Spatial distribution characteristics of tuberculosis and its visualization in Qinghai province, 2014-2016 / 中华流行病学杂志

Objective: To analyze the spatial distribution of tuberculosis (TB) and identify the clustering areas in Qinghai province from 2014 to 2016, and provide evidence for the prevention and control of TB. Methods: The data of pulmonary TB cases confirmed by clinical and laboratory diagnosis in Qinghai during this period were collected from National Disease Reporting Information System. The visualization of annual reported incidence, three-dimensional trend analysis and local Getis-Ord G(i)(*) spatial autocorrelation analysis of TB were performed by using software ArcGIS 10.2.2, and global Moran's I spatial autocorrelation analysis were analyzed by using software OpenGeoDa 1.2.0 to describe and analyze the spatial distribution characteristics and high incidence areas of TB in Qinghai from 2014 to 2016. Results: A total of 20 609 pulmonary TB cases were reported in Qinghai during this period. The reported incidences were 101.16/100 000, 123.26/100 000 and 128.70/100 000 respectively, an increasing trend with year was observed (trend χ(2)=187.21, P<0.001). The three-dimensional trend analysis showed that the TB incidence increased from northern area to southern area, and up-arch trend from the east to the west. Global Moran's I spatial autocorrelation analysis showed that annual reported TB incidence in different areas had moderate spatial clustering (Moran's I values were 0.631 3, 0.605 4, and 0.587 3, P<0.001). And local G(i)(*) analysis showed that there were some areas with high TB incidences, such as 10 counties of Yushu and Guoluo prefectures (Gande, Banma and Dari counties, etc., located in the southwest of Qinghai), and some areas with low TB incidences, such as Huangzhong county, Chengdong district and Chengbei district of Xining city and Dachaidan county of Haixi prefecture, and the reported TB incidences in the remaining areas were moderate. Conclusion: The annual reported TB incidence increased year by year in Qinghai from 2014 to 2016. The distribution of TB cases showed obvious spatial clustering, and Yushu and Guoluo prefectures were the key areas in TB prevention and control. In addition, the spatial clustering analysis could provide the important evidence for the development of TB prevention and control measures in Qinghai.

Current situation and related policies on the implementation and promotion of influenza vaccination, in China / 中华流行病学杂志

Influenza can be prevented through annual appropriate vaccination against the virus concerned. In China, influenza vaccine is categorized as "Class Ⅱ" infectious diseases which the cost is paid out of the user's pockets. The annual coverage of influenza vaccination had been 2%-3%. The main reasons for the low coverage would include the following factors: lacking awareness on both the disease and vaccine, poor accessibility of vaccination service, and the cost of vaccination. To reduce the health and economic burden associated with influenza, comprehensive policies should be improved, targeting the coverage of seasonal influenza vaccination. These items would include: ① Different financing reimbursement schemes and mechanisms to improve the aspiration on vaccination and on the vaccine coverage in high-risk groups, as young children, elderly, people with underlying medical conditions; ② to ameliorate equality of vaccination services; ③ to improve knowledge of the health care workers (HCWs) and the public on influenza and related vaccines; ④ to improve clinical and preventive medical practice and vaccination among HCWs through revising clinical guidelines, pathway and consensus of experts; ⑤ to provide more convenient, accessible and normative vaccination service system; ⑥ to strengthen research and development as well as marketing on novel influenza vaccines; ⑦ to revise items regarding the contraindication for influenza vaccine on pregnancy women, stated in the Chinese Pharmacopoeia.

Influenza vaccination and its influencing factors among clinical staff of the hospitals in 2016-2017 season, Xining, Qinghai province, China / 中华流行病学杂志

Objective: To investigate the influenza vaccination and its influencing factors among the clinical staff in Xining, Qinghai province, in the 2016-2017 influenza season, and to explore the promoting strategies to encourage the target population for influenza vaccination. Methods: Four sample hospitals were randomly selected from the total 11 tertiary hospitals in Xining city. Clinical staff that worked in the four hospitals and agreed to participate were recruited for investigation via a self-administered questionnaire. Results: During the 2016-2017 influenza season, the coverage rate of influenza vaccines among the clinical staff was 5.14% (95%CI: 4.80%-5.49%). Multivariate logistic regression showed that knowing the priority of vaccination, the frequency of vaccination, effect of vaccination, and possessing higher professional qualifications were major influencing factors for influenza vaccination. The intention on recommendation of seasonal influenza vaccine was higher in vaccinated group than that in the unvaccinated group (χ(2)=99.57, P<0.001). Conclusion: The lower coverage rate was primarily associated with the lack of knowledge about influenza vaccine among the clinical staff of the hospital. Tailored information should be provided to the clinical staff through effective methods to improve vaccination and the recommendation of influenza vaccine.

Technical guidelines for seasonal influenza vaccination in China, 2018-2019 / 中华流行病学杂志

Seasonal influenza vaccination is the most effective way to prevent influenza virus infection and its complications. Currently, China has licensed trivalent (IIV3) and quadrivalent inactivated influenza vaccine (IIV4), including split-virus influenza vaccine and subunit vaccine. In most parts of China, influenza vaccine is a category Ⅱ vaccine, which means influenza vaccination is voluntary, and recipients need to pay for it. To strengthen the technical guidance for prevention and control of influenza and the operational research on influenza vaccination in China, the National Immunization Advisory Committee (NIAC), Influenza Vaccine Technical Working Group (TWG), updated the 2014 technical guidelines and compiled the "Technical guidelines for seasonal influenza vaccination in China (2018-2019)" , based on most recent existing scientific evidences. The main updates include: epidemiology and disease burden of influenza, types of influenza vaccines, northern hemisphere influenza vaccination composition for the 2018-2019 season, and, IIV3 and IIV4 vaccines'major immune responses, durability of immunity, immunogenicity, vaccine efficacy, effectiveness, safety, cost-effectiveness and cost-benefit. The recommendations include: Points of Vaccination clinics (PoVs) should provide influenza vaccination to all persons aged 6 months and above who are willing to be vaccinated and do not have contraindications. No preferential recommendation is made for any influenza vaccine product for persons who can accept ≥1 licensed, recommended, and appropriate products. To decrease the risk of severe infections and complications due to influenza virus infection among high risk groups, the recommendations prioritize seasonal influenza vaccination for children aged 6-60 months, adults ≥60 years of age, persons with specific chronic diseases, healthcare workers, the family members and caregivers of infants <6 months of age, and pregnant women or women who plan to pregnant during the influenza season. Children aged 6 months to 8 years old require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection. If they were vaccinated in previous influenza season, 1 dose is recommended. People ≥ 9 years old require 1 dose of influenza vaccine. It is recommended that people receive their influenza vaccination by the end of October. Influenza vaccination should be offered as soon as the vaccination is available. Influenza vaccination should continue to be available for those unable to be vaccinated before the end of October during the whole season. Influenza vaccine is also recommended for use in pregnant women during any trimester. These guidelines are intended for CDC members who are working on influenza control and prevention, PoVs members, healthcare workers from the departments of pediatrics, internal medicine, and infectious diseases, and members of maternity and child care institutions at all levels.