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Vaccine-preventable disease control in the People’s Republic of China: 1949–2016
BACKGROUND: China's immunization program is one of the oldest and largest in the world. Rates of vaccine-preventable diseases (VPD) are comparable to those in high-income countries. The program's evolution has been characterized by ambitious target setting and innovative strategies that ha...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Ltd.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115483/ https://www.ncbi.nlm.nih.gov/pubmed/30497834 http://dx.doi.org/10.1016/j.vaccine.2018.10.005 |
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author | Yu, Wenzhou Lee, Lisa A. Liu, Yanmin Scherpbier, Robert W. Wen, Ning Zhang, Guomin Zhu, Xu Ning, Guijun Wang, Fuzhen Li, Yixing Hao, Lixin Zhang, Xuan Wang, Huaqing |
author_facet | Yu, Wenzhou Lee, Lisa A. Liu, Yanmin Scherpbier, Robert W. Wen, Ning Zhang, Guomin Zhu, Xu Ning, Guijun Wang, Fuzhen Li, Yixing Hao, Lixin Zhang, Xuan Wang, Huaqing |
author_sort | Yu, Wenzhou |
collection | PubMed |
description | BACKGROUND: China's immunization program is one of the oldest and largest in the world. Rates of vaccine-preventable diseases (VPD) are comparable to those in high-income countries. The program's evolution has been characterized by ambitious target setting and innovative strategies that have not been widely described. METHODS: We reviewed national and provincial health department archives; analyzed disease surveillance, vaccination coverage, and serosurvey data from 1950 through 2016; and, conducted in-depth interviews with senior Chinese experts involved early VPD control efforts. RESULTS: Widespread immunization began in the 1950s with smallpox, diphtheria, and Bacillus-Calmette Guerin vaccines, and in the 1960s with pertussis, tetanus, polio, measles, and Japanese encephalitis (JE) vaccines. The largest drops in absolute VPD burden occurred in the 1970s with establishment of the Rural Cooperative Medical System and a cadre of trained peasant health workers whose responsibilities included vaccinations. From 1970 to 1979, incidence per 100,000 population dropped 48% from 3.3 to 1.75 for diphtheria, 50% from 152.2 to 49.4 for pertussis, 77% from 2.5 to 0.6 for polio, 60% from 450.5 to 178.3 for measles, and 72% from 18.0 to 5.1 for JE, averting an average of 4 million VPD cases each year. Until the early 1980s, vaccines were delivered through annual winter campaigns using a coordinated ‘rush-relay’ system to expedite transport while leveraging vaccine thermostability. Establishment of the cold chain system during in the 1980s allowed bi-monthly vaccination rounds and more timely vaccination resulting in rates of diphtheria, pertussis, measles and meningitis falling over 90% from 1980 to 1989, while polio and JE rates fell 40–50%. In the 1990s, progress stalled as financing for public health was weakened by broad market reforms. Large investments in public health and immunizations by the central government since 2004 has led to further declines in VPD burden and increased equity. During 2011–2016, the incidence per 100,000 population was <2.0 for measles and <0.2 for pertussis, JE, meningococcal meningitis, and hepatitis A. From 1992 to 2014, the prevalence of chronic hepatitis B infection in children <5 years fell from 9.7% to 0.3%, a 97% decline. China was certified polio-free in 2000 and diphtheria was last reported in 2006. CONCLUSIONS: Long-term political commitment to immunizations as a basic right, ambitious targets, use of disease incidence as the primary metric to assess program performance, and nationwide scale-up of successful locally developed strategies that optimized use of available limited resources have been critical to China's success in controlling vaccine-preventable diseases. |
format | Online Article Text |
