45 years of immunization program to include 14 types of vaccines to prevent 15 diseases [since the full implementation of immunization in 1978, the incidence of preventable infectious diseases in China has dropped to a historical low]

Since 1978, China has fully implemented planned immunization, and it has been 45 years since then, and the vaccines included in the immunization program have gradually expanded from the initial 4 to 14, which can prevent 15 diseases such as hepatitis B and polio.

The implementation of the national immunization program has effectively controlled some infectious diseases and built immune barriers for children's health and safety. Today, China has interrupted the transmission of indigenous poliovirus, and after universal vaccination against newborns against hepatitis B, the carrier rate of hepatitis B virus among children under 5 years of age in China has dropped from 1992.9% in 7 to 2014.0% in 3, and nearly 3000 million fewer children infected with hepatitis B virus.

Vaccination has prevented countless child disabilities and deaths

Vaccination is the most effective means of preventing and controlling infectious diseases. The invention of vaccines and vaccination are also humanity's greatest public health achievements. Universal vaccination has averted countless child disabilities and deaths, and governments around the world have made vaccination a top public prevention service priority.

One day in mid-April, at around 4 a.m., at a community health service center in Fengtai District, Ms. Bai brought her eight-month-old child to be vaccinated. This time, the child will be vaccinated with the flow brain vaccine, which belongs to a type of vaccine, which means that the vaccination is free.

In the lobby of the community health service center, Ms. Bai first picked up the number on the number machine and then waited for the call. Although the child is only eight months old, Ms. Bai already knows the vaccination process, "The last time I came to get vaccinated, the staff had already told me the approximate time, and I made an appointment in advance on the baby (vaccination appointment mini program) and just followed the time. ”

The Beijing News reporter saw at the scene that many parents who brought their children to be vaccinated can get the number by showing the appointment code on the number machine, and the appointment time is in units of half an hour, and parents can choose the time period in advance. There are no more than 10 parents waiting in line for vaccination registration. After registration, it is time to go to the vaccination room for vaccination.

On the other side of the hall, there is also an observation area, where fully vaccinated children will observe for half an hour, and after confirming that there are no adverse reactions, they will leave the community health service center.

This process is the "standard process" for children to be vaccinated under the national immunization program process. It is also the establishment and improvement of the national immunization program that has effectively controlled the spread of a variety of infectious diseases.

Ms. Bai said that in addition to vaccinating her children according to the national immunization program's childhood immunization schedule, she also chose other types of vaccines such as pneumonia for her children, which parents often call self-paid vaccines. "I am very concerned about this information, and I will give my children the necessary vaccines." Ms. Bai said.

The cost of vaccines and syringes is covered by the central treasury

In September 1978, the Ministry of Health proposed to implement planned immunization throughout the country within three years, establish a three-level epidemic prevention network at the county level, commune (street) and brigade (neighborhood committee), establish planned immunization cards, books, forms, registers and rules and regulations, formulate plans and ensure the supply of biological products, organize vaccination according to the plan, and strive to eliminate diphtheria, polio, measles and other infectious diseases as soon as possible. This also marks the beginning of the planned implementation of childhood vaccination in China, and four vaccines, namely BCG, polio vaccine (polio vaccine), diphtheria, tetanus, and measles vaccine, have been included.

Universal childhood immunization is accompanied by increasing vaccination rates. In 1988 and 1990, BCG, polio, diphtheria, and measles vaccines reached the provincial and district vaccination targets of 85 per cent. In 1996, the above-mentioned vaccination rate reached the target of 85 per cent on a commune basis.

Over time, the number of vaccines included in immunization programmes has also increased. In 2002, the state included hepatitis B vaccine in the national planned immunization of children, and the number of vaccines in the immunization program reached five. The inclusion of hepatitis B vaccine is not unrelated to the prevention and treatment of hepatitis B virus at that time. In 5, the Ministry of Health issued the "2006-2006 National Plan for the Prevention and Control of Hepatitis B Viral Hepatitis", which proposed the prevention and control target of reducing the positive rate of hepatitis B surface antigen (HBsAg) in children under 2010 years of age to less than 5%, and in 1-2009, 2011.1994 million children in the birth cohort from 2001 to 6832 who were not vaccinated or did not complete the full hepatitis B vaccine vaccination nationwide.

In 2007, the State Council decided to expand the national immunization program to include hepatitis A vaccine, meningococcal meningitis vaccine, Japanese encephalitis vaccine, measles mumps rubella combination vaccine into the national immunization program, replace the whole cell diphtheria-tetanus-pertussis combination vaccine with acellular diphtheria, tetanus, and leptospirosis vaccine for specific groups of people in endemic areas.

So far, China's immunization program has increased to 14 vaccines, which can prevent 15 infectious diseases. At the same time, the cost of purchasing vaccines and syringes for immunization programmes, which was previously borne by provincial finances, was paid for by the central government.

