-12-years-old, 13-17-years-olds, 18-30-years-olds, and 31-46-years-olds were 15.01, 16.37, 14.00, and 14.77 per 100,000 doses administered. For bivalent, quadrivalent and 9-valent HPV vaccines, respective RIs were 8.49, 12.65, and 20.50 per 100,000 doses. Most AEFI reports were for common vaccine reactions - injection site reactions (redness/swelling, 6.31 reports per 100,000 doses) and systematic reactions (fever, 3.71 reports per 100,000 doses). The reporting incidence of rare vaccine reactions was 0.49 per 100,000 doses administered, with allergic rash most frequently reported. RIs of serious AEFI and serious rare vaccine reactions were 0.13 and 0.05 per 100,000 doses administered, respectively. CONCLUSIONS:The immunization safety profile of HPV vaccines available in China during 2021-2024 was acceptable based on this national AEFI data analysis. Serious adverse vaccine reactions were extremely rare; no new or clinically meaningful safety concerns were found.

BACKGROUND/OBJECTIVES:Although Clostridioides difficile infection (CDI) is a key cause of global morbidity and mortality, the burden of CDI in mainland China is not well-defined. The objective of this systematic literature review was to summarize the available epidemiologic evidence on the CDI disease burden (cases, hospitalizations, and deaths) in mainland China. METHODS:Six databases (three global [PubMed, Embase, Cochrane] and three Chinese [Chinese National Knowledge Infrastructure, Chinese Science Citation, Wanfang]) were searched on 5 August 2025 using CDI-related and epidemiological search terms. No date or language limits were applied. Real-world epidemiologic studies of adults and/or children with laboratory-confirmed CDI in mainland China reporting population-based CDI incidence, hospital-based CDI incidence, and/or CDI admission rates were included. All studies not meeting these criteria were excluded. Risk-of-bias (RoB) assessment was performed using the Newcastle-Ottawa Scale. Results were summarized descriptively. RESULTS:In total, 11 articles formed the evidence base for this review; each was a single-center, hospital-based study conducted in one of six cities in mainland China and published between 2014 and 2023. RoB assessment indicated that the evidence base was appropriate for this study. No study reported population-based CDI incidence. In total, 10 studies reported hospital-based CDI incidence (0 to 82.0/10,000 patient-days), and four reported CDI admission rates (0 to 23.1/1000 admissions). Eight studies reported mortality rates, which varied across studies. CONCLUSIONS:Several single-center, hospital-based studies demonstrate that CDI is present in hospitals in mainland China, but there are no published population-based CDI incidence estimates. These results should be interpreted considering this study's limitations, including potential publication and selection bias, heterogeneity, and limited generalizability. Overall, the burden of CDI is poorly understood in mainland China. Thus, prospective epidemiological studies, including those with sensitive detection methods, are needed to examine CDI burden across multiple cities in mainland China. These efforts would help illuminate the CDI burden and guide prevention efforts. (PROSPERO ID 1140152; registered 17 March 2026; funding by Pfizer Inc.).

What is already known about this topic?:Influenza poses a substantial health risk to children. Despite being an effective preventive intervention, influenza vaccine coverage among children in China remains low. What is added by this report?:This study identified factors associated with caregiver decisions on pediatric influenza vaccination. A child's prior influenza vaccination and caregivers' close contacts being vaccinated were positively associated with uptake. Concerns about vaccine efficacy were key barrier among caregivers who declined vaccination. What are the implications for public health practice?:The findings inform interventions to improve childhood influenza vaccination and strengthen prevention and control efforts.

What is already known about this topic?:Children with medical conditions who remain undervaccinated are at risk of vaccine-preventable diseases. What is added by this report?:In a multicenter retrospective study of 24,966 children with medical conditions, the median coverage of 10 National Immunization Program vaccines reached 97.33%, whereas timely completion was 89.21%. Children with brain, immune, or congenital disorders exhibited significantly lower vaccination coverage than those with other medical conditions. Post-diagnosis delays exceeded those before diagnosis. Overall adverse events following immunization rate was 23.7/100,000 doses administered. What are the implications for public health practices?:Research on the vaccination of children with brain, immune system, and congenital disorders is imperative. Integration of advanced practices will enhance the vaccination rate.

