India's Universal Immunization Programme (UIP) has substantially reduced the burden of vaccine-preventable diseases and remains one of the largest public health initiatives globally. However, despite sustained programmatic efforts, nearly one in four children remains incompletely immunized, and a considerable proportion of families continue to access vaccination services through the private healthcare sector. These services operate largely outside the governance framework of the UIP, resulting in fragmented practices, inconsistent reporting, variable quality standards, and missed opportunities for strengthening the national immunization ecosystem. This article argues that the private sector should be recognized not as a parallel system but as a strategic partner in achieving universal immunization goals. We propose a comprehensive integration framework that aligns private vaccination services with the UIP through six interconnected pillars: standardization of care, pricing and financing, capacity-building, vaccine storage and quality assurance, reporting and adverse event surveillance, and monitoring and evaluation. By embedding private providers within existing public health governance mechanisms and digital platforms, the framework promotes uniform standards of safety, accountability, affordability, and service delivery while preserving patient choice. Integrating private sector vaccination services through a coordinated, policy-driven approach offers a pragmatic pathway to improve coverage, strengthen surveillance, and build a more resilient and equitable immunization system in India.
Somen Kumar Pradhan, Hrusikesh Patra, Ashutosh Panda et al.
Background: Children of Myanmar migrants in Thailand have lower immunization coverage compared to Thai counterparts, leaving them at risk of vaccine preventable diseases. Evidence remains limited regarding immunization among Myanmar children in Chiang Rai Province, an important migration corridor between Northern Thailand and Myanmar. Objective: this study aimed to estimate the immunization status and identify its associated factors among children of Myanmar migrants in Chiang Rai province, Northern Thailand. Methods: A cross-sectional study was conducted among Myanmar migrant caregivers and their children aged under 7 years, who are residing in Chiang Rai Province, using a validated questionnaire by face-to-face interview. Descriptive statistics was used to summarize participant characteristics, while chi-square tests and binary logistic regressions were used to identify associated factors with statistical significance set at α< 0.05. Results: Among 423 children, 91 children (21.5%) were found as having incomplete immunization and six factors were significantly associated with it, including lacking Thai birth registration (aOR = 9.52; 95% CI: 3.74-24.27), lacking child's health insurance (aOR = 14.03; 95% CI: 6.45-30.54), history of return migration (aOR = 19.05; 95% CI: 8.48-44.13), negative peer practices (aOR = 8.09, 95% CI: 1.47-44.54), time barrier (aOR = 4.09, 95% CI: 1.20-13.94) and financial barrier (aOR = 7.07, 95% CI: 1.67-29.91). Conclusions: A moderate prevalence of incomplete immunization was strongly associated with factors across the levels of the modified socio-ecological model: intrapersonal, interpersonal, and institutional. Interventions addressing legal access, health insurance, community outreach, healthcare system responsiveness and cross-border continuity of care are recommended.
Shin Moe Oo, Pamornsri Inchon, Peeradone Srichan et al.
Survival
Peer-reviewed article·PubMed (US National Library of Medicine)·
Despite sustained universal infant hepatitis B vaccination, chronic hepatitis B (CHB) remains an important cause of cirrhosis and hepatocellular carcinoma in Thailand, particularly among adults born before vaccine implementation. This article summarizes the 2026 National Guideline on Elimination of Viral Hepatitis B in Thailand and presents a health-system framework for addressing the remaining disease burden. The guideline was developed by a multidisciplinary expert panel using evidence from international recommendations, peer-reviewed literature, national epidemiological data, implementation studies, and health economic analyses. The recommendations were formulated using the GRADE framework and adapted for implementation within Thailand's Universal Health Coverage system. The national strategy prioritizes birth-cohort HBsAg screening for adults born before 1992, simplified evidence-based treatment eligibility incorporating non-invasive fibrosis assessment and virological criteria, and first-line use of high genetic-barrier nucleos(t)ide analogs. Prevention of mother-to-child transmission prioritizes HBV DNA-guided antiviral prophylaxis, with simplified implementation pathways reserved for settings with substantial diagnostic constraints. Long-term care emphasizes structured monitoring, appropriate specialist referral, conservative treatment discontinuation criteria, defined retreatment thresholds, and risk-based semiannual ultrasound surveillance for hepatocellular carcinoma. Integration with antenatal services, HIV programs, and primary care facilities supports decentralized delivery and continuity of care. Thailand's 2026 hepatitis B guideline operationalizes evidence-based CHB management within a publicly financed decentralized health system and provides a scalable model for expanding hepatitis B diagnosis and treatment in endemic settings.
