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Immunization Services in China

  • Jingshan ZhengEmail author
  • Huaqing Wang
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Part of the Public Health in China book series (PUBHECH, volume 3)

Abstract

In July 1989, I (Jingshan Zheng) graduated from the Department of Public Health, School of Public Health, Tongji Medical University and was assigned to work at Jianli County Epidemic Prevention Station (EPS) in Hubei province. I worked in the Department of Epidemiology and was responsible for infectious disease surveillance and epidemic response, immunization services surveillance and management, prevention and control of parasitic diseases, disinfection, elimination of insects and mice, and prevention and control of sexually transmitted diseases (STDs).

2.1 Immunization Management System

2.1.1 My Story with the Immunization Program

In July 1989, I (Jingshan Zheng) graduated from the Department of Public Health, School of Public Health, Tongji Medical University and was assigned to work at Jianli County Epidemic Prevention Station (EPS) in Hubei province. I worked in the Department of Epidemiology and was responsible for infectious disease surveillance and epidemic response, immunization services surveillance and management, prevention and control of parasitic diseases, disinfection, elimination of insects and mice, and prevention and control of sexually transmitted diseases (STDs).

When I began working, two important events took place in the history of China’s disease prevention and control. The first event was that the “Law on Infectious Disease Prevention and Control in the Peoples Republic of China” was issued in 1989. The law required implementation of “a planned vaccination system” (similar to EPI) and a “vaccination card system” for children. The second event was that a goal to achieve vaccination coverage rates of more than 85% in every county was reviewed and agreed with by WHO China in 1990. The county I worked in was selected for review. I was placed in charge of the immunization program and was also responsible for assisting with surveillance, notifiable infectious diseases reports, and response to epidemics.

In 1997 I moved to the provincial EPS (later renamed to CDC) to undertake the responsibility of surveillance and management of the immunization program. In the years following, I was responsible for routine immunization coverage surveillance (1998), acute flaccid paralysis (AFP) surveillance (1999), preparation of documents for certification of polio-free status (2000), measles case-based surveillance (2001), integration of hepatitis B vaccine into the immunization program (2002), immunization information management system and pilot project for adverse events following immunization (AEFI) surveillance (2005), and implementation of expanding the national immunization program’s work (2007).

My understanding of EPI gradually deepened through personal engagement in the immunization program’s work and by guiding grassroots-level staff to improve vaccination coverage rates and improve quality of immunization information management, learning from experienced leaders and experts, participating in professional conferences and training courses organized by higher levels, and learning from grassroots EPI staff.

2.1.2 The Network for Immunization Services and Management [1]

After the implementation of EPI in China in 1978, a network of immunization services and management was established that consisted of a specialized department in all four levels of disease prevention and control institutions – national, provincial, prefecture, and county levels. Points of vaccination (PoV) were established at township (town, street, community) and village levels.

In the early days of EPI, the work of vaccination was largely undertaken by village doctors. The facilities were quite poor, and village clinics often had no specific vaccination room or vaccination space. In many clinics, vaccination and treatment were done in the same room. Immunization services were usually provided once every 2 months and once a month if conditions allowed. Management of vaccination information was relatively backward, and vaccination cards for children 0–7 years of age were usually written by village doctors. Every time a vaccination round was conducted, village doctors had to look through every vaccination card to find children targeted for vaccination. Parents were informed by house-to-house visits, by village staff, or by public broadcasts to bring their children to the clinic for vaccination. In many areas, village doctors carried vaccine carriers containing ice packages on their backs to travel house to house and vaccinate. Because vaccination was provided by the village, the number of PoV was huge. According to the National Immunization Review, there were more than 360,000 PoVs across China [2].

In 2005, the State Council issued a document called “Regulations on Vaccine Distribution and Vaccination Management” [3] (hereinafter referred to regulations). Subsequently, county health administrative departments began to manage the PoVs according to a strict qualification system. The eighth provision in the regulations stipulated that only health sector PoVs designated by the county health administrative departments were qualified to vaccinate. When county health departments designate PoVs, the geographical locations for which PoVs were responsible had to be made clear. The 21st provision in the regulations required that PoVs should meet the following criteria: (1) the PoV must have a license to practice; (2) the PoV must have qualified medical practitioners, physician assistants, nurses, or village doctors who were trained by county-level health administrative departments; (3) the PoV must have refrigeration facilities and equipment that meet requirements for vaccine storage and transportation and cold chain management.