Background Children with medical conditions face elevated risks from vaccine-preventable diseases, yet their vaccination coverage remains suboptimal. This study examines vaccination staff's willingness to immunize this special population, guided by the Theory of Planned Behavior (TPB) conceptual framework. Methods We conducted a cross-sectional questionnaire-based survey of vaccination staff working at any of 416 vaccination clinics that were selected at random from three exemplar cities of China. TPB-guided analyses included regression and structural equation modeling to examine predictors of vaccination willingness. Results A total of 428 vaccinating clinicians participated in the survey (response rate, 91.45%); 94.63% of respondents were female. The overall average score of willingness to vaccinate children with special health needs was 3.893 ± 0.795 points out of 5 points, indicating moderately-high willingness, with 50.9% of respondents having high willingness (≥4 points). Respondents' clinic type being a hospital clinic, position being the head of the clinic, and more frequent training were positively associated with willingness to vaccinate this special population. The structural equation model had good fit (CFI = 0.932, TLI = 0.920, χ2/df = 2.868). The structural equation model showed that perceived behavioral control had both a direct effect (β = 0.465, P < 0.001) and an indirect effect through subjective norms (β = 0.128, P = 0.001) on behavioral intention (willingness). Subjective norms (β = 0.323, P < 0.001) and behavioral attitudes (β = 0.095, P = 0.032) also exerted direct positive effects on behavioral intention. The total effects, ranked in descending order of influence, were perceived behavioral control, subjective norms, and behavioral attitudes. Conclusions The willingness of vaccination staff to vaccinate children with medical conditions is generally acceptable but has room for improvement. Perceived behavioral control emerged as the most critical influencing factor. We recommend (1) case-oriented practical training to boost competence; (2) unified, operable technical guidelines; (3) leadership engagement and social-support networks.

Background Physicians' recommendations play a key role promoting maternal vaccination. In China, obstetricians provide prenatal care and public health physicians (PHP) provide vaccination services. We assessed factors influencing maternal influenza immunization recommendation practices of obstetricians and PHPs. Methods A cross-sectional survey was conducted during June–July 2025 among practicing obstetricians and practicing PHPs in Shenzhen, China. Results Among the 104 obstetrician and 135 PHP respondents, 15.4% of obstetricians and 17.0% of PHPs report recommending maternal vaccination “often” or “always”. Obstetricians' confidence in influenza vaccination was significantly lower than that of PHPs. Factors associated with recommending maternal immunization were higher confidence in influenza vaccine (obstetricians), higher pregnant patient volumes, higher confidence and self-perception of sufficient information for maternal vaccination counseling (PHPs). Fear of disputes over adverse events was the main concern of obstetricians (69.2%) and PHPs (76.3%); the most trusted and influential information sources were China CDC, the Chinese Society of Obstetrics and Gynecology, and vaccine package inserts. Physicians suggested harmonizing package inserts and official guidelines. Conclusions Too few obstetricians and PHPs in China recommend maternal influenza vaccination. Knowledge and confidence in maternal vaccination need improvement. Disseminating authoritative information through official channels and targeted training for different type of physicians is essential. Physicians suggest harmonizing professional society clinical guidelines, public health guidelines, and influenza vaccine package inserts to provide clear, unambiguous recommendations for influenza vaccination during pregnancy.

