Weekly Briefings for China CDC Weekly, Vol 7, No. 17, 2025

Vaccination Status and Incidences of Measles, Mumps, and Rubella — Worldwide, 2014–2023

Qianqian Liu¹; Qi Bi¹; Siyu Liu¹; Yuexin Xiu¹; Fuzhen Wang¹; Zundong Yin¹; Xiaoxue Liu^1,#

1. National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Xiaoxue Liu, liuxx1@chinacdc.cn.

Measles, mumps, and rubella remain significant global health threats despite being vaccine-preventable diseases. The World Health Organization aims to achieve regional elimination of measles and rubella by 2030, yet substantial disparities in vaccination coverage and disease incidence persist across regions. We analyzed global vaccination and disease data to provide evidence for optimizing immunization strategies. We analyzed World Health Organization data on measles, mumps, and rubella from 2014–2023. Our analysis included vaccine types, recommended vaccination schedules, coverage rates, supplemental immunization activities, and disease incidence. We employed descriptive epidemiological methods for data synthesis and analysis. All countries implemented ≥1 measles-containing vaccine dose, with 190 (97.9%) countries using a ≥2-dose schedule. Global 2nd dose of measles-containing vaccine coverage increased from 59% to 74% during the study period. High-income regions maintained >90% coverage, while the African Region reported the lowest coverage (70% for the 1st dose and 49% for the 2nd dose of measles-containing vaccine). Supplemental immunization activities helped address coverage gaps but required integration with routine immunization systems. Rubella vaccine was implemented in 90.2% of countries, while mumps vaccine adoption remained lower at 63.9%. The African Region experienced high incidence rates for both measles (551.8 per million) and rubella (21.9 per million). The COVID-19 pandemic disrupted vaccination coverage (3–5% decline globally), with the African Region experiencing a post-pandemic U-shaped resurgence in cases. China's transition to measles, mumps, and rubella vaccine reduced mumps incidence to below 100 cases per million by 2020. While global control of measles, mumps, and rubella has progressed, inequities in vaccination coverage and pandemic-related disruptions threaten elimination goals. Strengthening routine immunization systems is critical. Achieving the World Health Organization’s 2030 targets will require sustained investment in health systems and implementation of equity-focused innovations.

全球麻疹、流行性腮腺炎和风疹免疫状况及发病趋势分析，2014–2023年

刘倩倩¹；毕琪¹；刘斯宇¹；修乐欣¹；王富珍¹；尹遵栋¹；刘晓雪^1,#

1.  传染病溯源预警与智能决策全国重点实验室，免疫规划中心，中国疾病预防控制中心，北京，中国。

^# 通信作者：刘晓雪，liuxx1@chinacdc.cn。

麻疹、流行性腮腺炎（流腮）和风疹虽属疫苗可预防疾病，仍是全球公共卫生重大威胁。世界卫生组织（WHO）提出2030年前实现区域消除麻疹与风疹目标，但疫苗接种率与疾病发病水平仍存在显著地域差异。本研究通过系统分析全球各国疫苗接种与疾病数据，旨在为优化免疫策略提供科学依据。文章基于WHO 2014–2023年麻疹、流腮及风疹数据，整合分析疫苗种类、接种程序、接种率、补充免疫活动（SIAs）及发病率等指标，采用描述性流行病学方法进行综合分析。所有国家均实施≥1剂次麻疹疫苗接种，190个国家（97.9%）采用≥2剂次程序。研究期间全球含麻疹成分疫苗第二剂接种率从59%提升至74%：高收入地区（欧洲区、西太平洋区）维持>90%接种率；非洲区接种率最低（首剂70%、第二剂49%）。补充免疫活动虽可短期填补免疫缺口，但需与常规免疫工作相结合。风疹疫苗应用率达90.2%，但腮腺炎疫苗纳入率仍较低（63.9%）。非洲区麻疹（551.8例/100万）与风疹（21.9例/100万）发病率居高不下。COVID-19导致全球疫苗接种率下降3-5%，非洲区出现"U型"反弹。中国过渡至两剂次MMR疫苗后，2020年起流腮发病率降至100/100万以下。全球麻疹、流腮与风疹防控取得进展，但接种率不均衡与疫情冲击等因素影响消除进程。加强常规免疫接种体系至关重要，需持续投入卫生系统建设并实施公平导向的创新策略，方有望实现WHO 2030年目标。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.094

Epidemiological and Clinical Features of Meningococcal Meningitis in Infants — China, 2006–2023

Qian Zhang¹; Jiajia Zhou¹; Mingshuang Li¹; Tingting Yan¹; Dan Wu¹; Zhijie An¹; Zundong Yin¹; Hui Zheng^1,#

1. National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease (NITFID), National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Hui Zheng, zhenghui@chinacdc.cn.

