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Survey of contraindications in children's routine vaccination in Hangzhou, China
Shijun Liu1, Jun Wang1, Yan Liu1
1a Hangzhou Center for Disease Control and Prevention , Hangzhou , China.
Insights
Many children miss routine vaccinations due to incorrect contraindication diagnoses. This study highlights common reasons for misdiagnosis and calls for further investigation into vaccination contraindications in children.
Area of Science:
- Pediatrics
- Epidemiology
- Public Health
Background:
- Routine childhood vaccinations are critical for disease prevention.
- Accurate identification of contraindications is essential for vaccine safety and efficacy.
- Misdiagnosis of contraindications can lead to unnecessary vaccination delays or omissions.
Purpose of the Study:
- To characterize the epidemiology of contraindications in routine pediatric vaccinations.
- To assess the diagnostic accuracy of vaccination providers regarding contraindications.
- To identify factors associated with misdiagnosed contraindications in children.
Main Methods:
- Cross-sectional study conducted in 34 urban and 15 suburban Community Health Centers (CHCs) in Hangzhou, China.
- Inclusion of all children attending CHCs for routine vaccinations.
- Expert review to classify recorded contraindications as true or false; multivariable analysis to identify influencing factors.
Main Results:
- A total of 2969 contraindications were recorded among 2801 children, with a prevalence of 3.03‰ per vaccine dose.
- Common contraindications included cough (24.78%), fever (21.86%), and medication use (19.54%).
- Measles-rubella (MR), measles-mumps-rubella (MMR), and hepatitis B (Hep B) vaccines showed higher contraindication prevalence.
- Approximately 13.53% of contraindications were deemed misdiagnosed by vaccination doctors.
- Misdiagnosis rates correlated with provider's sex, age, education, and CHC's total vaccination dose volume.
Conclusions:
- A significant proportion of children may miss routine vaccinations due to misdiagnosed contraindications.
- Provider-related factors and clinic-level vaccination volume influence contraindication misdiagnosis.
- Further research is needed to understand the epidemiological distribution of contraindications in pediatric vaccination.
Abstract:
Objective To describe the epidemiological characteristics of contraindications in children routine vaccination, to evaluate vaccination doctors' ability to determine contraindications. Method Using cross-section study, 34 urban and 15 suburb units were selected from 206 Community Health Center (CHC) in Hangzhou, China. Subjects were all children coming to CHCs for routine vaccination. All situations considered to be unsuitable for vaccination were recorded as contraindications. 3 experts were used to classify these abnormal records as true or false contraindications. Then, the multi-analysis was used to find factors related with the rate of false contraindications. Results There were 2801 children with 2969 contraindications in the present study. The prevalence of contraindications was 3.03‰ by dose of vaccines. Cough (24.78%), fever (21.86%) and medication (19.54%) were the most common contraindications in children routine vaccination. Measles-rubella vaccine (MR) (6.78‰), measles-mumps-rubella vaccine (MMR) (5.87‰) and hepatitis B vaccine (Hep B) (5.25‰) had higher prevalence of contraindications than other vaccines. According to the evaluation of 3 experts, about 13.53% of contraindications were misdiagnosed by vaccination doctor. The rate of misdiagnosed contraindications was correlated with the sex, age and educational background of vaccination doctor, total dose of vaccination of CHC. Conclusion A portion of children might miss the routine vaccination because of misdiagnosed contraindications. More investigations are needed to report the epidemiological distribution of contraindication in routine vaccination of children.