Guardians' satisfaction is an important quality indicator of vaccination services. However, there is insufficient contemporary, post-pandemic research on parent/guardian satisfaction with immunization services in China. In this study, we explore satisfaction of guardians of young children with vaccination services, and factors associated with satisfaction. During December 2022 to March 2023, we conducted a cross-sectional, questionnaire-based satisfaction survey of guardians of 0-6-y-old children attending any of 180 vaccination clinics in 10 provinces selected through a multi-stage stratified random sampling method. The primary outcome was guardian satisfaction with eight aspects of routine immunization services. Among 3,099 guardians, 84.6% were very satisfied or satisfied with all eight aspects of immunization services. Individual item satisfaction ranged from 85.8% (clinic queuing time) to 97.9% (staff service attitude). Multivariate logistic regression showed that medical-worker guardians were 2.13 times more likely to be satisfied than non-medical worker guardians (OR: 2.13; 95% CI: 1.32-3.44); satisfaction was positively associated travel time to clinic ≤10 min (OR: 1.78; 95% CI: 1.45-2.19); making an appointment (OR: 2.58; 95% CI: 2.10-3.16); having confidence in vaccine effectiveness (OR: 2.10; 95% CI: 1.33-3.29) and waiting times ≤10 min (OR: 1.29; 95% CI: 1.05-1.59). Guardians with an annual family income >100,000 yuan had a lower satisfaction level (OR: 0.61; 95% CI: 0.49-0.76). Guardians' satisfaction with vaccination services was high overall, but can be improved. Satisfaction is influenced by guardians' occupation, income, service accessibility, and knowledge. Optimizing appointment systems, shortening waiting times, and enhancing education about vaccination may improve the quality of immunization services and guardians' satisfaction.

BackgroundSeasonal influenza poses a significant public health challenge in China, yet vaccination uptake remains low even among healthcare workers. This study evaluates the effectiveness of multi-component interventions to improve influenza vaccination uptake, aiming to inform targeted public health strategies.MethodsA two-phase randomized controlled trial will be conducted in community hospitals across China targeting healthcare workers as participants. In phase 1, community hospitals will be randomized as units into one of three arms: standard nudge group, personalized nudge group, and control group. In phase 2, healthcare workers who remain unvaccinated after phase 1 will be individually randomized to either a motivational interview group or a control group. The primary outcome is influenza vaccination uptake, verified by official vaccination records. All data will be analyzed upon study completion.DiscussionNudge and motivational interview interventions are anticipated to significantly improve vaccination uptake among healthcare workers, and facilitate scale up of the effective interventions. By targeting healthcare workers, these interventions can also indirectly enhance vaccination coverage in the general population.Trial registrationClinicalTrials.gov NCT07157163. Registered on September 4, 2025.

Introduction:This study assesses the adverse events following vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPV23) in China from 2021 to 2024. Methods:We obtained reports of adverse events following immunization (AEFI) with PPV23 and the number of PPV23 doses administered during the study period from the Chinese National Immunization Information System (CNIIS). We descriptively analyzed the AEFI characteristics and reported incidences per 100,000 doses administered. Results:During the study period, 26.65 million doses of PPV23 were administered and 22,221 PPV23 AEFI were reported, i.e., a reported incidence of 83.37 AEFI per 100,000 doses administered. The incidence per 100,000 doses of common vaccine reactions was 80.51, and the incidences of rare vaccine reactions and serious AEFI were 1.70 and 0.43, respectively. The incidences of AEFI, common vaccine reactions, and rare vaccine reactions decreased with age. The most frequently reported common vaccine reactions were fever (54.07/100,000 doses) and local redness and swelling (41.61/100,000 doses), and the most frequent rare vaccine reaction was allergic rash (0.92/100,000 doses). 99.15% of adverse vaccine reactions occurred within 3 days after vaccination. Conclusion:PPV23 had a good safety profile during 2021 to 2024. The findings support the use of PPV23 as recommended from a safety perspective.

