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The December 2019 average weekly vaccine doses administered was used as the baseline of doses administered. On January 25, 2020, the Level 1 Response was declared, and most vaccination clinics suspended services. Figure 1 shows the number of NIP vaccine doses administered over time in Hubei Province and China outside of Hubei. The week after the declaration of the Level 1 Response, NIP vaccine doses administered declined by 90% for 4 weeks; in Hubei Province, doses administered remained low for 6 weeks. Following issuance of catch-up guidance, national catch-up vaccination activity began during the week of March 16–March 22, and vaccinations rapidly returned to pre-pandemic levels. Figure 1 also shows non-NIP vaccine doses administered over time. Non-NIP vaccine doses administered declined more sharply than NIP vaccine doses administered and remained low for a longer time.
Figure 1.NIP and non-NIP vaccine doses administered weekly in sampled vaccination clinics. (A) NIP vaccine doses administered in Hubei Province. (B) NIP vaccine doses administered outside of Hubei Province. (C) Non-NIP vaccine doses administered in Hubei Province. (D) Non-NIP vaccine doses administered outside of Hubei Province. Abbreviations: NIP=National Immunization Program; PLADs=province-level administrative divisions.
* The December 2019 average weekly NIP vaccine doses administered as a baseline of doses administered in Hubei Province. † The December 2019 average weekly NIP vaccine doses administered as a baseline of doses administered in China outside of Hubei Province. § The December 2019 average weekly non-NIP vaccine doses administered as a baseline of doses administered in Hubei Province. ¶ The December 2019 average weekly non-NIP vaccine doses administered as a baseline of doses administered in China outside of Hubei Province.Between January 23, 2020 and March 20, 2020, 41 (13%) of the 324 vaccination clinics surveyed continuously provided routine vaccination services for all vaccines; 283 (87%), including all Hubei clinics, suspended vaccination services for vaccines other than HepB1, BCG, rabies, and tetanus.
Figure 2 shows coverage on the 20th of each month for timely HepB1 and BCG vaccines, the primary series of 3 doses of poliovirus vaccine, 2 doses of measles-containing vaccine (MCV), 3 doses of hepatitis B vaccine (HepB), and 3 doses of diphtheria, tetanus toxoids and acellular pertussis combined vaccine (DTaP). Coverage began to decline in January 2020 and reached the lowest levels in February. Coverage for vaccines that were recommended to continue during clinic suspensions (HepB1 and BCG) decreased little, but the other vaccines had marked declines in coverage. Coverage began to recover in March after vaccination catch-up activities began and returned to December 2019 levels by May or June.
Figure 2.Coverage for specific vaccines reported by provincial-level administrative divisions based on standard vaccine administrative coverage reports. (A) Coverage for the 1st dose of HepB-timely vaccine. (B) Coverage for BCG vaccine. (C) Coverage for the 3rd dose of HepB vaccine. (D) Coverage for the 3rd dose of poliovirus vaccine. (E) Coverage for the 3rd dose of DTaP vaccine. (F) Coverage for the 2nd dose of measles-containing vaccine. Abbreviations: HepB=hepatitis B vaccine; BCG=Bacillus Calmette-Guérin vaccine; Polio=polioviru vaccine; DTaP=diphtheria, tetanus toxoids and acellular pertussis vaccine; MCV=measles-containing vaccine.
Table 1 shows results of the catch-up activities and resumption of routine immunization services PLAD-by-PLAD as of October 31, 2020. Among all clinics, 98.6% (range by PLAD: 83.6%–100.0%) were offering routine immunization services; PLADs had identified 69,245,168 NIP vaccine doses that needed to be caught up; among these, 93.9% (rang: 61.1%–100.0%) were administered by the end of October. Provinces identified 21,125,450 non-NIP vaccines that needed to be caught up; by the end of October, 96.2% (range: 87.0%–100.0%) had been administered.
