%0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e67367 %T Dissemination and Implementation Approach to Increasing Access to Local Pre-Exposure Prophylaxis (PrEP) Resources With Black Cisgender Women: Intervention Study With Vlogs Shared on Social Media %A Hill,Mandy J %A Mangum,Laurenia %A Coker,Sandra J %A Sutton,Tristen %A Santa Maria,Diane M %K PrEP %K cisgender Black women %K social media campaign %K PrEP access %K HIV prevention %K vlogging %K dissemination and implementation %K pre-exposure prophylaxis %K dissemination %K implementation %K HIV %K prevention %K human immunodeficiency virus %K cisgender %K social media %K marketing %K campaign %K education %K sexually transmitted diseases %K STDs %K vlog %D 2025 %7 28.3.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Black cisgender women account for only 2% of pre-exposure prophylaxis (PrEP)-eligible people in the United States who use PrEP to prevent HIV. Owing to the low PrEP use, Black cisgender women continue to contract HIV more frequently than women from every other racial group. Intervention efforts that can bridge the link between knowing that PrEP prevents HIV and support with access to PrEP are necessary for Black cisgender women. Objective: The purposes of the vlogs through the campaign were to share information about ways to prevent HIV using PrEP and fact-based education and provide access to PrEP resources with active links to local PrEP providers at local community health centers. Methods: In Phase 1, the study team formerly piloted full-length video blog posts (ie, vlogs; 10‐12 min each) with 26 women during an emergency department visit. Using the findings from Phase 1, Phase 2 involved a prospective 6-month social media marketing campaign. The study team led a Texas-Development CFAR-funded pilot grant to disseminate brief vlog snippets (30 s) of excerpts from full-length vlogs with a larger group of Black women in Harris County. Community members, who were aged 18‐55 years, usually consume content that is often viewed by Black cisgender women (ie, health and beauty) and reside in neighborhoods (based on zip code) in Harris County where most residents are Black or African American. They were shown a series of brief vlog snippets on their social media pages, along with a brief message about PrEP and an active hyperlink to local PrEP resources. The study team assessed implementation outcomes, including the feasibility and acceptability, appropriateness of vlogs, access to PrEP resources at local clinics, and clinical outcomes such as increased PrEP awareness among Black cisgender women. Results: Within 6 months, the campaign reached 110.8k unique individuals (the number of unique accounts that have seen your content at least once) who identified as women. When stratified by age, video plays (the number of times a video starts playing) at 50% of the vlogs (n=30,877) were most common among women aged 18‐24 years (n=12,017) and least common among women aged 45‐54 years (n=658). Key performance indicators showed that 1,098,629 impressions (the number of times a user saw the vlog) and 1,002,244 total video plays resulted in 15,952 link clicks to local PrEP resources. Conclusions: The campaign demonstrated the feasibility and acceptability of this approach with Black cisgender women and illustrated preliminary effectiveness at supporting access to local PrEP resources with Black cisgender women. Further dissemination and implementation of this approach is necessary to fully assess whether vlog viewership and clicks on links to PrEP resources can meaningfully empower Black cisgender women to access PrEP and help them to assess whether PrEP is personally a useful HIV prevention option. %R 10.2196/67367 %U https://publichealth.jmir.org/2025/1/e67367 %U https://doi.org/10.2196/67367 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57798 %T Public Preference and Priorities for Including Vaccines in China’s National Immunization Program: Discrete Choice Experiment %A Zhang,Lingli %A Li,Xin %A Chen,Jiali %A Wang,Xiaoye %A Sun,Yuyang %K discrete choice experiment %K national immunization program %K vaccines %K vaccination %K immunization %K public preferences %K China %K mixed logit model %K heterogeneity %K varicella %K public health %K infectious diseases %D 2024 %7 14.