After implementation of the regulations, standardized PoVs and fixed PoVs in villages and in hospital obstetric departments were further strengthened throughout China. More stringent PoV hardware and software requirements were put forward by health administrative departments, resulting in improved conditions of PoVs. In some areas, so-called qualified PoVs, model PoVs, standardized PoVs, digital PoVs, star PoVs, and warm PoVs were constructed to provide standardized, comfortable, and safe vaccination environments for children. Specifications for these clinics were indicated clearly in terms of area, functional zoning (generally including waiting, registration, vaccination, observation, cold chain, and data management), use of different rooms or tables for vaccination, frequency of immunization service provision (according to daily, weekly, or 10-day schedules), immunization information management, and vaccination publicity, among other things.

2.1.2.1 Vaccination Services Sites

According to the 2013 National Immunization Program Review, there were 216,269 PoVs in China in 2013. Among these, 50,859 (23.5%) provided centralized vaccination services at town or township levels, 131,642 (60.9%) were fixed-point clinics at the village level, 20,536 (9.5%) provided home-based vaccination, and 13,232 (6.1%) were located in obstetric departments or other facilities. Other than the PoVs in obstetric departments and other facilities, the remaining 203,037 PoVs provided services for an average population size of 6604 persons per PoV (30,648 per urban PoV, 19,551 per rural PoV, 1743 people per fixed, village-level PoV).

Compared with a survey conducted in 2004 [2], the total number of PoVs had been reduced by 41.1% by 2013, mainly through decreases in house-to-house PoVs (an 82.5% reduction) and village-level PoVs (a 31% reduction). The percent of the population served in urban area and township PoVs increased from 62.6% to 80.5%, while the population served by house-to-house PoVs decreased from 12.3% to 3.5% (Fig. 2.1).
Fig. 2.1

Proportion of population by PoV types. Comparison between 2004 and 2013

2.1.2.2 Vaccination Service Frequency

According to the 2013 National Immunization Program Review, among 81,819 POVs studied (excluding PoVs in obstetrics departments), 14,847 (18.1%) provided daily vaccination and covered 45% of the population; 8565 (10.5%) provided weekly vaccination and covered 30.3% of the population; 6682 (8.2%) PoVs provided vaccination services once every 10 days and covered 7.5% of the population; 51,709 (63.2%) provided monthly services and covered 17.1% of the population; and 16 (0.02%) provided bimonthly vaccination services and covered 0.1% of the population.

According to the 2004 evaluation [2], the proportion of PoVs providing daily, weekly or 10-day, monthly, and bimonthly vaccination were 2%, 5.6%, 42.8%, and 46.8%, respectively, and covered 10.4%, 22.6%, 43.2%, and 22.1% of the population, respectively. Compared with 2004, POVs providing daily and weekly (or 10-day) vaccination services had increased significantly by 2013, with a larger population covered and a decrease in PoVs providing only bimonthly vaccination services. PoVs providing monthly vaccination increased, but the population they covered declined (Fig. 2.2).
Fig. 2.2

Population covered by PoV service type. Comparison between 2004 and 2013

2.1.2.3 Standardization of PoVs

Standardized PoVs refer to PoVs at the township level that are approved by the health administrative department and trained and qualified professional and technical personnel with fixed vaccination spaces and equipment and provide vaccination services at set times and sites in accordance with the “Working Standards on Immunization.” A project on standardized PoV construction was initiated in Jiangsu in 1988 and expanded to the whole of China by 2000.

The construction of standardized PoVs was an innovative activity that upgraded traditional PoVs to a standardized, information-rich, scientific management system. This effort was a “people-oriented, high-quality service” project that represents an important strategy to improve the quality of immunization services and support a sustainable national immunization program. This work also demonstrated an important guarantee to carry out a “prevention first” policy and to strengthen grassroots capacity – especially construction of healthcare systems in rural areas that serve to prevent and control infectious diseases.

Through the construction of standardized PoVs, the quality and level of vaccination was greatly improved, and the prevention and control of infectious diseases was improved in the following ways:

Development of a primary healthcare (PHC) network at the grassroots level to meet the public health demand. According to the requirements for PoV construction, qualified professional and technical personnel should be allocated appropriately for duties and responsibilities, with consideration of the population size and the area and geographical conditions of the administrative region. Thus, PHC services are to be undertaken by qualified staff in an improved service environment to satisfy the health needs of the public.

