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Time Interval Distribution of Hepatitis B Vaccine Immunization among Infants in China from 2017 to 2021

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18 January 2024

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Abstract
Infant hepatitis B vaccine coverage in China is high, with over 95% of infants immunized; however, high vaccine coverage can often mask low timeliness. The vaccination interval between the second and third dose is not clearly defined by immunization guidelines in China. This retrospective cohort study assessed the time interval distribution of hepatitis B vaccination among a cohort of randomly selected live births from Centers for Disease Control and Prevention across four provinces or municipalities in China between January 2017 and December 2021. Among the infants analyzed, 163,224 received the first dose of hepatitis B vaccine with 146,905 (90.0%) and 135,757 (83.2%) infants receiving the second and third doses, respectively. A total of 132,577 (90.2%) infants received the second dose between 28–61 days after the first dose. Of the 119,437 (88.0%) infants that completed the hepatitis B series between 61–214 days after the second dose, 87,067 (64.1%) infants were vaccinated with the third dose between 151–180 days after the second dose. The time interval distribution for the three doses of hepatitis B vaccine varied across the four provinces or municipalities (P<0.001). Of the 58,077 infants who completed the hepatitis B vaccine series, 36,377 (62.6%) infants used the same type of hepatitis B vaccine for all three doses. Overall, the timeliness of hepatitis B vaccination for infants was lower than expected, with regional disparities observed. This highlights the need for improved timeliness through the introduction of a defined timeframe for the last two doses of vaccine, and training for obstetricians and related personnel.
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Subject: Medicine and Pharmacology  -   Epidemiology and Infectious Diseases

1. Introduction

Perinatal transmission is a major mode of hepatitis B virus (HBV) transmission worldwide, with infection rate highest in China [1]. In response, China has implemented efforts to reduce transmission through universal infant immunization. In 2002, China integrated a hepatitis B vaccine into the Expanded Program on Immunization, and provided all neonates with free HBV immunization [2], resulting in high vaccine coverage, with over 95% of infants receiving three doses [3]. The schedule recommended in the 2021 immunization program of the National Health Commission of People’s Republic of China [4] involves administration of the first dose within 24 hours after birth, and administration of subsequent doses at 1 and 6 months of age, respectively, and it’s the birth dose that’s really impactful on MTCT, the subsequent doses are to establish longer term protection for other modes of transmission [2,5].
Preventing perinatal and early childhood infections by providing hepatitis B vaccine for infants beginning from birth has proven to be a safe, effective, and important component of the comprehensive strategy to eliminate HBV transmission worldwide [5,6,7,8,9,10]. The Global Alliance for Vaccines and Immunization (GAVI), created in the early 2000s, has played an important role in promoting the implementation of universal hepatitis B vaccination in low- and middle-income countries, with children from 73 countries vaccinated between 2011–2020 [11]. This resulted in a dramatic increase in vaccine coverage in infants from 1% in 1990 to 84% in 2015 [12]. By the end of 2021, 190 countries adopted a universal hepatitis B vaccination policy, with global coverage of three doses of hepatitis B vaccine estimated at 85% [13].
Studies measuring vaccine timeliness have become more frequent in recent years, and suggest that the first dose of hepatitis B vaccine should be administered within 24 hours of birth regardless of the mother’s HBV status [6,14,15,16,17,18], as recommend by the World Health Organization (WHO) [6]. The United States Advisory Committee on Immunization Practices (ACIP) proposed a 3-dose series at ages 0, 1–2, and 6–18 months [19]. In addition, 111 member states introduced a “birth dose” of hepatitis B vaccine to newborns within the first 24 h after birth [13]. Moreover, infants who received the first dose of hepatitis B vaccine at birth were more likely to complete the 3-dose series along with other recommended vaccinations in a timely manner [20].
Multiple factors influence coverage and timely administration of hepatitis B vaccines, including immigrant populations [2], region [21], location of birth [5,21], parental attitudes to vaccination [22,23,24], health care providers [25], and restricted medical resources or limited health consciousness [26]. A nationwide study from China demonstrated that 3-dose vaccine coverage was lower in those born before 2001, residing in western provinces or rural locations, home-birthed, or with Tibetan or Uigur ethnicity [2]. Vaccination coverage and timeliness of vaccine administration are related; however, high coverage can sometimes mask low timeliness. In 2012, the WHO verified that China achieved the hepatitis B surface antigen 1% prevalence control goal among children <5 years of age through universal hepatitis B immunization of newborns [27]. As such, it is important for future research to focus on further enhancing the effectiveness and economic benefits related to hepatitis B immunization.
Currently, the vaccination interval between the second and third doses of hepatitis B vaccine is not clearly defined in the Chinese immunization guidelines, nor is the timely vaccine series completion defined in China. The aim of this study was to analyze the time interval distribution of three doses of hepatitis b vaccine administration across four provinces of China to further optimize the immunization schedule and the vaccine-type used.

