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Rubella is listed by the World Health Organization (WHO) as a disease that needs to be eliminated worldwide. The aim of this study was to understand the progress and challenges towards rubella elimination in Beijing, China, by analyzing molecular surveillance data combined with immunization and surveillance strategies as well as epidemiological data. With high immunization coverage under the 3-dose policy (8 months, 18 months, and 6 years) and supplementary immunization activities for the floating population, rubella incidence showed a downward trend since 2010, despite two epidemics that occurred in 2014-2015 and 2019. The reported rubella cases were generally concentrated in the age group of 15-34 years. Although citywide surveillance for congenital rubella syndrome (CRS) has been carried out since 2016, only one case has been confirmed by laboratory testing. Furthermore, molecular surveillance data showed that rubella viruses (RVs) circulating in Beijing during 2010-2020 were evidently heterogeneous; the domestic lineage 1E-L1 and multiple imported lineages, including 2B-L1, 1E-L2, and 2B-L2c, were identified in the last decade. Meanwhile, two lineage-related switches were determined, including the displacement of lineage 1E-L1 with lineage 2B-L1 around 2014 and the transition between lineage 2B-L1 and lineage 1E-L2 and 2B-L2c in 2018-2019. This RV transmission pattern was similar to that observed across the country, whereas lineages 1E-L1 and 2B-L2c were prevalent in Beijing for a shorter period. Overall, these results indicate the need to maintain routine immunization with rubella-containing vaccines, promote regular supplementaryimmunizationactivities, and enhance rubella and CRS surveillance even in order to accelerate rubella elimination in Beijing. Further, the existing immunization strategies must be optimized to further close the immunity gap.

Background: This review aimed to estimate the disease burden of herpes zoster (HZ) in China and explore the application of the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach in observational studies of disease incidence. Methods: We searched for the literature for observational studies analysing HZ incidence in populations of all ages in China and assessed the quality of each study using the guidelines for the evaluation of incidence studies. Meta-analysis models were constructed to calculate the pooled incidence of HZ and pooled risks of postherpetic neuralgia (PHN), HZ recurrence, and hospitalisation. The studies were divided into subgroups according to sex, age, and quality assessment score and analysed. The quality of evidence for incidence was rated using the GRADE system. Results: Twelve studies with a total of 25,928,408 participants were included in this meta-analysis. The pooled incidence for all ages was 4.28‰ (95% confidence interval [CI]: 1.22–7.35). It increased by age group and increased significantly in those aged ≥60 years, which was 11.69‰ (95% CI: 6.56–16.81). The pooled risks of PHN, recurrence, and hospitalisation were 12.6% (95% CI: 10.1–15.1), 9.7% (95% CI: 3.2–16.2) and 6.0/100,000 population (95% CI: 2.3–14.2), respectively. The quality of the evidence assessment of the pooled incidence for all ages was ‘very low’, which was rated down by one category in limitations and one category in publication bias, with no categories rating it up. The result of the quality of evidence assessment for the ≥60 years old subgroup was ‘low’. Conclusions: HZ is a serious public health problem in China and is more significant in individuals older than 60 years. Therefore, an immunisation strategy for the zoster vaccine should be considered. The GRADE approach can be applied to the rating quality of evidence in disease incidence studies, but the process needs to be more specific and operable.

What is already known about this topic? The World Health Organization (WHO) varicella vaccines position paper states that countries where varicella is an important public health burden could consider introducing varicella vaccine (VarV) in the routine childhood immunization program ( 1 ). VarV has been available for many years in China but is not included in most routine immunization programs in China. As a result, substantial heterogeneity in vaccination coverage exists across regions. What is added by this report? In Beijing, adding a second dose of VarV for children and increasing coverage reduced the incidence of varicella. Lowering the age of the first dose of VarV to 12 months could further reduce varicella, especially among toddlers. What are the implications for public health practice? Governments should use economic analysis to consider inclusion of VarV into the routine children immunization program as a free vaccine and adopting a 2-dose schedule that starts at 12 months of age.