PLADs Vaccination clinics NIP vaccines Non-NIP vaccines Percent providing services (%) Delayed doses* Catch-up doses Proportion (%) Delayed doses† Catch-up doses Proportion (%) Beijing§ − − − − − − − Tianjin 100.0 32,075 31,630 98.6 9,762 9,502 97.3 Hebei 99.9 7,228,632 6,964,041 96.3 2,669,102 2,509,140 94.0 Shanxi 99.9 1,462,997 1,346,620 92.1 405,745 382,112 94.2 Inner Mongolia 99.8 939,486 893,109 95.1 186,617 183,835 98.5 Liaoning 99.9 1,118,704 1,054,974 94.3 261,928 251,225 95.9 Jilin 98.7 382,524 349,567 91.4 130,856 122,509 93.6 Heilongjiang 99.9 637,656 577,515 90.6 115,797 110,763 95.7 Shanghai 100.0 897,991 865,132 96.3 185,417 185,417 100.0 Jiangsu 100.0 3,528,687 3,478,797 98.6 639,167 628,668 98.4 Zhejiang 99.9 2,986,684 2,950,844 98.8 1,455,320 1,391,286 95.6 Anhui 99.9 4,447,023 4,155,207 93.4 2,179,128 2,038,938 93.6 Fujian 100.0 1,562,159 1,499,684 96.0 430,223 417,319 97.0 Jiangxi 99.8 1,774,694 1,700,334 95.8 813,939 771,354 94.8 Shandong 100.0 3,919,999 3,738,325 95.4 1,757,863 1,757,863 100.0 Henan 100.0 6,790,723 6,493,789 95.6 2,174,028 2,078,188 95.6 Hubei 99.7 4,794,164 4,589,315 95.7 66,752 62,933 94.3 Hunan 100.0 1,045,019 995,186 95.2 483,531 420,817 87.0 Guangdong 100.0 5,742,000 5,397,965 94.0 858,000 802,230 93.5 Guangxi 100.0 3,588,731 3,294,704 91.8 2,311,663 2,311,663 100.0 Hainan 100.0 560,774 528,880 94.3 130,154 126,392 97.1 Chongqing 100.0 928,856 903,312 97.3 51,775 51,775 100.0 Sichuan 100.0 2,846,229 2,665,495 93.7 1,238,050 1,167,422 94.3 Guizhou 100.0 3,124,650 3,114,981 99.7 799,961 798,538 99.8 Yunnan 98.1 765,741 722,294 94.3 263,412 252,670 95.9 Tibet 100.0 1,049,504 641,587 61.1 89,130 89,130 100.0 Shaanxi 99.9 1,512,670 1,482,942 98.0 340,744 332,159 97.5 Gansu 100.0 18,793 18,793 100.0 111,965 111,965 100.0 Qinghai 100.0 56,579 53,220 94.1 14,057 13,890 98.8 Ningxia 100.0 390,378 382,662 98.0 82,498 82,498 100.0 Xinjiang 83.6 5,043,800 4,044,873 80.2 859,350 859,350 100.0 Production and Construction Corps 100.0 67,246 67,246 100.0 9,516 9,250 97.2 Total 98.6 69,245,168 65,003,023 93.9 21,125,450 20,330,801 96.2 Note: The COVID-19 epidemic period was calculated from the date of the first province in China launched the Level 1 Response to the date of the last province in China lowered the Level 1 Response (24 January 2020–2 May 2020).
Abbreviations: NIP=National Immunization Program; PLADs=province-level administrative divisions.
* The doses of the NIP vaccines for children who missed or delayed vaccine doses due to COVID-19, including children who have reached the vaccine starting age specified in the NIP vaccine immunization procedure on any day during the COVID-19 epidemic and those who have missed the NIP vaccine, were included in the doses of delayed NIP vaccinations due to the COVID-19 epidemic.
† The doses of the non-NIP vaccines for children who missed or delayed vaccine doses due to COVID-19, including children who have reached the starting age of the vaccine immunization program of the non-NIP vaccines, have been scheduled for vaccination on any day during the COVID-19 epidemic. The doses of delayed non-NIP vaccinations due to the COVID-19 epidemic will be counted.
§ Beijing Municipality provided routine vaccination services during COVID-19 epidemic, so no date was reported.Table 1. Vaccination clinics providing services at the end of October 2020 and delayed and caught up vaccinations of NIP and non-NIP vaccines based on reports from PLADs.
Table 2 shows results of the catch-up activities month-by-month and vaccine-by-vaccine for selected NIP vaccines. Using vaccine doses administered in December 2019 as a comparison, the table illustrates declines from baseline followed by catch-up vaccinations above baseline.