Infants have the highest incidence of meningococcal meningitis (MM) among all age groups in China. Infants receive their first and second doses of serogroup A meningococcal polysaccharide vaccine at 6 and 9 months of age. We extracted data on MM cases among 0–11-month-old children reported during 2006–2023 from the National Notifiable Diseases Registry System and the National Meningococcal Disease Surveillance System and conducted an epidemiological and clinical analysis. During the study period, 721 infant MM cases were reported. Incidence decreased from 7.31 cases per million to 2.74 per million, while the all-age incidence declined from 1.27 cases per million to 0.06 per million. Among 210 cases with serogrouping results, five serogroups (A, B, C, W, Y) and non-groupable strains were detected. Serogroup A cases decreased from 36.36% to 1.87% during the study period, while serogroup B increased from 14.55% to 67.29%. Fever, nausea, and/or vomiting were common symptoms across all serogroups. The frequencies of petechiae and/or purpura in serogroup A (73%) and C (92%) were substantially higher than in other serogroups. Among serogroup B cases, 26.42% developed petechiae or purpura, 26.42% exhibited neck stiffness, and 13.21% had positive Kernig's or Brudzinski's signs. The incidence of MM in infants has significantly decreased but remains higher than incidence across all age groups. Serogroup B cases were the most common. Atypical symptoms in infant cases challenge timely diagnosis. We suggest eligible infants receive meningococcal vaccination timely, and the development of serogroup B meningococcal vaccines should be accelerated.

婴儿流脑病例流行病学和临床特征分析 — 中国，2006-2023年

张倩¹；周佳佳¹；李明爽¹；闫婷婷¹；吴丹¹；安志杰¹；尹遵栋¹；郑徽^1,#

1. 传染病溯源预警与智能决策全国重点实验室，免疫规划中心，中国疾病预防控制中心，北京，中国。

^# 通讯作者: 郑徽，zhenghui@chinacdc.cn。

在中国，0-11月龄婴儿报告流行性脑脊髓膜炎（简称流脑）发病率在所有年龄组中最高。按照国家免疫规划接种程序，婴儿分别在6月龄和9月龄接种1剂次A群流脑多糖疫苗。在本研究中，2006-2023年0-11月龄婴儿流脑发病资料来源于全国法定传染病报告系统；流脑病例血清分群和临床症状资料来源于全国流脑监测信息报告管理系统。研究运用描述性流行病学方法开展分析。2006-2023年，全国共报告721例婴儿流脑病例，报告发病率由7.31/100万下降至2.74/100万，全年龄组发病率自1.27/100万下降至0.06/100万。在210例报告了分群结果的流脑病例中，共检出五种血清群（A、B、C、W、Y）和未分群；其中A群病例占比自36.36%下降到1.87%，而B群则自14.55%上升至67.29%。发热、恶心和/或呕吐是婴儿流脑病例的常见症状，在各血清群间无显著差异。A群（73%）和C群（92%）病例中出现瘀点瘀斑的可能性高于其他群病例。在B群病例中，26.42%出现了瘀点瘀斑，26.42%表现出颈项强直，13.21%有布氏征或克氏征。2006-2023年，我国婴儿流脑发病率显著下降，但仍高于全年龄组总体发病率。B群脑膜炎球菌成为婴儿流脑的主要致病菌群。婴儿流脑病例临床表现常不典型，给及时诊断带来挑战。我们建议适龄婴儿应及时接种脑膜炎球菌疫苗，并应加快研发B群脑膜炎球菌疫苗。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.095

Post-Marketing Surveillance of Adverse Events Following Recombinant Zoster Vaccine — China, 2020–2023

Yan Li¹; Keli Li^1,#; Minrui Ren¹; Yuan Li¹; Lina Zhang¹; Chunxiang Fan¹; Zhaonan Zhang¹; Lei Cao¹; Wenzhou Yu¹; Zundong Yin¹