What is already known on this topic? Preclinical trials showed the effectiveness of domestic inactivated vaccine candidates for coronavirus disease 2019 (COVID-19). However, it is necessary to evaluate the willingness of the public to receive future domestic vaccines and to understand factors associated with willingness at the early stages of vaccine development. What is added by this report? Through May 25, 2020, 70.48% were willing to receive future domestic COVID-19 vaccines. Confidence in vaccines had the largest impact on public willingness, while age and presence of underlying chronic disease did not significantly increase public willingness. What are the implications for public health practice? It is necessary to increase awareness of COVID-19 vaccines among people with high risk of severe infection and to build public confidence in vaccines. Releasing accurate, timely, and reliable data to the public can help increase willingness to get vaccinated.

BACKGROUND One-dose voluntary varicella vaccination for children was introduced in Beijing since 1998. In Oct 2012, a second dose varicella vaccine (VarV) was recommended to further decrease varicella disease and the outbreaks. We describe the impact of the 2-dose voluntary vaccination strategy on varicella epidemiology in Beijing, China. METHODS Varicella incidence rates and outbreak characteristics in 2011-2017 was examined using surveillance data. Varicella vaccination coverage among children born in 2007-2012 was estimated through Beijing children immunization registry system. Vaccine effectiveness (VE) for VarV2 was estimated by screening method. RESULTS Overall varicella incidence decreased by 37.8% from 103.2 per 100,000 population in 2011 to 64.2 per 100,000 population in 2017. Incidence declines in children aged

What is already known about this topic? The coronavirus disease 2019 (COVID-19) vaccine development has been progressing, but acceptance of the new vaccines by healthcare workers (HCWs) was not well known prior to approval of COVID-19 vaccines in China. What is added by this report? This study found that before vaccine approval, Beijing HCWs expressed moderate willingness to get vaccinated. Factors positively influencing willingness included free vaccination and belief that the vaccine had been fully evaluated. A negatively influencing factor was presence of an underlying disease. Trust in vaccines, in general, was positively associated with willingness to get new vaccines. What are the implications for public health practice? COVID-19 vaccines should be provided at no cost to HCWs. Effective measures should be taken to enhance the acceptance of COVID-19 vaccination among HCWs in China.

Background The objectives of this review were to evaluate the vaccine effectiveness (VE) of the two-dose varicella vaccine for healthy children in China and explore the application of the approach of Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) in observational studies on VE. Methods We searched for observational studies on two-dose varicella VE for children in China aged 1–12 years that were published from 1997 to 2019, and assessed the quality of each study using the Newcastle Ottawa Scale (NOS). We used meta-analysis models to obtain the pooled two-dose VE, and the studies were divided into subgroups and analysed according to whether or not it was an outbreak investigation and its NOS score. The quality of evidence of VEs were rated by approach of the GRADE system. Results A total of 12 studies and 87,196 individuals were included. The pooled two-dose VE was 90% (95% confidence interval [CI]: 69–97%). The VE of outbreak studies (87% [95% CI: 76–93%]) was lower than non-outbreak studies (99% [95% CI: 98–99%]). There was no significant difference in VEs by different NOS quality. The quality of the evidence assessment of pooled two-dose VE was “low”, which was rated down by one category in limitations and publication bias respectively and rated up by two category in large effect. The quality of evidence assessment in subgroup of NOS score ≥ 7 was “moderate”. Conclusions The VE of two-dose varicella vaccine is relatively high in preventing varicella, and is recommended for countries which need further control for varicella. However, higher quality evidence is needed as a supplement for stronger recommendations. The approach of GRADE could be applied for rating the quality of evidence in observational study.