2. Materials and Methods

2.1. Study design and study setting

We conducted a retrospective cohort study to assess vaccination status among randomly sampled live births with immunization records across four provinces or municipalities (Beijing, Anhui, Guizhou, and Inner Mongolia) between 1 January 2017 and 31 December 2021. A total of 3% of infants from at least three counties were randomly selected from each province or city.

2.2. Study population and data sources

The study population included all infants born from 1 January 2017 to 30 June 2021, that had immunization records between 1 January 2017 and 31 December 2021, allowing infants born at the end of June sufficient time to complete the 3-dose hepatitis B vaccination program. Notably, data may not have been complete for internal migrants (e.g., those who have moved from one county or province to another) due to electronic medical records not having been transferred. Exclusion criteria included incomplete or inconsistent data, such as missing or incorrect birth dates (such as birth after vaccination), vaccination time (or inconsistent vaccination sequence, such as the date of the third dose being earlier than the first dose), or vaccination dose (data only available for the first or third dose, but no information for the second dose).

2.3. Variables of interest

The primary endpoint was the proportion of infants who received three doses of hepatitis B vaccine at different intervals and was derived from two variables: date of birth and date of receiving hepatitis B vaccination. For the first dose of vaccine, timely vaccination was limited to 24 hours after birth, following international recommendations. Any vaccination after 24 hours of birth was considered delayed.
For the second and the third dose, guidelines recommend vaccination at 1 and 6 months of age, respectively, but a specific time interval is not defined. The time interval between the first and second dose was divided into three groups: 28–42 days, 43–61 days, and ≥62 days after the first dose. The time interval between the second and third dose was divided into seven groups: <60 days, 61–90 days, 91–120 days, 121–150 days, 151–180 days, 181–214 days, and ≥215 days after the second dose.
Sampled data from Beijing and Anhui was used to analyze the usage of three types of vaccines, coded as A, B, and C, differentiated by the technological platform used in their production, including the percentage of infants using the same or different type of vaccine between the various doses of the 3-dose schedule. Data for the other provinces was not available due to data privacy restrictions. Floating population defined as residing in an area for less than 6 months.

2.4. Statistical analysis

The total number of infants for each dose and the corresponding time interval between doses were presented as numbers and percentages. Chi-squared test/Fisher exact tests were used to compare the percentages of infants with different vaccination schedules and different types of vaccines. The level of statistical significance was set at 0.05 and Stata 16.0 (Stata Corp LP, College Station, TX) was used for all statistical analyses.

2.5. Ethical approval

The study was approved by the Ethics Committee of Peking University Health Science Center (IRB00001052-23084) and Guizhou Center for Disease and Prevention and Control (Q2023-10).

3. Results

3.1. Dose uptake

Description of the sociodemographic characteristics stratified by province are presented in Table 1. Among the infants analyzed, 163,224 received the first dose of hepatitis B vaccine. Vaccination uptake decreased for the subsequent two doses, with 146,905 (90.0%) and 135,757 (83.2%) infants receiving the second and third dose, respectively.