1. National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding authors: Keli Li, likl@chinacdc.cn.

To assess adverse events following recombinant zoster vaccine (RZV) in China during the post-marketing period. The study obtained data on adverse events following immunization (AEFI)   and vaccination doses of RZV from the Chinese National Immunization Information System (CNIIS). We analyzed  RZV AEFI reports from 2020 through 2023. During the study period, 1.99 million doses of RZV were administered and 10,525 RZV AEFI cases were reported. The reporting incidence of AEFI was 527.76 per 100,000 doses administered, with serious AEFI at 0.55, common vaccine reactions (usually minor) at 518.19, and rare vaccine reactions (possibly serious) at 4.06 per 100,000 doses. Among adverse vaccine reactions, the most frequently reported common vaccine reactions were fever (333.76/100,000) and local redness and swelling (213.51/100,000), while the main reported rare vaccine reaction was allergic rash (3.01/100,000). Most RZV AEFIs were common vaccine reactions, consistent with adverse events reported in RZV clinical trials.  The incidence of rare vaccine reactions was very low，and most of which were allergic rash. No special safety concerns were identified  and AEFI surveillance should be continued.

重组带状疱疹疫苗疑似预防接种异常反应监测分析 — 中国，2020–2023年

李燕¹；李克莉^1,#；任敏睿¹；李媛¹；张丽娜¹；樊春祥¹；张肇南¹；曹雷¹；余文周¹；尹遵栋¹

1. 传染病溯源预警与智能决策全国重点实验室，免疫规划中心，中国疾病预防控制中心，北京，中国。

^# 通信作者：李克莉，likl@chinacdc.cn。

本研究评估了中国重组带状疱疹疫苗（RZV）上市后的疑似预防接种异常反应（AEFI）监测情况。研究通过中国国家免疫规划信息系统获得2020-2023年RZV AEFI数据和RZV接种数据，分析2020-2023年RZV AEFI报告情况。2020至2023年，共报告接种RZV199万剂次，报告接种后AEFI 10525例。AEFI报告发生率为527.76/10万剂，其中严重AEFI报告发生率为0.55/10万剂，一般反应报告发生率为518.19/10万剂，异常反应报告发生率为4.06/10万剂。不良反应中，最常报告的一般反应为发热和局部红肿，报告发生率分别为333.76/10万剂、213.51/10万剂；报告较多的异常反应为过敏性皮疹，报告发生率为3.01/10万剂。大多数RZV AEFI为一般反应，与临床试验报告情况一致。异常反应报告发生率极低，其中过敏性皮疹报告居多。未发现需特别关注的安全性担忧，需持续进行AEFI监测。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.092

Post-Marketing Surveillance of Adverse Events Following Rotavirus Vaccination — China, 2013–2023

Yuan Li¹; Keli Li^1,#; Yan Li¹; Chunxiang Fan¹; Lina Zhang¹; Minrui Ren¹; Lei Cao¹; Wenzhou Yu¹; Zundong Yin¹

1. National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Keli Li, Likl@chinacdc.cn.

The safety of rotavirus vaccine (RV) is a significant concern worldwide, particularly regarding whether RVs can cause intussusception, as did the world's first RV. Two live attenuated RVs were licensed in China. Passive surveillance for adverse events following immunization (AEFI) provides valuable evidence for potential safety signal detection of RV in China. We obtained data on RV doses administered and RV AEFI reports from the Chinese National Immunization Information System (CNIIS) during January 2013 to December 2023. We conducted a descriptive analysis of RV AEFI characteristics and estimated incidences of RV-related AEFI. During the study period, 77.36 million doses of RV were administered and 20,556 RV-related AEFI reports were made, yielding an overall incidence of 26.57 AEFI per 100,000 doses administered; incidences were 26.42 for RV1 and 26.85 for RV5. Among all RV AEFI, 20,334 (98.92%) were non-serious. Vaccine product-related reactions accounted for 95.68% of AEFI reports, including 18,192 (88.50%) common and 1,476 (7.18%) rare vaccine reactions. Among common vaccine reactions, case reports per 100,000 doses administered were 16.85 (13,031 reports) for fever, 5.84 (4,520 reports) for gastrointestinal disorders, and 1.28 (988 reports) for rash. Among rare vaccine reactions, case reports per 100,000 doses were 1.43 (1,104 reports) for allergic rash, 0.07 (56 reports) for thrombocytopenic purpura, 0.03 (26 reports) for febrile convulsion, and 0.01 (5 reports) for intussusception. Most RV AEFI were mild and non-serious, and the incidence of rare vaccine reactions was very low. RVs have favorable safety surveillance profiles and AEFI evaluation should be continued.