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Several important vaccines, such as the Haemophilus influenzae type b vaccine, rotavirus vaccine, pneumococcal conjugate vaccine, and influenza vaccine, have not been included in China’s National Immunization Program (NIP) due to a prolonged absence of updates and limited resources. Public engagement could identify concerns that require attention and foster trust to ensure continuous support for immunization. Objective: This study aimed to identify public preferences for vaccine inclusion in the NIP and to determine the desired vaccine funding priorities in the Chinese population. Methods: A dual-response discrete choice experiment was utilized to estimate the relative importance of 6 attributes, including incidence of vaccine-preventable diseases, mortality of vaccine-preventable diseases, vaccine effectiveness, vaccine cost, vaccinated group, and vaccine coverage. Participants were recruited through the Wenjuanxing platform using a census-based quota sample of the nationwide population aged 18 years and older. A mixed logit model was used to estimate the coefficient of attribute preferences and predict the selection probability. Subgroups and interaction effects were analyzed to examine the heterogeneity in preferences. Results: In total, 1258 participants completed the survey, of which 880 were involved in the main analysis and 1166 in the sensitivity analysis. The relative importance and model estimates of 2 attributes, vaccine cost and vaccination group, varied between the unforced- and forced-choice settings. All 6 vaccine attributes significantly influenced the preferences for vaccine inclusion, with vaccine effectiveness and coverage as the most important factors, followed by the vaccinated group and mortality of vaccine-preventable diseases in the unforced-choice settings. The top vaccines recommended for China’s NIP included the varicella vaccine, Haemophilus influenzae type b vaccine, enterovirus 71 vaccine, and influenza vaccine for preschoolers and school-aged children. The current analysis also revealed distinct preference patterns among different subgroups, such as gender, age, education, and income. The interaction analysis indicated that the region and health status of participants contribute to preference heterogeneity. Conclusions: Public preferences for including vaccines in the NIP were primarily influenced by vaccine effectiveness and coverage. The varicella vaccine should be prioritized for inclusion in the NIP. The public preferences could provide valuable insights when incorporating new vaccines in the NIP. %R 10.2196/57798 %U https://publichealth.jmir.org/2024/1/e57798 %U https://doi.org/10.2196/57798 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e67634 %T Authors’ Reply: Promoting Oral Health Literacy Among UAE Public Sector Employees %A Carrouel,Florence %A du Sartz de Vigneulles,Benjamin %A Clément,Céline %A Lvovschi,Virginie-Eve %A Verot,Elise %A Tantardini,Valeria %A Lamure,Michel %A Bourgeois,Denis %A Dussart,Claude %A Lan,Romain %K health literacy %K oral health literacy %K workplace %K civil servant %K health promotion %K prevention %K United Arab Emirates %D 2024 %7 12.11.2024 %9 %J JMIR Public Health Surveill %G English %X %R 10.2196/67634 %U https://publichealth.jmir.org/2024/1/e67634 %U https://doi.org/10.2196/67634 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e66452 %T Promoting Oral Health Literacy Among UAE Public Sector Employees %A Nair,Satish C %K health literacy %K Gulf countries %K oral health literacy %K health promotion %K United Arab Emirates %K workplace %D 2024 %7 12.11.2024 %9 %J JMIR Public Health Surveill %G English %X %R 10.2196/66452 %U https://publichealth.jmir.org/2024/1/e66452 %U https://doi.org/10.2196/66452 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e64270 %T Digital Contact Tracing Implementation Among Leaders and Health Care Workers in a Pediatric Hospital During the COVID-19 Pandemic: Qualitative Interview Study %A O'Dwyer,Brynn %A Jaana,Mirou %A Hui,Charles %A Chreim,Samia %A Ellis,Jennifer %+ Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada, 1 6135625731 ext 3400, jaana@telfer.uottawa.ca %K COVID-19 %K surveillance %K technology %K digital contact tracing %K qualitative %K hospitals %K Reach, Effectiveness, Adoption, Implementation, and Maintenance framework %K RE-AIM %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Health systems had to rapidly implement infection control strategies to sustain their workforces during the COVID-19 pandemic. Various outbreak response tools, such as digital contact tracing (DCT), have been developed to monitor exposures and symptoms of health care workers (HCWs). Limited research evidence exists on the experiences with these technologies and the impacts of DCT innovations from the perspective of stakeholders in health care environments. Objective: This study aims to identify the factors influencing the adoption of DCT, highlight variations in perspectives across 3 key stakeholder groups concerning the impact of DCT, and provide benchmarking evidence for future pandemic preparedness. Methods: Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we conducted an exploratory qualitative study to investigate the implementation and impact of DCT at the Children’s Hospital of Eastern Ontario between December 2022 and April 2023. We conducted 21 semistructured interviews with key stakeholders, including health care administrators (6/21, 29%), occupational health and