3.2. Time interval distribution of the three doses of vaccine

Of the 135,757 infants who completed the three doses hepatitis B vaccination schedule, a total of 100,434 (74.0%) infants received the first dose within 24 hours, the second dose 28–61 days after the first dose, and the third dose 61– 214 days after the second dose.
For the first dose of hepatitis B vaccine, 145,254 (89.0%) received within 24 hours after birth.
The time interval distribution for the second dose of hepatitis B vaccine across the four regions is shown in Table 2. Among the 146,905 infants who received two doses of hepatitis B vaccine, 132,577 (90.2%) received the second dose between 28–61 days after the first dose. The proportion of infants who received the second dose between 28–42 days after the first dose was the highest in Anhui (n=22,940, 78.5%), and lowest in Beijing (n=22,180, 68.2%; P<0.001); however, the proportion of infants who received the second dose between 43–61 days after the first dose was higher in Inner Mongolia (n=7032, 21.0%) compared to the other three regions (Beijing n=5618, 17.3%; Anhui n=3918, 13.4%; Guizhou n=11,659, 21.0%) (Table 2). The proportion of infants vaccinated between 43–61 days after the first dose was higher than those vaccinated ≥62 days after the first dose (19.2% vs. 9.8%, respectively).
Of the 135,757 infants who received the third dose of hepatitis B vaccine, 119,437 (88.0%) completed the full series between 61–214 days after the second dose. 87,067 (64.1%) were vaccinated between 151–180 days after the second dose, and 17,210 (12.7%) were vaccinated between 181–214 days after the second dose (Table 3). Only around 1% (n=1,386) of infants were immunized ≤91 days after the second dose. Furthermore, proportionally more infants in Inner Mongolia (n=25,290, 88.9%) received the third dose of hepatitis B vaccine between 151–180 days after the second dose compared with Beijing (n=14,393, 48.1%), Anhui (n=17,935, 63.8%), or Guizhou (n=29,449, 59.8%; Table 3). The proportion of infants who received the third dose of hepatitis B vaccine between 121–214 days after the second dose reached 85.6% (n=116,266; Table 3).

3.3. Dose uptake within the specific time interval by region

The proportion of infants receiving the first, second or third hepatitis B dose varied significantly across the four regions (Beijing, Anhui, Inner Mongolia, and Guizhou; P<0.001; Table 1). In Anhui and Inner Mongolia, 23,990 (81.2%) and 34,255 (86.4%) infants received the first dose of hepatitis B vaccine within 24 hours after birth, respectively, compared with 30,518 (93.8%) and 56,491 (91.8%) infants born in Beijing and Guizhou, respectively (Table 1). Conversely, the proportion of infants receiving the second dose of hepatitis B vaccine between 28–61 days after the first dose was 26,858 (91.9%) and 28,126 (95.3%) in Anhui and Inner Mongolia, respectively, compared with 27,798 (85.5%) and 49,795 (89.5%) of infants born in Beijing and Guizhou, respectively (Table 1). Similarly, those receiving the third dose of hepatitis B vaccine between 61–214 days after the second dose were higher in Anhui (n=25,989, 92.4%) and Inner Mongolia (n= 28,393, 99.8%), compared with Beijing (n=21,736, 72.6%) and Guizhou (n= 43,319, 88.0%) (Table 1). The proportion of infants who received the first dose of hepatitis B vaccine within 24 hours, the second dose between 28–61 days after the first dose, and the third dose between 61–214 days after the second dose, was higher in Inner Mongolia (n=25,049, 88.0%) and Guizhou (n=38,235, 77.7%), compared with Beijing (n=17,617, 58.8%) and Anhui (n=19,533, 69.5%) (Table 1).

3.4. Analysis of three doses of immunization using different types of hepatitis B vaccines

A total of 58,077 children from Beijing and Anhui who received all three doses of hepatitis B vaccine were analyzed to assess the type of vaccine used for each dose. Of those included, 36,377 (62.6%) infants used the same type of vaccine for all three doses, 21,613 (37.2%) infants used two different types of vaccines for the three doses, and only 87 (0.2%) infants used completely different types of vaccines for the three doses (Table 4). Furthermore, 12,590 (21.7%) infants used a different type of hepatitis B vaccine for the second dose than for the first dose.