Standardization of vaccination practices. Centralized service delivery, a high technical level of vaccinators, and a clean environment improved the quality of vaccination services while preventing loss of vaccine potency. Standardized vaccination practices reduced cross infection and vaccination accidents, facilitated timely treatment of adverse events following immunization (AEFI), and ensured the safety of vaccination.

More vaccination opportunities improved vaccination coverage. Standardized POVs provided more vaccination services per month and longer vaccination sessions, increasing opportunities for vaccination and increasing vaccination coverage levels. At the same time, development of the immunization program was promoted by the improvement of the working environment and the skills and professionalization of the vaccinators, leading to greater trust in vaccination by the general public.

Improvement of PoV efficiency. Standardized PoVs facilitated immunization information management and solved management problems with vaccination of migrant children. Vaccination cards, certificates, and records were improved. Statistical data were more accurate and reliable, and efficiency was greatly improved.

Reduction of vaccine wastage. Standardized PoVs provide services for more people per session, which may reduce vaccine wastage.

Development of technologies for communication and information management enabled automatic short message service notifications to be used through the immunization information system, QQ, WeChat, and other social media channels to inform parents of upcoming vaccination visits and make the visits more timely and efficient. Information sent to parents included the vaccines to be administered, the appointment time and location, and any precautions for the vaccines.

2.1.2.4 Management System and Coordination of the Immunization Program

The Chinese government has always attached great importance to immunization, giving strong support through laws, regulations, policies, personnel, and funding.

In 2005 the State Council issued the regulations, and then the Ministry of Health issued “Standards for Vaccination” (2005), “Vaccine Storage and Transportation Management Standards” (2006), and “Identification of AEFI” (2008) to standardize technology, terminology, and performance management of the immunization program.

A national immunization coordination committee was established in 1996 after being approved by the State Council. It consisted of the MoH, the Ministry of Education (MoE), the National Women’s Federation, the Ministry of Broadcast and Television, the Ministry of Foreign Trade and Economic Cooperation, and the National Ethnic Affairs Commission, among other organizations.

After expanding the national immunization program in 2007 through the addition of new EPI vaccines, the State Council established an immunization coordination mechanism. In this mechanism, MoH is responsible for development and implementation of the national immunization program and for conducting its annual planning process. The Ministry of Finance (MoF) is responsible for immunization program fiscal policy. The National Development and Reform Commission is responsible for storage and distribution of NIP vaccines and for confirming prices of the vaccines. MoE is responsible for checking vaccination cards when children enter kindergarten and primary school – a strategy that has been included into the management system for infectious disease prevention and control. The Chinese Food and Drug Administration (CFDA) is responsible for monitoring and management of production and distribution of NIP vaccines. Local institutions of health, finance, development and reform, education, food, and drug administration are to establish appropriate coordination mechanisms under the leadership of local governments. Local governments are charged with strengthening organization and leadership, clarifying responsibilities, strengthening coordination and cooperation, and improving implementation and management of EPI.

2.1.2.5 Government Increased Investment in Vaccination

After expanding NIP in 2007, the central government increased the program’s budget from 210 million yuan in 2006 to 2.7 billion yuan – primarily for the purchase of vaccines and syringes and for subsidies for middle and western underdeveloped areas. In 2008, an additional 374 million yuan were allocated as supplementary funds for cold chain improvement in western provinces. Local governments included NIP-related indicators into their social development indicator system, enhancing policy support and funding for NIP. After 2010, vaccination services were included into the integrated management system for the primary public health services, with vaccination subsidies covered by primary public health services funding.

2.1.2.6 Establish and Improve the Vaccine Cold Chain System

China began to work with UNICEF on cold chain projects in 1981. By the mid-1980s, more than 90% of the population was covered by an improved cold chain management system. From 1996 to 2004, China used a loan of 716 million yuan from the World Bank (Health VII Project) to supplement cold chain equipment in ten provinces in the middle provinces of China, including Gansu, Guangxi, Guizhou, and other provinces. After the expansion of NIP, the investment in cold chain infrastructure was increased in parallel. The central government invested 374 million yuan in the middle and western provinces for cold chain development in 2009, addressing needs for their cold chain operations.