safety specialists (8/21, 38%), and HCWs (7/21, 33%). Stakeholders were asked about the factors influencing engagement with the DCT tool, organizational-level uptake, the implementation process, long-term use and sustainability of DCT, and unintended consequences. Verbatim transcripts were subject to thematic analysis using NVivo (QSR International). Results: The implementation of DCT was viable and well received. End users indicated that their engagement with the DCT tool was facilitated by its perceived ease of use and the ability to gain awareness of probable COVID-19 exposures; however, risk assessment consequences and access concerns were reported as barriers (reach). Participants commonly agreed that the DCT technology had a positive influence on the hospital’s capacity to meet the demands of COVID-19 (effectiveness). Implementors and occupational specialists referred to negative staffing impacts and the loss of nuanced information as unintended consequences (effectiveness). Safety-focused communication strategies and having a DCT tool that was human-centered were crucial factors driving staff adoption of the technology. Conversely, adoption was challenged by the misaligned delivery of the DCT tool with HCWs’ standard practices, alongside the evolving perceived threat of COVID-19. Stakeholders collectively agreed on the viability of DCT and its applicability to infectious disease practices (maintenance). Conclusions: Hospital stakeholders were highly satisfied with DCT technology and it was perceived as feasible, efficient, and having a positive impact on organizational safety. Challenges related to the alignment and delivery of DCT, alongside the evolving perspectives on COVID-19, posed obstacles to continued adoption by HCWs. Our findings contribute to evidence-based practices and present benchmarks that can inform preparedness for future pandemics and infectious disease outbreaks and help other organizations implement similar technologies. %M 39499919 %R 10.2196/64270 %U https://publichealth.jmir.org/2024/1/e64270 %U https://doi.org/10.2196/64270 %U http://www.ncbi.nlm.nih.gov/pubmed/39499919 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59690 %T Obstetric Emergency Supply Chain Dynamics and Information Flow Among Obstetric Emergency Supply Chain Employees: Key Informant Interview Study %A Dougherty,Kylie %A Gebremariam,Abebe %A Biza,Heran %A Belew,Mulusew %A Benda,Natalie %A Tesfaye,Yihenew %A Cranmer,John %A Bakken,Suzanne %+ Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair St, Chicago, IL, 60611, United States, 1 (312) 503 1725, kylie.dougherty@northwestern.edu %K basic emergency obstetric care needs %K BEmOC %K supply chain %K Ethiopia %K Sociotechnical Model %D 2024 %7 5.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: For the past several decades, the Ethiopian Ministry of Health has worked to decrease the maternal mortality ratio (MMR)—the number of pregnant women dying per 100,000 live births. However, with the most recently reported MMR of 267, Ethiopia still ranks high in the MMR globally and needs additional interventions to lower the MMR to achieve the sustainable development goal of 70. One factor contributing to the current MMR is the frequent stockouts of critical medications and supplies needed to treat obstetric emergencies. Objective: This study describes the obstetric emergency supply chain (OESC) dynamics and information flow in Amhara, Ethiopia, as a crucial first step in closing stockouts and gaps in supply availability. Methods: Applying qualitative descriptive methodology, the research team performed 17 semistructured interviews with employees of the OESC at the federal, regional, and facility level to describe and gain an understanding of the system in the region, communication flow, and current barriers and facilitators to consistent emergency supply availability. The team performed inductive and deductive analysis and used the “Sociotechnical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems” to guide the deductive portion. Results: The interviews identified several locations within the OESC where barriers could be addressed to improve overall facility-level readiness, such as gaps in communication about supply needs and availability in health care facilities and regional supply hubs and a lack of data transparency at the facility level. Ordering supplies through the integrated pharmaceutical logistics system was a well-established process and a frequently noted strength. Furthermore, having inventory data in one place was a benefit to pharmacists and supply managers who would need to use the data to determine their historic consumption. The greatest concern related to the workflow and communication of the OESC was an inability to accurately forecast future supply needs. This is a critical issue because inaccurate forecasting can lead to undersupplying and stockouts or oversupplying