id | pubmed-7115483 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Elsevier Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-71154832020-04-02 Vaccine-preventable disease control in the People’s Republic of China: 1949–2016 Yu, Wenzhou Lee, Lisa A. Liu, Yanmin Scherpbier, Robert W. Wen, Ning Zhang, Guomin Zhu, Xu Ning, Guijun Wang, Fuzhen Li, Yixing Hao, Lixin Zhang, Xuan Wang, Huaqing Vaccine Article BACKGROUND: China's immunization program is one of the oldest and largest in the world. Rates of vaccine-preventable diseases (VPD) are comparable to those in high-income countries. The program's evolution has been characterized by ambitious target setting and innovative strategies that have not been widely described. METHODS: We reviewed national and provincial health department archives; analyzed disease surveillance, vaccination coverage, and serosurvey data from 1950 through 2016; and, conducted in-depth interviews with senior Chinese experts involved early VPD control efforts. RESULTS: Widespread immunization began in the 1950s with smallpox, diphtheria, and Bacillus-Calmette Guerin vaccines, and in the 1960s with pertussis, tetanus, polio, measles, and Japanese encephalitis (JE) vaccines. The largest drops in absolute VPD burden occurred in the 1970s with establishment of the Rural Cooperative Medical System and a cadre of trained peasant health workers whose responsibilities included vaccinations. From 1970 to 1979, incidence per 100,000 population dropped 48% from 3.3 to 1.75 for diphtheria, 50% from 152.2 to 49.4 for pertussis, 77% from 2.5 to 0.6 for polio, 60% from 450.5 to 178.3 for measles, and 72% from 18.0 to 5.1 for JE, averting an average of 4 million VPD cases each year. Until the early 1980s, vaccines were delivered through annual winter campaigns using a coordinated ‘rush-relay’ system to expedite transport while leveraging vaccine thermostability. Establishment of the cold chain system during in the 1980s allowed bi-monthly vaccination rounds and more timely vaccination resulting in rates of diphtheria, pertussis, measles and meningitis falling over 90% from 1980 to 1989, while polio and JE rates fell 40–50%. In the 1990s, progress stalled as financing for public health was weakened by broad market reforms. Large investments in public health and immunizations by the central government since 2004 has led to further declines in VPD burden and increased equity. During 2011–2016, the incidence per 100,000 population was <2.0 for measles and <0.2 for pertussis, JE, meningococcal meningitis, and hepatitis A. From 1992 to 2014, the prevalence of chronic hepatitis B infection in children <5 years fell from 9.7% to 0.3%, a 97% decline. China was certified polio-free in 2000 and diphtheria was last reported in 2006. CONCLUSIONS: Long-term political commitment to immunizations as a basic right, ambitious targets, use of disease incidence as the primary metric to assess program performance, and nationwide scale-up of successful locally developed strategies that optimized use of available limited resources have been critical to China's success in controlling vaccine-preventable diseases. Elsevier Ltd. 2018-12-18 2018-11-26 /pmc/articles/PMC7115483/ /pubmed/30497834 http://dx.doi.org/10.1016/j.vaccine.2018.10.005 Text en © 2018 Elsevier Ltd. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Article Yu, Wenzhou Lee, Lisa A. Liu, Yanmin Scherpbier, Robert W. Wen, Ning Zhang, Guomin Zhu, Xu Ning, Guijun Wang, Fuzhen Li, Yixing Hao, Lixin Zhang, Xuan Wang, Huaqing Vaccine-preventable disease control in the People’s Republic of China: 1949–2016 |
title | Vaccine-preventable disease control in the People’s Republic of China: 1949–2016 |
title_full | Vaccine-preventable disease control in the People’s Republic of China: 1949–2016 |
title_fullStr | Vaccine-preventable disease control in the People’s Republic of China: 1949–2016 |
title_full_unstemmed | Vaccine-preventable disease control in the People’s Republic of China: 1949–2016 |
title_short | Vaccine-preventable disease control in the People’s Republic of China: 1949–2016 |
title_sort | vaccine-preventable disease control in the people’s republic of china: 1949–2016 |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115483/ https://www.ncbi.nlm.nih.gov/pubmed/30497834 http://dx.doi.org/10.1016/j.vaccine.2018.10.005 |
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