Two-dose varicella vaccination has been available in Beijing since 2012 in the private sector. We investigated a varicella outbreak in a highly vaccinated elementary school population.A cohort study was carried out and a varicella case was defined as an acute onset of generalized maculopapulovesicular rash without other apparent cause in a student attending the school from March 29 through May 17, 2015. Breakthrough varicella was defined as varicella42days after the last vaccine dose among both 1- or 2-dose varicella vaccine recipients. Vaccination information was collected from immunization records; information on prior varicella and clinical presentations was collected by surveying students' parents.Of the 1056 students in the school, 1027 (97.3%) reported no history of varicella. Prior to the outbreak, 98.6% of students had received ≥1 dose of varicella vaccine, and most (63.2%) students received two doses. Twenty varicella cases were identified for an overall attack rate of 2.0%. Half of the cases occurred in the classroom of the index case-patient, a two-dose recipient who was not isolated after symptom onset. Breakthrough varicella accounted for 95% of cases (19/20) with attack rates of 14.3% (1/7), 1.6% (6/362) and 2.0% (13/649) among unvaccinated, one-dose, and two-dose students, respectively. Most case-patients (18/20, 90%) had50 lesions. No difference in clinical presentations was found between one-dose and two-dose recipients with breakthrough varicella.Moderate two-dose varicella vaccine coverage was insufficient to prevent a varicella outbreak. Two-dose recipients with breakthrough varicella are contagious. High two-dose varicella vaccine coverage and timely isolation of cases may be needed for varicella outbreak prevention in the two-dose era.

Although the incidence of measles has been dramatically reduced by the highly effective measles vaccine, cases of measles and outbreaks continue to occur in vaccinated population because of immunization failure. We report on an outbreak in which two cases had previous evidence of measles immunity and then one of them transmitted measles infection to an unvaccinated contact. The cases and contacts exposed during the outbreak were investigated. Clinical information and epidemiological information were obtained. Serum samples were collected for measles-specific immunoglobulin M (IgM), immunoglobulin G (IgG) and IgG avidity. Throat swabs were obtained to test for measles virus RNA. Two measles cases (case 1 and case 2) who have received one dose of MCV in past 5 years, and both working at a hospital in Beijing, occurred in 18(th) and 20(nd) of January, respectively. Out of the 102 contacts, one additional case (case 3) who had a close, long-term co-exposure with case 1 was reported subsequently. No additional cases of measles occurred among 15 contacts of case 3. The index case was not ascertained through the outbreak review. All three cases had laboratory confirmation of measles infection. Both case 1 and case 2 had high-avidity IgG antibody characteristic of a secondary immune response and developed a modified clinical presentation. This report confirms that a vaccinated individual with documented secondary vaccine failure (SVF) could transmit measles and is the second report since a New York City outbreak (the first report in China). The outbreak represented a series of rare events, so we can conclude that the SVF individuals in the transmission chain of measles are unlikely to threaten measles elimination. The importance of the herd immunity in preventing transmission and sensitive surveillance activities in case of misdiagnosis is emphasized.

Background Few measles outbreaks among adults are reported in China, and outbreak response costs are seldom documented. We report an adult measles outbreak and response in 4 linked office buildings in Beijing and its associated costs. Method The World Health Organization measles case definitions were used to determine suspected and confirmed measles cases. Surveillance data were used to describe the outbreak, and records and interviews of response staff were used to describe the response. Costs were determined by use of retrospective surveys of cases, review of records, and interviews of staff. Results The outbreak lasted 19 days, and involved 22 cases aged 23–49 years. Nineteen cases had a local household registration. All cases were employed by 8 companies in 4 linked office buildings. Among the 22 cases, 8 had temperature less than 38.5 degree, 18 had no Koplik spots and none had complications or hospitalizations. A total of 7930 contacts were identified, and of these, 6869 were employees in the office buildings. All the child contacts aged 8 months–14 years had been up-to-date for measles-containing vaccine (MCV); no adult could document their vaccination or measles history. Of contacts, about 96% were offered post-exposure vaccination. The total household costs were $13,298, or $605 per case. Control costs were $384,594, or $17,481 per case. Involved companies paid for 90.7% of control costs. Conclusion Office buildings provide a mechanism for measles transmission. Timely control activities were challenged by the highly infectious nature of measles and mild presentations of cases. The outbreak response was very costly. Financial support by involved companies can provide needed resources for outbreak management.