Immunization coverage remained above 90%.

After the implementation of the national immunization program, the vaccination rate has increased significantly, and by 2013, the vaccination rate of the national immunization program at the township level has reached the target of 90%, and the vaccination service network has gradually improved. By the end of 2020, there were 82555,2022 vaccination units nationwide, and a vaccine service system covering the whole country had been established. In February 2, the National Health Commission held a press conference on the progress and effectiveness of major disease prevention and control since the 90th National Congress of the Communist Party of China, and the relevant person in charge said that China has established an immunization planning monitoring and management system covering the national, provincial, municipal and county levels and a three-level vaccination service network at the county, township and village levels. National immunization programme vaccination coverage continues to remain above <>%.

This has also effectively controlled the onset of vaccine-specific infectious diseases, and the incidence of vaccine-preventable infectious diseases has also been reduced to an all-time low. This change can be seen in a set of data.

Through oral polio sugar pills, since 1995, China has interrupted the transmission of indigenous poliovirus, saving thousands of children from physical disabilities; After the popularization of neonatal hepatitis B vaccination, the hepatitis B virus carrier rate of children under 5 years of age in China has dropped from 1992.9% in 7 to 2014.0% in 3, and the number of children infected with hepatitis B virus has decreased by nearly 3000 million; Before the popularization of childhood immunization, diphtheria in China could cause tens of thousands of children to become ill every year, and since 2006, no cases of diphtheria have been reported; In the middle of the last century, the annual incidence of measles in China was as high as more than 900 million, 26,1995 children died of measles, and the measles vaccine was used in 2018, and by 4000, the number of cases was less than 60,304; In the 20s of last century, the highest incidence of brain flow in China reached 2020.200 million cases, nearly 20,3 deaths, and by 2018, the number of cases has been less than 1800; The highest year for JE reported nearly 1,5 cases and nearly <>,<> deaths, with the number of cases falling to <>,<> in <>. Through immunization programs, China has achieved the goal of no polio, no diphtheria cases have been reported, the incidence level of other vaccines is close to that of developed countries, the morbidity and mortality of children aged <> and <> years old have been greatly reduced, and the average life expectancy has been improved.

【Vaccine Analysis】

Polio vaccine: Experts test sons who have just turned their moon

Polio is an intestinal infectious disease caused by poliovirus with limb asymmetric paralysis as the main clinical manifestation, and is one of the main causes of physical disability in children, also known as polio.

In 1957, 31-year-old virologist Gu Fangzhou was commissioned to conduct polio research. Gu Fangzhou's research team first isolated poliovirus from the feces of patients in Beijing, Shanghai, Tianjin, Qingdao and other places and successfully typed it. Two years later, the Ministry of Health decided to send Gu Fangzhou and others to the Soviet Union to investigate the production process of polio vaccine. According to the "Biography of Gu Fangzhou", in December of that year, with the approval of the Ministry of Health, a polio vaccine research collaboration group was established, and Gu Fangzhou served as the leader of the team to carry out polio vaccine research. In December 12, the first batch of 1960 million doses of vaccine was successfully produced, and the peak epidemic in the cities where the vaccine was released was reduced. In order to create a vaccine that is convenient for transportation and loves to eat by children, Gu Fangzhou and others successfully developed a sugar pill vaccine after more than a year of research and testing.

It is worth mentioning that the first phase of the vaccine phase III trial needs to test the effect in a small number of people, which means that the subjects are exposed to unknown risks. Professor Sabin, a live vaccine researcher in the United States, is stuck in this step because he cannot find suitable test subjects. At the risk of paralysis, Gu Fangzhou drank a small vial of vaccine solution without hesitation. Gu Fangzhou's concern is that most adults themselves are immune to poliovirus, and they must prove that the vaccine is safe for children. So, whose child to experiment with? Who is willing to leave the child to Gu Fangzhou for experimentation? Gu Fangzhou gritted his teeth and made an amazing decision: test on his son who had just reached the full moon! Inspired by Gu Fangzhou, colleagues also gave vaccines to their children. The testing period passed slowly, and in the face of the children's still bright smiling faces, Gu Fangzhou and his colleagues cried with joy: The vaccine is safe!

The successful development of a vaccine plays a key role in eradicating poliovirus. The last indigenous case of wild poliovirus in China occurred in 1994. In 2000, the "Signing Ceremony of China's Polio Eradication Confirmation Report" was held, when Gu Fangzhou, who was 74 years old at that time, signed his name, and the Western Pacific Region of the World Health Organization declared China a polio-free region, marking China's successful achievement of polio-free goals.

BCG: The first dose of babies after birth to prevent tuberculosis

BCG is the first vaccine a newborn receives after birth. BCG vaccination is an effective measure to prevent tuberculous meningitis and miliary tuberculosis in children.