2.1.2.7 Establish and Improve Surveillance Systems

Beginning in 1991, China gradually established surveillance systems for the immunization program, including a system for measuring routine immunization coverage (1991), vaccine management (2007), cold chain management (2010), AEFI (2005), AFP(1991), measles (2002), hepatitis B (2002), Japanese encephalitis (2007), and meningococcal meningitis (MM) (2008). Several of these were integrated with the laboratory surveillance network, for example, the polio, measles, JE, and MM laboratories. Establishment and optimization of surveillance systems played a critical role for evaluation of progress of the immunization program, timely detection of epidemics and epidemic risk, control and elimination of vaccine preventable diseases, and enhancement of the capacities for surveillance and management of the immunization program.

2.1.2.8 Professional Advisory Groups for Immunization

A National Immunization Technical Advisory Group (NITAG) was established for EPI under the Ministry of Health. As a technical advisory group, the NITAG plays an important role in development of policy and technical guidance for China’s immunization program.

NITAG had its origins as the EPI committee under the Medical Sciences Committee of MoH, which had been established in October 1982 along with six regional coordination committees for EPI. In June 1988, the EPI committee was placed under MoH and consisted of 26 members. In October 1992, the membership partially changed and the committee was increased to 28. In March 1997, the composition of the committee was changed to be 27 members with 3 consultants. In October 2004, the EPI committee was renamed to the “NITAG of MoH” and consisted of 30 members: 1 chairman, 3 vice chairmen, and 26 members. In 2010, MoH established a subcommittee for the immunization program consisting of 29 members, under the Expert Committee for Disease Prevention and Control. The subcommittee for the immunization program included experts in vaccine development, vaccine identification, pediatrics, infectious diseases, immunology, health policy and management, public health, epidemiology, and health statistics.

2.2 Human Resource for Immunization Program

2.2.1 Personnel for Surveillance and Management in China CDC [4]

According to the “standards of immunization,” relevant professional and technical personnel should be allocated based on responsibilities and duties, taking into account population size, service area, and geographical conditions in the administrative regions at CDCs. Personnel in immunization program at CDCs are mainly responsible for surveillance and management of the immunization program.

2.2.1.1 Provincial-Level Immunization Program Staff

There were 453 provincial immunization staff members in 2004, with an average of 14.5 staff members per province. The technical/professional titles of provincial immunization staff were usually intermediate and junior, accounting for 33.55% and 30.02% of staff, respectively (Table 2.1). Their educational levels were most commonly university and college, accounting for 50.55% and 24.06% of staff (Table 2.2).
Table 2.1

Technical title of immunization staff at provincial, prefecture, and county level in 2004

Level

Staff

Title of professional staff

Total

Average

Senior

%

Intermediate

%

Junior

%

No title

%

Provincial

453

14.6

123

27.15

152

33.55

136

30.02

42

 9.27

Prefecture

518

 6.6

 79

15.25

216

41.70

197

38.03

26

 5.02

County

596

 6.4

 18

 3.02

168

28.19

335

56.21

75

12.58

Table 2.2

Educational level of immunization staff at provincial, prefecture, and county level in 2004

Level

Staff

Education

Total

Average

Postgraduate

%

University

%

Junior college

%

Secondary technical school

%

No

%

Provincial

453

14.6

35

7.73

229

50.55

109

24.06

 63

13.91

17

 3.75

Prefecture

518

 6.6

 9

1.73

162

31.21

143

27.55

178

34.30

27

 5.20

County

596

 6.4

 2

0.34

 65

10.92

191

32.10

275

46.22

62

10.42

2.2.1.2 Prefecture-Level Immunization Program Staff

A comprehensive review in 2004 showed that there were 518 prefecture-level immunization staff, with an average of 6.5 staff members per prefecture. The number of staff differed widely among prefectures – for example, there were 26 staff in Qingyuan, Guangdong province, and only 1 staff person in Haidong, Qinghai province. Technical titles of prefecture-level staff were generally intermediate and junior level, accounting for 41.70% and 38.03% of staff members. Their educational levels were generally university and secondary technical school, accounting for 31.21% and 34.30% of staff.