轮状病毒疫苗疑似预防接种异常反应监测分析 — 中国，2013–2023年

李媛¹，李克莉^1,#，李燕¹，樊春祥¹，张丽娜¹，任敏睿¹，曹雷¹，余文周¹，尹遵栋¹

1.传染病溯源预警与智能决策全国重点实验室，免疫规划中心，中国疾病预防控制中心，北京，中国。

^# 通信作者: 李克莉，Likl@chinacdc.cn。

研究分析了中国2013-2023年轮状病毒疫苗（Rotavirus vaccine, RV）疑似预防接种异常反应（Adverse events following immunization, AEFI）监测数据。从中国疾病预防控制信息系统免疫规划系统，收集2013年1月至2023年12月RV接种数据和AEFI报告数据，对RV AEFI报告特征进行描述性分析，并计算AEFI报告发生率。2013-2023年，中国共接种7,736万剂RV，并报告20,556例RV相关AEFI，AEFI总报告发生率为26.57/10万剂；单价RV和五价RV的报告发生率分别为26.42/10万剂和26.85/10万剂。AEFI中非严重病例占98.92%（20,334例），不良反应占95.68%，其中一般反应18,192例（88.50%），异常反应1,476例（7.18%）。一般反应中，发热、胃肠道疾病、皮疹报告发生率分别为16.85/10万剂（13031例）、5.84/10万剂（4520例）、1.28/10万剂（988例）。异常反应中，过敏性皮疹、血小板减少性紫癜、热性惊厥、肠套叠报告发生率分别为1.43例/10万剂（1104例）、0.07例/10万剂（56例）、0.03例/10万剂（26例）、0.01例/10万剂（5例）。RV AEFI多为轻微、非严重AEFI，异常反应报告发生率极低。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.093

Cost-Effectiveness Analysis of Sequential Screening Strategies for Hepatitis B Virus Infection by Birth Cohort — China

Lei Wang¹; Hui Zheng¹; Lanfang Xia¹; Guomin Zhang¹; Fuzhen Wang¹; Zundong Yin¹; Huaqing Wang^1,#

1 National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding authors: Huaqing Wang, wanghq@chinacdc.cn.

Eliminating hepatitis B virus (HBV) as a major public health threat is a global health priority that requires cost-effective screening strategies. This study evaluated the cost-effectiveness of sequential birth cohort HBV screening strategies in China. Using a Markov model, we compared five screening strategies with current practice, calculating HBV-related deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICER). One-way deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the results. The sequential birth cohort screening strategy (Sequential Screening 1: screening the 1991–2000 cohort in 2025–2026, the 1971–1990 cohort in 2027–2028, and the 1951–1970 cohort in 2029–2030) was the most cost-effective, with an ICER of 58,523 Chinese Yuan (CNY) per QALY at a willingness-to-pay threshold of three times the per-capita Gross Domestic Product (GDP). An alternative strategy that prioritized the 1951–1970 cohort in 2025–2026 averted the most HBV-related deaths (approximately 3.44 million) and gained 24.9 million QALYs, with an ICER of 60,113 CNY per QALY, also showing cost-effectiveness. Our findings support sequential birth cohort screening as an optimal and innovative approach to achieving the WHO HBV elimination targets, offering evidence-informed guidance for policymakers to optimize screening programs and resource allocation.