Little data are available on the overall incidence and characteristics of herpes zoster (HZ) in China, thus a community-based retrospective survey was conducted during December 2012 to March 2013 to collect HZ incident data over the past year in selected districts of Beijing, China. A total of 237 incident HZ cases were identified from 118,220 residents and majority of HZ patients (219/237, 92.4%) sought healthcare. Annual HZ incident rates were 1.90/1000 after adjusted and higher among females (2.4/1000) than males (1.7/1000). HZ rates increased with age and with a sharply rise among those aged ≥50 years particular for female. 217 cases were available for interview with 193 (88.9%) primary, 24 (11.1%) recurrent and 10 (4.6%) postherpetic neuralgia (PHN) cases respectively. No difference was shown between the primary and recurrent HZ cases in sex (P = 0.42), age (P = 0.72), times of healthcare seeking (P = 0.45), number of dermatome (P = 0.72), pain degree (P = 0.54), and hospitalization (P = 1.0). According to the survey, it can be speculated that disease burden of HZ is serious and caused at least 2.77 million cases annually in China. The recurrent HZ cases has similar characteristics to primary HZ cases. High proportion of healthcare seeking reminds that HIS records would be a feasible source for HZ surveillance to evaluate the trends and changes in China.

Background Measles-containing vaccine (MCV) was introduced in 1965 in Beijing and given to the children aged 8m–14y. In population-based surveillance system, real-time polymerase chain reaction (RT-PCR) and immunoglobulin M(IgM) serology tests have been conducted for each suspected case since 2013. We used the surveillance data to evaluate the adequacy of the tests for laboratory confirmation during 2014–2016. Methods Informations on IgM tests, RT-PCR, age, vaccination history for confirmed cases were from the surveillance system. Laboratory confirmed cases were defined as cases with positive IgM serology and/or positive RT-PCR. All tests were conducted in the laboratories accredited by Beijing CDC or Beijing CDC laboratory. Results Totally 4600 cases were confirmed. Sensitivities of IgM tests within 0–3 days post rash, IgM tests within 4–28 days post rash and RT-PCR within 0–3 days post rash were 56.53%, 82.06% and 94.39%, respectively. The combined sensitivity of IgM tests and RT-PCR decreased by the interval between rash onset and collection of virologic specimen. MCV immunization history lowered sensitivity of IgM tests and RT-PCR. Among the cases aged ≥ 15 years, around 95% had no written immunization records. The sensitivity of IgM tests within 0–3 days post rash was less than 60%. Around 60% had unknown immunization histories. Compared with unvaccinated cases based on written records, unvaccinated cases based on recollection had no significantly different sensitivity of laboratory tests. But unknown immunization history significantly lowered sensitivity of RT-PCR within 0–3 days post rash. Conclusions Neither IgM tests nor RT-PCR reached 100% sensitive for confirmed cases. Virologic specimen should be collected as early as possible to achieve maxim sensitivity. Cases with unknown immunization history could not be treated as unvaccinated. Combination of the two tests and further laboratory assays were needed especially for vaccinated cases or cases aged ≥15 years.

Background Hospital-based case control studies have found family history of herpes zoster (HZ) was associated with risk of HZ, but the role of family history is not fully examined for other HZ-associated outcomes such as recurrent HZ, occurrence of postherpetic neuralgia (PHN), and HZ with different pain severities. Methods We conducted a population-based matched case control study. HZ cases that occurred during December 1, 2011 to November 30, 2012 were identified by face-to-face interview with all residents of eight selected communities/villages from three districts of Beijing, China. Medical records were reviewed for those who sought healthcare for HZ. For each case-patient, three, age-matched controls (±5 years) without HZ were enrolled from the same community/village of the matched case. Data on family history of HZ were collected by interview and only defined among first-degree relatives. Results A total of 227 case-patients and 678 matched controls were enrolled. Case-patients were more likely to report a family history of HZ [odds ratio (OR) =2.4, P = 0.002]. Compared with controls, association of family history decreased from HZ with PHN to HZ without PHN (OR = 6.0 and 2.3, respectively; P = 0.002 for trend), from recurrent HZ to primary HZ (OR = 9.4 and 2.2, respectively; P = 0.005 for trend), and from HZ with moderate or severe pain to HZ with mild or no pain (OR = 3.2 and 0.8, respectively; P