2.2.1.3 County-Level Immunization Program Staff

In 2004, there were 596 immunization staff members, with an average of 6.4 staff per county. The number of professional staff varied widely among counties – for example, there were 23 staff in Ulanhot County in Inner Mongolia, but no immunization staff in Rongjiang County, Guizhou province. Technical titles of these staff were usually junior level, accounting for 56.21% of staff. Education levels were mainly junior college and technical secondary school, accounting for 32.10% and 46.22% of staff.

2.2.1.4 Immunization Program Staff in 2013

According to a review in 2013, there were 568 province-level immunization staff members, for an average of 17.8 staff per province. Beijing had the largest number of EPI staff (33), and Xinjiang Constructive Military Corps had the fewest (4). Among the 310 sampled prefectures, there were 1987 prefecture-level immunization staff members, for an average of 6.4 staff per prefecture, similar to results in 2006. Among the 947 counties studied, there were 4486 county-level immunization staff – an average of 4.74 per county.

2.2.2 Township and Village Immunization Program Staff

Township and village immunization staff are mainly responsible for basic immunization services, although some staff members also conduct surveillance and management for the local immunization program.

In accordance with the regulations, vaccinators should have a valid certificate as a practicing physician or as an assistant practicing doctor, nurses, or village doctors. He or she should be trained by country health administrative departments and must have passed relevant examinations.

In 2004, there were 9683 staff in 186 township hospitals that were studied, among whom included 1111 healthcare and prevention staff, accounting for 11.47% of the total staff. Among the healthcare and prevention staff, there were 855 immunization staff, accounting for 76.96% of this group of professionals; 475 were full-time staff, accounting for 4.9% of total staff at the township hospital.

A comprehensive evaluation showed that there were 4761 village doctors, among whom 1807 engaged in the immunization program, accounting for 37.96% in total village doctors, an average of 1 staff per village. The difference in number of immunization staff was related to the types of vaccination services provided.

In 2013 an NIP evaluation showed that there were 65,709 township immunization staff in 947 counties surveyed, an average of 69.4 staff per county. Compared with 2004, the average number of immunization staff per county increased by 13.9 (27.2%). There were 108,068 village-level vaccination staff, an average of 114.1 per county, and a decrease of 6.3% compared to 2004.

2.2.3 Training of Immunization Program Staff

In the early days of EPI, China established a cascade training system for immunization staff in order to improve operational and management quality.

2.2.3.1 Training Models

In addition to a traditional training model in which the national level trains the provincial level, the provincial level trains the prefecture level, the prefecture level trains the county level, and the county level trains the township level; higher levels can train more than the level immediately below them. For example, the province level trains the county level, and the county level trains the village level to reduce the number of levels of training and to improve the training outcomes.

In addition to conventional lectures in training courses and routine meetings, a “participatory (interactive) training method” was introduced in China to train immunization staff. The new training methods include small-scale lectures, group discussion, case studies, role play, debate, games, skill demonstration and practice, and interpersonal communication skills.

2.2.3.2 Training of Staff

According to an NIP review in 2004, provinces conducted two to seven training courses each between 2002 and 2003, with various types of training conducted in most of the prefectures, counties, and townships (Table 2.3). Townships trained village staff in meetings. In the townships evaluated, 66.9% of the village doctors were trained by higher levels. Detailed information is presented in the table below.
Table 2.3

Training of immunization program staff in 2002 to 2003

Level

No. investigated

No. providing training

Training number

Average days per training

Number of persons trained

Average persons trained per time

Provincial

 31

 31

151

 3.6

12,145

80.4

Prefecture

 79

 67

207

 1.9

15,004

72.3

County

 93

 78

261

 1.5

14,041

53.8

Township

187

175

2885

89.9

61,221

21.2

After adding new vaccines to the routine immunization schedule in 2007, all provinces conducted training for the expanded schedule. According to preliminary results, all 31 provinces and Xinjiang Construction Military Corps conducted training on the expanded NIP in 2007–2008, with a total of 421,984 individuals trained.

2.3 Vaccination Service Model at Grassroots Level

2.3.1 Grassroots Vaccination Service Patterns

Vaccination service delivery is divided into routine immunization and vaccination campaigns.

2.3.1.1 Routine Immunization [5]

Routine immunization implies that PoVs routinely provide vaccination service to age-eligible persons to prevent and control infectious diseases, in accordance with the current schedule of NIP vaccines, the “China Pharmacopoeia (3rd edition, 2005),” or the vaccine label, which is developed based on the epidemiology of the disease and the local vaccination plan.