Vaccines 19-Dec* 20-Jan 20-Feb 20-Mar 20-Apr 20-May 20-Jun Doses Doses Ratio (%) Doses Ratio (%) Doses Ratio (%) Doses Ratio (%) Doses Ratio (%) Doses Ratio (%) HepB 61,799 47,484 76.8 25,931 42.0 71,183 115.2 64,802 104.9 55,201 89.3 −† − BCG 20,312 18,405 90.6 15,676 77.2 18,519 91.2 16,252 80.0 14,333 70.6 −§ − Polio¶ 73,633 51,338 69.7 12,283 16.7 75,659 102.8 92,596 125.8 87,722 119.1 87,125 118.3 DTaP** 85,204 55,422 65.1 12,194 14.3 79,239 93.0 103,876 121.9 102,910 120.8 94,691 111.1 DT 14,104 9,208 65.3 1,040 7.4 13,058 92.6 22,226 157.6 25,616 181.6 25,380 180.0 MCV†† 37,892 23,970 63.3 6,303 16.6 50,293 132.7 54,040 142.6 45,852 121.0 42,650 112.6 MPSV-A§§ 36,656 21,193 57.8 3,756 10.3 26,745 73.0 31,280 85.3 43,666 119.1 42,846 116.9 MPSV-AC¶¶ 27,485 18,800 68.4 1,914 7.0 24,462 89.0 41,057 149.4 40,179 146.2 41,912 152.5 JE*** 42,771 27,052 63.3 5,072 11.9 39,428 92.2 55,883 130.7 50,079 117.1 48,013 112.3 HepA††† 24,056 16,121 67.0 2,672 11.1 21,371 88.8 33,712 140.1 33,047 137.4 32,676 135.8 Total 423,912 288,993 68.2 86,841 20.5 419,957 99.1 515,724 121.7 498,605 117.6 415,293 121.5 Abbreviations: HepB=hepatitis B vaccine; BCG=Bacillus Calmette-Guérin vaccine; Polio=poliovirus vaccine; DTaP=diphtheria, tetanus toxoids and acellular pertussis vaccine; DT=diphtheria and tetanus toxoids vaccine; MCV=measles-containing vaccine; MPSV-A=group A meningococcal polysaccharide vaccine; MPSV-AC=group A and C meningococcal polysaccharide vaccine; JE=Japanese encephalitis vaccine; HepA=hepatitis A vaccine.
* The baseline was vaccine doses administered in December 2019.
† The HepB1 vaccine doses administered was not available in June 2020.
§ The BCG vaccine doses administered was not available in June 2020.
¶ Included children who might have been vaccinated with bivalent oral attenuated live poliovirus vaccine, trivalent inactivated poliovirus vaccine, diphtheria,tetanus toxoids,acellular pertussis (adsorbed),inactivated poliovirus and haemophilus type b conjugate vaccine.
** Included children who might have been vaccinated with diphtheria-tetanus toxoids-acellular pertussis combined vaccine (adsorbed), diphtheria, tetanus toxoids, acellular pertussis (adsorbed) and haemophilus type b combined vaccine, diphtheria, tetanus toxoids, acellular pertussis (adsorbed), inactivated poliovirus and haemophilus type b conjugate vaccine.
†† Included children who might have been vaccinated with live attenuated measles vaccine, live attenuated measles and rubella combined vaccine, live attenuated measles and mumps combined vaccine, live attenuated measles, rubella and mumps combined vaccine.
§§ Included children who might have been vaccinated with group A meningococcal polysaccharide vaccine, group A and C meningococcal conjugate vaccine, group A and C meningococcal and haemophilus type b conjugate vaccine.
¶¶ Included children who might have been vaccinated with group A and C meningococcal polysaccharide vaccine, and group ACYW135 meningococcal polysaccharide vaccine.
*** Included children who might have been vaccinated with live attenuated Japanese Encephalitis vaccine, and inactivated Japanese encephalitis vaccine.
††† Included children who might have been vaccinated with live attenuated hepatitis A vaccine, inactivated hepatitis A vaccine, inactivated hepatitis A and rDNA hepatitis B combined vaccine.Table 2. Comparison of vaccine doses administered monthly in sampled vaccination clinics from January 2020 to June 2020 with vaccine doses administered in December 2019 based on individual records from Immunization Information System (IIS).
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