Varicella vaccine is available in the private sector in China, with a single dose currently recommended for children aged ≥12 months. We investigated a varicella outbreak in a school in Beijing with high varicella vaccination coverage to describe the outbreak, examine risk factors for vaccine failure, and calculate vaccine effectiveness.A varicella case was defined as an acute generalized maculopapular rash without other apparent cause in a student without prior varicella attending the elementary school during August 30-December 28, 2010. Varicella among vaccinated students (breakthrough varicella) was defined as varicella occurring42 days after vaccination. Students' vaccination status was verified with immunization records and clinical presentations were collected from health care practitioners.Of the 951 students, 934 (98%) had no prior varicella history. Among these students, 916 had received 1 dose of varicella vaccine and 2 had received 2 doses (98% vaccination coverage) before the outbreak. A total of 87 cases occurred during the outbreak; most had breakthrough varicella (86/87, 99%) and mild disease (83/87, 95%). Age at vaccination (15 months vs. ≥15 months) and time since vaccination before outbreak (5 years vs. ≥5 years) were not associated with development of breakthrough varicella. Single-dose varicella vaccination was 89% effective in preventing any varicella and 99% in preventing moderate/severe varicella.Single-dose varicella vaccination is highly effective in reducing varicella incidence and mitigating disease severity, but not high enough to prevent outbreak. A two-dose program might help to prevent varicella outbreaks in Beijing.

BACKGROUND After the first monovalent 2009 pandemic influenza A (H1N1) vaccine became available in September 2009, Chinese officials conducted a mass vaccination program in Beijing. We evaluated the safety and effectiveness of the vaccine. METHODS During a 5-day period in September 2009, a total of 95,244 children and adults received the PANFLU.1 vaccine (Sinovac Biotech), a monovalent split-virion vaccine of 15 μg of hemagglutinin antigen without adjuvant. We assessed adverse events after immunization through an enhanced passive-surveillance system and through active surveillance, using diary cards and telephone interviews. Active surveillance for neurologic diseases was implemented in hospitals citywide. To assess vaccine effectiveness, we compared the rates of reported laboratory-confirmed cases of 2009 H1N1 virus infection in students who received the vaccine with the rates in those who did not receive the vaccine, starting 2 weeks after the mass vaccination. RESULTS As of December 31, 2009, adverse events were reported by 193 vaccine recipients. Through hospital-based active surveillance, 362 cases of incident neurologic diseases were identified within 10 weeks after the mass vaccination, including 27 cases of the Guillain-Barre syndrome. None of the neurologic conditions occurred among vaccine recipients. From 245 schools, 25,037 students participated in the mass vaccination and 244,091 did not. During the period from October 9 through November 15, 2009, the incidence of confirmed cases of 2009 H1N1 virus infection per 100,000 students was 35.9 (9 of 25,037) among vaccinated students and 281.4 (687 of 244,091) among unvaccinated students. Thus, the estimated vaccine effectiveness was 87.3% (95% confidence interval, 75.4 to 93.4). CONCLUSIONS Among 95,244 children and adults in Beijing, the PANFLU.1 vaccine had a safety profile similar to those of seasonal influenza vaccines and appeared to be effective against confirmed H1N1 virus infection in school-age children. (Funded by the Beijing Municipal Health Bureau.).

To investigate the changes of epidemiological characteristics of measles in Beijing before and after Supplementary Immunization Campaigns (SIA) (2007-2010 vs 2011-2014) of measles-containing vaccine (MCV) among children aged between 8 months and 14 years in 2010.Descriptive epidemiological analysis was conducted on surveillance data of measles cases (clinical cases and laboratory confirmed cases), with the occurrence during 2007-2014, and of outbreaks, with the occurrence during 2009-2014, from National Notifiable Disease Reporting System. MapInfo geographic information system (Version 8.5) was used to illustrate the distribution of measles incidence by district. Annual measles incidence was classified into 5 groups at the same intervals between the upper and lower limits to analyze the morbidity of the different areas.In total, 7 722 and 3 132 measles cases were reported during 2007-2010 and 2011-2014, with the annual incidence of 11.59 and 3.84 cases per 100 000 population, respectively. Comparing with the results during 2007-2010, total number of measles cases and average annual incidence during 2011-2014 were decreased by 59.4%, and 66.9%, respectively. Among measles cases during 2011-2014, percentage of cases aged 15 years or above were 57.7%(56/97), 62.0%(49/79), 65.5%(370/565), and 71.4% (1 707/2 391), respectively, which increased by years. During 2007-2010, the highest risk age for adults was 20-34, while 2011-2014, 5 years older: 25-39. During 2009-2010, 2011-2012, and 2013-2014, 50.3% (447/889), 30.3% (10/33), and 57.8% (201/348), respectively, of measles cases aged 8-17 months were unvaccinated by MCV. Percentages of measles cases aged 0-7 months, 8 months-14 years, 15-39 years and 40 years or above during 2013-2014, who visited hospitals 7-21 days before disease onset, were 59.8% (238/398), 49.3% (237/481), 32.2% (529/1641), and 37.6% (164/436), respectively. A total of 11 nosocomial measles outbreaks occurred during 2013-2014, which was much higher than that during 2009-2010 (2 nosocomial outbreaks). And universities accounted for the majority of outbreak settings of schools (3/4). All 11 outbreaks among grouped employees during 2009-2012 occurred in factories, restaurants, or large shopping centers, while the largest proportion (6/16) of that kind of outbreaks during 2013-2014 occurred in office buildings.SIA of MCV in 2010 effectively decreased measles transmission in Beijing. But routine immunization of MCV still needed to be improved. The issue of adult measles has been a prominent problem. Hospitals, office buildings and universities were the focus of prevention of measles transmission.