and waste of medication due to expiration. Conclusions: As a result of these interviews, we gained a nuanced understanding of the information needs for various levels of the health system to maintain a consistent supply of obstetric emergency resources and ultimately increase maternal survival. This study’s findings will inform future work to create customized strategies that increase supply availability in facilities and the region overall, specifically the development of electronic dashboards to increase data availability at the regional and facility levels. Without comprehensive and timely data about the OESC, facilities will continue to remain in the dark about their true readiness to manage basic obstetric emergencies, and the central Ethiopian Pharmaceutical Supply Service and regional hubs will not have the necessary information to provide essential emergency supplies prospectively before stockouts and maternal deaths occur. %M 39235860 %R 10.2196/59690 %U https://formative.jmir.org/2024/1/e59690 %U https://doi.org/10.2196/59690 %U http://www.ncbi.nlm.nih.gov/pubmed/39235860 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58942 %T Promoting Health Literacy in the Workplace Among Civil Servants: Cross-Sectional Study %A Carrouel,Florence %A du Sartz de Vigneulles,Benjamin %A Clément,Céline %A Lvovschi,Virginie-Eve %A Verot,Elise %A Tantardini,Valeria %A Lamure,Michel %A Bourgeois,Denis %A Lan,Romain %A Dussart,Claude %K health literacy %K oral health literacy %K workplace %K civil servant %K health promotion %K prevention %D 2024 %7 15.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: In 2022, the World Health Organization highlighted the alarming state of oral health (OH) worldwide and urged action to include OH in initiatives on noncommunicable diseases. The population needs improved OH skills and attitudes and an adequate level of OH literacy (OHL) and general health literacy (HL). The implementation of health promotion actions in the workplace, which is a part of most people’s lives, appears to be an opportunity. In France, civil servants have several socioprofessional levels and represent an excellent model with results transposable to the population. Objective: This study aimed at determining the OHL and HL level of civil servants in France in order to implement specific prevention actions in their workplaces. Methods: A cross-sectional study of French civil servants was conducted in France from October 2023 to February 2024. Participants completed three validated questionnaires in French: (1) a questionnaire on OH knowledge, (2) the Oral Health Literacy Instrument, French version (OHLI-F; this is composed of reading comprehension and numeracy sections) to assess the OHL level, and (3) the Short Test of Functional Health Literacy in Adults, French version (s-TOFHLA-F) to assess the HL level. The scores for OH knowledge, the OHLI-F, and the s-TOFHLA-F were reported as means (SD) and the 95% CI. These scores were classified into 3 categories: adequate (75-100), marginal (60-74) and inadequate (0-59). ANOVA and binary logistic regression were performed. The OHLI-F reading comprehension and OHLI-F numeracy scores were compared using the Welch 2-sample t test and a paired t test (both 2-tailed). For the correlation matrix, the Pearson correlation and related tests were computed. Results: A total of 1917 persons completed the 3 questionnaires, with adequate levels of OHL (n=1610, 84%), OH knowledge (n=1736, 90.6%), and HL (n=1915, 99.9%). The scores on the s-TOFHLA-F (mean 98.2, SD 2.8) were higher than the OHLI-F (mean 80.9, SD 7.9) and OH knowledge (mean 87.6, SD 10.5). The OHLI-F was highly correlated with OH knowledge (P<.001), but the OHLI-F and OH knowledge had a low correlation with s-TOFHLA-F (P=.43). The OHLI-F reading comprehension score was significantly higher than the OHLI-F numeracy score (P<.001). Age, education level, and professional category impacted the 3 scores (P<.001). The professional category was a determinant of adequate OHLI-F and OH knowledge scores. Conclusions: Some French civil servants had inadequate or marginal levels of OH knowledge (n=181, 9.5%) and OHL (n=307, 16%) but none had an inadequate level of HL. Results highlighted the relevance of implementing OH promotion programs in the workplace. They should be nonstandardized, adapted to the literacy level of professional categories of workers, and focused on numeracy skills. Thus, appropriate preventive communication and improved literacy levels are the means to achieve greater disease equity and combat the burden of noncommunicable diseases. %R 10.2196/58942 %U https://publichealth.jmir.org/2024/1/e58942 %U https://doi.org/10.2196/58942 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54769 %T COVID-19 Vaccine Hesitancy: Umbrella Review of Systematic Reviews and Meta-Analysis %A Rahbeni,Tahani Al %A Satapathy,Prakasini %A Itumalla,Ramaiah %A Marzo,Roy Rillera %A Mugheed,Khalid A L %A Khatib,Mahalaqua Nazli %A Gaidhane,Shilpa %A Zahiruddin,Quazi Syed %A Rabaan,Ali A %A Alrasheed,Hayam A %A Al-Subaie,Maha F %A Al Kaabil,Nawal A %A Alissa,Mohammed %A Ibrahim,Amani Ahmed A L %A Alsaif,Hussain Abdulkhaliq %A Naser,Israa Habeeb %A Rustagi,Sarvesh %A Kukreti,Neelima %A Dziedzic,Arkadiusz %+ Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, 162, Poonamallee High Road, Poonamallee, Chennai, 600077, India, 91 8763766300, prakasini.satapathy@gmail.com %K COVID-19 %K vaccine acceptance %K vaccine hesitancy %K umbrella review %K systematic review %K meta-analysis %K vaccine %K hesitancy %K global perceptions %K perception %K random effect model %K synthesis %K healthcare workers %K patients %K patient %K chronic disease %K pregnant women %K parents %K child %K children %D 2024 %7 30.4.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: The unprecedented emergence of the COVID-19 pandemic necessitated the development and global distribution of vaccines, making the understanding of global vaccine acceptance and hesitancy crucial to overcoming barriers to vaccination and achieving widespread immunization. Objective: This umbrella review synthesizes findings from systematic reviews and meta-analyses to provide insights into global perceptions on COVID-19 vaccine acceptance and hesitancy across diverse populations and regions. Methods: We conducted a literature search across major databases to identify systematic reviews and meta-analysis that reported COVID-19 vaccine acceptance and hesitancy. The AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) criteria were used to assess the methodological quality of included systematic reviews. Meta-analysis was performed using STATA 17 with a random effect model. The data synthesis is presented in a table format and via a narrative. Results: Our inclusion criteria were met by 78 meta-analyses published between 2021 and 2023. Our analysis revealed a moderate vaccine acceptance rate of 63% (95% CI 0.60%-0.67%) in the general population, with significant heterogeneity (I2 = 97.59%). Higher acceptance rates were observed among health care workers and individuals with chronic diseases, at 64% (95% CI 0.57%-0.71%) and 69% (95% CI 0.61%-0.76%), respectively. However, lower acceptance was noted among pregnant women, at 48% (95% CI 0.42%-0.53%), and parents consenting for their children, at 61.29% (95% CI 0.56%-0.67%). The pooled vaccine hesitancy rate was 32% (95% CI 0.25%-0.39%) in the general population. The quality assessment revealed 19 high-quality, 38 moderate-quality, 15 low-quality, and 6 critically low-quality meta-analyses. Conclusions: This review revealed the presence of vaccine hesitancy globally, emphasizing the necessity for population-specific, culturally sensitive interventions and clear, credible information dissemination to foster vaccine acceptance. The observed disparities accentuate the need for continuous research to understand evolving vaccine perceptions and to address the unique concerns and needs of diverse populations, thereby aiding in the formulation of effective and inclusive vaccination strategies. Trial Registration: PROSPERO CRD42023468363; https://tinyurl.com/2p9kv9cr %M 38687992 %R 10.2196/54769 %U https://publichealth.jmir.org/2024/1/e54769 %U https://doi.org/10.2196/54769 %U http://www.ncbi.nlm.nih.gov/pubmed/38687992 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53948 %T The Impact of Optimal Glycemic Control on Tuberculosis Treatment Outcomes in Patients With Diabetes Mellitus: Systematic Review and Meta-Analysis %A Zhao,Li %A Gao,Feng %A Zheng,Chunlan %A Sun,Xuezhi %+ Department of Tuberculosis III, Wuhan Pulmonary Hospital, Hubei Province, Wuhan, 430030, China, 86 15871745280, sxz16032002@163.com %K optical glycemic control %K poor glycemic control %K tuberculosis treatment %K diabetes mellitus %K health management, healthcare %K health care %K glycemic control %K tuberculosis %K TB %K DM %K diabetes %K systematic review %K meta-analysis %K risks %K treatment %K treatment outcome %K mortality %K patients %K burden %K disease burden %D 2024 %7 2.4.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Diabetes mellitus (DM) increases the risk of developing tuberculosis (TB), and optimal glycemic control has been shown to reduce the risk of complications and improve the TB treatment outcomes in patients with DM. Objective: This study aims to investigate the role of glycemic control in improving TB treatment outcomes among patients with DM. Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) assessing the impact of oral glycemic control in patients with TB who have DM. Outcomes of interest were radiological findings, treatment success, sputum positivity, and mortality. Evaluations were reported as risk ratios (RRs) with 95% CIs using weighted random-effects models. Results: The analysis included 6919 patients from 7 observational studies. Our meta-analysis showed significant differences between patients with optimal glycemic control and those with poor glycemic control with regard to improved treatment outcomes (RR 1.13, 95% CI 1.02-1.25; P=.02; I²=65%), reduced sputum positivity (RR 0.23, 95% CI 0.09-0.61; P=.003; I²=66%), and fewer cavitary lesions (RR 0.59, 95% CI 0.51-0.68; P<.001; I²=0%) in radiological findings. There was no significant difference between the 2 groups in terms of mortality (RR 0.57, 95% CI 0.22-1.49; P=.25; I²=0%), multilobar involvement (RR 0.57, 95% CI 0.22-1.49; P=.25; I²=0%) on radiologic examination, and upper lobe (RR 0.94, 95% CI 0.76-1.17; P=.58; I²=0%) and lower lobe (RR 1.05, 95% CI 0.48-2.30; P=.91; I²=75%) involvement on radiologic examination. Conclusions: We concluded that optimal glycemic control is crucial for reducing susceptibility, minimizing complications, and improving treatment outcomes in patients with TB with DM. Emphasizing effective health management and health care strategies are essential in achieving this control. Integrating comprehensive care among patients with TB with DM will enhance patient outcomes and alleviate the burden of disease in this population. Trial Registration: PROSPERO CRD42023427362; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=427362 %M 38564244 %R 10.2196/53948 %U https://publichealth.jmir.org/2024/1/e53948 %U https://doi.org/10.2196/53948 %U http://www.ncbi.nlm.nih.gov/pubmed/38564244 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53982 %T The Effectiveness of National Expanded Program on Immunization With Hepatitis A Vaccines in the Chinese Mainland: Interrupted Time-Series Analysis %A Ming,Bo-Wen %A Li,Li %A Huang,Hao-Neng %A Ma,Jia-Jun %A Shi,Chen %A Xu,Xiao-Han %A Yang,Zhou %A Ou,Chun-Quan %+ State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, No1023, South Shatai Road, Baiyun District, Guangzhou, 510515, China, 86 020 61649461, ouchunquan@hotmail.com %K hepatitis A %K incidence %K Expanded Program on Immunization %K vaccine %K interrupted time series %K intervention %K China %D 2024 %7 28.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The high prevalence of hepatitis A delivered a blow to public health decades ago. The World Health Organization (WHO) set a goal to eliminate viral hepatitis including hepatitis A by 2030. In 2008, hepatitis A vaccines were integrated into the Expanded Program on Immunization (EPI) in China to alleviate the burden of hepatitis A, although the effectiveness of the EPI has not been well investigated. Objective: We aimed to evaluate the intervention effect at both provincial and national levels on the incidence of hepatitis A in the Chinese mainland from 2005 to 2019. Methods: Based on the monthly reported number of hepatitis A cases from 2005 to 2019 in each provincial-level administrative division, we adopted generalized additive models with an interrupted time-series design to estimate province-specific effects of the EPI on the incidence of hepatitis A among the target population (children aged 2-9 years) from 2005 to 2019. We then pooled province-specific effect estimates using random-effects meta-analyses. We also assessed the effect among the nontarget population and the whole population. Results: A total of 98,275 hepatitis A cases among children aged 2-9 years were reported in the Chinese mainland from 2005 to 2019, with an average annual incidence of 5.33 cases per 100,000 persons. Nationally, the EPI decreased the hepatitis A incidence by 80.77% (excess risk [ER] –80.77%, 95% CI –85.86% to –72.92%) during the study period, guarding an annual average of 28.52 (95% empirical CI [eCI] 27.37-29.00) cases per 100,000 persons among the target children against hepatitis A. Western China saw a more significant effect of the EPI on the decrease in the incidence of hepatitis A among the target children. A greater number of target children were protected from onset in Northwest and Southwest China, with an excess incidence rate of –129.72 (95% eCI –135.67 to –117.86) and –66.61 (95% eCI –67.63 to –64.22) cases per 100,000 persons on average, respectively. Intervention effects among nontarget (ER –32.88%, 95% CI –39.76% to –25.21%) and whole populations (ER –31.97%, 95% CI –39.61% to –23.37%) were relatively small. Conclusions: The EPI has presented a lasting positive effect on the containment of hepatitis A in the target population in China. The EPI’s effect on the target children also provided a degree of indirect protection for unvaccinated individuals. The continuous surveillance of hepatitis A and the maintenance of mass vaccination should shore up the accomplishment in the decline of hepatitis A incidence to ultimately achieve the goal set by the WHO. %M 38416563 %R 10.2196/53982 %U https://publichealth.jmir.org/2024/1/e53982 %U https://doi.org/10.2196/53982 %U http://www.ncbi.nlm.nih.gov/pubmed/38416563