乙型肝炎病毒感染逐步队列筛查策略成本-效果分析 — 中国

王磊¹；郑徽¹；夏兰芳¹；张国民¹；王富珍¹；尹遵栋¹；王华庆^1,#

1.传染病溯源预警与智能决策全国重点实验室，免疫规划中心，中国疾病预防控制中心，北京，中国。

^# 通信作者：王华庆，wanghq@chinacdc.cn。

消除乙型病毒性肝炎公共卫生危害是全球卫生的优先事项，这需要具有成本效果的筛查策略，本研究对中国实施逐步队列筛查策略的成本效果进行了评价。采用Markov模型，将五种筛查策略与维持当前现状相比，计算避免HBV相关死亡人数、获得质量调整生命年（QALYs）以及增量成本-效果比（ICER）。采用单因素敏感性分析和概率敏感性分析评价研究结果的可靠性。以三倍人均国内生产总值（GDP）作为意愿支付阈值，逐步队列筛查策略（逐步筛查策略1：在2025-2026年筛查1991-2000年队列人群，在2027-2028年筛查1971-1990年队列人群，在2029-2030年筛查1951-1970年队列人群）最具有成本效果，ICER为58,523元/每获得1个QALY。另一种逐步队列筛查策略，优先在2025-2026年筛查1951-1970年队列人群，避免HBV相关死亡人数最多（约344万例），并获得2490万QALYs，ICER为60,113元/每获得1个QALY，同样具有成本效果。本研究结果表明，为实现世界卫生组织（WHO）消除乙肝这一目标，逐步队列筛查策略是一种最佳且具有创新性的策略，能为决策者优化筛查措施和资源分配提供循证依据。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.096

A Novel Adaptive Design Approach for Early-Phase Clinical Trials to Optimize Vaccine Dosage

Xin Tong^1,2,&; Dongfang You^1,&; Fang Shao¹; Mengyi Lu^1,2,#; Yang Zhao^1,3,#

1. Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing City, Jiangsu Province, China;

2. National Vaccine Innovation Platform, Nanjing Medical University, Nanjing City, Jiangsu Province, China;

3. Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing City, Jiangsu Province, China.

^& Joint first authors.

^# Corresponding authors: Yang Zhao, yzhao@njmu.edu.cn; Mengyi Lu, mylunjyk@njmu.edu.cn.

Vaccines are a cornerstone of global health, with their efficacy and safety dependent on appropriate dosage determination. Early-phase vaccination trials face significant challenges due to minimal toxicity and nonmonotonic dose response curves, creating a major obstacle in vaccine development. To address this gap, we propose a novel Bayesian phase I/II trial design for dose response curves exhibiting plateau or unimodal patterns to identify the optimal biological dose (OBD), effectively balancing efficacy and toxicity. We employ a logistic dose-efficacy design that makes dose escalation and de-escalation decisions while simultaneously considering both efficacy and safety. Extensive simulation studies evaluate the performance of this design. Comparative analyses with commonly used vaccine dose-finding designs demonstrate that our method excels in identifying the optimal toxicity-efficacy trade-off, offering both simplicity and accuracy. Sensitivity analyses across various prior settings confirm the robustness and efficiency of our approach. Additionally, our design provides a user-friendly framework for clinicians, with superior operating performance compared to existing designs, particularly in terms of accuracy and robustness. Our innovative Bayesian design represents a significant advancement in addressing the inherent challenges of early-phase vaccination clinical trials, offering improved accuracy and efficacy in vaccine dosage determination.

一种用于早期临床试验的新型自适应设计用于疫苗剂量优化

童心^1,2,&；尤东方^1,&；邵方¹；陆梦依^1,2,#; 赵杨^1,3,#

1. 生物统计学系，公共卫生学院，南京医科大学，南京市，江苏省，中国；

2. 国家疫苗研发创新平台，南京医科大学，南京市，江苏省，中国；

3. 江苏省恶性肿瘤生物标志物与防治重点实验室，肿瘤个体化医学省部共建协同创新中心，南京医科大学，南京市，江苏省，中国。

^& 共同第一作者。

^# 通信作者：赵杨，yzhao@njmu.edu.cn；陆梦依，mylunjyk@njmu.edu.cn。

疫苗是全球健康的基石，其有效性与安全性依赖于合理的剂量探索方法。然而，在早期疫苗临床试验阶段，常因疫苗的毒性反应较弱，且剂量反应关系呈非单调模式，从而成为疫苗研发过程中的关键难题。针对这一问题，本文提出了一种新型的贝叶斯 I/II 期临床试验设计，针对呈现平台或单峰形状的剂量反应曲线，识别疗效-毒性权衡下的最优生物剂量(OBD)。本设计基于logistic剂量-疗效模型，在考虑疗效和安全性的同时做出剂量升降的决策，并通过大量的模拟试验来评估该设计的表现性能。与现有主流疫苗剂量探索设计相比，本设计在实现毒性-疗效的最佳权衡方面表现出色，兼具简便性与准确性。在不同先验设定下，该设计具备良好的稳健性与高效性。此外，该设计对临床医生具有良好的可操作性，显示出优于现有设计的实际应用潜力。本研究提出的贝叶斯Ⅰ/Ⅱ期试验设计为疫苗剂量探索提供了新方案，有助于提升早期试验的科学性与效率，具有良好的临床应用前景。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.097