Children in Shanghai whose families migrated from rural areas have lower rates of measles vaccination

Children in Shanghai, China whose families migrated from rural areas — now roughly 40% of the city’s total population — are half as likely as “local” children to receive the first dose of measles vaccine by 9 months of age and 42% less likely to receive the second measles dose by 24 months. The lower rates of timely first dose measles vaccination among rural migrants vs. local children — 78% vs. 89% – – are a key obstacle to measles elimination in China. This indicates a need to specifically target non-local children for vaccination, especially those living in primarily migrant communities.

China could save money by including the Hib vaccine in the national immunization program

If China — one of the few remaining countries in the world that haven’t introduced Hib vaccine in their national immunization program — decides to include the vaccine in their program, it could actually be cost saving; the vaccination costs would be less than the averted costs of illness from Hib meningitis and pneumonia, if a vaccine price matching UNICEF’s (US$2/dose) can be obtained. The vaccination will be cost-effective, but not cost saving, if the program pays the current market price in China of US$10 per dose.

North Korean refugee children in China have low vaccination rates due to lack of legal status

Children born to North Korean refugee women in China have much lower vaccination rates than local Chinese or migrant children — with full immunization rates of 14% compared to 93% for local ethnic Chinese children and 55% for migrant children. While all ethnic Chinese children are registered and provided with free vaccinations and there are specific programs targeting migrant children, children born to Korean refugees have no legal status and are thus excluded from the public health care system.

Efforts to eliminate measles can improve national health systems

Efforts to eliminate measles — which has been called a public health “canary in the coalmine” since it’s a sign of weak health systems — can also serve to strengthen immunization programs as well as the broader health systems. These efforts include improving infection prevention and control practices in health care facilities, disease surveillance and outbreak detection systems, and countries’ ability to prepare for and respond to infectious disease outbreaks.

A measles outbreak can be costly for national governments

A measles outbreak in the Federated States of Micronesia (FSM) in 2014, causing nearly 400 confirmed cases, cost nearly US$4 million (around US$10,000 per case), 88% of which was for a mass vaccination campaign, outbreak investigations, and other containment costs. While the U.S. government covered 2/3 of the costs, the economic burden to FSM — in labor and other costs of containing the outbreak, the direct costs of illness, and productivity losses — were the equivalent of the country’s entire education budget for one year.

Vaccinating infants with PCV also reduced disease and hospitalizations in older individuals

The cost-effectiveness of vaccinating infants with PCV-13 in China was estimated to be 21 times greater when the indirect effects of vaccination in reducing invasive pneumococcal disease and hospitalized cases of pneumonia in older (unvaccinated) individuals was taken into account — with costs per quality of life-year gained (QALY) of around US$564 (Y3,777) vs. $11,836 (Y79,204) when only the direct impact on vaccinated children is considered.