Tuberculosis is a chronic infectious disease caused by infection with Mycobacterium tuberculosis. Tuberculosis bacteria may invade various organs throughout the body, but mainly invade the lungs, called tuberculosis. Tuberculosis, also known as tuberculosis and the "white plague", is an ancient infectious disease that has been around since the dawn of mankind.

Gao Mengqiu, chief physician of the Second Department of Tuberculosis of Beijing Chest Hospital affiliated to Capital Medical University, previously introduced in an interview with the Beijing News that only tuberculosis is contagious and belongs to Class B notifiable infectious diseases in China, and the common symptoms are cough, sputum, and accompanied by bloody sputum, low-grade fever, night sweating, afternoon fever, chest pain, fatigue and weakness, weight loss, dyspnea and other symptoms.

The World Health Organization estimates that nearly 20 billion people are latently infected with TB globally. In 2019, there were about 996.121 million new TB cases and 130.10 million deaths worldwide, which has remained at the same level in recent years. The global TB incidence rate is <> per <> <>.

In the early 20th century, tuberculosis was a disease with a high mortality rate. In 1907, French scientists Kammed and Jelan began to cultivate a highly pathogenic tuberculosis bacterium isolated from the milk of tuberculosis-affected cows. In 1921, sterilized live tuberculosis seedlings were first used in humans to prevent tuberculosis. In honor of the two scientists Kammed and Jielan, who worked hard for the vaccine, people call the vaccine "BCG".

Why should newborns be vaccinated with BCG? Children under 5 years of age are at high risk of tuberculosis (TB). Among them, infants and young children, especially children under 2 years of age, are at risk of developing severe disseminated diseases such as TB meningitis or miliary disseminated TB, which are common causes of TB death in children. Immunization in the neonatal period resulted in the highest level of vaccine protection, reducing tuberculous meningitis and miliary tuberculosis by 90%, and severe disease by 92% in school-age children with a negative tuberculin skin test. The World Health Organization recommends that newborns be vaccinated with BCG as early as possible in areas of high and moderate TB endemicity. Our immunization schedule is 1 dose of BCG at birth.

Hepatitis B vaccine: Timely vaccination within 24 hours of birth

According to the existing immunization program procedures, newborns should be vaccinated against hepatitis B within 24 hours of birth, making hepatitis B vaccine one of the first vaccines to be given to newborns after birth.

Hepatitis B is caused by hepatitis B virus (HBV), an infectious disease with liver inflammation and necrotic lesions, and the clinical manifestations are mainly digestive tract symptoms (such as loss of appetite, malaise, nausea, vomiting, abdominal pain, jaundice, etc.), accompanied by other systemic symptoms, the course of the disease is prolonged, and it is easy to turn into chronic hepatitis, liver cirrhosis and liver cancer.

Why was hepatitis B vaccinated in such a short period of time? According to the official website of the Chinese Center for Disease Control and Prevention, most of the hepatitis B virus surface antigen carriers in China come from vertical transmission of mother and child and early childhood infection, because newborns have no immunity to hepatitis B virus, and the immune function is not yet perfect, once infected with hepatitis B virus, it is easy to become hepatitis B virus surface carriers, less than 1 year old infants infected with hepatitis B virus, more than 90% of people will become chronic hepatitis B virus surface antigen carriers. Therefore, it is especially important that babies are vaccinated against hepatitis B as soon as possible after birth. All newborns should receive the first dose of hepatitis B vaccine within 24 hours of birth and complete the full course of 1 doses of hepatitis B vaccine according to the immunization schedule of 0, 1, and 6 months. If a newborn is born to an HBsAg-positive or unknown mother, a first dose of hepatitis B vaccine is recommended as soon as possible within 3 hours of birth; If a newborn born to an HBsAg-positive or unknown mother weighs less than 12 g, the first dose of hepatitis B vaccine should also be given as soon as possible after birth, and 1 more doses of hepatitis B vaccination should be completed according to the procedure when the infant reaches 2000 month, 1 months, and 1 months of age.

The hepatitis B vaccines used globally are all recombinant protein vaccines, and the current hepatitis B vaccines in China are prepared by using Saccharomyces cerevisiae, Hanson's yeast and Chinese hamster ovary (CHO) cell expression system to express S protein (HBsAg) in vitro, supplemented by aluminum hydroxide adjuvant.

In 1992, China included hepatitis B vaccine into planned immunization management, and promoted neonatal hepatitis B vaccination nationwide. In 2002, hepatitis B vaccine was formally included in immunization, and hepatitis B vaccine was provided free of charge to all school-age children, allowing for a small fee for vaccination services. Since June 2005, hepatitis B vaccination for newborns nationwide has been free of charge, and vaccination service fees are no longer charged.

Beijing News reporter Zhang Xiulan