2.3.1.2 Vaccination Campaigns

Vaccination campaigns are centralized vaccination services provided at certain locations and time, targeting specific populations for one or more infectious diseases. Vaccination campaigns are divided into three categories – supplemental, emergency, and concentrated.

Supplementary immunization activities (SIAs)

A SIA is a mass vaccination campaign targeting certain populations within a short time period, based on the epidemiology characteristics of infectious diseases, herd immunity, and objectives for control of the disease. SIAs are conducted regardless of the vaccine history and have a purpose to rapidly increase the vaccination rate to establish an effective immunity barrier and protect the susceptible population.

Currently, the vaccines most commonly used in SIAs are oral poliovirus vaccine (OPV) and measles vaccine. Polio vaccine SIAs are divided into national SIAs and local SIAs according to geographical scope, while measles SIAs are generally divided into initial SIAs and follow-up SIAs. Follow-up SIAs are conducted periodically (such as every 3–5 years) after the initial SIA in order to accelerate control of measles.

Emergency response vaccination

Emergency response vaccination means vaccination targeting a susceptible population in order to control an outbreak or when there is an epidemic trend.

Emergency response vaccination during outbreaks and epidemics of infectious diseases should be approved by the governments or the public health administrative institutions at county level or above, in accordance with the law and the “Regulations on Response to Public Health Emergency.” Emergency vaccination should follow the “regulations.” Emergency response vaccination action plans are developed by CDCs, and the appropriate vaccination patterns are selected and conducted as soon as possible.

Concentrated vaccination

Routine immunization services are generally provided one to three times every year for eligible children in remote areas, such as islands, plateau pastoral, and other inaccessible areas, often through a house-to-house approach. This model of vaccination is also referred to as concentrated vaccination.

Concentrated vaccination was widely used in China before expanding NIP. After China expanded NIP, there is a requirement that at least six rounds of vaccination should be provided every year. Concentrated vaccination is being used less often, but it is still used in isolated, remote areas with poor transportation and adverse climate. The NIP review in 2004 showed that in some areas of Tibet, concentrated vaccination was still used quarterly or semiannually to provide vaccination services.

2.3.2 Grassroots Vaccination Service Pattern and Frequency

Grassroots vaccination service patterns and frequencies can be divided into several common types, such as fixed PoV, home-based PoV, and temporary PoV.

2.3.2.1 Fixed PoV

Fixed PoV refers to the PoVs that have been established by health administrative departments at the county level or above that provide immunization services for those visiting the PoV. Fixed PoVs are at healthcare institutions at the township level or above or are at village clinics. Fixed PoVs can be divided into vaccination outpatients, village PoV, and PoV at birth.

Vaccination Outpatient Services

According to the regulations, health institutions in urban areas and towns should establish vaccination outpatient services based on population density, age-eligible population size, and service radius. Vaccination can be provided on a daily, weekly, or every 10-day basis. Township hospitals establish vaccination outpatient services in rural areas when appropriate and provide centralized vaccination for the township on a periodic basis.

In general there are strict requirements for vaccination outpatient services in terms of room area, function partitioning, arrangement of vaccination room/table, vaccination personnel, vaccine refrigeration conditions, safety injection, publicity on vaccination, and room temperature, in order to provide children with a relatively warm, friendly vaccination environment with standardized vaccination services that facilitate the improvement of the quality of vaccination services.

In accordance with the regulations, standards and management of vaccination outpatient should be developed by provincial health administrative departments.

Village PoV

In rural areas, based on population density, traffic patterns, and service radius, one or several village PoVs are set up to provide fixed vaccination services on a 10-day, monthly, or bimonthly basis, with at least six rounds of services provided every year. Fixed PoVs are generally set in the village clinics.

Village PoVs can provide standardized vaccination services, with key characteristics.

Convenient

The fixed PoV is usually set in appropriate geographic locations with convenient transportation, with services provided at fixed times. Village POVs generally have a service radius of less than 2 km. Some PoVs can provide comfortable conditions, providing heating in winter and cooling in summer.

Capable vaccine management

Village PoVs make full use of modern cold chain equipment, such as purpose-built vaccine carriers and refrigerators, to ensure storage and transportation under temperature-controlled conditions to ensure vaccine potency.

Educational

Village PoVs educate the general public on vaccination using posters and other teaching materials.