3.5. Univariate analysis of vaccination using different types of hepatitis B vaccines

A univariate analysis of the 58,077 infants who completed all three doses of hepatitis B vaccine showed that several factors influenced the number of different vaccine types used. The proportion of Han that received the same type of vaccine was higher than for other ethnic groups (64.9%vs. 53.9%), respectively. Additionally, in 2018 and 2019, 57.5 and 57.2%, respectively, received the same type of vaccine, which were lower compared with other years included in this analysis. However, the proportion of infants vaccinated with all doses at the same location was higher than those who received subsequent hepatitis B vaccines at an alternative location (79.2% vs. 62.1%). Furthermore, a higher proportion of second born children (64.6%) received the same type of vaccine compared with those born in any other birth order (Table 5, P<0.001).

3.6. Vaccination coverage of other National Immunization Program vaccines

A total of 69,183 immunization records for infants from Anhui and Inner Mongolia who had received at least the first dose of hepatitis B vaccine were analyzed to determine the coverage rates of other vaccines, including the diphtheria, tetanus and pertussis vaccine (DTP), oral poliovirus vaccine (OPV), inactivated polio vaccine (IPV), meningococcal conjugate vaccines (MCV), and bacillus Calmette-Guerin vaccine (BCG). Vaccination coverage rates for DTP, MCV, and BCG all exceeded 90%; however, vaccine coverage rates were lower for subsequent doses. The coverage rates of the first and second dose of OPV also exceeded 90%; however, coverage for the third dose reached only 16.7%. Similarly, the coverage rate for the first dose of IPV was 82.1% but decreased to 56.3% for the second dose (Table 6).

4. Discussion

This retrospective cohort study conducted in the four provinces or municipalities in China, (Anhui, Inner Mongolia, and Guizhou, and one province-level municipality Beijing), China, we found that vaccine coverage and timeliness of hepatitis B vaccination differed among the four regions analyzed (Anhui Inner Mongolia, Guizhou and Beijing); however, approximately 70% of infants received all three doses of hepatitis B vaccine within the specific time interval defined as vaccinating first dose within 24 hours after birth, the second dose between 28 and 61 days after the first dose, and the third dose between 61 and 214 days after the second dose. The proportion of infants vaccinated between 28–42 days after the first dose was higher than those vaccinated between 43–61 days and ≥62 days after the first dose. For the third dose, more than half of the infants were vaccinated between 151–180 days after the second dose.
These data showed that the proportion of infants who received all three doses hepatitis B vaccine within the pre-defined time intervals did not reach 95%. These findings are similar to a previous study conducted in Hohhot, China, which found that timely vaccination with the first dose of hepatitis B vaccine was achieved in only 90% of newborns in 2019 and 2021 [28]. Conversely, a study in Guangxi. China, found that the timely vaccination was achieved in 94.88% of newborns, with delayed vaccination attributed to low birth weight, preterm delivery, and dystocia [29]. This suggests that newborns from rural areas may not receive their first dose of vaccine in a timely manner.
Under- or delayed-vaccination is a significant, avoidable public health risk, and contributes to the low overall vaccine coverage (40–60%) observed in some population subgroups [30,31]. As low vaccine coverage increases the overall susceptibility of the population to outbreaks of vaccine preventable diseases, it is important that medical resources are readily accessible across all areas. Local health departments should be encouraged to assess vaccination coverage so that they can use it as a baseline for designing and implementing interventions in the region, with the aim of increasing vaccination rates. Although a previous study on hepatitis B vaccine coverage rate in the central and western regions of China showed that timely full and complete coverage increased from 46.6% in 2011 to 59.3% in 2016, this study was conducted earlier and may underestimate the full coverage rate [32]. Overall, our data show that the majority of infants who received both the second and third doses of hepatitis B vaccine were clustered between 28–61 days (90.3%) after the first dose and between 121–214 days (85.6%) after the second dose, respectively. This indicates that setting a clear vaccination schedule would further improve vaccination uptake and timely vaccination rate.
In terms of the different types of vaccines used, we found that the majority of infants were immunized with the same type of vaccine. However, although the vaccination procedure for all three doses of hepatitis B vaccine is not clearly stipulated by the Chinese hepatitis B vaccination procedure, our study also revealed that 21.7% of infants received a different type of hepatitis B vaccine for their first two doses, and 37.2% of infants received two types of hepatitis B vaccine for over the three doses; this may due to convenience and availability of vaccines. This reflects real-world clinical practice, whether for newborns or other populations, as an individual may receive two different vaccines for sequential immunizations due to issues with vaccine procurement and supply. However, it is important to note that multiple studies have shown that different types of hepatitis B vaccines display comparable effects in terms of safety and immunogenicity [33,34], with no significant difference in immunization of effect noted between schedules using the same of different hepatitis B vaccines for the 3-dose schedule [34,35]. Notably, our data also revealed that infants were more likely to receive the same type of vaccine if they were of Han nationality, vaccinated in the same location, or second born children or later. This is likely related to the accessibility of hepatitis B vaccine, parents’ knowledge, and previous experience of the hepatitis B vaccine.
Lastly, our data also showed that infants vaccinated with hepatitis B vaccines were more than 90% likely to receive the DTP, OPV, MCV, and BCG vaccines. However, the proportion of those who received OPV3 was lower because China implemented an updated immunization program incorporating bivalent IPV and bivalent OPV on 1 May 2016 [36].
This study had multiple limitations that warrant discussion. Firstly, those who did not receive the second and third dose or received the third dose outside of the specified timeframe (1 January 2017 and 31 December 2021), were not included in the analysis, which may have led to an overestimation of the timely vaccination rate. However, according to previous research, the proportion of infants receiving three doses within the pre-defined time interval did not reach 95%, therefore highlighting the need for improved timely vaccination rates and implementation of vaccination time intervals for both the second and third hepatitis B vaccine doses. Secondly, the factors affecting timely vaccination were not analyzed as this was beyond the scope of this study.