Phunchai Charatcharoenwitthaya, Tawesak Tanwandee, Pisit Tangkijvanich et al.
Survival
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: Rotavirus vaccines (RVs) are coadministered in the United States with diphtheria-tetanus-acellular pertussis (DTaP) vaccines but have age restrictions for the first and last doses. We examined how delays in preventive care visits for vaccination affected RV initiation and series completion. METHODS: We compared the timeliness of DTaP vaccination relative to RV in children born January 1, 2018 to June 30, 2023 across 8 US health systems. Adjusted risk ratios (aRRs) were estimated using modified Poisson regression to identify risk factors for delayed DTaP vaccination and no RV vaccination. RESULTS: Among 391 892 children who initiated DTaP, 12 546 (3.2%) did not initiate RV. Of these, 7721 (61.5%) children had delayed DTaP initiation and were age-ineligible for RV at the time of DTaP initiation. Children who became eligible for RV during the early stage of the COVID-19 pandemic (March to May 2020) had a higher risk of delayed DTaP and no RV initiation (aRR = 2.20; 95% CI, 1.98-2.45), as did children with fewer than 5 primary care visits within the first year of life (aRR = 4.03; 95% CI, 3.81-4.26), and Medicaid recipients (aRR = 2.34; 95% CI, 2.23-2.45). Similar factors were associated with failure to complete the RV series due to age restrictions. CONCLUSIONS: Age restrictions may have contributed to lack of RV initiation and series completion in this cohort. Public health strategies tailored to populations at risk for delayed vaccination may be needed to promote timely administration of RV.
Jordan E Cates, Jacob Haapala, Julia M Baker et al.
SurvivalUS
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: Despite well-established childhood immunization programs in many high-income countries, vaccination series are often delayed or not completed. Gaps in vaccination coverage are more common among children from socioeconomically disadvantaged households, among whom they are associated with higher rates of related hospitalizations. We aimed to assess the extent of these gaps in Germany, as well as the presence of socioeconomic inequality and the factors accounting for it. METHODS: Using health insurance claims data from Techniker Krankenkasse for 2016-2019, we examined vaccination coverage for a comprehensive set of STIKO-recommended childhood vaccinations in six birth-year cohorts (2011-2018; approximately 430,000 children; 2.5 million recommended vaccinations). Coverage was defined as completion of the recommended series with all doses administered within the recommended age window. Socioeconomic inequality was quantified using the Erreygers-corrected concentration index and decomposed into contributions from factors such as parental education and travel time to the treating physician. RESULTS: Approximately 80% of vaccination series in the sample were complete and administered within the recommended age window. Vaccination coverage showed a small but statistically significant socioeconomic gradient (concentration index = 0.024, 95% confidence interval: 0.023 to 0.025) favoring children from higher socioeconomic households. In the decomposition analysis, provider type accounted for the largest share of this gradient, with lower completion rates and timeliness among children whose outpatient care was mainly delivered by general practitioners compared with pediatricians. Parental education contributed to a lesser extent, and travel time contributed little to the observed inequality. CONCLUSIONS: Childhood vaccination coverage in Germany remains below national targets and shows a small socioeconomic gradient. The gradient appears to be less strongly related to logistical access barriers than to differences in how vaccinations are delivered in outpatient care outside pediatric settings. These provider-type differences in vaccination delivery may therefore be more relevant for narrowing the observed gradient than further reductions in travel time.