China recently announced inclusion of HPV vaccine into the National Immunization Program for 13-year-old females, directly benefiting annual cohorts of 7-8 million girls. This commentary discusses the significance of HPV vaccine introduction in China and the prospects for life-course vaccination and global collaboration for cervical cancer elimination. Private-sector HPV vaccine availability over the past decade yielded low, inequitable, and off-target coverage, while program inclusion ensures equitable access, properly timed before sexual debut. We describe necessities of locally-obtained burden-of-disease evidence and ample, affordable domestic HPV vaccine, and show the value of five years of large-scale pilot introductions that gave government confidence in nationwide introduction. Government-backed policy counters vaccine hesitancy by reinforcing public trust, and China's strengthening vaccine R&D ecosystem and participation in WHO prequalification promote affordable global vaccine supply. HPV inclusion aligns with Immunization Agenda 2030 priorities on coverage, equity, life-course vaccination, and sustainable supply.

What is already known about this topic?:Human rabies vaccine has been in use for many years and has played a vital role in rabies prevention and control in China. What is added by this report?:From 2021 to 2024, the overall reported rate of adverse events following immunization (AEFI) with human rabies vaccine was 18.57 per 100,000 doses, of which 96.29% were common vaccine reactions. Rare vaccine reactions occurred at a rate of 0.49 per 100,000 doses; allergic rash was the most frequently reported rare reaction and usually was non-serious. The rate of rare and serious vaccine reactions was 0.07 per 100,000 doses. What are the implications for public health practice?:Human rabies vaccine, one of the most commonly used non-program vaccines in China, its AEFI rate fell within an acceptable range. Continued AEFI surveillance is essential for evaluating the post-marketing immnization safety of this vaccine.

Objective:To assess adverse events following recombinant zoster vaccine (RZV) in China during the post-marketing period. Methods:The study obtained data on adverse events following immunization (AEFI) and vaccination doses of RZV from the Chinese National Immunization Information System (CNIIS). We analyzed RZV AEFI reports from 2020 through 2023. Results:During the study period, 1.99 million doses of RZV were administered, and 10,525 RZV AEFI cases were reported. The reporting incidence of AEFI was 527.76 per 100,000 doses administered, with serious AEFI at 0.55, common vaccine reactions (usually minor) at 518.19, and rare vaccine reactions (possibly serious) at 4.06 per 100,000 doses. Among adverse vaccine reactions, the most frequently reported common vaccine reactions were fever (333.76/100,000) and local redness and swelling (213.51/100,000), while the main reported rare vaccine reaction was allergic rash (3.01/100,000). Conclusions:Most RZV AEFIs were common vaccine reactions, consistent with adverse events reported in RZV clinical trials. The incidence of rare vaccine reactions was very low, and most of which were allergic rash. No special safety concerns were identified and AEFI surveillance should be continued.

Introduction:Two live attenuated rotavirus vaccines (RVs) were licensed in China. Passive surveillance for adverse events following immunization (AEFI) provides valuable evidence for potential safety signal detection of RV in China. Methods:We obtained data on RV doses administered and RV AEFI reports from the Chinese National Immunization Information System (CNIIS) during January 2013 to December 2023. We conducted a descriptive analysis of RV AEFI characteristics and estimated incidences of RV AEFI. Results:During the study period, 77.36 million doses of RV were administered, and 20,556 RV AEFI reports were made, yielding an overall incidence of 26.57 AEFI per 100,000 doses administered; incidences were 26.42 for RV1 and 26.85 for RV5. Among all RV AEFI, 20,334 (98.92%) were non-serious. Vaccine product-related reactions accounted for 95.68% of AEFI reports, including 18,192 (88.50%) common and 1,476 (7.18%) rare vaccine reactions. Among common vaccine reactions, case reports per 100,000 doses administered were 16.85 (13,031 reports) for fever, 5.84 (4,520 reports) for gastrointestinal disorders, and 1.28 (988 reports) for rash. Among rare vaccine reactions, case reports per 100,000 doses were 1.43 (1,104 reports) for allergic rash, 0.07 (56 reports) for thrombocytopenic purpura, 0.03 (26 reports) for febrile convulsion, and 0.01 (5 reports) for intussusception. Conclusions:Most RV AEFIs were mild and non-serious, and the incidence of rare vaccine reactions was very low. RVs have reasonable safety surveillance profiles and AEFI evaluation should be continued.