Peer-reviewed article
Timeliness of Routine Vaccination, Catch-Up Completion, and Immune Function in Chinese Children with Special Healthcare Needs: A Retrospective Cohort Study.
Yuyuan Zeng, Xihan Li, Yu Tian, Yuming Liu, Jianhong Wang et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined vaccination timeliness and immune function in Chinese children with special healthcare needs using medical records and follow-up surveys. Children with special needs received routine vaccines much later than healthy children, with Japanese encephalitis and measles vaccines having the lowest completion rates. While some children caught up on missed doses, delays were common especially among those with neonatal or perinatal disorders. The research found that immune function varied by disease type, with lower antibody levels in some groups.
Key points
- Timely vaccination rates for all National Immunization Program vaccines were significantly lower in children with special healthcare needs compared to healthy children benchmarks (all p < 0.001)
- Japanese encephalitis virus vaccine had only 24.0% timely completion and measles-containing vaccine 25.9%, the lowest among all vaccines studied
- Catch-up vaccination completion varied by vaccine type: hepatitis B dose 3 (86.3%) and BCG (81.8%) were highest, while diphtheria-tetanus vaccine was lowest at 49.4%
- Children with neonatal/perinatal disorders had disproportionately high delays for BCG and hepatitis B dose 1 vaccines
- Caregiver concerns and vaccination provider hesitancy were identified as primary barriers to catch-up vaccination
Limitations
The study provides data specific to China and may not generalise to other healthcare systems. The retrospective design and self-reported follow-up data may introduce recall bias and missing information.
Abstract
BACKGROUND: Children with special healthcare needs (CSHCNs) face persistent barriers to timely immunization in China, but comparative evidence across disease groups and vaccines, and data on immune function, are limited. METHODS: We conducted a retrospective cohort study linking electronic medical records, vaccination records, and a structured telephone and questionnaire follow-up. We estimated timely vaccination by National Immunization Program (NIP) dose definitions, assessed catch-up completion at follow-up, and compared cellular/humoral/complement immune indices with published pediatric reference ranges. Group differences used ANOVA/Kruskal-Wallis and chi-square (χ2)/Fisher's exact tests with Bonferroni correction. RESULTS: Timely vaccination was lower than the national healthy child benchmarks for all NIP vaccines (all p < 0.001); the Japanese encephalitis virus (JE; 24.0%) and measles-containing vaccine (MCV; 25.9%) had the lowest timely completion. A subset of CSHCNs did not receive recommended catch-up vaccinations, primarily due to persistent caregivers' concern and point of vaccination (POV) staff's hesitancy. Delays clustered in neonatal/perinatal disorders for Bacillus Calmette-Guérin (BCG) and hepatitis B vaccine, dose 1 (HepB1). Catch-up completion was highest for hepatitis B vaccine, dose 3 (HepB3) (86.3%) and BCG (81.8%), and lowest for the diphtheria and tetanus vaccine (DT) (49.4%); MCV2 completion was particularly low in hematological diseases. Immunoglobulin A (IgA) and immunoglobulin G (IgG) concentrations were significantly lower in neonatal/perinatal disorders and infectious disease groups versus neurological and immune disorder groups (p < 0.05). No severe adverse events were reported after catch-up. CONCLUSIONS: CSHCNs in China face substantial barriers to timely NIP immunization. Timeliness and catch-up vary substantially by vaccine and underlying condition; neonatal/perinatal disorders contribute disproportionately to early-life delays. Disease-specific guidance, strengthened POV-specialist clinic coordination, immunological monitoring, and supportive policies could improve the vaccination coverage and effectiveness in this vulnerable population.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Catch-up vaccination offered to children with special healthcare needs who had missed or delayed doses
- Population
- Chinese children with special healthcare needs including neonatal/perinatal disorders, neurological conditions, infectious diseases, hematological diseases, and immune disorders
Key finding
Catch-up completion rates varied substantially by vaccine: hepatitis B dose 3 at 86.3%, BCG at 81.8%, but diphtheria-tetanus vaccine only at 49.4%