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: Beliefs of a child's primary caregiver are known to influence immunization uptake. As coverage increases, the characteristics of households with undervaccinated children may be shifting. METHODS: We conducted a cross-sectional survey of households with a child 12-23 months of age. Vaccine status was verified by inspection of immunization cards or caregiver report. Composite scores captured caregiver beliefs and experiences with vaccination. Associations between these measures and vaccination status were evaluated using weighted logistic regression. RESULTS: Caregivers of 1689 children were surveyed. The odds of full vaccination were not associated with composite beliefs (adjusted odds ratio [aOR] 1.04 [95% confidence interval {CI} 0.95 to 1.14]) or experiences scores (aOR 1.04 [95% CI 0.96 to 1.13]). Specific beliefs that vaccines prevent severe disease (aOR 2.68 [95% CI 1.64 to 4.37]) and protect the community (aOR 1.67 [95% CI 1.10 to 2.53]) were positively associated, whereas beliefs that children receive too many vaccines (aOR 0.60 [95% CI 0.44 to 0.83]) were negatively associated with full vaccination. Positive experiences, including knowing someone affected by a vaccine-preventable disease (aOR 2.10 [95% CI 1.47 to 3.00]) were also linked to full vaccination. CONCLUSIONS: Although composite scores were not associated with immunization status, individual beliefs and experiences may still factor into caregiver decisions to vaccinate their children.
Annika K Gunderson, Taeim Kwon, Yohhan Kumarasinghe et al.
SurvivalUG
Peer-reviewed article·PubMed (US National Library of Medicine)·
Objectives. To examine individual-, school-, and neighborhood-level factors associated with COVID-19 primary and booster vaccination among New York City public school students. Methods. We analyzed data from a population-based cohort study of 917 062 students aged 5 to 18 years enrolled in 2021/2022. Enrollment data were linked to the Citywide Immunization Registry, Medicaid claims, and neighborhood indicators (January 2020-July 2023). We assessed multivariable regression associations between vaccination status and demographic, clinical, school, and contextual characteristics. Results. Overall, 51.3% of all students completed the primary series and 10.8% received a booster. Uptake was highest among non-Hispanic Asian students (72.1%; 95% confidence interval [CI] = 71.9, 72.3) and lowest among non-Hispanic Black (42.2%; 95% CI = 42.0, 42.4) and non-Hispanic White students outside Manhattan (39.7%; 95% CI = 39.5, 40.0). Students with preexisting conditions were modestly more likely to have received vaccination than peers (54.9%; 95% CI = 54.8, 55.1 vs 49.8%; 95% CI = 49.7, 49.9). Uptake increased with older age and proximity to vaccination sites but was lower among Medicaid-enrolled students. Conclusions. Coverage in the largest US school district was lower than national pediatric estimates, with only modestly higher coverage among children at elevated medical risk, despite their prioritization in vaccination efforts. Public Health Implications. Children at elevated medical risk remained undervaccinated. Addressing barriers in insurance, neighborhood, and care delivery systems is critical to improving vaccine uptake. (Am J Public Health. Published online ahead of print August 6, 2026:e1-e11. https://doi.org/10.2105/AJPH.2026.308604).
Eric Geng Zhou, Sophia Day, Kira Argenio et al.
Survival
Peer-reviewed article·PubMed (US National Library of Medicine)·
OBJECTIVE: To analyze the classification of the risk of transmission of vaccine-preventable diseases among children under 2 years of age in a large Brazilian municipality in 2022 and 2023. METHOD: Ecological epidemiological study using secondary data on vaccination coverage (VC) for nine immunobiologicals recommended in the vaccination schedule for children under 2 years of age. Immunobiological dose data were obtained from the National Immunization Program Information System (Sistema de Informações do Programa Nacional de Imunizações - SI-PNI), while data were collected from the Ministry of Health website and filtered by place of residence. Data were analyzed using the R software package. RESULTS: In 2022, 100% of the Health Surveillance Units (Unidades de Vigilância em Saúde - UVIS) showed low VC for the second dose of the measles-mumps-rubella (MMR) vaccine. In the same year, 61% and 54% of the UVIS achieved adequate VC for the hepatitis A and human rotavirus vaccines, respectively. In 2023, improvements in VC were observed for most vaccines, except for the meningococcal C and varicella vaccines, which showed a reduction in the number of UVIS achieving adequate VC. Regarding the classification of the risk of reintroduction of vaccine-preventable diseases, the proportion classified as "low and very low" increased from 0% in 2022 to 10.7% in 2023. CONCLUSION: VC improved in 2023 for most vaccines analyzed across the UVIS. However, variations in VC were observed according to vaccine type and year. These findings reinforce the need to maintain regional actions aimed at achieving vaccination targets, given the indications of a recovery in VC.