5. Conclusions

As there are currently large regional disparities in the timeliness of infant hepatitis B vaccination, it is necessary to precisely define the time of vaccination for the last two doses of hepatitis B vaccine, to further investigate the factors affecting timely vaccination, and strengthen training for obstetricians and related personnel. Additionally, our study showed the interchangeability of hepatitis B vaccine that exists in real-world clinical practice, with different types of hepatitis B vaccine used for immune prophylaxis, which may also help improve full vaccination coverage and timeliness of hepatitis B vaccination.

Author Contributions

Conceptualization, F.C., and H.N.; collected and analyzed the data, and prepared tables, S.Z., X.T., L.W., T.Z., X.C., M.W., X.Z., M.L., and J.W.; funding acquisition, X.T., and F.C.; writing - original draft preparation, S.Z., and J.D.; writing - review and editing, F.C., N.H., Y.L., C.W., M.L., Q.L., and J.W. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by the Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University; Development and Application Promotion of Inner Mongolia Immunization Planning Information Management System. This study was also funded by Sanofi. Sanofi was not involved in the study design, including protocol development, the data analysis plan, data interpretation, and manuscript writing. Sanofi also provided funding for editorial support.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the he Ethics Committee of Peking University Health Science Center IRB00001052-23084) and Guizhou Center for Disease and Prevention and Control (Q2023-10).

Data Availability Statement

Original data are available on request. Readers who wish to gain access to the data can contact the corresponding author. Requests to access these datasets should be directed to FC, cuifuq@bjmu.edu.cn.

Acknowledgments

The authors also thank Roopsha Brahma, PhD for editorial assistance and manuscript coordination on behalf of Sanofi. Editorial support with the preparation of the manuscript was provided by Holly McAlister and Nichola Cruickshanks, inScience Communications, Springer Healthcare Ltd, UK, and was funded by Sanofi.