To evaluate the effect of outbreaks control in school settings after a 2 dose varicella vaccine immunization strategy implemented in Beijing.Epidemiological data of varicella outbreaks in school and kindergarten settings, which were reported by all 16 districts (county) during 2007-2013 according to the technical management norms of Beijing, was collected. The first dose and second dose varicella vaccine coverage rate of eligible children after the 2 dose varicella vaccine immunization strategy implementation were estimated through BJIIMS. Based on above we analyzed the changes of outbreak quantity, case quantity and the distribution characteristics between the pre-adjustment era (2007-2011 years) and late adjustment era (2013) of the 2 dose immunization strategy.In pre-adjustment era (2007-2011 years), an average of 74 (95% CI: 60-89) outbreaks was reported and 964 (95% CI: 812-1 116) cases were involved per year. In late adjustment era (2013): Outbreaks (35) declined 52.7%, involved cases (371) declined 61.5%; Outbreaks epidemic duration shortened from 22 days of pre-adjustment era to 18 days; Outbreaks involved 10-24 cases declined 64.7% (from 34 to 12); Outbreaks involved ≥ 25 cases declined 71.4% (from 7 to 2); Outbreaks of different school type as well as different regions without exception declined dramatically. Cumulative one-dose vaccine coverage in children of 2-6 yr of age was 89.6% (812 859/907 579), and cumulative second-dose vaccine coverage in children of 4-7 yr of age was 44.3% (289 764/647 732).Implementation of a 2 dose varicella vaccine immunization strategy effectively controlled outbreaks in school and kindergarten settings.

BACKGROUND: In China varicella vaccine has been available in the private sector to children >/=12 months of age since 1998 with a single-dose indication. In December 2006 varicella became a notifiable disease in Beijing. We used surveillance data to describe varicella vaccine uptake from 2005 to 2010 and varicella epidemiology in Beijing from 2007 to 2010. METHODS: Limited sociodemographic and clinical information was available from the passive surveillance system. Varicella vaccine coverage was estimated for each year for children born between 2004 and 2008 using the number of children in the immunization registry of each birth year as the denominator without adjustment for history of varicella. RESULTS: Vaccine coverage increased within each birth cohort between 2005 and 2010. The coverage at 2 years of age increased from 62.4% in 2005 to 74.1% in 2010 and was 80.4% in children 3-6 years of age in 2010. Between 2007 and 2010 15544 to 18256 varicella cases were reported annually with stable overall incidence (range: 1.0-1.1/1000 persons) but the incidence in children 1-4 years of age decreased significantly from 6.2 per 1000 children in 2007 to 4.4 per 1000 children in 2010 (P /=20 years of age) there were significant increases in the number and proportion of cases from 2557 (16.5%) in 2007 to 4277 (23.4%) in 2010 (P < 0.001). CONCLUSIONS: Moderately high 1-dose vaccine coverage in young children has been achieved with declining disease incidence but varicella remains a common seasonal disease in the population. Current epidemiology suggests that a government-funded varicella vaccine program that includes catch-up vaccination for older children adolescents and adults needs consideration.