Mariana de Souza Araújo, José Elisomar Silva de Santana, Melissa Palmieri et al.
Survival
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: Diphtheria remains a vaccine-preventable disease of public health concern in low- and middle-income countries, with recurrent outbreaks linked to immunity gaps among older children and adolescents. In Nigeria, although routine infant immunisation coverage has improved, uptake of recommended booster doses among adolescents remains suboptimal. This study assessed factors associated with acceptance of the diphtheria booster dose among in-school adolescents in Kano metropolis, northern Nigeria. METHODOLOGY: A cross-sectional explanatory sequential mixed-methods study was conducted among 650 adolescents aged 10-19 years. Quantitative data were collected using a structured questionnaire and analysed with descriptive statistics, chi-square tests, and logistic regression. Qualitative data were obtained through focus group discussions and key informant interviews with adolescents, parents, and teachers, and analysed thematically to contextualise quantitative findings. RESULTS: Overall, 81.8% of respondents expressed willingness to accept the diphtheria booster dose. In adjusted analysis, acceptance was significantly associated with being in senior secondary school (aOR = 2.21; 95% CI: 1.31-3.75). Parental marital status (aOR = 0.56; 95% CI: 0.34-0.91), parental education (aOR = 0.58; 95% CI: 0.35-0.94), and knowledge of the booster dose (aOR = 0.20; 95% CI: 0.10-0.41) were also significantly associated with acceptance. Qualitative findings revealed that willingness was often conditional on parental approval, perceived vaccine safety, and service availability. Key barriers included poor awareness, misconceptions, fear of side effects, and limited parental involvement, while facilitators included school-based health education, peer influence, parental encouragement, teacher support, and school-based vaccination platforms. CONCLUSION: Although stated willingness to accept the diphtheria booster dose was high, acceptance is influenced by school-related, parental, and perceptual factors. Strengthening school-based vaccination platforms, enhancing parental engagement, and implementing culturally sensitive communication strategies may improve booster uptake and prevent future outbreaks.
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: Timely hepatitis B vaccine birth-dose (HepBV-BD) vaccination is a cornerstone strategy for preventing mother-to-child transmission of hepatitis B virus (HBV). Although hepatitis B vaccination coverage in China has improved substantially, evidence regarding long-term district-level spatiotemporal inequalities in timely birth-dose vaccination remains limited, particularly in western China. This study assessed spatiotemporal disparities in hepatitis B vaccination coverage across Chongqing, China, from 2016 to 2025. METHODS: This ecological descriptive study used district- and county-level vaccination surveillance data from the Chongqing Immunization Information Management System. Temporal trends in HepBV-BD, timely birth-dose (TBD), HepBV2, and HepBV3 coverage were analyzed. Regional disparities, interregional inequalities, and spatial clustering were assessed using Global Moran's I and Local Indicators of Spatial Association (LISA). RESULTS: All vaccination indicators improved substantially during the study period. TBD coverage increased from 81.9% to 95.4%, whereas HepBV3 coverage increased from 83.7% to 98.7%. TBD coverage was strongly positively associated with HepBV3 coverage(r = 0.95, p < 0.001). Mountainous ethnic minority regions consistently exhibited the lowest TBD coverage despite marked improvement over time. Absolute interregional inequality decreased from 30.8 to 8.4 percentage points. Although Global Moran's I was not statistically significant, LISA analysis identified persistent localized low-coverage clusters in southeastern mountainous regions and emerging high-high clusters in northern Chongqing. CONCLUSIONS: Hepatitis B vaccination coverage in Chongqing improved markedly between 2016 and 2025, accompanied by declining geographic inequality. Nevertheless, persistent spatial inequities in timely birth-dose vaccination remained in mountainous ethnic minority areas. Continued monitoring of spatial inequalities, together with strengthened primary healthcare capacity, culturally tailored health education, and equitable resource allocation, may help support geographically targeted immunization strategies and accelerate progress toward the WHO goal of eliminating viral hepatitis as a public health threat by 2030.