Combined with medical services

Village PoVs can be combined with medical services in village clinics because regular emergency medicine is available. The capacity for observation after vaccination is also available in PoVs, providing ready access to medical equipment and trained staff for timely response to adverse reactions.

Designed for vaccination

Fixed PoVs can be divided into appropriate functional areas that have different tables for different vaccines, in order to prevent administration of an incorrect vaccine and to ensure the safety of vaccination.

PoV at Birthing Facilities

In accordance with the principle of “the person who assists in the delivery should be responsible for vaccination,” obstetrics departments of medical institutions are responsible for hepatitis B and BCG vaccine administration. Hepatitis B vaccination must be accomplished within 24 h of birth to prevent vertical transmission of hepatitis B.

In order to improve the timely hepatitis B vaccine vaccination rate, healthcare personnel at the hospital regularly go to obstetric departments to determine the condition of newborns and to prepare vaccines, equipment, and registration materials in advance. They provide the first dose of hepatitis B vaccine for the neonates within 24 h after birth. PoVs in obstetric departments of hospitals must have trained obstetric staff; have appropriate vaccine storage equipment; have sufficient hepatitis B vaccine, vaccination equipment, and registration materials in hand; and have a specialized vaccination room and table available for use. After childbirth, the first dose of hepatitis B vaccine and BCG is administered directly to the newborn by obstetric staff.

2.3.2.2 Home-Based Vaccination

In remote mountainous areas, islands, pastoral areas, and other inaccessible areas, home-based vaccination is used to provide convenient and timely services to children. Home-based vaccination has the following requirements:
  • Vaccination services should be provided at a frequency of no less than six times per year.

  • Vaccination dates should be set for a time that is convenient for most people.

  • Information about the vaccination should be sent to the child’s guardian prior to visit so that during the vaccination visit, the child and guardian will remain at home, prepared with the child’s vaccination card.

  • The vaccines must be stored in the specified temperature conditions in vaccine carriers in order to ensure potency. In cold areas, when removing vaccines from a vaccine carrier, it is also necessary to take measures to prevent hepatitis B, DPT, and DT vaccines from freezing.

  • For home-based vaccination, special attention should be paid to multidose vaccines, such as BCG, DPT, DT, and measles vaccines to ensure sterile conditions for the vaccine and use of the vaccine within a specified time period.

  • Safe injection practices and proper waste disposal must be used at all times.

2.3.2.3 Temporary PoV

When a mass vaccination campaign or an emergency vaccination is conducted in gathering areas of certain populations, such as migrant communities, temporary PoVs can be used to provide vaccination services to supplement fixed PoVs and home-based PoVs. The following requirements apply to temporary PoVs:
  • Temporary PoVs should be fixed PoVs when possible. This can help ensure appropriate cold chain and safe injection practices. Informed consent before vaccination, observation after vaccination, and timely treatment of adverse reactions must be strictly observed.

  • Temporary PoVs can be set up in school medical facilities, meeting rooms or offices in some institutions, and health rooms or clinics. Eye-catching signs should be used. A temperature-controlled environment is preferred for the comfort of those being vaccinated.

  • Temporary PoV should supplement fixed PoVs and home-based PoVs. Age-eligible children who lack cards and records should still be vaccinated to avoid missed opportunities. Vaccinations performed in temporary vaccination PoVs should be included in the local children’s routine immunization management system. Immunization cards and records should be obtained as soon as possible, and missed NIP vaccines should be provided in accordance with the vaccine schedule.

References

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    Ze Wen-yuan. Science of vaccine and immunization. 2nd ed. Shanghai: Shanghai Science and Technology Literature Press; 2001.Google Scholar
  2. 2.
    Ministry of Health. The national immunization review report in China 2004. Beijing: People’s Medical Publishing House; 2005.Google Scholar
  3. 3.
    The State Council. Regulations on vaccine distribution and vaccination management. 2005.Google Scholar
  4. 4.
    Xi Jing-jing, Cao Lei, Zheng Jingshan. Immunization programmes human resources status and management countermeasures in China. Chin J PHM. 2014;30:372–3.Google Scholar
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    Ministry of Health. The guideline of immunization practice. 2005.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. & People's Medical Publishing House, PR of China 2019

Authors and Affiliations

  1. 1.National Immunization Program, Chinese Center for Disease Control and PreventionBeijingChina

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