Evaluation of a school entry immunization record check strategy in 4 counties of Ningxia and Hubei provinces, China

Abstract

China has a national requirement that children's vaccination status is to be checked upon entry to kindergarten and school; children who have missed vaccine doses are to be referred to vaccination clinics to receive the necessary vaccinations. Most provinces have Immunization Information Systems (IIS) that contain and manage vaccination records of children served by immunization clinics. We conducted an evaluation in Hubei and Ningxia provinces using IIS data to determine the effect of their school entry immunization record checking strategy (SECS) on vaccination coverage and rate of catch-up for selected vaccines. We selected two counties with well-functioning IISs from each province. Names and demographic information of children enrolled in 185 kindergartens and 125 primary school in 2016 were used to identify children in the IIS and obtain their vaccination records. We calculated vaccination coverage before and after implementation of the SECS and determined catch-up rates for 5 vaccines, of which 3 are given before 2 years of age and 2 are given after 2 years of age. Among the 20,215 newly-enrolled children, 75% were able to be matched with IIS records. Few children who had missed one or more doses of the 3 vaccines recommended in the first two years of life received catch-up doses after SECS. For vaccines scheduled after 2 years of age, there was a statistically significant (p < 0.05) coverage increase in both provinces following the school-entry record check. Among children who were age-eligible for the selected vaccines before SCES, the catch-up rate was <50%. SECS provides opportunities to identify incompletely vaccinated children, improve coverage, and remind families of school-age children about up-coming vaccinations; SECS has potential to improve completeness of IIS data and enrollment of children in immunization clinics. Evidence-based policy with implementation guidance and routine monitoring are necessary to improve China's school entry checking strategy.

Keywords: Catch up; China; School entry vaccination check program; Vaccination coverage.