Conflicts of Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

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Table 1. Doses of vaccines administered within the pre-defined timeframe.
Table 1. Doses of vaccines administered within the pre-defined timeframe.
Provinces or province-level municipality Doses Total Administered within the custom time interval Administered after the custom time interval
N n (%) n (%)
Beijing* 1 32,532 30,518 (93.8) 2014 (6.2)
2 32,515 27,798 (85.5) 4717 (14.5)
3 29,955 21,736 (72.6) 8163 (27.3)
1 to 3 29,955 17,617 (58.8) 12,338 (41.2)
Anhui* 1 29,533 23,990 (81.2) 5543 (18.8)
2 29,230 26,858 (91.9) 2372 (8.1)
3 28,122 25,989 (92.4) 2085 (7.4)
1 to 3 28,122 19,533 (69.5) 10,000 (30.5)
Inner Mongolia* 1 39,650 34,255 (86.4) 5395 (13.6)
2 29,516 28,126 (95.3) 1390 (4.7)
3 28,449 28,393 (99.8) 8 (0.03)
1 to 3 28,449 25,049 (88.0) 14,601 (12.0)
Guizhou* 1 61,509 56,491 (91.8) 5018 (8.2)
2 55,644 49,795 (89.5) 5849 (10.5)
3 49,231 43,319 (88.0) 5563 (11.3)
1 to 3 49,231 38,235 (77.7) 23,274 (22.3)
Total 1 163,224 145,254 (89.0) 17,970 (11.0)
2 146,905 132,577 (90.3) 14,328 (9.8)
3 135,757 119,437 (88.08) 15,819 (11.7)
1 to 3 135,757 100,434 (74.0) 60,213 (26.0)
The custom time interval for the first dose was within 24 h after birth, for the second dose was 28–61 days after the first dose, and the third dose was 61–214 days after the second dose; Administered after than the custom time interval for the first dose was >24 hours after birth, for the second dose was ≥62 days after the first dose, and the third dose was ≥215 days after the second dose. *: P<0.001, comparison the proportion between different doses in the same provinces or province-level municipality.
Table 2. Distribution of time intervals of the second dose vaccination.
Table 2. Distribution of time intervals of the second dose vaccination.
Provinces or province-level municipality Total Between 28–42 days after the first dose Between 43–61 days after the first dose ≥62 days after the first dose
N n (%) n (%) n (%)
Beijing* 32,515 22,180 (68.2) 5618 (17.3) 4717 (14.5)
Anhui* 29,230 22,940 (78.5) 3918 (13.4) 2372 (8.1)
Inner Mongolia* 29,516 21,094 (71.5) 7032 (23.8) 1390 (4.7)
Guizhou* 55,644 38,136 (68.5) 11,659 (21.0) 5849 (10.5)
Total 146,905 104,350 (71.0) 28,227 (19.2) 14,328 (9.8)
*: P<0.001, comparison the proportion between different doses in the same provinces or province-level municipality.
Table 3. Distribution of time intervals for the third dose.
Table 3. Distribution of time intervals for the third dose.
Provinces or province-level municipality Days after the second dose
Total ≤60 61–90 91–120 121–150 151–180 181–214 ≥215
N n (%) n (%) n (%) n (%) n (%) n (%) n (%)
Beijing 29,955 56 (0.2) 321 (1.1) 749 (2.5) 3234 (10.8) 14,393 (48.1) 3039 (10.2) 8163 (27.3)
Anhui 28,122 48 (0.2) 128 (0.5) 638 (2.3) 4203 (15.0) 17,935 (63.8) 3085 (11.0) 2085 (7.4)
Inner Mongolia 28,449 48 (0.2) 51 (0.2) 162 (0.6) 1067 (3.8) 25,290 (88.9) 1823 (6.4) 8 (0.03)
Guizhou 49,231 349 (0.7) 385 (0.8) 737 (1.5) 3485 (7.1) 29,449 (59.8) 9263 (18.8) 5563 (11.3)
Total 135,757 501 (0.3) 885 (0.7) 2286 (1.7) 11,989 (8.8) 87,067 (64.1) 17,210 (12.7) 15,819 (11.7)
Table 4. Use of different types of hepatitis B vaccines.
Table 4. Use of different types of hepatitis B vaccines.
First dose Second dose Third dose Using the same type of vaccine to complete the course
Type N % Type N % Type N % N %
A 313 0.5 A 127 40.6 A 83 65.4 83 0.1
B 13 10.2
C 31 24.4
B 56 17.9 A 1 1.8
B 38 67.9
C 17 30.4
C 130 41.5 A 3 2.3
B 14 10.8
C 113 86.9
B 24,540 42.3 A 54 0.2 A 24 44.4 12,858 22.1
B 20 37.0
C 10 18.5
B 17,853 72.8 A 54 0.3
B 12,858 72.0
C 4941 27.7
C 6633 27.0 A 28 0.4
B 1331 20.1
C 5274 79.5
C 33,224 57.2 A 66 0.2 A 35 53.0 23,436 40.4
B 12 18.2
C 19 28.8
B 5651 17.0 A 6 0.1
B 3116 55.1
C 2529 44.8
C 27,507 82.8 A 31 0.1
B 4040 14.7
C 23,436 85.2
Total 58,077 36,377 62.6
A, B and C represent three different types of hepatitis B vaccines.
Table 5. Characteristics of infants who received all three doses of hepatitis B vaccine.
Table 5. Characteristics of infants who received all three doses of hepatitis B vaccine.
Characteristics Using the same type of hepatitis B vaccine Using the different type of hepatitis B vaccine OR P Value
N (%) N (%) 95% CI
Birth order
1 25,493 (62.1) 15,577 (37.9) Reference
2 6103 (64.6) 3350 (35.4) 1.11 (1.09, 1.17) <0.001
3 or more 4782 (63.3) 2772 (36.7) 1.05 (1.003, 1.11) 0.042
Ethnicity
Han 29,872 (64.9) 16,133 (35.1) Reference
Other 6506 (53.9) 5566 (46.1) 0.63 (0.61, 0.63) <0.001
Year of birth
2017 9993 (66.2) 5106 (33.8) Reference <0.001
2018 7939 (57.5) 5877 (42.5) 0.69 (0.66, 0.69) <0.001
2019 7174 (57.2) 5380 (42.9) 0.68 (0.65, 0.69) <0.001
2020 7449 (70.4) 3128 (29.6) 1.22 (1.20, 1.28) <0.001
2021 3823 (63.4) 2208 (36.6) 0.88 (0.83, 0.91) <0.001
Vaccination at the same location
Yes 1435 (79.2) 377 (20.8) Reference
No 34,961 (62.1) 21,322 (37.9) 0.43 (0.39, 0.44) <0.001
Floating population
Yes 8650 (63.3) 5015 (36.7) Reference
No 27,728 (62.4) 16,684 (37.6) 0.96 (0.92,1.01) 0.067
Total 36,378 (62.6) 21,699 (37.4)
CI, confidence interval; OR, Odd ratio.
Table 6. Vaccination coverage rate for other vaccines in Anhui and Inner Mongolia.
Table 6. Vaccination coverage rate for other vaccines in Anhui and Inner Mongolia.
Total number Number of vaccinations Coverage rate (%)
DTP
DTP1 69,183 65,413 94.6
DTP2 69,183 64,958 93.9
DTP3 69,183 64,566 93.3
OPV
OPV1 69,183 65,340 94.5
OPV2 69,183 65,076 94.1
OPV3 69,183 11,536 16.7
IPV
IPV1 69,183 56,800 82.1
IPV2 69,183 38,972 56.3
MCV 69,183 66,697 96.4
BCG 69,183 66,295 95.8
BCG, Bacillus Calmette-Guerin Vaccine; DTP, diphtheria, tetanus, and pertussis mixed vaccine; IPV, inactivated polio vaccine; MCV, meningococcal vaccine; OPV, oral polio vaccine.
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